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PubMedDate not supplied

The reflective diary: an aid to practice-based learning.

This article explores the use of reflective learning diaries in conjunction with a modified form of the Benner assessment tool (Benner 1984). The authors describe a practicum, based on the findings of a small action research study for the development and use of reflective diaries during clinical placement. The results suggest that students, preceptors, reflective diaries and assessment tools can be combined to create a positive learning environment.

Competency-Based Education↗

PubMedDate not supplied

Self-assessment and reflection in nurse education.

It is widely argued that nurse learners should learn to become reflective practitioners and that self-assessment plays a part in this (Ekebergh et al 2004, Thorpe 2004). Problems arise, however, when consideration is given to just how this right be achieved. This article examines the challenges of assessing reflection where self-assessment has played a part. It highlights the challenges that can arise when reflection and self-assessment are used for different educational purposes. It identifies why this work is challenging and suggests some parameters that may assist colleagues in making learning more successful.

Curriculum↗

PubMedDate not supplied

Learning to nurse: reflections on bathing a patient.

The reflective process allows nurses to view their practice by bringing their theoretical knowledge and nursing practice closer together. In this article, a nursing student describes different methods of reflection and applies them to her experience of bathing a patient. Issues of bathing, preparation and the conflicts with time management are explored, demonstrating the benefits of reflection as a tool for learning.

Adaptation, Psychological↗

PubMed1985

A specular reflection arising from the ventricular wall: a potential pitfall in the diagnosis of germinal matrix hemorrhage.

Reflection artifacts may complicate the diagnosis of intracranial hemorrhage in preterm neonates. A linear focus of bright echoes in the region of the germinal matrix at or anterior to the caudothalamic grooves, often seen on parasagittal scans, may be mistaken for a germinal matrix hemorrhage but is actually a reflection of the ultrasound beam at the wall of the lateral ventricle. Cranial sonograms of 100 preterm infants were retrospectively analyzed and categorized with regard to presence and size of specular reflection. Eight cases demonstrated a bright echogenic focus; seven of these potentially could have been mistaken for hemorrhages.

Cerebral Hemorrhage↗

PubMed2002

Guidance of retrobulbar injection with real-time tomographic reflection.

OBJECTIVE: Retrobulbar and peribulbar injections are common ophthalmologic procedures used to deliver anesthetics and other medications for ophthalmic therapy and surgery. These injections, typically performed without any type of guidance, can lead to complications that are rare but visually devastating. The needle may penetrate the optic nerve, perforate the globe, or disperse toxic quantities of drugs intraocularly, causing major visual loss. Sonographic guidance may increase the accuracy of the needle placement, thereby decreasing the incidence of complications. However, difficulties arise in coordinating the relative location of the image, the needle, and the patient. Real-time tomographic reflection is a new method for in situ visualization of sonographic images, permitting direct hand-eye coordination to guide invasive instruments beneath the surface of the skin. METHOD: In this preliminary study, real-time tomographic reflection was used to visualize the eye and surrounding anatomic structures in a cadaver during a simulated retrobulbar injection. RESULT: The needle tip was easily followed as it was advanced into the retrobulbar space. CONCLUSIONS: The images presented in this preliminary study show the use of real-time tomographic reflection to visualize insertion of an invasive instrument into the human body.

Anesthesia, Local↗

PubMed1998

Professional nurses as reflective clinical learning facilitators.

With the rapid changes taking place in the country, including the education system in general and nursing education in particular, the role of professional nurses as reflective clinical learning facilitators need to be re-visited in order to meet the changing health needs of the community and to facilitate outcome-based nursing education and evidence-based quality nursing care. The purpose of this paper is to explore and describe the perceptions of professional nurses as reflective clinical learning facilitators in the clinical learning units, within the context of a specific health-care service in Gauteng. A phenomenological method using descriptive naïve sketches was used to collect data from twenty professional nurses complying with certain inclusion criteria. A content analysis was performed and eight categories (main concepts) were identified in order of priority as follows: communication/collaboration; role-modelling; continuous assessment and evaluation; up-to-date knowledge; scientific approach; clinical teaching; management and professionalism. After a literature control was conducted, these main concepts were confirmed. It is recommended that a model to facilitate reflective thinking in clinical nursing education be developed, using these concepts as basis for the provisional conceptual framework.

Clinical Competence↗

PubMed1999

Comparison between anti-reflection-coated and uncoated spectacle lenses for presbyopic highway patrol troopers.

