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As collaborative problem-solving skills are increasing in importance, Project-Based Learning (PBL) is being implemented in various ways, but the results differ depending on the participants. This study shows that the results of PBL depend on student interaction type and learning motivation. The difference in the levels of interaction and learning motivation between two groups of students utilizing different discussion processes was qualitatively explored. The participants in this study consisted of 8 students in the 6th grade of elementary school, and the intervention was conducted over the course of 10 lessons. The group for which the leader arbitrarily resolved conflicts had a type of inactive interaction and the level of motivation for learning was outside of the acceptable range compared to the group that took part in a democratic discussion. As the project progressed, it changed to a type of inactive interaction. Thus, the results suggest that the roles of individuals in a group should be adjusted to account for to the characteristics of PBL and the structure of the task; furthermore, an inquiry into how learning motivation changes according to social interactions with others should be conducted.

Purpose: Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. Patients and Methods: This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Results: Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025– 0.290; p = 0.001). Conclusion: The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions. [ABSTRACT FROM AUTHOR]

Thus, we aimed to investigate how real-time documentation of in-hospital medication changes prevents undocumented medication changes at discharge and improves physician-pharmacist communication. Methods: We conducted a retrospective cohort study in a tertiary hospital. Two pharmacists reviewed medical records of patients admitted to the acute medical unit from April to June 2020. In-hospital medication discrepancies were determined by comparing preadmission and hospitalization medication lists and it was verified whether the physician's intent of medication changes was clarified by documentation. By a documentation rate of medication changes of 100% and < 100%, respectively, fully documented (FD) and partially documented (PD) groups were defined. Any undocumented medication changes at discharge were considered a "documentation error at discharge". Pharmacists' survey was conducted to assess the impact of appropriate documentation on the pharmacists. Results: After reviewing 400 medication records, patients were categorized into FD (61.3%) and PD (38.8%) groups. Documentation errors at discharge were significantly higher in the PD than in the FD group. Factors associated with documentation errors at discharge included belonging to the PD group, discharge from a non-hospitalist-managed ward, and having three or more intentional discrepancies. Pharmacists showed favorable attitudes towards physician's documentation. Conclusion: Appropriate documentation of in-hospital medication changes, facilitated by free-text communication, significantly decreased documentation errors at discharge. This analysis underlines the importance of communication between pharmacists and hospitalists in improving patient safety during transitions of care. Plain Language Summary: During transitions of care, communication failures among healthcare professionals can lead to medication errors. Therefore, effective sharing of information is essential, especially when intentional changes in prescription orders are made. Documenting medication changes facilitates real-time communication, potentially improving medication reconciliation and reducing discrepancies. However, inadequate documentation of medication changes is common in clinical practice. This retrospective cohort study underlines the importance of real-time documentation of in-hospital medication changes. There was a significant reduction in documentation errors at discharge in fully documented group, where real-time documentation of medication changes was more prevalent. Pharmacists showed favorable attitudes toward the physician's real-time documenting of medication changes because it provided valuable information on understanding the physician's intent and improving communication and also saved time for pharmacists. This study concludes that physicians' documentation on medication changes may reduce documentation errors at discharge, meaning that proper documentation of medication changes could enhance patient safety through effective communication. [ABSTRACT FROM AUTHOR]

One of the most challenging elements of modeling the behaviour of reinforced concrete (RC) walls is combining realistic material models that can capture the observable behaviour of the physical system. Experiments with realistic loading rates and pressures reveal that steel and concrete display complicated nonlinear behaviour that is challenging to represent in a single constitutive model. To investigate the response of a reinforced concrete structure subjected to dynamic loads, this paper's study is based on many different material models to assess the advantages and disadvantages of the models on 2D and 3D RC walls using the LS-DYNA program. The models consisted of the KCC model and the CDP model, which represented plasticity and distinct tensile/compressive damage models, and the Winfrith model, which represented plasticity and the smeared crack model. Subsequently, the models' performances were assessed by comparing them to experimental data from reinforced concrete structures, in order to validate the accuracy of the overall behaviour prediction. The Winfrith model demonstrated satisfactory results in predicting the behaviour of 2D and 3D walls, including maximum strength, stiffness deterioration, and energy dissipation. The method accurately predicted the maximum strength of the Winfrith concrete model for the 2D wall with an error of 9.24% and for the 3D wall with errors of 3.28% in the X direction and 5.02% in the Y direction. The Winfrith model demonstrated higher precision in predicting dissipation energy for the 3D wall in both the X and Y directions, with errors of 6.84% and 6.62%, correspondingly. Additional parametric analyses were carried out to investigate structural behaviour, taking into account variables such as concrete strength, strain rate, mesh size, and the influence of the element type. [ABSTRACT FROM AUTHOR]