Open-ended Response Items Research Articles

Diversity, Equity, and Inclusion Initiatives from Providers of Continuing Pharmacy Education

Abstract: Although continuing education (CE) plays an important role in educating health care providers on diversity, equity, and inclusion (DEI), little is known about the DEI initiatives promoted and implemented by providers of CE. Surveys were electronically administered to accredited pharmacy continuing education providers (CEPs) from 2021 to 2023. Survey items were assessed providers' current efforts and best practices for incorporating DEI into organizational culture and educational programming. Frequencies and percentages were calculated for categorical responses, and a general interpretivist approach was used to code open-ended response items and describe themes. Overall, 50 and 33 responses were received in 2021/2022 and 2023, respectively. The most common step taken by programs to advance DEI was to engage pharmacists and/or pharmacy technicians in DEI discussions. Qualitative analysis described categories and themes as follows: best practices (CE programming DEI strategies, organizational DEI strategies), DEI goals (mission statement and DEI strategic plan, developing CE, continuing pharmacy education committee and task force, and faculty development and guidance), and accrediting body support (sharing best practices and training and technical support). Although CEPs described current efforts and best practices related to DEI in CE, organizations involved in CE accreditation can continue to explore ways to support DEI initiatives.

Confidence in diagnosing and managing care for cognitive impairment in primary care: a survey comparing barriers by primary care clinician type.

As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC). Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square. Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care. Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care.

Award Recipients’ Perceived Benefits of a PK-12 Engagement Awards Program

Faculty and staff in higher education are motivated to engage in college programs by different factors. Award programs can be a tool to engage faculty and staff in programs. This study described the perceived benefits of an engagement award that recognized faculty and staff that had excelled in outreach and program engagement. Data included quantitative scale items and qualitative open-ended response items from award recipients across the College of Agriculture. Award recipients reported benefits included increased overall perceived value of the PK-12 Engagement Program, increased recognition of their program excellence and impact, an increased dissemination of program activities and outcomes, career benefits, and networking opportunities. The funding that accompanied the award was reported to offer support for the program and development of the program. Findings of this study offer insightful information to guide the development of engagement awards for other programs.

Trends in dental hygiene academic leadership development: Influencers, barriers, and enabling mechanisms.

This quantitative exploratory study was designed to learn about trends and forces impacting leadership development (LD) opportunities for dental hygiene (DH) program directors. A 10-item electronic survey was created and disseminated using Qualtrics system to directors of all accredited DH programs in the United States (N = 325). Surveys included closed and open-ended response items to capture quantitative and qualitative data. The analysis included descriptive statistics and thematic categorization of free responses. Eight-two surveys were returned (25% response rate). Leadership development training experiences varied among participants; 79% (n = 65) reported completing some form of LD training. Institutional support was variable among the DH program directors, yet most (76%, N = 62) indicated some level of school support for LD training opportunities for DH program directors. Feedback indicated that most options included campus-sponsored courses or events (28%, N = 47), professional association courses or events (24%, N = 40), and programs within the school, department, or division (24%, N = 40). Study findings support positive perceptions of the need, demand, and value of LD. Respondents shared beliefs in the benefits of LD and the value of placing resources to support these opportunities, yet also acknowledged substantial challenges including time, funding, and workforce needs. By addressing barriers and capitalizing on driving forces, programs can create systemic approaches to fostering LD for current and future DH program directors.

ChemVLab+: Integrating Next Generation Science Standards Practices with Chemistry

The Next Generation Science Standards encourage students to develop the reasoning and practice skills of scientists. Rather than promoting rote memorization, teachers engage students with real-world phenomena and prompt students to think critically. ChemVLab+ is a series of freely available, online modules that require students to reason like chemists by integrating core concepts with investigations in authentic contexts. Each activity reflects four key design principles as well as a novel framework for developing chemical reasoning specific to the practice of designing and interpreting experiments. The current paper describes the development and testing of the ChemVLab+ modules. A within-teacher randomized control trial study (treatment = 15 class sections with 371 students; control 14 class sections with 332 students) found that students using the ChemVLab+ modules outperformed students completing a set of active control modules that offered a more traditional instructional approach and problem-solving opportunities. ChemVLab+ students scored higher than their active control peers on 7 of 8 module quizzes and performed particularly well on open-ended response items that were focused on chemical reasoning for experiments. Analyses of demographic effects also revealed a positive interaction between BIPOC students and the ChemVlab+ intervention.

