Supervising Undergraduate Nursing Students on Their Bachelor's Thesis. A Qualitative Study

Introduction

The bachelor's thesis (BT) in undergraduate education is often an autonomous and individual assignment. It aims to demonstrate knowledge gained through education, to be an assessment tool, and to give new learning outcomes through working on the thesis. The process of working with the BT most often includes individual supervision. There is an absence of support for teachers supervising undergraduate nursing theses, which includes a lack of national or institutional guidelines, role definitions and research material.

Objective

Given the lack of helpful guidelines, this study aims to explore what the teachers emphasize as important regarding their supervision of nursing students writing their BT.

Methods

The study has a qualitative approach, featuring individual semi-structured interviews with nursing teachers supervising nursing students on the BT. Reflexive thematic analysis is used as the method of analysis.

Results

The analyses resulted in two generated themes, each with two subthemes, describing the patterns the teachers emphasize as important aspects of their supervision of nursing students writing their BT. The themes were "The pedagogical approach to the supervision" and "The advantages of the bachelor's thesis to the nursing profession."

Conclusions

The teachers balanced different roles in the supervision of the students. They wanted the students to grow through challenging them, grounded in a relationship of trust and confidence. They were role models for how to be critical thinkers and incorporated critical thinking as a pedagogical implement in supervision, wanting to raise the students to become nurses who think critically. The teachers sought to combine clinical relevance with academic literacy to secure a new generation of nurses able to be a part of the future development of the profession. They wanted to equip the students with knowledge, skills, and confidence to speak up and communicate nursing. Last, the teachers combined their clinical and academic identities in the supervision of the BT.

Association of serum cortisol and cortisone levels and risk of recurrence after endocrine treatment in breast cancer

Metabolic reprogramming in breast cancer involves changes in steroid hormone synthesis and metabolism. Alterations in estrogen levels in both breast tissue and blood may influence carcinogenesis, breast cancer growth, and response to therapy. Our aim was to examine whether serum steroid hormone concentrations could predict the risk of recurrence and treatment-related fatigue in patients with breast cancer. This study included 66 postmenopausal patients with estrogen receptor-positive breast cancer who underwent surgery, radiotherapy, and adjuvant endocrine treatment. Serum samples were collected at six different time points [before the start of radiotherapy (as baseline), immediately after radiotherapy, and then 3, 6, 12 months, and 7-12 years after radiotherapy]. Serum concentrations of eight steroid hormones (cortisol, cortisone, 17α-hydroxyprogesterone, 17β-estradiol, estrone, androstenedione, testosterone, and progesterone) were measured using a liquid chromatography-tandem mass spectrometry-based method. Breast cancer recurrence was defined as clinically proven relapse/metastatic breast cancer or breast cancer-related death. Fatigue was assessed with the QLQ-C30 questionnaire. Serum steroid hormone concentrations measured before and immediately after radiotherapy differed between relapse and relapse-free patients [(accuracy 68.1%, p  = 0.02, and 63.2%, p  = 0.03, respectively, partial least squares discriminant analysis (PLS-DA)]. Baseline cortisol levels were lower in patients who relapsed than in those who did not (p < 0.05). The Kaplan-Meier analysis showed that patients with high baseline concentrations of cortisol (≥ median) had a significantly lower risk of breast cancer recurrence than patients with low cortisol levels ( Collapse

Key Words

• Breast cancer recurrence
• Cortisol
• Cortisone
• Fatigue
• Steroid hormones

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MESH Headings

• Humans
• Female
• Breast Neoplasms/drug therapy
• Cortisone/analysis
• Hydrocortisone/analysis
• Neoplasm Recurrence, Local
• Steroids
• Recurrence

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Grants

• 2020/FO298770 Stiftelsen Dam
• 2020/3806-4 and 28346 The Liaison Committee for Education, Research and Innovation in Central Norway
• 2020/14-304/2020 Kreftfondet at St. Olavs Hospital
• 2020 and 2021 NTNU ISB småforsk
• 2019 Norwegian National Network for Breast Cancer Research
• NTNU Norwegian University of Science and Technology (incl St. Olavs Hospital - Trondheim University Hospital)

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Affiliation(s)

Feng Wang Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Guro F Giskeødegård Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Sissel Skarra Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Monica J Engstrøm Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway Deprtment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Lars Hagen Deprtment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim, Norway PROMEC Core Facility for Proteomics and Modomics, Norwegian University of Science and Technology, NTNU, and the Central Norway Regional Health Authority Norway, Trondheim, Norway
Jürgen Geisler Deparment of Oncology, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Tomi S Mikkola Department of Gynecology, Helsinki University Hospital, Helsinki, Finland
Matti J Tikkanen Folkhälsan Research Center, University of Helsinki, Helsinki, Finland Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Julia Debik Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Randi J Reidunsdatter Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Tone F Bathen Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

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Age at Menarche, age at Natural Menopause, and Risk of Lung and Colorectal Cancers: A Mendelian Randomization Study

Background

The roles of age at menarche and age at menopause in the etiology of lung and colorectal cancers are unclear.

