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Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2022)

Background: The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, Educator (RIME) framework to measure progress are used successfully in physician training programs. Currently, little is known about use of these tools in nurse practitioner (NP) training. Objectives: To answer the following: In NP trainees, does a standardized case presentation using the OMP, compared with the current approach, improve diagnostic reasoning skills as measured by the RIME framework competency evaluation in six weeks? Methods: Quality improvement project using Plan, Do, Study Act (PDSA) cycles performed at the Veteran’s Affairs NP Residency in Los Angeles. Eleven preceptors and 4 NP trainees participated in a 12-week intervention using OMP techniques to support trainee diagnostic reasoning scored weekly using the RIME framework. Preceptor knowledge of the OMP and RIME framework assessed pre-intervention was supplemented with a 1-hour workshop to address knowledge gaps. Preceptors performed return demonstrations of OMP techniques, RIME scoring, then educated trainees on OMP and RIME [PDSA Cycle 1; weeks 1-6]. PDSA Cycle 2 was one-to-one meetings between trainees and program director with preceptor feedback for individualized plans for improvement [weeks 7-12]. RIME scores, preceptor self-efficacy, and use of teaching skills were measured pre-and post-intervention and a survey completed by preceptors and trainees at the end of the study. Demographic characteristics and survey responses were assessed with descriptive statistics and paired sample t-test for mean scores pre- and post-intervention. Results: Mean RIME scores improved (1.62 [0.17] vs. 2.23 [0.38], p<.001) post 12-week intervention [PDSA Cycle 1 and 2]. After PDSA Cycle 1, individual scores revealed an outlier not at goal. PDSA Cycle 2 started weeks 7-12. Mean RIME scores improved between PDSA Cycle 1 and 2 (2.07 [0.25] vs. 2.48 [0.39], p<.001), respectively. Preceptor self-efficacy and use of the teaching skills scores improved but not significantly. Program evaluation surveys showed the majority of preceptors (91%) and trainees (100%) found the OMP model and RIME framework helpful. Conclusion: Use of the OMP improved precepting standardization and diagnostic reasoning in NP trainees. RIME scoring facilitated improvement discussions. A multi-site evaluation in a larger cohort is needed to validate findings.

    Cover page: A Quality Improvement Project to Enhance Precepting in a Primary Care Nurse Practitioner Residency Program
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2001)

    Objectives

    The purpose of this study was to assess whether the newer stent delivery systems provide a stented lumen cross-sectional area (CSA) that is equal to the delivery balloon nominal dimensions.

    Background

    First generation stents were often not adequately expanded with their delivery system and frequently required higher pressure or a larger balloon after deployment. Newer stents were designed to optimize expansion with noncompliant, high-pressure balloons provided as the delivery systems.

    Methods

    Intravascular ultrasound (IVUS) was used to evaluate 38 stents in 32 patients after deployment at 14 to 16 atm with their delivery balloon system. Minimum stent lumen CSA and stent minimum lumen diameter (MLD) were measured by IVUS imaging. The manufacturer's expected stent diameter was defined as the balloon diameter measured by the company at the maximum pressure used. The manufacturer's expected stent area was calculated based on the manufacturer's expected stent diameter.

    Results

    The MLD (2.5 +/- 0.5 mm) and minimum stent CSA (6.0 +/- 1.7 mm(2)) by IVUS were significantly smaller than the manufacturer's expected stent diameter (3.5 +/- 0.4 mm) and area (9.5 +/- 1.9 mm(2)) (p < 0.0001, respectively). The mean MLD by IVUS was 72 +/- 8% of the expected stent diameter, and the mean minimum stent CSA by IVUS was 62 +/- 10% of the expected stent area.

    Conclusions

    Despite moderately high-pressure inflations, the mean minimum stent CSA actually achieved was, on average, only 62% of the manufacturer's expected stent area. To optimize stent deployment, these IVUS observations should be considered during coronary artery stenting.
      Cover page: Optimizing stent expansion with new stent delivery systemsCreative Commons 'BY' version 4.0 license
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