ACCEPTABILITY OF ANIMATRONIC PETS AMONG COMMUNITY-DWELLING VETERANS LIVING WITH DEMENTIA AND THEIR CAREGIVERS

Abstract Animatronic pets can improve psychosocial outcomes among older adults, but little is known about in-home use by Veterans living with dementia and the perceptions of informal caregivers regarding these tools. This quality improvement project examined the usability and acceptability of animatronic pets by community dwelling Veterans living with dementia from the perspective of informal caregivers. Usability and acceptability were examined through a structured telephone interview with 17 caregivers. Usability was operationalized as frequency of: pet use by the Veteran (1=Not at all, 4=Daily or all of the time), and reminders provided by caregivers (1=Not at all, 4=Daily or all of the time). Acceptability was defined as perceived benefit (measured using an acceptability tool; 0= Not at all, 2=A great deal beneficial) and satisfaction (measured using acceptability tool with close and open-ended response items) as reported by caregivers. Results indicated high usability (71% of Veterans used the pet daily with reminders provided by 30% of caregivers) and acceptability (Benefit: (M=1.5/2, SD=0.7); Satisfaction: 94% of caregivers would continue to encourage use of the animatronic pet by the Veteran and recommend one to others). Open-ended responses suggest that they may be less satisfying to those who lost a real pet or did not have an affinity for pets earlier in life. Animatronic pets can be used with minimal assistance by Veterans with dementia and are acceptable to informal caregivers. As VA initiatives support provision of these pets, additional research is needed to examine their broader impact on Veterans living with dementia specifically.

“Where the Rubber Meets the Road”: Providing Students with Rigorous Learning Experiences in a Curriculum and Instruction Doctoral Residency Seminar

The purpose of this article is to describe a doctoral residency seminar course that is part of a Ph.D. in Curriculum and Instruction degree program. Courses such as these provide new doctoral students with the necessary experiences to help them succeed in the program. This course is a venue for students to discuss the degree program, including academic writing, publishing, presenting at conferences, teaching in higher education, and serving the university, profession, and community, and course assignments corresponding to these areas will be presented. After completing my Summer 2021 seminar course, my students received an electronic survey that consisted of six Likert scale items and six open-ended response items that asked about their experiences in the course, as well as five demographic items. Descriptive statistics were run for the survey’s Likert items. The open-ended responses were coded, and the codes were grouped into themes. Overall, the responses to the Likert scale items were positive. The following themes emerged from the survey: academic writing and disseminating research, networking, the dissertation journey, and recommendations for future seminar courses. The findings have implications for doctoral program instructors who are creating or sustaining a seminar course.

A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula.

This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment. Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used. A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models. Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation. Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.

“Strong, fearless, tough, enduring”: Collegiate male wrestlers’ perceptions of body image and masculinity

BackgroundSuccessful wrestling performance is largely dictated by weight. Some wrestlers engage in rapid weight loss methods to maximize performance at lower weight classes. Data from other sports suggest these methods can negatively affect body image (BI) and physical health and put athletes at risk for disordered eating behaviors, but the actual impact in wrestling is unknown. The present study examined the relationship between perceptions of masculinity and BI to eating disorder (ED) risk in male collegiate wrestlers. MethodsSurvey data were collected from active male NCAA wrestlers (n= 63). Wrestlers completed the Eating Attitudes Test, the Multidimensional Body-Self Relations Questionnaire, the Hoffman Gender Scale, and three open-ended response items. ResultsED risk was positively correlated to appearance self-importance (r= 0.361, p < 0.01) and body weight vigilance (r= 0.618, p < 0.01) and negatively correlated to BI satisfaction (r = -0.328, p < 0.05). Gender self-acceptance was correlated to lower importance placed on BI (r= 0.402, p < 0.01). Additionally, 35 (53.9%) participants reported at least one maladaptive eating behavior (e.g. binging, vomiting, laxative use). Qualitative data indicates similarities in traits associated with successful wrestlers and the traditional ideal male (mental and physical strength, toughness, surpassing limits). ConclusionsThe masculine traits exemplified by the sport of wrestling may negatively impact BI and encourage maladaptive eating and/or weight-control behavior and increase ED risk. The information in this study can be used to inform the development of safer weight loss practices and specialized educational programs for ED risk for wrestlers. This study highlights a need for further qualitative analysis of weight-control behaviors in collegiate wrestling.

