Confidence and performance in objective structured clinical examination

Introduction: The objective structured clinical examination (OSCE )is commonly used as a standard assessment approach in midwifery education. Student’s confidence may impact on the OSCE performancebut the evidence on this is very limited. Objectives: This study aimed to evaluate the relationship between confidence and OSCE performance in midwifery students. Methods: 103 pre-registration midwifery students (42 year one students: 61 year three students) from Sheffield Hallam University took part in this study as part of their routine OSCE assessment. They completed pre- and post-exam questionnaires, which asked them to rate their confidence in the clinical skills being assessed on a scale from 1 to 10 (1=not confident; 10 =totally confident). Results: The results showed significant increases in mean confidence levels from before to after OSCE for both first and third year students (5.52 (1.25) to 6.49 (1.19); P=0.001 and 7.49(0.87) to 8.01(0.73); P<0.001, respectively). However, there was no significant correlation between confidence levels before undertaking the OSCE and the final OSCE test scores (r= 0.12; P=0.315). Conclusions: The increased level of confidence after the OSCE is important but how thisis transformed into improved clinical skills in practical settings requires further investigation. The lack of significant correlation between OSCEresults and student’s confidence, may indicate additional evidence for the objectivity of the OSCE . This, however, may be due to the inherent complexity of assessing such relationships. Larger studies with mixed methodology are required for further investigation of this important area of education and assessment research

Student nurses' career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey.

BACKGROUND: The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices. METHODS: The aim of the study was to examine nursing students' perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students' views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice. RESULTS: One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered. CONCLUSION: The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of 'targeted' placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option

An explorative study on robotics for supporting children with Autism Spectrum Disorder during clinical procedures

This short report presents a small-scale explorative study about children with Autism Spectrum Disorder (ASD) interaction with robots during clinical interactions. This is part of an ongoing project, which aims at defining a robotic service for supporting children with developmental disabilities and increase the efficiency of routine procedures that may create distress, e.g.having blood taken or an orthopaedic plaster cast applied. Five children with confirmed diagnoses of ASD interacted with two social robots: the small humanoid NAO and the pet-like MiRo. The encounters mixed play activities with a simulated clinical procedure. We included parents/carers in the interaction to ensure the child was comfortable and at ease. The results of video analysis and parents' feedback confirm possible benefits of the physical presence of robots to reduce children’s anxiety and increase compliance with instructions. Parents/carers convincingly support the introduction of robots in hospital procedures to their help children

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units

Objectives This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. Design Cohort study and survey data. Setting OOH appointments offered in four units in one region in England (October 2015 to November 2016). Methods Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. Results There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. Conclusions The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs

Weight gain following stroke : its everybody's business

Introduction: Approximately 900,000 people in England live with the effects of stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation. Local stakeholders identified a problem of increased numbers of patients experiencing long term weight gain following a stroke. Method: Mixed method study incorporating i) survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data analysed using framework analysis. Results: Weight gain post stroke is not monitored routinely and prevalence is therefore unknown. Findings from this study indicate that post-stroke weight gain is a problem for some people. Contributing factors identified include social isolation, depression and loss of control in cognition and communication affecting ability to manage diet and weight. Ambiguity was seen to arise because weight gain following stroke can be both a sign of progress and of a problem. Results indicate fragmented communication between health care professionals across care pathways limits opportunities to address weight gain. Additional limiting factors include limited availability of specialist support and funding cuts to community based services. Conclusion: Health care professionals need to be mindful of the risk of long term weight gain following stroke. Whether in acute, intermediate, rehabilitation or primary care settings, systems should be in place to identify opportunities for advice and support regarding diet and physical activity by, for example, embracing initiatives such as Making Every Contact Count (MECC). A large cohort study would provide population based data on prevalence and causes of weight gain following a stroke

Weight gain following stroke in younger age (below 70 years) in men and women: challenges and opportunities for prevention and action

This report presents findings from a study to explore the incidence of weight gain in working age adults aged men and women in South Yorkshire. The project was developed following a research prioritisation event focused on obesity. The event was conducted with staff from a range of stakeholder organisations including health, social care, and voluntary sector. Methods: Survey of respondents of the South Yorkshire Cohort, under 70 years old and had had a stroke. In-depth interviews (n=12)with patients responding to the survey living in Sheffield and participants from a local volunteer run stroke support group and professionals (n=18). Framework analysis techniques were adopted. Findings: Long term weight gain is an issue for some patients following their stroke. Interviews with patients highlighted a range of lifestyle related challenges that people face following a stroke. Reduction in activity levels was reported as a key influence on weight gain. The health care system and stroke pathway currently provides short-term support to patients to aid recovery and rehabilitation. Longer-term support is harder to access. Existing and new support networks provided by health services, family and friends are essential in recovery and prevention of weight gain. Interviews with staff revealed gaps in their knowledge of their colleagues' roles across the stroke care pathway. Communication between health care professionals across the care pathway was also limited. The presence of patients who gain weight following a stroke was not evident across the entire stroke pathway for example staff in the acute setting were less likely to notice weight gain. Not all staff gave health promotion advice to patients, however all staff thought health promotion advice should be offered to patients, at a time appropriate to the individual and in a manner that will engage the patient in behaviour change. Staff highlighted the need to engage family members in a patient’s rehabilitation to prevent long term weight gain.</p

