Background: Transgender individuals experience considerable prejudice and bias, creating barriers to health care. Purpose: The purpose of this study was to determine the effect of a virtual patient simulation scenario of caring for a transgender adult on nursing students' attitudes and beliefs about transgender people. Methods: A validated 29-item instrument developed to assess an individual's view of transgender identity was administered in a pre-/posttest nonequivalent-groups design to junior-and senior-level nursing students. Results: Statistically significant differences were found between the control and treatment groups for the subscale human value. Conclusions: Findings support experiential learning in nursing as an effective tool in teaching cultural competence and sensitivity when caring for transgender patients. Attitudes and beliefs of senior nursing students and junior nursing students toward transgender individuals differed, with senior students being more receptive.
As the science of simulation continues to evolve, so does the need for additions and revisions to the Healthcare Simulation Standards of Best Practice. Therefore, the Healthcare Simulation Standards of Best Practice TM are living documents.
StandardSimulation-based experiences may include evaluation of the learner.
The Sibutad gold deposit has gold associated in quartz veins. The most important of these is the Lalab orebody, which contains ore-grade gold, predominantly, in milky quartz veins and veinlets. Here, alteration quartz and fi ne-grained crystalline clear and milky quartz were formed from hydrothermal fl uids in three stages, namely stages I, II and III. Fluid inclusion microthermometry was carried out on stage I milky quartz, stage II fi negrained alteration quartz and stage III milky quartz ± barite veins and veinlets. Homogenization temperatures (T H ) are >248°C in stage I, 214 -232°C in stage II and 186 -239°C in stage III. These fl uid inclusions have salinity between 1 and 2 wt% NaCl equivalent. In terms of gold assay, stage I drill-core samples have gold grades 0.53 -0.76 g/ton Au, stage II samples have 1.12 -3.70 g/ton Au and stage III samples have 9.06 -23.88 g/ton Au. This correlation suggests that gold was precipitated from the stage II and III fl uids.
Background
Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies.
Methods
The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI.
Results
In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899).
Conclusion
The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity.
Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK).
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