Addiction curriculum design for medical students.

As mortality and morbidity due to substance use disorder (SUD) are increasing for women, especially during pregnancy and postpartum, it is imperative to equip medical providers with skills to identify SUD and initiate treatments. We designed a curriculum to provide third-year medical students with clinical exposure to SUD during pregnancy. This novel, experience-based SUD curriculum was focused on providing adequate knowledge, skills and confidence to provide compassionate, patient-centred care to women with SUD. Obstetrics and Gynecology clerkship third-year medical students rotated 1 day through a clinic that provides Obstetrics and Gynecology and addiction medicine services. Congruent with COVID-19 limitations, students completed pre-clinic assignments and in-clinic tasks (e.g., screening, brief intervention, referral to treatment [SBIRT]) under supervision. After implementation of this pilot curriculum, 20 students and 10 teachers completed surveys (100% response rate) with open-ended response items. Quantitative data and open-ended responses using electronic surveys were sequentially analysed to evaluate the curriculum's feasibility and acceptability. We designed a novel curriculum that focused on SUD learning objectives and providing exposure to third-year medical students, and our findings indicate that it is feasible and acceptable to both students and teachers. In the future, we plan to provide this curriculum to both our third- and fourth-year medical students, and we encourage teachers and providers at other institutions to utilise it during their clinical training.

Impact of the COVID-19 pandemic on emergency medicine education: Insights from faculty and residents.

ObjectivesThe COVID‐19 pandemic continues to impact health systems across the United States and worldwide in an unprecedented way; however, its influence on frontline medical trainees’ educational experiences is unknown. Our objective was to determine the effects of COVID‐19 on emergency medicine (EM) training programs and residents.MethodsWe performed a mixed‐methods cross‐sectional survey study of faculty and residents at programs registered with Foundations of Emergency Medicine. Participants completed an online survey consisting of closed and open‐ended response items. We reported descriptive statistics for discrete and continuous data. Free‐response data were analyzed qualitatively using a thematic approach.ResultsNinety‐two percent of faculty (119/129) and 47% (1,965/4,154) of residents responded to our survey. We identified three major themes related to effects on learning: 1) impact on clinical training, 2) impact on didactic education, and 3) impact on the trainee. Nearly all residencies (96%, 111/116) allowed residents to work with patients suspected of having COVID‐19, although fewer (83%, 96/115) allowed residents to intubate them. We found that 99% (1918/1928) of residents experienced virtual didactics. Faculty and trainees noted multiple educational challenges and strategies for adaptation. Trainees also expressed concerns about stress and safety.ConclusionCOVID‐19 has impacted EM education in many ways including clinical training, didactic education, and trainee emotional state and concentration. Challenges and suggested solutions for learning in the virtual environment were also identified. While the pandemic continues to evolve and impact EM residents in various ways, our results may inform strategies to support medical educators and trainees during pandemics or other periods of significant disruption or crisis.

Using journey mapping to understand the patient experience with selecting a Medicare part D plan using a pharmacy consultation service

BackgroundPatient experience with community pharmacy services can be informed by human-centered design principles and approaches. Pharmacy services may benefit from detailed evaluations of consumer experience and patient-centered service design. ObjectivesTo use an online journey mapping platform to understand the patient experience with selecting a Medicare Part D plan for individuals that did, and did not, use a free, pharmacy-led, Medicare Part D consultation service. MethodsThis was a two-group cross-sectional survey study in a single, rural community pharmacy. Surveys consisted of 7 demographic items, 30 Likert-type items, and 7 open-ended response items. The pharmacy used purposeful convenience sampling to distribute a paper survey to individuals 65 years of age and older currently enrolled in Medicare Part D between June and August 2019. Surveys were distributed to 36 patients currently enrolled in a Medicare Part D plan, with 18 surveys distributed to patients who had previously used a pharmacy-led Medicare Part D consultation service and 18 surveys distributed to patients who did not use the service. Surveys were uploaded to an online journey mapping platform, producing data visualizations for each group. Multiple choice survey items were analyzed using descriptive statistics, wth service user and nonuser groups compared using Mann-Whitney U tests. Open-ended survey responses were coded by the research team using an inductive approach. ResultsIn total, 36 surveys were returned to the community pharmacy for a response rate of 100%. The journey map platform generated Persona, Empathy, and Current Journey outputs, which mapped Good Experiences and Bad Experiences within the Medicare Part D plan selection experience. Personas differed in their median household incomes ($25,000–$39,999 for service users compared to $50,000–$74,999 for nonusers). Empathy and Current Journey outputs showed that service users had a wider variety of emotions compared to non-users. Mann-Whitney U tests yielded 5 items with statistically significant differences (p-values <0.05) in the plan-selection experience, with both groups similarly uncertain about their plan decision. Qualitative responses indicate patient trust was universally important to a complex decision-making process. ConclusionsAn online journey mapping platform provided insight into how patients experience a pharmacy service that extends beyond satisfaction. For community pharmacies providing Medicare Part D plan consultation services, pharmacies should consider how they can improve the service experience through communication style and patient-centered service design.