Long term weight gain following stroke : exploring incidence and explanations

Stroke is the leading cause of long term disability and third leading cause of death (Curioni et al, 2009). Survival rates are increasing. Approximately 900,000 people in England live with the effects of a stroke (NICE 2010). Health behaviour modification can be crucial in stroke rehabilitation and in avoiding long term impairment. Consultation with stakeholders identified increased numbers of patients experiencing long term weight gain following a stroke. This study aims to explore i) the existence of weight gain following a stroke ii) factors contributing to weight gain and iii) implications for the stroke rehabilitation pathway. A mixed method study incorporating i) a survey of South Yorkshire Health Cohort participants (n=87); ii) interviews with staff (n=18) and stroke patients (n=10). Data were analysed using framework analysis methods. Across the care pathway inconsistencies exist in the recognition that weight gain is an issue for patients post stroke. The findings draw on components of the Theory of Integrated Care (Kodner & Spreeuwenberg, 2002). Applying the theory to the findings provides a means to explain how patients may become lost across the different aspects of the stroke care pathway. Fragmented communication between health care professionals across the pathway limits opportunities to address the risks and realities of weight gain. Ambiguity arises for patients because weight gain following a stroke can be both a sign of progress and of a problem. Individualising care and integration of weight management advice across the whole pathway (acute, community and primary care settings) may prevent weight gain in stroke survivors.</p

Is there some degree of unmet need in primary care?: analysis of a patient cohort accessing a new out of hours units

Background The increasing demands on Emergency Departments has led to considerable rhetoric on the availability of general practitioner (GP) appointments of which one perceived solution is to offer more out of hours (OOH) care. In England, OOH healthcare provision is regarded as urgent care only and offered as a mixture of telephone triage, drop-in centres, emergency departments (ED), and triaged appointments. This evaluation describes the patients who used new OOH appointments offered through the UK Prime Minister’s Challenge Fund scheme which was intended to extend patient access to primary care. The aim of this paper is to report on the demographic profile of attendees and to offer some indication of the impact on ED. Methods The study used de-identifiable cohort data from 14 months of OOH appointments offered in 4 units in Sheffield and the responses to the standard NHS patient-opinion questionnaire modified for this programme. Descriptive analysis of the appointment data was conducted. Multivariate logistic regression analysis of the survey data examined the characteristics of the patients who would have gone to the Emergency Department (ED) had the OOH appointments not been available. Results There were 24,448 appointments for 19,701 different patients resulting in 29,629 service outcomes (i.e. clinical advice, prescription issued). Six percent of appointments were deemed urgent and two-thirds were non-urgent but needed follow-up. Less than 1% of appointments were judged inappropriate by the consulting GP. The non-attendance rate was 1.8%. Females accounted for 60% of all attendances and 70% in the under 35 age group. The patients from the poorest 5th of the population used nearly 40% of the appointments. The patient survey found OOH appointments were extremely popular - 93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Regression analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that males, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. Conclusion Similar to the published literature, the users of the OOH service were substantially different from in-hours service users; consisting of young adults and children as opposed to the elderly. The findings of this analysis also support the idea that there may be unmet need in the poorest fifth of the population. Future analysis of access to primary care services needs to incorporate patient perceptions and not just statistical data

Polydiariosis in cultured oyster Crassostrea gigas from Ponta do Sambaqui, Florianópolis, SC - Brasil

The infestation of polychaetes Polydora in oyster C. gigas within cultivation was accompanied by monthly samples whereas the physical and chemical parameters of seawater were monitored weekly. The total area occupied by bubbles and tubes in the inner surface of the valve was determined, indicating the possible damage to the main physiological characteristics of oysters. It was observed prevalence of annelid Polydora sp. (Polychaeta: Spionidae) in all samples each month, reaching 100% in the period of cooler waters. The histological analysis showed that the tissues and organs were intact, occurring the formation of gametes. In oysters severely infested, it was possible to observe intense fibrosis in the mantle, showing repair of the tissue.A infestação por poliquetas do gênero Polydora em ostras C. gigas de cultivo foi acompanhada por meio de coletas mensais enquanto os parâmetros físico-químicos da água do mar foram monitorados semanalmente. Foi determinada a área total ocupada pelas bolhas e tubos na superfície interna das valvas, observando os possíveis danos às principais características fisiológicas da ostra. Houve prevalência do anelídeo Polydora sp. (Polychaeta: Spionidae) em todos os meses amostrados, chegando a 100% no período de águas mais frias. As análises histológicas mostraram que os tecidos e órgãos estavam intactos, ocorrendo a formação de gametas. Nas ostras severamente infestadas, foi possível observar intensa fibrose na região do manto, mostrando reparo do tecido