Objective

We aimed to investigate potential causal associations between age at menarche, age at natural menopause, and risk of lung and colorectal cancers using a Mendelian randomization (MR) approach.

Methods

From the Trøndelag Health Study in Norway, we defined two cohorts of 35 477 and 17 118 women to study the effects of age at menarche and age at natural menopause, respectively. We ran univariable MR to evaluate the potential causal associations. We performed multivariable MR adjusting for genetic variants of adult body mass index (BMI) to estimate the direct effect of age at menarche.

Results

Genetically predicted 1-year increase in age at menarche was associated with a lower risk of lung cancer overall (hazard ratio [HR, 0.64; 95% CI, 0.48-0.86), lung adenocarcinoma (HR, 0.61; 95% CI, 0.38-0.99), and lung non-adenocarcinoma (HR, 0.66; 95% CI, 0.45-0.95). After adjusting for adult BMI using a multivariable MR model, the direct effect estimates reduced to HR 0.72 (95% CI, 0.54-0.95) for lung cancer overall, HR 0.67 (95% CI, 0.43-1.03) for lung adenocarcinoma, and HR 0.77 (95% CI, 0.54-1.09) for lung non-adenocarcinoma. Age at menarche was not associated with colorectal cancer. Moreover, genetically predicted age at natural menopause was not associated with lung and colorectal cancers.

Conclusion

Our MR study suggested that later age at menarche was causally associated with a decreased risk of lung cancer overall and its subtypes, and adult BMI might be a mediator.

Indexing cardiac volumes for peak oxygen uptake to improve differentiation of physiological and pathological remodeling: from elite athletes to heart failure patients

AIMS

Cardiovascular structures adapt to meet metabolic demands, but current methodology for indexing by body size does not accurately reflect such variations. Therefore, we aimed to investigate how left ventricular end-diastolic volume (LVEDV) and left atrial maximal volume (LAVmax) are associated with absolute (L/min) peak oxygen uptake (VO2peak) and fat-free mass (FFM) compared to body surface area (BSA). We subsequently assessed the impact of indexing by absolute VO2peak, FFM, and BSA to discriminate pathological from physiological remodeling.

METHODS AND RESULTS

We used data from 1190 healthy adults to explore relationships for BSA, FFM, and absolute VO2peak with LVEDV and LAVmax by regression and correlation analyses. We then compared these indexing methods for classification to normalcy/pathology in 61 heart failure patients and 71 endurance athletes using the chi-squared and Fisher exact tests and the net reclassification and integrated discrimination indices. Absolute VO2peak correlated strongly with LVEDV, explaining 52% of variance vs. 32% for BSA and 44% for FFM. Indexing LVEDV for VO2peak improved discrimination between heart failure patients and athletes on top of indexing to BSA. Seventeen out of 18 athletes classified to pathology by BSA were reclassified to normalcy by VO2peak indexing (P < 0.001), while heart failure patients were reclassified to pathology (39-95%, P < 0.001). All indexing methods explained below 20% of the variance in LAVmax in univariate models.

CONCLUSIONS

Indexing LVEDV to VO2peak improves the ability to differentiate physiological and pathological enlargement. The LVEDV to absolute VO2peak ratio may be a key index in diagnosing heart failure and evaluating the athlete's heart.

Prediction of outcome from MRI and general movements assessment after hypoxic-ischaemic encephalopathy in low-income and middle-income countries: data from a randomised controlled trial

OBJECTIVE

To evaluate the accuracy of neonatal MRI and general movements assessment (GMA) in predicting neurodevelopmental outcomes in infants with hypoxic-ischaemic encephalopathy (HIE).

DESIGN

Secondary analyses of a randomised controlled trial (RCT).

SETTING

Tertiary neonatal intensive care unit in India.

METHODS

Fifty infants with HIE were included in an RCT of therapeutic hypothermia (25 cooled and 25 non-cooled). All infants underwent brain MRI at day 5, GMA at 10-15 weeks and outcome assessments including Bayley Scales of Infant and Toddler Development, third edition, at 18 months. Associations between patterns of brain injury, presence/absence of fidgety movements (FMs) and outcomes were assessed.

