Validation of the Italian version of the Yale-Brown Obsessive Compulsive Scale-Second Edition (Y-BOCS-II) in a clinical sample

OBJECTIVE: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the most widely accepted measure of obsessive-compulsive disorder (OCD) symptom severity. Recently, the scale has been revised into a second edition (Y-BOCS-II) in order to improve its measurement properties. The present study aimed to evaluate the psychometric properties of the Italian version of the Y-BOCS-II Severity Scale (SS) in a large clinical sample. METHOD: The original version of the Y-BOCS-II was translated into Italian, which involved forward and back-translation procedures. The Italian Y-BOCS-II-SS was administered to one hundred twenty-five treatment-seeking adults with OCD, together with the original Y-BOCS-SS and a battery of self-report measures assessing OCD symptom severity and depressive and anxious symptomology. The factor structure, internal consistency, temporal stability, and construct validity were investigated on the whole sample, while inter-rater and test-retest reliability were assessed on a subsample of participants. RESULTS: Factor analyses revealed a two-factor structure different from those of the original scale, comprising (1) symptom severity; and (2) interference from symptoms. Internal consistency, test-retest reliability over a 2-week period and inter-rater reliability were satisfactory. The Y-BOCS-II-SS also showed excellent construct validity (and better than the Y-BOCS-SS), with good convergent and discriminant validity when assessed against other OCD symptom measures and measures of depression, anxiety and worry. CONCLUSIONS: These findings suggest that the Italian version of the Y-BOCS-II-SS retains the adequate psychometric properties of the original and that it can be confidently used as an assessment tool of OCD symptoms in both clinical and research settings.

Study protocol: the registrar clinical encounters in training (ReCEnT) study

Background
Patient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.
Methods/design
This is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.
Conclusions
The study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

Nurse academics perceptions of the efficacy of the OSCA tool

The use of Objective Structured Clinical Examination/Objective Structured Clinical Assessment (OSCE/OSCA) has been well documented. How assessors currently view the process, and if the OSCA tool still fulfils the assessment requirements, is unclear. In this study, the beliefs and expectations of assessors towards the assessment tool used in an undergraduate nursing degree to assess clinical skills was investigated. A cross-sectional study used semi-structured interviews and focus groups with 16 lecturers in nursing from a rural Australian university. This represents 65% of the total nurse academic staff employed there. The key issues that the academic staff raised reflect those from previous studies, such as the use of OSCA as formative assessment or a quality check process before the clinical practice. The OSCAs were seen as a good assessment tool, which gave students the opportunity to receive feedback on their performance in relation to clinical skills. The drawbacks identified in relation to the use of OSCAs were that the OSCA was seen as stressful to students. This drawback was thought to be further compounded if there was a lack of congruence regarding essential criteria between assessors. If not adequately addressed these drawbacks will erode the potential the OSCA tool has to foster uniformity, which was one of the main reasons for its implementation. .

Assessing Australian undergraduate clinical learning

Determining the clinical preparedness of undergraduate nursing students is vital in developing graduates who are ready to assume the roles of registered nurses. This paper reports findings relating to clinical assessment in Australian undergraduate nursing programs. Using data collected in a national survey and selected case studies, current assessment practices are described. Although students were increasingly exposed to a narrower range of clinical experiences, claims to comprehensive preparation of nurses remain prominent. Issues in the congruity between assessment methods and purported outcomes of clinical learning programs are discussed.

The reliability of clinical indicators of oxygenation: a literature review

Despite oxygen being one of the most frequently administered substances in the hospital environment, there is little empirical data regarding its use. Review of the literature regarding the clinical assessment of hypoxia and hypoxaemia reveals inconsistency in the definition of terms and raises questions as to the reliability of the clinical indicators currently used to assess the need for supplemental oxygen. Assessment of the need for supplemental oxygen and continued re-evaluation of the patient's oxygen requirements is a nursing responsibility. Physical assessment, in combination with pulse oximetry, is the most common method used by nurses to assess oxygenation status. This paper critically appraises the literature to examine the reliability of clinical indicators of oxygenation used by nurses in acute care settings.

