Vietnamese nursing students' perceptions of their clinical learning environment: A cross-sectional survey

This study investigated Vietnamese nursing students' perceptions of their clinical learning environment. The study was undertaken in two phases: 1) translation and adaptation of research instrument and 2) a cross-sectional survey was followed. Despite validity issues identified, data from two valid sub-scales and structured questions provided insights into the clinical learning environment that is the environment did not operate from an adult learner philosophy or provide a student-centred environment. The results are significant for development of clinical learning environment in Vietnam and that cultural differences between populations should be carefully considered in future research.

The influence of a novel simulated learning environment upon student clinical subjective refraction performance: A pilot study

Background: Optometry students are taught the process of subjective refraction through lectures and laboratory based practicals before progressing to supervised clinical practice. Simulated learning environments (SLEs) are an emerging technology that are used in a range of health disciplines, however, there is limited evidence regarding the effectiveness of clinical simulators as an educational tool. Methods: Forty optometry students (20 fourth year and 20 fifth year) were assessed twice by a qualified optometrist (two examinations separated by 4-8 weeks) while completing a monocular non-cycloplegic subjective refraction on the same patient with an unknown refractive error simulated using contact lenses. Half of the students were granted access to an online SLE, The Brien Holden Vision Institute (BHVI®) Virtual Refractor, and the remaining students formed a control group. The primary outcome measures at each visit were; accuracy of the clinical refraction compared to a qualified optometrist and relative to the Optometry Council of Australia and New Zealand (OCANZ) subjective refraction examination criteria. Secondary measures of interest included descriptors of student SLE engagement, student self-reported confidence levels and correlations between performance in the simulated and real world clinical environment. Results: Eighty percent of students in the intervention group interacted with the SLE (for an average of 100 minutes); however, there was no correlation between measures of student engagement with the BHVI® Virtual Refractor and speed or accuracy of clinical subjective refractions. Fifth year students were typically more confident and refracted more accurately and quickly than fourth year students. A year group by experimental group interaction (p = 0.03) was observed for accuracy of the spherical component of refraction, and post hoc analysis revealed that less experienced students exhibited greater gains in clinical accuracy following exposure to the SLE intervention. Conclusions: Short-term exposure to a SLE can positively influence clinical subjective refraction outcomes for less experienced optometry students and may be of benefit in increasing the skills of novice refractionists to levels appropriate for commencing supervised clinical interactions.

#20 [updated] Community wide interventions for increasing physical activity - Clinical Version

People who are physically active have higher levels of health related fitness, and a lower risk profile for developing a number of disabling medical conditions and chronic diseases. However, despite considerable evidence of the benefits of regular physical activity, global levels of physical inactivity remain stubbornly high. In response, governments are looking to find ways to increase the physical activity of their populations.

Attributes of clinical role models as described by senior veterinary students in Australia

Role models incite admiration and provide inspiration, contributing to learning as students aspire to emulate their example. The attributes of physician role models for medical trainees are well documented, but they remain largely unexplored in the context of veterinary medical training. The aim of the current study was to describe the attributes that final-year veterinary students (N=213) at the University of Queensland identified when reflecting on their clinical role models. Clinical role model descriptions provided by students were analyzed using concept-mapping software (Leximancer v. 2.25). The most frequent and highly connected concepts used by students when describing their role model(s) included clients, vet, and animal. Role models were described as good communicators who were skilled at managing relationships with clients, patients, and staff. They had exemplary knowledge, skills, and abilities, and they were methodical and conducted well-structured consultations. They were well respected and, in turn, demonstrated respect for clients, colleagues, staff, and students alike. They were also good teachers and able to tailor explanations to suit both clients and students. Findings from this study may serve to assist with faculty development and as a basis for further research in this area.

Clinical Escherichia coli isolates utilize alpha-hemolysin to inhibit in vitro epithelial cytokine production

Uropathogenic Escherichia coli is the primary cause of urinary tract infections, which affects over 60% of women during their lifetime. UPEC exhibits a number of virulence traits that facilitate colonization of the bladder, including inhibition of cytokine production by bladder epithelial cells. The goal of this study was to identify the mechanism of this inhibition. We observed that cytokine suppression was associated with rapid cytotoxicity toward epithelial cells. We found that cytotoxicity, cytokine suppression and alpha-hemolysin production were all tightly linked in clinical isolates. We screened a UPEC fosmid library and identified clones that gained the cytotoxicity and cytokine-suppression phenotypes. Both clones contained fosmids encoding a PAI II(J96)-like domain and expressed the alpha-hemolysin (hlyA) encoded therein. Mutation of the fosmid-encoded hly operon abolished cytotoxicity and cytokine suppression. Similarly, mutation of the chromosomal hlyCABD operon of UPEC isolate F11 also abolished these phenotypes, and they could be restored by introducing the PAI II(J96)-like domain-encoding fosmid. We also examined the role of alpha-hemolysin in cytokine production both in the murine UTI model as well as patient specimens. We conclude that E. coli utilizes alpha-hemolysin to inhibit epithelial cytokine production in vitro. Its contribution to inflammation during infection requires further study.