BACKGROUND: The use of anti-reflection coatings (AR) for spectacle lenses is steadily increasing. These ultra-thin coatings reduce reflections in lenses, increasing light transmittance about 8% (from 91% to 99%). Patient reports of crisper detail and brighter environment indicate that this perceived increase in visual function would probably be of benefit to many, including highway patrolmen who must make daily judgments on the basis of fine visual detail. METHODS: Nineteen presbyopic Missouri State Highway Patrolmen (MSHP) participated in this crossover study. Subjects randomly wore Varilux Comfort progressive addition lenses in CR-39 that were uncoated or AR-coated. The AR coating was Crizal. Subjects wore each lens for 1 month, then compared the lenses directly for 1 week. Data were collected for lens scoring (both general and job specific) and lens preferences. RESULTS: The AR-coated lens was found to be significantly better in most categories. Reduction in glare and reflections during the day, night, indoors, and in the patrol vehicle--as well as improvement in overall night vision--were highly significant. Eighty-nine percent of the subjects chose the Crizal-coated lenses as their overall preferred lens. CONCLUSIONS: The results of this study appear to demonstrate a noticeable subjective preference for AR-coated lenses when used by a group engaged in a visually demanding occupation.

Adult↗

PubMed2000

TabBO: a model reflecting common molecular features of androgen-independent prostate cancer.

We established two human prostate cancer cell lines, MDA PCa 2a and MDA PCa 2b, the TabBO model system, that reflect common features of human androgen-independent prostate cancer that are not present in other model systems: bone origin, prostate-specific antigen production, androgen receptor expression, and androgen sensitivity. We therefore hypothesized that molecular pathways in our model system reflect common alterations responsible for the progression of a subset of human prostate cancer. Progression to androgen independence has been hypothesized to be largely associated with impairment of the regulation of cell growth or apoptosis of prostate cancer cells. Therefore, in this study, we examined molecular markers known or suspected to be important in prostate cancer progression and key regulators of cell growth and apoptosis: p53, p21WAF1/CIP1, Bcl-2, Bax, retinoblastoma (Rb), and p16INK4A/MITS1. We analyzed the expression of these markers in the cell lines, their tumor of origin, and tumors derived from the cell lines by s.c. inoculation into nude mice. DNA sequencing of the entire open reading frames of the p53 and p21 genes revealed no mutations. Additionally, accumulation of the p53 protein was not found by Western blot analysis, nor was overexpression of the Bcl-2 oncoprotein detected. Bax expression was detected in MDA PCa 2a cells, whereas it was absent in MDA PCa 2b. Rb and p16 protein expression was normal as measured by both Western blot and immunochemical analyses. Immunohistochemical studies of p53, p21, Bcl-2, and Rb in both samples from the original human cancer from which the lines were derived and mouse xenografts derived from the lines revealed similar levels of protein. These results are consistent with reports indicating that 40-50% of bone metastases of prostate cancer have wild-type p53, 50-70% do not overexpress the Bcl-2 protein, and mutations in the p21 gene are rare. Therefore, we conclude that MDA PCa 2a and MDA PCa 2b reflect molecular pathways in a common subset of human androgen-independent prostate cancer and that important molecular players in apoptosis (namely, p53 and Bcl-2) seem to be intact in this subset of androgen-independent prostate cancer. Understanding the signal-transduction pathways operating in these cell lines may help to identify therapeutic targets for prostate cancer.

Androgens↗

PubMed2000

A new infrared spectral library of controlled and noncontrolled drug standards using internal reflection spectroscopy.

An infrared spectral library containing 455 controlled and noncontrolled solid drug standards was generated using internal reflection spectroscopy. All attenuated total reflection (ATR) spectra were obtained with small diamond internal reflection elements. ATR spectra will have minor variations from transmission spectra commonly found in commercial infrared libraries.

Databases, Factual↗

PubMed2000

Confocal assay for invasion: use of propidium iodide fluorescence and laser reflectance to quantify the rate of migration of cells through a matrix.

BACKGROUND: Most assays used to measure invasion are based on manual counting of the number of cells that have migrated completely through commercial coated filters. We describe here a confocal fluorescence-imaging method that can assess the relative rates of invasion of cells into a matrix. METHODS: After being seeded on the matrix and a period of incubation, the cells are fixed and treated with RNase. Propidium iodide is then added to stain the double-stranded DNA. A confocal microscope system is used to obtain high-resolution images of the red propidium iodide fluorescence and laser reflectance from optical sections at increasing depths in the matrix. The section with high laser reflectance marks the top of the matrix. RESULTS: Data were calculated as the total area of red fluorescence above background in each section and were plotted as a percentage of the summed fluorescent areas in all sections. CONCLUSIONS: Because the distance into the matrix of the nuclei can be calculated by measuring from the reflective upper surface of the matrix, the method is useful for assessing the rate of cell migration and for comparing the ability of different cells to invade through different matrices under varying conditions.