Asymptomatic hypoechoic regions on patellar tendon ultrasound : a 4-year clinical and ultrasound followup of 46 tendons

Patellar tendon ultrasound appearance is commonly used in clinical practice to diagnose patellar tendinopathy and guide management. Using a longitudinal study design we examined whether or not the presence of a hypoechoic ultrasonographic lesion in an asymptomatic patellar tendon conferred a risk for developing jumper's knee compared with a tendon that was ultrasonographically normal. Ultrasonographic, symptomatic and anthropometric assessment was completed at baseline and followup. Magnetic resonance imaging was performed on four tendons that resolved ultrasonographically in the study period. Forty-six patellar tendons were followed over 47±11.8 months. Eighteen tendons were hypoechoic at baseline and 28 were ultrasonographically normal. Five tendons resolved ultrasonographically in the study period. Magnetic resonance imaging in four of these tendons was normal. Seven normal patellar tendons at baseline developed a hypoechoic area but only two became symptomatic. Analysis of ultrasonography at baseline and clinical outcome with Fisher's exact test shows there is no association between baseline ultrasound changes and symptoms at followup. In this study there is no statistically significant relationship between ultrasonographic patellar tendon abnormalities and clinical outcome in elite male athletes. Management of jumper's knee should not be solely based on ultrasonographic appearance; clinical assessment remains the cornerstone of appropriate management.

Critical incident analyses : a practice learning tool for students and practitioners

The development of critical skills in social work students and practitioners has been a major focus of social work education and training in recent years. Critical incident analysis has developed as a tool to aid critical reflection in practice, in health and social work. This paper provides an overview of the use of the tool in these fields. It then reports on a demonstration project which sought to examine how critical incident analysis might be used as a form of assessment and as a supervisory tool by social work students and practice teachers. An evaluation of the project is provided. Completion of critical incident analyses using the framework was found to provide a structured approach to critical reflection. It assisted the integration of theory and practice and the examination of value issues. Students and practice teachers identify its use in supervision and its potential as an assessment tool. The paper concludes with a discussion on the potential uses of critical incident analyses, with particular attention given to its use to develop anti-oppressive practice.

The painful nonruptured tendon : clinical aspects

Tendon injuries account for a substantial proportion of overuse injuries in competitive and recreational sports participants, as well as in individuals whose jobs require repetitive activity. Overuse type injuries account for 30% to 50% of all sports injuries, and in many endurance and power sports tendon injuries are clearly the most frequent reason for interruptions to training and competition [1] . Because tendon problems are so common, and not easily managed, this issue of Clinics is devoted to them. This article aims to provide an understanding of the pathology underlying the conditions before outlining current evidence for clinical assessment and treatment of tendinopathies.

Professional attitudes towards deliberate self-harm in patients with borderline personality disorder

Objective: The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. The clinician gender, primary occupation and service setting, level of university training and years of experience, frequency of clinical contact, and completion of specific training in borderline personality disorder were expected to influence the attitudes of health professionals towards working with borderline patients that engage in self-harm.

Method: A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service.

Results: Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm.

Conclusions: The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.

An interventional study to improve paramedic diagnosis of stroke

Objective: The aim of the Faster Access to Stroke Therapy (FAST) study was to determine the effect of educational intervention andthe use of a prehospital stroke tool on the paramedic diagnosis of stroke.

Methods: Paramedics in emergency medical service units servicing a university teaching hospital were divided into two groups: FAST study paramedics (n = 18) and non-FAST study paramedics (n = 43). The FAST study paramedics received stroke education and instruction in the use of a prehospital stroke assessment tool [Melbourne Ambulance Stroke Screen (MASS)] to assist in stroke diagnosis. Based on final hospital diagnosis, the sensitivities of paramedic stroke diagnosis in the two groups were compared for a 12-month period before andafter the intervention.