RESULTS

Seventeen of 47 (36%) had adverse outcome (5 (21%) cooled vs 12 (52%) non-cooled, p=0.025). Eight infants died (four before an MRI, another three before GMA). Two developed severe cerebral palsy and seven had Bayley-III motor/cognitive composite score <85. Twelve (26%) had moderately/severely abnormal MRI and nine (23%) had absent FMs. The positive predictive value (95% CI) of an adverse outcome was 89% (53% to 98%) for moderate/severe basal ganglia and thalami (BGT) injury, 83% (56% to 95%) for absent/equivocal signal in the posterior limb of the internal capsule (PLIC) and 67% (38% to 87%) for absent FMs. Negative predictive values (95% CI) were 85% (74% to 92%) for normal/mild BGT injury, 90% (78% to 96%) for normal PLIC and 86% (74% to 93%) for present FMs.

CONCLUSIONS

Neonatal MRI and GMA predicted outcomes with high accuracy in infants with HIE. The GMA is a feasible low-cost method which can be used alone or complementary to MRI in low-resource settings to prognosticate and direct follow-up.

TRIAL REGISTRATION NUMBER

CTRI/2013/05/003693.

The Prognostic Effect of KRAS Mutations in Non-Small Cell Lung Carcinoma Revisited: A Norwegian Multicentre Study

BACKGROUND

due to emerging therapeutics targeting KRAS G12C and previous reports with conflicting results regarding the prognostic impact of KRAS and KRAS G12C in non-small cell lung cancer (NSCLC), we aimed to investigate the frequency of KRAS mutations and their associations with clinical characteristics and outcome. Since mutation subtypes have different preferences for downstream pathways, we also aimed to investigate whether there were differences in outcome according to mutation preference for the Raf, PI3K/Akt, or RalGDS/Ral pathways.

METHODS

retrospectively, clinicopathological data from 1233 stage I-IV non-squamous NSCLC patients with known KRAS status were reviewed. KRAS' associations with clinical characteristics were analysed. Progression free survival (PFS) and overall survival (OS) were assessed for the following groups: KRAS wild type (wt) versus mutated, KRAS wt versus KRAS G12C versus KRAS non-G12C, among KRAS mutation subtypes and among mutation subtypes grouped according to preference for downstream pathways.

RESULTS

a total of 1117 patients were included; 38% had KRAS mutated tumours, 17% had G12C. Among KRAS mutated, G12C was the most frequent mutation in former/current smokers (45%) and G12D in never smokers (46%). There were no significant differences in survival according to KRAS status, G12C status, among KRAS mutation subtypes or mutation preference for downstream pathways.

CONCLUSION

KRAS status or KRAS mutation subtype did not have any significant influence on PFS or OS.

Genetic associations with temporal shifts in obesity and severe obesity during the obesity epidemic in Norway: A longitudinal population-based cohort (the HUNT Study)

BACKGROUND

Obesity has tripled worldwide since 1975 as environments are becoming more obesogenic. Our study investigates how changes in population weight and obesity over time are associated with genetic predisposition in the context of an obesogenic environment over 6 decades and examines the robustness of the findings using sibling design.

METHODS AND FINDINGS

A total of 67,110 individuals aged 13-80 years in the Nord-Trøndelag region of Norway participated with repeated standardized body mass index (BMI) measurements from 1966 to 2019 and were genotyped in a longitudinal population-based health study, the Trøndelag Health Study (the HUNT Study). Genotyping required survival to and participation in the HUNT Study in the 1990s or 2000s. Linear mixed models with observations nested within individuals were used to model the association between a genome-wide polygenic score (GPS) for BMI and BMI, while generalized estimating equations were used for obesity (BMI ≥ 30 kg/m2) and severe obesity (BMI ≥ 35 kg/m2). The increase in the average BMI and prevalence of obesity was steeper among the genetically predisposed. Among 35-year-old men, the prevalence of obesity for the least predisposed tenth increased from 0.9% (95% confidence interval [CI] 0.6% to 1.2%) to 6.5% (95% CI 5.0% to 8.0%), while the most predisposed tenth increased from 14.2% (95% CI 12.6% to 15.7%) to 39.6% (95% CI 36.1% to 43.0%). Equivalently for women of the same age, the prevalence of obesity for the least predisposed tenth increased from 1.1% (95% CI 0.7% to1.5%) to 7.6% (95% CI 6.0% to 9.2%), while the most predisposed tenth increased from 15.4% (95% CI 13.7% to 17.2%) to 42.0% (95% CI 38.7% to 45.4%). Thus, for 35-year-old men and women, respectively, the absolute change in the prevalence of obesity from 1966 to 2019 was 19.8 percentage points (95% CI 16.2 to 23.5, p < 0.0001) and 20.0 percentage points (95% CI 16.4 to 23.7, p < 0.0001) greater for the most predisposed tenth compared with the least predisposed tenth, defined using the GPS for BMI. The corresponding absolute changes in the prevalence of severe obesity for men and women, respectively, were 8.5 percentage points (95% CI 6.3 to 10.7, p < 0.0001) and 12.6 percentage points (95% CI 9.6 to 15.6, p < 0.0001) greater for the most predisposed tenth. The greater increase in BMI in genetically predisposed individuals over time was apparent after adjustment for family-level confounding using a sibling design. Key limitations include a slightly lower survival to date of genetic testing for the older cohorts and that we apply a contemporary genetic score to past time periods. Future research should validate our findings using a polygenic risk score constructed from historical data.

