Occupational Therapy Assistant Students’ Perspectives About the Development of Clinical Reasoning

A mandatory component of the training of occupational therapy assistant (OTA) students is the development of their clinical reasoning skills. As the demand for OTAs continues to increase in response to the growing need for occupational therapy services, the number of academic programs to prepare these future therapists has expanded. Unfortunately, there is no empirical literature addressing the preparation of OTA students, specifically the development of their clinical reasoning skills. Artifact analysis, focus groups, and questionnaires were used to explore OTA students’ perceptions of what Level II fieldwork learning experiences facilitated the development of their clinical reasoning skills. The results suggest OTA students develop clinical reasoning skills during Level II fieldwork by engaging in a variety of learning experiences with support from fieldwork educators who are welcoming and approachable. Learning experiences that students perceived as most helpful to the development of clinical reasoning included hands-on learning, opportunities to witness best practice, receipt of clear expectations and regular feedback, gradual responsibility for caseload management, and opportunities for collaboration. This study adds to the profession’s body of knowledge and has implications for OTA educators, fieldwork educators, OTA students, and future consumers of occupational therapy services

Methods to improve recruitment to randomised controlled trials : Cochrane systematic review and meta-analysis

Peer reviewedPublisher PD

Occupational Therapy Assistant Students ’ Perspectives About the Development of Clinical Reasoning

A mandatory component of the training of occupational therapy assistant (OTA) students is the development of their clinical reasoning skills. As the demand for OTAs continues to increase in response to the growing need for occupational therapy services, the number of academic programs to prepare these future therapists has expanded. Unfortunately, there is no empirical literature addressing the preparation of OTA students, specifically the development of their clinical reasoning skills. Artifact analysis, focus groups, and questionnaires were used to explore OTA students’ perceptions of what Level II fieldwork learning experiences facilitated the development of their clinical reasoning skills. The results suggest OTA students develop clinical reasoning skills during Level II fieldwork by engaging in a variety of learning experiences with support from fieldwork educators who are welcoming and approachable. Learning experiences that students perceived as most helpful to the development of clinical reasoning included hands-on learning, opportunities to witness best practice, receipt of clear expectations and regular feedback, gradual responsibility for caseload management, and opportunities for collaboration. This study adds to the profession’s body of knowledge and has implications for OTA educators, fieldwork educators, OTA students, and future consumers of occupational therapy services

Clinical and Professional Reasoning Development in Level II Fieldwork: Occupational Therapy Assistant Students’ Perception

Occupational therapy academic programs are tasked with preparing occupational therapy assistant (OTA) students to develop and use clinical and professional reasoning in practice. A component of this academic education, Level II fieldwork (FW), develops clinical and professional reasoning by allowing students to practice this skill. Although numerous studies have investigated this topic in occupational therapy students, only one small study has previously investigated this in OTA students during Level II FW. Thus, we designed a mixed methods study of OTA students during Level II FW (n = 58) to confirm and expand our knowledge of learning experiences that develop clinical and professional reasoning skills. Six major aspects of Level II FW were identified by participants as contributing to the development of their clinical and professional reasoning skills: “hands-on experience,” “thinking on your feet,” “the value of community-based placements,” “the supervision approach of the FW educator,” “application of evidence-based practice,” and “interprofessional interactions.” Three of these themes were novel as they did not emerge from the previous study. According to most participants their clinical and professional reasoning development was positively impacted when their FW educator chunked information (88.5%), modeled best practice (84.6%), asked questions (84.6%), or engaged in story-telling (84.6%), with the latter two being perceived as most impactful. The study results suggest that the development of clinical and professional reasoning may be highly individualized and driven by what students experience

Prediction of Rapid Early Progression and Survival Risk with Pre-Radiation MRI in WHO Grade 4 Glioma Patients

Recent clinical research describes a subset of glioblastoma patients that exhibit REP prior to start of radiation therapy. Current literature has thus far described this population using clinicopathologic features. To our knowledge, this study is the first to investigate the potential of conventional ra-diomics, sophisticated multi-resolution fractal texture features, and different molecular features (MGMT, IDH mutations) as a diagnostic and prognostic tool for prediction of REP from non-REP cases using computational and statistical modeling methods. Radiation-planning T1 post-contrast (T1C) MRI sequences of 70 patients are analyzed. Ensemble method with 5-fold cross validation over 1000 iterations offers AUC of 0.793 with standard deviation of 0.082 for REP and non-REP classification. In addition, copula-based modeling under dependent censoring (where a subset of the patients may not be followed up until death) identifies significant features (p-value <0.05) for survival probability and prognostic grouping of patient cases. The prediction of survival for the patients cohort produces precision of 0.881 with standard deviation of 0.056. The prognostic index (PI) calculated using the fused features suggests that 84.62% of REP cases fall under the bad prognostic group, suggesting potentiality of fused features to predict a higher percentage of REP cases. The experimental result further shows that mul-ti-resolution fractal texture features perform better than conventional radiomics features for REP and survival outcomes