Results: The sensitivity for the FAST study paramedics in identifying stroke improved from 78% (95% confidence interval [CI]: 63% to 88%) to 94% (95% CI: 86% to 98%) (p = 0.006) after receiving the stroke education session and with use of the MASS tool. There was no change in stroke diagnosis for the non-study paramedics 78% (95% CI: 71% to 84%) to 80% (95% CI: 72% to 87%) (p = 0.695). Prenotification of impending arrival to the emergency department was associated with higher-priority triage in the emergency department, and subsequent shorter times for door to medical review (15 min vs. 31 min, p < 0.001) and door to computed tomography (CT) scanning (94 min vs. 144 min, p < 0.001).

Conclusions: Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with prenotification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.

Pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD)

Cardiovascular disease (CVD) accounts for 18% of disease burden in Australia, and 35% of deaths. Evidence- based management of CVD risk requires systematic consideration of individual risk factors and overall CVD risk, and a balanced approach to lifestyle modification, the optimal use of medicines, and medicines adherence.

This project examines a pHot model for primary prevention of CVD in community pharmacy aimed at improving quality of care. Pharmacists from ten pharmacies received training in CVD risk factor management and facilitating patient lifestyle modification.

They recruited 70 participants aged 50-74 years, taking medicines for blood pressure (BP) or cholesterol, and without diabetes or CVD, At baseline, research assistants conducted a clinical assessment of anthropometric and biomedical risk factors, and conducted interviews to examine health behaviours, medicines use and related issues. Data was analysed by a consultant pharmacist and summary reports produced, with recommendations and targets for risk reduction. These were addressed by patients and their community pharmacists over five monthly sessions. At follow up, the relative risk reduction for CVD onset over the next five years was 24%, contributed to by reductions in mean systolic BP (-7mmHg), diastolic PP (-5 mmHg), total:HDL cholesterol ratio (—0.2), waist circumference (—2cm in males, —0.7cm in females) and other risk factors.

Several key health behaviours improved, including diet quality and physical activity levels. Prevalence of non-adherence to cardiovascular medicines dropped by 1 6% to 22%.

The potential health benefits from this intervention need to be confirmed via larger, controlled clinical trials. Overall, this appears to be a feasible and potentially effective public health measure.

An observational study of health professionals’ use of evidence to inform the development of clinical management tools

Aim. This observational study sought to investigate the process of evidence use by health professionals during development of evidence-based clinical management tools.

Background. Studies conducted to explore the process of research use are scarce and knowledge of this process is essential for our understanding of the influences on research use in practice.

Design. A qualitative, non-participant, observational design.

Methods. Behaviour and actions of two separate multidisciplinary teams were observed and audio-recorded during a combined total of seven meetings for the development of clinical management tools. Semi-structured, one-to-one interviews were conducted approximately half-way through the development process and following completion of the clinical management tools.

Results. Three major themes emerged from this research. First, the process of clinical management tool development and evidence use. Nurses assumed responsibility for coordination of development which focused on describing current practice. Second, the forms of evidence employed during the development process included the use of experiential knowledge, opinions and knowledge of the context, in addition to research evidence. However, reference to research evidence was limited and its incorporation into the instrument was infrequently observed. Third, the use of research evidence emerged with respect to how such evidence was employed.

Conclusion. This study focused on real-life discussion and decision-making that occurred between health professionals when developing evidence-based clinical management tools. Health professionals may have a tendency to rely on their professional experience and current practice in preference to seeking and applying relevant research evidence.

Relevance to clinical practice. Nurses have an important role to play in the development of multidisciplinary evidence-based clinical management tools, but to actively participate in this process they need to be familiar with the relevant research evidence and have the skills and confidence to integrate the evidence into practice.

Fall incidence and fall prevention practices at acute care hospitals in Singapore : a retrospective audit

Objective To investigate the incidence of falls and explore fall prevention practices at acute care hospitals in Singapore.