Athletic Training Students' Perspectives and Performance When Learning Online

Context Technology continues to change throughout the world, and higher education is not absent from the adjustment. Athletic training educators should adapt to online learning opportunities that enhance the curriculum for their students. Objective To explore athletic training students' thoughts and knowledge when learning through a distance education platform. Design Cross-sectional, mixed-methods survey. Setting Six professional postbaccalaureate athletic training programs. Patients or Other Participants A total of 55 second-year athletic training students. Intervention(s) One-week asynchronous eLearning module focused on the background and use of telemedicine in health care. Main Outcome Measure(s) Participants completed the technology acceptance model tool before and after the module to gather their perspectives about online learning. During the eLearning module, knowledge acquisition was assessed with quizzes. Finally, a transactional distance theory tool including 2 open-ended response items was delivered at the end of the eLearning module. Results We identified that participants had a low acceptance for technology at the onset of the study that improved after the eLearning intervention for the constructs of self-efficacy (P = .010) and perceived ease of use (P ≤ .001) of eLearning technologies. The transactional distance tool highlighted that the facilitator and readings were helpful, which was also indicative of the scores on the module quizzes. We also identified benefits to eLearning from the student perspective, which included previous experiences, learning on their own time, and feelings that the module was productive to their growth as students. Some participants stated that the eLearning module presented too much work and was missing interaction, whereas others were neutral relative to the comparison between traditional and online learning. Conclusions Overall, the results of this study identified that technology acceptance and transactional distance are important components of online learning. Athletic training educators should educate learners regarding the differences in online education requirements.

Postpartum Tobacco Use and Perceived Stress among Alaska Native Women: MAW Phase 4 Study.

Prior research explored reasons for tobacco use among pregnant Alaska Native (AN) women but did not address the postpartum period. This study followed up with AN women one to three years postpartum who had participated in a prenatal smoking cessation intervention study (Motivate Alaska Women (MAW) Phase 3) and had consented to be re-contacted for future studies. Of 47 eligible women, 32 (68%) participated. A semi-structured phone interview was conducted a mean of 2.0 years after delivery (range 1.6–2.8). Measures assessed self-reported tobacco use status in the 12 months after delivery, at 12 months postpartum, and at the time of the interview; reasons for maintaining abstinence, continued use, or relapse; and included the Perceived Stress Scale (PSS) and Negative Affect (NA) scale. Content analysis was used to generate themes from open-ended response items. Tobacco use was reported by 23 women (72%) at delivery, 30 (94%) within the 12 months after delivery, 27 (84%) at 12 months postpartum, and 29 (91%) at the time of the interview. Among nine women not using tobacco at delivery, seven (78%) relapsed during the 12 months after delivery. Of the 29 current tobacco users, 28 (97%) smoked cigarettes. Twenty-seven participants (84%) reported stress and 15 (52%) indicated addiction as reasons for continuing, starting, or resuming tobacco use. Types of stressors were related to parenting and traumatic experiences. Among current tobacco users, mean NA score (18.7) was significantly higher (p = 0.01) than the normative mean (14.8), but no differences were detected for PSS score. In this sample of AN women, postpartum tobacco use was highly prevalent, and stress was a primary reason that women endorsed for using tobacco. These preliminary results have several practice and research implications for exploring ways to support non-tobacco use among postpartum AN women.

