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A growing body of literature focused on the pedagogical relationship between information literacy (IL) and metacognition suggests that facilitating learners' reflections promotes IL learning. However, activating and assessing this relationship is difficult. This article describes a constructivist activity that models for students how to practice IL while increasing awareness of metacognitive approaches. The modified jigsaw activity, including a worksheet, facilitates individual reflection and peer-to-peer learning through structured conversation regarding popular press articles. Using a grounded theory approach, coding of students' worksheets showed IL development related to comprehension, procedure, evaluation, and reflection. Moreover, the worksheet offers instructors insight into student learning processes and progress. This article offers evidence of how to enhance and make more visible the connection between IL and metacognition for both students and instructors.

The number of anesthetic body procedures in the United States is rapidly increasing, with many being performed on an outpatient basis. These procedures are advertised as being safe, and many times the serious complications may not be discussed. Although local anesthetic systemic toxicity is a rare complication, it is associated with an increase in morbidity. The emergency department staff should be aware of the possibility of this rare complication, as well as the variety of resulting symptoms (from minor to severe), potential sequelae, and appropriate management for patients who have undergone an outpatient anesthetic body procedure. Multiple factors contribute to the development of local anesthetic systemic toxicity, resulting in life-threatening effects on the neurologic and cardiovascular systems. Also, the site of administration, along with the local anesthetic agent used, can impact the risk of the development of local anesthetic systemic toxicity. To minimize the risk and ensure the best possible outcome for these patients, emergency department staff must be highly aware of the mechanisms, risk factors, prevention, and management/treatment of local anesthetic systemic toxicity. [ABSTRACT FROM AUTHOR]

To overcome barriers to improved outcomes, we undertook an intervention to teach schoolchildren how to detect a stroke and call emergency medical services (EMS). We obtained permission from parents and guardians to use an 8-min puppet show to instruct the fourth, fifth, and sixth graders about stroke detection, symptomatology, and calling EMS. A pretest and three posttests--one immediately following the presentation, one at 3 months, and a third at 6 months--were administered. Responses from 282 students were evaluable. Significant improvements (p < 0.001) in knowledge were found through all posttests in identifying what parts of the body stroke affected and through the first two posttests in recognizing symptoms stroke victims experienced. Students demonstrated at pretest a high awareness of EMS and 911 (97.5%) and showed slight, but not significant, improvement over time.

As multidisciplinary emergency care becomes increasingly complex, all team members must be aware of their respective roles and responsibilities. In the emergency department, nurse practitioners are integral members of the team. They possess a wide range of clinical and leadership competencies that allow them to perform specific and differentiated tasks within the emergency department. A well-defined competency not only contributes to the promotion of a positive work culture but also clarifies performance expectations, identifies skill gaps, and supports team development. Furthermore, it allows the nurse practitioner to adapt to changing conditions while maintaining patient safety. The competencies of emergency nurse practitioners have evolved over the past 2 decades. The authors discuss the importance of establishing clear expectations for emergency nurse practitioner practice in this article and the alignment of competencies with organizational culture and objectives. [ABSTRACT FROM AUTHOR]

Discusses the integration of wilderness pursuits and outdoor opportunities with more traditional student orientation activities, an area of programming that has become increasingly popular over the last several years in response to changing student interests. Addresses the structure of wilderness pursuit orientation programs, liability issues, and program evaluation. (EV)

Cultural sensitivity and improved communication and assessment skills for undergraduate nursing students are the primary aims of a medical mission experience based on an innovative learning environment in a rural African village. Nursing faculty implement components of Irby's Conceptual Framework for Learning Environments to facilitate students' integration and understanding of didactic information and the holistic practice of nursing while decreasing students' dependence on technology. [ABSTRACT FROM AUTHOR]