Breast Neoplasms↗

PubMed2001

Estimating near-infrared leaf reflectance from leaf structural characteristics.

The relationship between near-infrared reflectance at 800 nm (NIRR) from leaves and characteristics of leaf structure known to affect photosynthesis was investigated in 48 species of alpine angiosperms. This wavelength was selected to discriminate the effects of leaf structure vs. chemical or water content on leaf reflectance. A quantitative model was first constructed correlating NIRR with leaf structural characteristics for six species, and then validated using all 48 species. Among the structural characteristics tested in the reflectance model were leaf trichome density, the presence or absence of both leaf bicoloration and a thick leaf cuticle (>1 μm), leaf thickness, the ratio of palisade mesophyll to spongy mesophyll thickness (PM/SM), the proportion of the mesophyll occupied by intercellular air spaces (%IAS), and the ratio of mesophyll cell surface area exposed to IAS (A(mes)) per unit leaf surface area (A), or A(mes)/A. Multiple regression analysis showed that measured NIRR was highly correlated with A(mes)/A, leaf bicoloration, and the presence of a thick leaf cuticle (r = 0.93). In contrast, correlations between NIRR and leaf trichome density, leaf thickness, the PM/SM ratio, or %IAS were relatively weak (r < 0.25). A model incorporating A(mes)/A, leaf bicoloration, and cuticle thickness predicted NIRR accurately for 48 species (r = 0.43; P < 0.01) and may be useful for linking remotely sensed data to plant structure and function.

Journal Article↗

PubMed2001

Integrating a structured ethical reflection curriculum into high school community service experiences: impact on students' sociomoral development.

It is widely accepted within the field of community service that reflection is an important factor in promoting personal and sociomoral development. The purpose of this research was to determine if a particular form of reflection--decision making with an emphasis on the ethical nature of community service--has special value in achieving service-learning goals. Three dimensions of adolescent identity development served as dependent variables: agency, social relatedness, and moral-political awareness. Four hundred seventy-six high school students were assessed on the dependent variables before and after experiencing one of three conditions: community service with an ethical reasoning component; community service with reflection, but without an ethical reasoning component; and no community service (control). After one semester, it was found that students in the first condition (ethical decision making curriculum integrated into the community service program) made greater advances on all three dimensions of identity formation when compared with students in the other two conditions. Specifically, it was found that they became more systematic in their ethical reasoning and more likely to consider situations and issues from an ethical point of view.

Adolescent↗

PubMed2001

Upper extremities deep venous thrombosis: comparison of light reflection rheography and colour duplex ultrasonography for diagnosis and follow-up.

BACKGROUND: Non-invasive diagnosis of axillary-subclavian vein thrombosis or documentation of the post-thrombotic syndrome performing methods currently in use is not definitive. The purpose of this prospective study was to compare two methods for the diagnosis and follow-up of patients with primary and secondary axillary-subclavian vein thrombosis: light reflection rheography (LLR) which is a reflection of venous pressure changes in the extremity as record from the subdermal capillary plexus, and colour duplex ultrasonography (CDUS). METHODS: In 36 patients with primary and secondary axillary-subclavian vein thrombosis were used a 4006 GE (Milwaukee, USA) colour duplex ultrasonography and an AV-1000 Hemodynamics instrument for the light reflection rheography for diagnosis and follow-up. The LLR methodology that applied was simple, involving testing of the venous outflow in the upper extremities in response to exercise, and with normally respiratory variations of an open venous system that was also assessed by the non-invasive modalities. In the LLR application of venous congesting pressure, and measurement of the rate of venous outflow when the congesting pressure is released was also performed. RESULTS: Both methods were able to diagnose the axillary-subclavian thrombosis in the initial acute state. There were no cases of false-positive results in either method. The CDUS presented a lower sensitivity in comparison to LLR in the follow-up period of the patients. A positive study was confirmed by phlebography in each instance. CONCLUSIONS: The tracing obtained by LLR is easy to interpret and provides objective evidence of proximal venous occlusion. The test is easy to apply and the instrumentation is relatively inexpensive. Both LLR and CDUS, could prove to be an exciting development among non invasive diagnostic techniques for axillary-subclavian vein thrombosis, with major sensitivity of LLR in the follow-up.

Adult↗

PubMed2001

[A shared room of reflection where the patient's symptoms are valid sources of knowledge].