Design A retrospective audit to collect baseline data on (1) incidence of falls (patient fall rates and fall injury rates) and (2) fall prevention practices, was conducted in five acute care hospitals in Singapore from December 2004 to March 2005.

Study participants Medical record data (n = 6000) of patients admitted into the medical, surgical and geriatric units in the five hospitals.

Outcome measures Fall incidence was obtained from the hospital's fall databases and incident reports for the period of June 2003 to May 2004. In total, 6000 medical records from five hospitals were randomly selected, retrieved and reviewed to determine whether falls, fall assessments and interventions were being initiated and documented.

Results The number of fallers for all hospitals was 825. Analysis showed that patient fall rates ranged from 0.68 to 1.44 per 1000 patient days, and the proportion of falls associated with injury ranged from 27.4% to 71.7%. The use of a fall risk assessment tool by nurses was recorded in 77% of all the nursing records.

Conclusion This study has laid the foundation for further research for fall prevention in Singapore by describing current fall rates, fall-associated injury rates and the status of fall prevention practices in acute care settings. The results will be used to inform the development of a tailored multifaceted strategy to facilitate the implementation of Fall Prevention Clinical Practice Guidelines to reduce the burden of falls and fall injuries in hospitals in Singapore.

Reflexive capability maturity assessment for firm management of multipartner international projects

This paper reports the findings of a research project which was aimed at developing and promoting a greater understanding of the uniqueness of successful Australian-Malaysian partnerships and joint ventures undertaken on complex multi-partner mega construction projects. The aim of the investigation was to identify the critical success factors specific to such partnerships. The theoretical framework was grounded in a previous empirical study on design firm internationalisation which demonstrated that long-term success in international markets is enhanced by the management of integration of transformation of social, cultural and intellectual capital within the firm. A generic adaptive performance framework mapping the key performance indicators for each of these dimensions was developed which can be modified to unique contexts related to specific geographical localities. In the Australian Malaysian Institute study the framework is tested within the context of firm and shared partnership capital. The broad interpretive framework of adaptive performance was refined as a result of the findings of the four case studies of Malaysian organisations to develop a partnerships capacity performance measurement framework for Malaysian firms working on international projects. Six in-depth interviews were conducted with ten participants across the four Malaysian firms and a thematic analysis was undertaken of the transcripts. A reflexive capability maturity assessment tool was developed from insights gained into the underlying causes of key barriers coupled with common themes emerging in relation to the successful approaches used by case study firms to overcome those barriers. Specific examples of the case study firms' demonstration of reflexive capability in the areas of market knowledge, design management and market entry are presented.

Biological maturity and primary school children's physical activity : influence of different physical activity assessment instruments

Biological maturation may attenuate hypothesized sex differences in children’s physical activity but overall the evidence for this is equivocal. In this study, we investigated how the selection of different physical activity assessment instruments affects the detected relationship between biological maturation and late primary school children’s physical activity. Altogether, 175 children (97 girls, 78 boys) aged 10.690.3 years completed the PAQ-C self-report questionnaire and wore ActiGraph GT1M accelerometers for 5 consecutive days. Maturity status was predicted by estimating attainment of age at peak height velocity. Following initial exploration of sex differences in PAQ-C (t-test) and multiple ActiGraph outcome variables (MANOVA), the influence of maturity status was controlled using ANCOVA and MANCOVA. Unadjusted analyses revealed that boys were significantly more active than girls according to the PAQ-C (PB0.0001, d0.52) and ActiGraph (PB0.0001, d0.360.72). After controlling for maturity status, the differences in PAQ-C scores increased (P0.001, d0.64), but the significant differences disappeared for the ActiGraph data (P0.36, d0.170.33). The detected relationship between maturity status and late primary school children’s physical activity is dependent on the physical activity assessment tool employed, reflecting the different aspects of physical activity captured by the respective measures.