The school nurse role parallels the growing complexity of health care, education, and the social needs of youth in the United States. The complex and chaotic environment of the school setting requires leaders to be flexible and to have the ability to recognize and tackle the ever-changing needs of this environment. School nurses are in a prime position to enact change and drive the culture of the community, giving it purpose, while allowing its members to have a focus on their work. Nurses, as complexity leaders, are positioned to understand that change is a continual process that stems from collaboration, complex systems thinking, and innovation mindsets. [ABSTRACT FROM AUTHOR]

As Doctor of Nursing Practice (DNP) students and graduates begin to apply new knowledge in real-life situations, they are transforming their organizations. The impact of DNP projects is noted by measurable outcomes in diverse settings. This article presents 4 unique clinical/organizational examples of DNP projects. The authors have identified an application of complexity science and leadership theory in their practice changes. In addition, they share their thoughts and feelings as emerging leaders. [ABSTRACT FROM AUTHOR]

Over the last decade, trends in fluid resuscitation have changed dramatically as have our practices. Research is driving trauma centers across the globe to initiate modifications in fluid resuscitation of the hemorrhagic trauma patients both in the prehospital and intrahospital arena. This is being done by combining the theory of permissive hypotension and damage control surgery with hemostatic resuscitation as the preferred methods of resuscitation in patients with hemorrhagic shock. The literature illustrates that previous strategies we considered to be beneficial are actually detrimental to the outcomes of these severely injured patients. This complex and continuously changing adaptation in practice must be made without losing our strategic focus of improvement of outcomes and recognition of the morbidity associated with bleeding of the trauma patient. Designating limits on large-volume crystalloid resuscitation will prevent cellular injury. These wiser resuscitation strategies are key in the efforts to reduce mortality and to improve outcomes. This article is to serve as a review of each of the resuscitative fluid strategies as well as new methods of trauma resuscitation. [ABSTRACT FROM AUTHOR]

Health care providers must understand and value the unique contributions of all interdisciplinary professionals, with the goal of optimizing the wellness or illness needs of each patient. Work cannot be done in silos, and the ability to develop and sustain effective professional partnerships is essential. Health care teams must work within a complex environment that depends on the shared efforts of multiple professionals to successfully provide care in a fragmented, highly stressed system. Implementing partnerships that foster relationships through shared interests, vision, and values can aid in the coordination of resources to provide a more positive patient experience and outcome. The development of partnerships requires time and acceptance of shared risks and responsibilities. In return, involved parties will be able to build trust, share rewards, and expand the possibilities of what can be accomplished. The purpose of this review is to describe results-oriented partnerships, which include the attributes of collaboration, coordination, and communication. Essential concepts and practical tools for success are reviewed to offer new and existing partnerships a lens through which to view interdisciplinary interactions that can contribute to organizational success and longevity. Potential pitfalls that may impact patient services and organizational health are also discussed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Seed Science is the property of Associacao Brasileira de Tecnologia de Sementes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Despite clinical guidelines, many patients with hypercholesterolemia do not achieve treatment goals in clinical practice. OBJECTIVES: This study examined physician attitudes and beliefs about hyperlipidemia and whether they are associated with lipid treatment decisions. METHODS: This was a cross-sectional study of 107 physicians who completed a validated survey of attitudes and beliefs about hyperlipidemia and provided treatment histories for 1187 statin-treated patients with coronary heart disease (CHD) or who were CHD risk-equivalent. Logistic regressions (using generalized estimating equation) estimated the impact of patient characteristics and physician attitudes and beliefs on whether a patient received increases in the statin dose. RESULTS: Approximately 70% of the 843 patients who were not at low-density lipoprotein cholesterol goal (<100 mg/dL) with initial statin therapy received a dose increase, although only one-half attained goal. Controlling for patient characteristics, patients whose physicians believed 'close enough to goal is good enough' had 47% lower odds of having a dose increase (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.34-0.82), whereas patients whose physicians believed 'statins are effective' had almost twice the odds of having a dose increase (OR, 1.78; 95% CI, 1.05-3.00). CONCLUSIONS: Although the understanding of basic and clinical science remains fundamental, clinical guideline authors may want to consider the importance of physician attitudes and beliefs in determining translation of their guidelines into clinical practice. [ABSTRACT FROM AUTHOR]