Phenotypic Variation and Bistable Switching in Bacteria

Microbial research generally focuses on clonal populations. However, bacterial cells with identical genotypes frequently display different phenotypes under identical conditions. This microbial cell individuality is receiving increasing attention in the literature because of its impact on cellular differentiation, survival under selective conditions, and the interaction of pathogens with their hosts. It is becoming clear that stochasticity in gene expression in conjunction with the architecture of the gene network that underlies the cellular processes can generate phenotypic variation. An important regulatory mechanism is the so-called positive feedback, in which a system reinforces its own response, for instance by stimulating the production of an activator. Bistability is an interesting and relevant phenomenon, in which two distinct subpopulations of cells showing discrete levels of gene expression coexist in a single culture. In this chapter, we address techniques and approaches used to establish phenotypic variation, and relate three well-characterized examples of bistability to the molecular mechanisms that govern these processes, with a focus on positive feedback.

Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Background: Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture. Methods: We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age. Results: The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful. Conclusion: Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation

MCM3AP in recessive Charcot-Marie-Tooth neuropathy and mild intellectual disability

Defects in mRNA export from the nucleus have been linked to various neurodegenerative disorders. We report mutations in the gene MCM3AP, encoding the germinal center associated nuclear protein (GANP), in nine affected individuals from five unrelated families. The variants were associated with severe childhood onset primarily axonal (four families) or demyelinating (one family) Charcot-Marie-Tooth neuropathy. Mild to moderate intellectual disability was present in seven of nine affected individuals. The affected individuals were either compound heterozygous or homozygous for different MCM3AP variants, which were predicted to cause depletion of GANP or affect conserved amino acids with likely importance for its function. Accordingly, fibroblasts of affected individuals from one family demonstrated severe depletion of GANP. GANP has been described to function as an mRNA export factor, and to suppress TDP-43-mediated motor neuron degeneration in flies. Thus our results suggest defective mRNA export from nucleus as a potential pathogenic mechanism of axonal degeneration in these patients. The identification of MCM3AP variants in affected individuals from multiple centres establishes it as a disease gene for childhood-onset recessively inherited Charcot-Marie-Tooth neuropathy with intellectual disability.Peer reviewe

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Expression profiling of blood samples from an SU5416 Phase III metastatic colorectal cancer clinical trial: a novel strategy for biomarker identification

BACKGROUND: Microarray-based gene expression profiling is a powerful approach for the identification of molecular biomarkers of disease, particularly in human cancers. Utility of this approach to measure responses to therapy is less well established, in part due to challenges in obtaining serial biopsies. Identification of suitable surrogate tissues will help minimize limitations imposed by those challenges. This study describes an approach used to identify gene expression changes that might serve as surrogate biomarkers of drug activity. METHODS: Expression profiling using microarrays was applied to peripheral blood mononuclear cell (PBMC) samples obtained from patients with advanced colorectal cancer participating in a Phase III clinical trial. The PBMC samples were harvested pre-treatment and at the end of the first 6-week cycle from patients receiving standard of care chemotherapy or standard of care plus SU5416, a vascular endothelial growth factor (VEGF) receptor tyrosine kinase (RTK) inhibitor. Results from matched pairs of PBMC samples from 23 patients were queried for expression changes that consistently correlated with SU5416 administration. RESULTS: Thirteen transcripts met this selection criterion; six were further tested by quantitative RT-PCR analysis of 62 additional samples from this trial and a second SU5416 Phase III trial of similar design. This method confirmed four of these transcripts (CD24, lactoferrin, lipocalin 2, and MMP-9) as potential biomarkers of drug treatment. Discriminant analysis showed that expression profiles of these 4 transcripts could be used to classify patients by treatment arm in a predictive fashion. CONCLUSIONS: These results establish a foundation for the further exploration of peripheral blood cells as a surrogate system for biomarker analyses in clinical oncology studies