Empowerment through a teacher leadership academy

Purpose The purpose of this paper is to examine the effectiveness of a teacher leadership academy (TLA) organized through a school district/university partnership in a small, US Suburban School District in increasing teachers’ participation in leadership activities. Design/methodology/approach TLA participants (n=11) were surveyed using the Teacher Leadership Activities Scale, and their results were compared to a control group of teachers in the district who were not participating in the TLA (n=12). Interviews and open-ended response items provided qualitative data to examine how the TLA contributed to teachers’ growth as leaders. Findings Results indicated that teachers in the TLA did increase participation in teacher leadership activities. Qualitative data revealed themes of many espoused benefits from TLA participation, including increased interactions with administrators, improved understanding of the obstacles associated with implementing changes, and expanded leadership capacity. Research limitations/implications Conditions that both enhanced and detracted from teacher leaders’ growth were identified and outlined, including formal leaders’ participation in TLA activities, material support for projects, and a supportive atmosphere (enhancers) and administrative roadblocks and the inability to remediate capacity issues for teacher leaders (detractors). Originality/value The conditions outlined above will assist those interested in creating TLAs in doing so with purpose and increased chance for buy in and success.

Drunchies Hangover

Background and Purpose: Alcohol intoxication affects college students' eating patterns. Yet, little is known about dietary habits on the day after heavy alcohol consumption. The purpose of this study was to examine college students’ dietary choices during alcohol consumption and on the following day by gender and level of alcohol consumption (including none). Methods: Ethnically diverse undergraduates (N = 286; 52% male, 48% female, M age = 19, SD age = 1) at a public university in the Midwest completed an anonymous on-line survey. The survey included Behavioral Risk Factor Surveillance System nutrition items, items on consumption of "empty calorie foods," and open-ended response items on dietary choices that were coded by a nutritionist. Results: Participants reported differences in the likelihoods of consuming non-nutrient dense foods after drinking alcohol both before sleeping and the next day compared to at other times when they were not consuming alcohol. Conclusion: College students are more likely to eat after drinking alcohol and tend to consume less healthy foods. These dietary practices necessitate the need for customized interventions focusing on the dietary influences of alcohol consumption.

Writing assessment literacy: Surveying second language teachers’ knowledge, beliefs, and practices

Abstract Assessing student writing constitutes the major portion of second language writing teachers’ workloads; however, studies assessing and quantifying teachers’ writing assessment literacy (knowledge, beliefs, practices) are comparatively rare. In the present study, second language writing instructors from tertiary institutions (N = 702) were surveyed. Data were collected with a 54-item survey instrument administered through SurveyMonkey ® . Items were formulated to ascertain writing teachers’ backgrounds and perspectives on assessment using multiple choice, Likert-scale, and open-ended response items. Analysis focuses on four research questions: (1) How have second language writing teachers obtained assessment knowledge? (2) What do second language writing teachers believe about writing assessment? (3) What are the assessment practices of second language writing teachers? (4) What is the impact of linguistic background and teaching experience on writing assessment knowledge, beliefs, and practices? Teachers reported training in writing assessment through graduate courses, workshops, conference presentations; however, nearly 26% of teachers in this survey had little or no training. The results also showed relative effects of linguistic background and teaching experience on teachers’ writing assessment knowledge, beliefs, and practices.

Academic performance and the practice of self-directed learning: The adult student perspective

The practice of self-directed learning is important to adult students as it allows them to learn effectively while juggling work, family and other commitments. This study set out to examine the self-directed learning characteristics present in the adult students’ study process at the case university. The relationship between the adult students’ perceived competence level in self-directed learning and their academic performance was also investigated. In this study, 1695 adult students in the case university participated in a survey that included both Likert-type and open-ended response items. Eleven indicators of self-directed learning were conceptualised and quantified. These indicators included: Goal Setting, Time Management, Procrastination Management, Assignment Preparation, Exam Preparation, Note-taking Capability, Research Capability, Seminar Class Readiness, Technical Readiness, Online Class Readiness and Stress Management. The findings showed that the adult students’ perceived level of competence in the 11 self-directed learning indicators had a direct or an indirect effect on their academic performance. Based on the findings, the case university has conceptualised some new initiatives in the provision of support in terms of self-directed learning to help its adult students to do well in their studies.