Background:: The Ezetimibe Add-on to Statin for Effectiveness (EASE) trial examined the effectiveness and safetyprofile of ezetimibe (EZE) added to ongoing statin therapy in 3030 patients with low-density lipoprotein cholesterol (LDL-C) levels exceeding National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP 111) goals. Objective:: Because people aged >65 years are at increased risk for development of coronary heart disease (CHD),these subgroup analyses of data from the EASE trial were conducted to determine the extent of change in LDL-C levels and attainment of NCEP ATP III LDL-C goals with the addition of EZE to ongoing statin therapy in patients aged 65 to 74 years (the older group) and ≥75 years (the elderly group). Methods:: In the multicenter (299 sites), community-based, double-blind, placebo-controlled EASE trial, patientswere randomly assigned in a 2:1 ratio to receive EZE 10 mg/d or placebo in addition to their ongoing statin therapy for 6 weeks. The primary efficacy end point was the percent reduction in LDL-C levels, and the principal secondary end point was the proportion of patients achieving NCEP ATP III target LDL-C levels. The effects of the addition of EZE on additional lipid and lipoprotein measures and high-sensitivity C-reactive protein were also examined, as was tolerability. Study analyses were performed in the modified intent-to-treat population. Results:: This subgroup analysis included data from 841 patients in the older age group (579 EZE + statin,262 placebo + statin), which constituted 27.8% of the overall EASE population, and 466 in the elderly group (307 EZE + statin, 159 placebo + statin), which constituted 15.4% of the overall EASE population. The former group included 436 (51.8%) men and 405 (48.2%) women, with a mean (SD) age of 69.2 (3.0) years; the latter group included 227 (48.7%) men and 239 (51.3%) women, with a mean age of 78.5 (3.2) years. The characteristics of the 2 groups were comparable at baseline. In the older group, 717 (85.3%) had CHD or a CHD risk equivalent, as did 421 (90.3%) of those in the elderly group. Thirty-two patients in the older group and 17 in the elderly group discontinued the study. The reasons for discontinuation included clinical adverse events (n = 23), withdrawal of consent (n = 15), loss to follow-up (n = 4), protocol deviation (n = 2), and other reasons (n = 5). EZE + statin significantly reduced LDL-C compared with placebo + statin (older group: mean [SE] treatment difference, −25.1% [1.4]; P < 0.001; elderly group: treatment difference, −22.0% [1.8]; P < 0.001). The LDL-Glowering effects of treatment were consistent in the 2 groups. EZE + statin therapy significantly improved other lipid parameters (triglycerides, non high density lipoprotein cholesterol, and total cholesterol, P < 0.001 in both age groups; high-density lipoprotein cholesterol, P < 0.03 in the older group only) and high-sensitivity C-reactive protein levels compared with EZE + placebo (P < 0.03). The attainment of LDL-C goals also was significantly increased with EZE + statin compared with placebo — statin (older group: 72.3% vs 18.9%, respectively; odds ratio [OR] — 14.59; 95% CI, 9.55 to 22.28; P < 0.001; elderly group: 73.3% vs 18.9%; OR = 13.44; 95% CI, 7.72 to 23.41; P < 0.001). EZE + statin therapy was well tolerated by patients in both age groups, with a safety profile comparable to that of placebo + statin. Conclusions:: In these older and elderly patients,many of them at hgih risk for CHD, EZE added to ongoing statin therapy was well tolerated and was an effective treatment option for improving lipid profiles and attainment of LDL-C goals. Adding EZE improved rates of attainment of NCEP ATP III LDL-C goals without increases in the dose or potency of statin therapy. Further studies are necessary to determine whether these results can be generalized to other older and elderly populations. [Copyright &y& Elsevier]