CONCLUSIONS

In the context of increasingly obesogenic changes in our environment over 6 decades, our findings reveal a growing inequality in the risk for obesity and severe obesity across GPS tenths. Our results suggest that while obesity is a partially heritable trait, it is still modifiable by environmental factors. While it may be possible to identify those most susceptible to environmental change, who thus have the most to gain from preventive measures, efforts to reverse the obesogenic environment will benefit the whole population and help resolve the obesity epidemic.

Prevalence of multimorbidity with frailty and associations with socioeconomic position in an adult population: findings from the cross-sectional HUNT Study in Norway

OBJECTIVES

To explore prevalences and occupational group inequalities of two measures of multimorbidity with frailty.

DESIGN

Cross-sectional study.

SETTING

The Nord-Trøndelag Health Study (HUNT), Norway, a total county population health survey, 2006-2008.

PARTICIPANTS

Participants older than 25 years, with complete questionnaires, measurements and occupation data were included.

OUTCOMES

≥2 of 51 multimorbid conditions with ≥1 of 4 frailty measures (poor health, mental illness, physical impairment or social impairment) and ≥3 of 51 multimorbid conditions with ≥2 of 4 frailty measures.

ANALYSIS

Logistic regression models with age and occupational group were specified for each sex separately.

RESULTS

Of 41 193 adults, 38 027 (55% female; 25-100 years old) were included. Of them, 39% had ≥2 multimorbid conditions with ≥1 frailty measure, and 17% had ≥3 multimorbid conditions with ≥2 frailty measures. Prevalence differences in percentage points (pp) with 95% confidence intervals of those in high versus low occupational group with ≥2 multimorbid conditions and ≥1 frailty measure were largest in women age 30 years, 17 (14 to 20) pp and 55 years, 15 (13 to 17) pp and in men age 55 years, 15 (13 to 17) pp and 80 years, 14 (9 to 18) pp. In those with ≥3 multimorbid conditions and ≥2 frailty measures, prevalence differences were largest in women age 30 years, 8 (6 to 10) pp and 55 years, 10 (8 to 11) ppand in men age 55 years, 9 (8 to 11) pp and 80 years, 6 (95% CI 1 to 10) pp.

CONCLUSION

Multimorbidity with frailty is common, and social inequalities persist until age 80 years in women and throughout the lifespan in men. To manage complex multimorbidity, strategies for proportionate universalism in medical education, healthcare, public health prevention and promotion seem necessary.

Socioeconomic inequalities in the prevalence of complex multimorbidity in a Norwegian population: findings from the cross-sectional HUNT Study

OBJECTIVES

Multimorbidity, the co-occurrence of multiple long-term conditions, is common and increasing. Definitions and assessment methods vary, yielding differences in estimates of prevalence and multimorbidity severity. Sociodemographic characteristics are associated with complicating factors of multimorbidity. We aimed to investigate the prevalence of complex multimorbidity by sex and occupational groups throughout adulthood.

DESIGN

Cross-sectional study.

SETTING

The third total county survey of The Nord-Trøndelag Health Study (HUNT), 2006-2008, Norway.

PARTICIPANTS

Individuals aged 25-100 years with classifiable occupational data and complete questionnaires and measurements.

OUTCOME MEASURE

Complex multimorbidity defined as 'the co-occurrence of three or more chronic conditions affecting three or more different body (organ) systems within one person without defining an index chronic condition'.

ANALYSIS

Logistic regression models with age and occupational group were specified for each sex separately.

RESULTS

38 027 of 41 193 adults (55% women) were included in our analyses. 54% of the participants were identified as having complex multimorbidity. Prevalence differences in percentage points (pp) of those in the low occupational group (vs the high occupational group (reference)) were 19 (95% CI, 16 to 21) pp in women and 10 (8 to 13) pp in men at 30 years; 12 (10 to 14) pp in women and 13 (11 to 15) pp in men at 55 years; and 2 (-1 to 4) pp in women and 7 (4 to 10) pp in men at 75 years.

CONCLUSION

Complex multimorbidity is common from early adulthood, and social inequalities persist until 75 years in women and 90 years in men in the general population. These findings have policy implications for public health as well as healthcare, organisation, treatment, education and research, as complex multimorbidity breaks with the specialised, fragmented paradigm dominating medicine today.