Integration of clinical information systems in Saudi Arabian health care contexts: A grounded theory exploration

This research examined the implementation of clinical information system technology in a large Saudi Arabian health care organisation. The research was underpinned by symbolic interactionism and grounded theory methods informed data collection and analysis. Observations, a review of policy documents and 38 interviews with registered nurses produced in-depth data. Analysis generated three abstracted concepts that explained how imported technology increased practice and health care complexity rather than enhance quality patient care. The core category, Disseminating Change, also depicted a hierarchical and patriarchal culture that shaped the implementation process at the levels of government, organisation and the individual.

Clinical tips: Bowel cancer screening

So, when was the last time you checked your poo? Checking your poo – it probably is not a conversation many patients want to have with their pharmacists. But bowel cancer screening remains an important tool in cancer detection...

Clinical tips: Treating addiction explained

Helping treat and manage addiction through pharmacotherapy is part of a complex process, write Dr Esther Lau and Professor Lisa Nissen, from the School of Clinical Sciences, Queensland University of Technology...

AJP clinical update: Eye health

For most people our eyes provide around 80% of the information from our surroundings, and pharmacists are perfectly placed to help consumers maintain good eye health.

Clinical tips: Diabetes explained

For many people, diabetes can start insidiously, without people knowing or being aware that they have diabetes. Signs and symptoms can just start with something very benign, such as feeling more thirsty than usual, or that they are going to the bathroom more because they are drinking more fluids from being thirsty...

Clinical tips: Mental health and Christmas explained

Christmas is usually a time for celebration, being with family and friends, opening presents, stuffing yourself silly with food at Christmas lunch – then doing it all over again at dinner. However, this may not be the case for some people. Relationships with family may be strained, or there may have been the loss of a loved one or significant other...

Feedback and clinical practice improvement: A tool to assist workplace supervisors and students

In work integrated learning, students may report difficulties applying theory learned at university to clinical practice. One contributing factor may be students' inability to engage in meaningful reflection and self-correcting behaviours. This paper reports the evaluation of a tool, process and resources developed to assist students to reflect on feedback and engage in self-assessment. Students were assisted to develop self-assessment skills by reflecting on, and engaging with feedback from previous workplace experiences to develop goals, learning outcomes and strategies to improve performance with mostly positive results. A secondary aim was to identify common learning strategies or barriers that impacted on student outcomes. Four themes emerged from the qualitative data: 1) preparing for clinical learning; 2) relationships and engagement levels; 3) shared awareness, and; 4) developing clinical practice. Overall students felt the tool assisted them to narrow their attention on what needed to be improved. While supervisors believed the tool helped them to focus on specific needs of each student. Common barriers to clinical practice improvement related to a lack of opportunity in some settings, and lack of staff willingness to support students to achieve identified goals. Students and supervisors found the use of the tools beneficial and assisted students to demonstrate a greater understanding of how to apply feedback received to support their learning in the clinical environment.

Clinical Tips: Crohn's and Colitis

Inflammatory bowel disease (IBD) describes a group of chronic relapsing inflammatory conditions of the gastrointestinal tract (GIT), with Crohn’s disease and ulcerative colitis being the two most common. Ulcerative colitis affects the colon, with the inflammation limited to the colonic mucosal layers. In contrast, the full thickness of the gut wall can be inflamed in Crohn’s disease, and any part of the GIT can be affected – from the mouth to the anus, though the small and large intestine are most commonly involved...

Clinical tips: Food poisoning

Food poisoning is used to describe a range of illnesses caused by drinking or eating contaminated drink or food. Infectious pathogens include bacteria, viruses, parasites, or their toxins, though food poisoning can also be a result of eating poisonous plants e.g. some mushrooms, or animals e.g. puffer fish. Common symptoms include nausea, vomiting, watery diarrhoea, abdominal pain and cramps, and fevers, though these will vary depending on the causative pathogen or toxin. Symptoms can start within hours of eating contaminated food, or may begin days or weeks later. Most food poisoning is mild in nature, lasts for several hours to a few days, and generally resolves without treatment. However, some cases of food poisoning can also be extremely severe, with people requiring medical attention or admission to hospital...

Clinical tips: Actively supporting customers to make a significant lifestyle change for New Year

We have all made these New Year’s resolutions before ... to be healthier, to eat better, to look after ourselves more, to go to the gym more. Each year, we are adamant we will stick with these resolutions, but deep down, we all know most of us will have given up before February even arrives. So we have put together a few tips to help you actively support your customers to make a significant lifestyle change for the New Year. Healthy eating – it is important for your customers to have realistic expectations. It is all too easy to say they will stop eating junk food, and start ‘eating healthy’. Advising them that it is important to be realistic and starting with a few small measurable goals, such as aiming to eat two servings of fruits or five servings of vegetables each day, will work better in the long run. Small tweaks and modifications can add up to a major change quite quickly...