Exploring Patient Involvement in Decision Making for Vascular Procedures

Initiatives to develop patient-centered approaches to health care are a priority that may have profound effects on health care, particularly within value-based purchasing and risk-sharing models. Patient-centered care requires more direct engagement of patients in their own care, including treatment decisions. Patient participation in treatment selection for vascular procedures has not been characterized, and the potential effects of greater patient involvement are unknown. We conducted a prospective study among patients undergoing vascular procedures to identify important sources of information and characterize experienced vs desired decision-making roles. Patients undergoing elective vascular procedures were identified from an outpatient clinic and vascular laboratory. An instrument consisting of multiple choice and open-ended response items related to patients' roles in decision making, sources of information, and perceived treatment success was administered. Diagnostic, demographic, and educational data were collected. Descriptive statistics are presented as count (%) for categoric variables or mean ± standard deviation for continuous variables. Categoric responses are presented as median (interquartile range) based on a 1-5 ordinal scale. The participants were 74 patients undergoing intervention for abdominal aortic aneurysm (n = 20), hemodialysis access (n = 14), carotid stenosis (n = 20), and peripheral arterial disease (n = 20). Mean age was 68.8 ± 12.4 years, 43% were women, and 26% were African American. Highest educational level was college or graduate school for 35% of participants, 61% had computer access, and 41% regularly used e-mail. Participants identified providers as the most important information sources (1 [1, 1] for doctors and 2 [1, 3] for nurse practitioners, where 1 = “very important” and 5 = “not important”), whereas family and friends, written materials, and other patients were less important (3 [1, 5], 3 [2, 4], and 3 [2, 5], respectively), and television/video and internet resources were least important (4.5 [3, 5] and 5 [3, 5], respectively). Although participants had high levels of confidence in provider recommendations (1 [1, 1] for all procedure categories, where 1= “very satisfied” and 5 = “not satisfied”), they had a strong preference to discuss all potential treatment options (1 [1, 1], where 1 = “strongly agree” and 5 = “strongly disagree”) and to choose their treatment together with their doctor (1 [1, 2]) as opposed to only discussing the recommended treatment (2 [1, 3]) or delegating selection to the doctor alone (2 [1, 3]). Patients undergoing hemodialysis access and abdominal aortic aneurysm procedures most often reported discussion of more than one option (1.5 [1, 3] and 1.5 [1, 5], respectively), whereas discussion of multiple options was less common for peripheral arterial disease (2 [1, 3.5]) and carotid stenosis (3 [1, 5]). Thirty-seven participants (50%) considered their first treatment successful, 27 (36.5%) considered another subsequent treatment successful, and 10 (13.5%) considered none successful. Patients experience varying participation levels in decision making for vascular procedures and often believe that their treatments are unsuccessful. Although patients consider providers an important source of information and have confidence in their recommendations, they prefer to discuss all treatment options being considered. Patients also prefer shared decision making over complete delegation to the provider. Increasing patient involvement in treatment decisions has potential to improve patient satisfaction but may require tools to facilitate more active participation. Potential impacts on other outcomes remains to be determined.

Constraints on Group Counseling in Mixed Secondary Schools in Ekiti North Senatorial District of Ekiti-State, Nigeria

The aim of the study was to find out whether our secondary schools are properly and effectively staff with trained counselors, to assess the adequacy of facilities available in our schools, whether enough facilities are available for effective group counseling, to identify the problems that may arise in grouping session and to highlight actions of school administrators that may hinder group counseling in secondary schools. The research designs employed were the survey method and questionnaire with selected secondary schools in Ekiti North Senatorial District of Ekiti State, Nigeria, between May 2011 and November 2011.The sample comprised fifty (50) secondary schools in five (5) local government areas. Five research questions were administered. The researcher designed a questionnaire with structured response items and open-ended–response items and administered on – the spot which facilitated a 100% return. The counselors of the fifty mixed secondary schools in the areas formed the population of study. The questionnaire incorporates both structure and open-ended response items. Respondents were asked to tick (?) against the correct responses to each of the structured items and supply necessary information in the space provided for each of the open-ended items. The percentages were computed for each of the response under each item in the questionnaire. Then, Two-way ANOVA was used for the hypotheses. The results were obtained by checking the total frequency of each response ticked (?) or written – out) under each item by the respondents, divide the calculated number by the total number of subjects (Population) and multiply the product by 100. There is paucity of trained counselors in the secondary schools, adequate facilities are not provided for counseling, principals do not encourage group counseling in their schools though they are not ignorant of its potency and some problems emanated from the idea of grouping male and female for counseling purposes in mixed secondary schools.