BACKGROUND: The consultation is supposed to clarify the origin of the patient's complaints and what can be done to alleviate them. Diagnostic work and interaction are challenged by subjective symptoms with no objective findings. In our project "Symptoms as a source of knowledge" we studied women's medically unexplained disorders from the viewpoint that the patient's knowledge represents significant potential for creative understanding. MATERIAL AND METHODS: Concepts and hypotheses about symptoms applied as diagnostic sources of knowledge were drawn from qualitative analysis of findings from the subprojects. We have explored issues of relevance and validity that shape the consultation as a medical and cultural space. RESULTS: Symptoms beyond established categories can disturb a room of reflection which includes patient as well as doctor. The patient may feel dismissed as a person, the process of objectivising becomes defocused, and the diagnostic activity deals with the patient's credibility. Signs related to "either-or" appear as a more comprehensible medical pattern than signs of 'more-or-less'. The probability of a common room of reflection may be related to cultural attitudes to time, blame, and womanliness. INTERPRETATION: When traditional medical analytic tools fail, alternative rooms of reflection can be established from recognition, resources, and dialogue, enhancing surprises and curiosity.

Clinical Competence↗

PubMed2001

Introduction: promoting and maintaining a reflective professional staff in a hospital-based social work department.

Promoting and sustaining a staff of reflective social work practitioners requires a supportive departmental structure and culture. Providing such support is a particular yet necessary challenge to social work administrators in the current health care environment. This article discusses an array of administrative strategies employed in one hospital social work department to promote reflective social work practice. More specifically, it describes the role of practice-based research in enhancing worker reflectiveness.

Allied Health Personnel↗

PubMed2001

Reflective practice: a critical incident.

Reflection identifies one's professional capabilities, increases knowledge of self and improves understanding and management of patients. Conducting reflective practice is conducive to professional development and growth. A complex medical and nursing management of a psychiatric emergency is illustrated through this critical incident. Psychiatric nurses play a key role in deescalating the aggressive behaviour of psychotic patients. Through reflection, the basic tools of psychiatric nurses are reviewed and the prime components of psychiatric therapy are discussed.

Critical Care↗

PubMed2002

In vivo reflectance measurement of optical properties, blood oxygenation and motexafin lutetium uptake in canine large bowels, kidneys and prostates.

Motexafin lutetium (MLu) is a second-generation photosensitizer for photodynamic therapy (PDT) of cancer. We have developed and applied a diffuse optical reflectance spectrometer for in vivo measurement of MLu uptake, optical properties, haemoglobin concentration and haemoglobin oxygen saturation in normal canine large bowels, kidneys and prostates. The probe consists of a broadband fibre-optic-coupled light source and detector fibres placed at various distances from the source fibre to collect reflected light. An analysis based on the diffusion approximation of the photon transport equation was used to recover tissue optical properties from the reflectance measurements. The instrumentation and analysis methods were validated using measurements from homogeneous, highly scattering phantoms with known MLu concentrations. The same techniques were then used to estimate chromophore concentrations of normal canine large bowels, kidneys and prostates. We estimated (mean (standard deviation)) total haemoglobin concentrations of 119 (25), 340 (92) and 51 (11) microM in the large bowels, kidneys and prostates of four dogs, respectively; tissue blood oxygen saturations in these same organs were 75 (15), 76 (21) and 74 (16) per cent, respectively. Tissue MLu concentrations (mg l(-1)) were estimated from data taken 3.5 h after injection of a 2 mg kg(-1) injected dose; data from three dogs gave concentrations of 2.4 (0.4) in large bowels, 6.8 (1.3) in kidneys and 2.2 (1.1) in prostates. The reduced scattering coefficients, mu's, estimated for large bowels, kidneys and prostates at 730 nm were, respectively: 10.1 (1.3), 19.6 (4.0) and 12.7 (0.6) cm(-1). We observed significant variability in MLu uptake, tissue scattering and haemoglobin concentration between organs and even between the same organ in different dogs. This class of in situ optical property measurement may be desirable to individualize PDT drug and light delivery.

Algorithms↗

PubMed1998

[An optical model of axial reflection and its clinical application].

A developed optical model of axial reflection on retinal blood vessels has been presented in this paper. The loss of the transparency of retinal arterial vessel wall is a frequent expression of retinal vascular pathology. With the change of parameters, the model can simulate the progress of the axial reflection exactly during the onset and progression of hypertension. This non-invasive and quantitative method is useful for study in the relationship between hypertension and retinal vessel axial reflection. It can help doctors approach a diagnosis of hypertension.

Computer Simulation↗