Evaluating a standardised clinical assessment tool for pre-registration midwifery students: a cross-sectional survey of midwifery students and midwives in Australia

Abstract
Background: Assessment of clinical competence is a core component of midwifery education. Clinical assessment tools have been developed to help increase consistency and overcome subjectivity of assessment.
Aim: The study had two main aims. The first was to explore midwifery students and educators/clinical midwives’ views and experiences of a common clinical assessment tool used for all preregistration midwifery programmes in Victoria and the University of South Australia. The Second was to assess the need for changes to the tool to align with developments in clinical practice and evidence-based care.
Methods: A cross-sectional, web-based survey including Likert-type scales and open-ended questions was utilised.
Setting: Students enrolled in all four entry pathways to midwifery at seven Victorian and one South Australian University and educators/clinical midwives across both states.
Findings: One hundred and ninety-one midwifery students’ and 86 educators/clinical midwives responded.
Overall, students and educators/clinical midwives were positive about the Clinical Assessment Tool with over 90% reporting that it covered the necessary midwifery skills. Students and educators/clinical midwives reported high levels of satisfaction with the content of the learning tools. Only 4% of educators/clinical midwives and 6% of students rated the Clinical Assessment Tool as poor overall. Changes to some learning tools were necessary in order to reflect recent practice and evidence.
Key conclusions and implications for practice: A common clinical assessment tool for evaluating midwifery students’ clinical practice may facilitate the provision of consistent, reliable and objective assessment of student skills and competency.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

Objective To determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis. Design A reliability study using two raters and two test sessions. Setting Tertiary care paediatric centre. Participants Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic. Main outcome measures Based on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters. Results In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (ϕ = 0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (ϕ ≥ 0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus. Conclusions Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

A Case Study on Using the Via Christi Breastfeeding Assessment Tool in a Clinical Setting

Aims- The goal of this study is to obtain a subjective point of view of the use, benefits, and shortcomings of the Via Christi breastfeeding Assessment Tool in a clinical setting. Methods- This case study is based on a single yet detailed interview with a lactation consultant who has utilized the Via Christi Breastfeeding Tool in a clinical setting. Findings- Advantages of the Via Christi Breastfeeding Assessment Tool include that the tool is practical and concrete, encompassing both a subjective dimension and the basic elements of breastfeeding. Shortcomings of the tool include its non-specificity in focus on the feeding technique only and excluding other factors involved with the birth and mother- baby couplet. Conclusion- The Via Christi Breastfeeding Tool serves as a good initial screening of breastfeeding, which in result leads to the recommendation of further and more extensive study of a specific mother-baby couplet breastfeeding measures if needed.

Can a community pharmacy sleep assessment tool aid the identification of patients at risk of sleep disorders in the community : a pilot study

Background: When experiencing sleep problems for the first time, consumers may often approach community pharmacists for advice as they are easily accessible health care professionals in the community. In Australian community pharmacies there are no specific tools available for use by pharmacists to assist with the assessment and handling of consumers with sleep enquiries. Objective: To assess the feasibility of improving the detection of sleep disorders within the community through the pilot of a newly developed Community Pharmacy Sleep Assessment Tool (COP-SAT). Method: The COP-SAT was designed to incorporate elements from a number of existing, standardized, and validated clinical screening measures. The COP-SAT was trialed in four Australian community pharmacies over a 4-week period. Key findings: A total of 241 community pharmacy consumers were assessed using the COP-SAT. A total of 74 (30.7%) were assessed as being at risk of insomnia, 26 (10.7%) were at risk of daytime sleepiness, 19 (7.9%) were at risk of obstructive sleep apnea, and 121 (50.2%) were regular snorers. A total of 116 (48.1%) participants indicated that they consume caffeine before bedtime, of which 55 (47%) had associated symptoms of sleep onset insomnia. Moreover, 85 (35%) consumed alcohol before bedtime, of which 50 (58%) experienced fragmented sleep, 50 (58%) were regular snorers, and nine (10.6%) had apnea symptoms. The COP-SAT was feasible in the community pharmacy setting. The prevalence of sleep disorders in the sampled population was high, but generally consistent with previous studies on the general population. Conclusion: A large proportion of participants reported sleep disorder symptoms, and a link was found between the consumption of alcohol and caffeine substances at bedtime and associated symptoms. While larger studies are needed to assess the clinical properties of the tool, the results of this feasibility study have demonstrated that the COP-SAT may be a practical tool for the identification of patients at risk of developing sleep disorders in the community.

Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals

Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.

Measuring multidisciplinary team effectiveness in a ward-based healthcare setting : development of the Team Functioning Assessment Tool

Nontechnical skills relating to team functioning are vital to the effective delivery of patient care and safety. In this study, we develop a reliable behavioral marker tool for assessing nontechnical skills that are critical to the success of ward-based multidisciplinary healthcare teams. The Team Functioning Assessment Tool (TFAT) was developed and refined using a literature review, focus groups, card-sorting exercise, field observations, and final questionnaire evaluation and refinement process. Results demonstrated that Clinical Planning, Executive Tasks, and Team Relations are important facets of effective multidisciplinary healthcare team functioning. The TFAT was also shown to yield acceptable inter-rater agreement.

Measuring ward-based multidisciplinary healthcare team functioning : a validation study of the Team Functioning Assessment Tool (TFAT)

The team functioning assessment tool (TFAT) has been shown to be a reliable behavioral marker tool for assessing nontechnical skills that are critical to the success of ward-based healthcare teams. This paper aims to refine and shorten the length of the TFAT to improve usability, and establish its reliability and construct validity. Psychometric testing based on 110 multidisciplinary healthcare teams demonstrated that the TFAT is a reliable and valid tool for measuring team members’ nontechnical skills in regards to Clinical Planning, Executive Tasks, and Team Functioning. Providing support for concurrent validity, high TFAT ratings were predicted by low levels of organizational constraints and high levels of group potency. There was also partial support for the negative relationships between time pressure, leadership ambiguity, and TFAT ratings. The paper provides a discussion on the applicability of the tool for assessing multidisciplinary healthcare team functioning in the context of improving team effectiveness and patient safety for ward-based hospital teams.

Temporary tattoos:a novel OSCE assessment tool

Background: There are many issues regarding the use of real patients in objective structured clinical examinations (OSCEs). In dermatology OSCE stations, standardised patients (SPs) with clinical photographs are often used. Temporary transfer tattoos can potentially simulate skin lesions when applied to an SP. This study aims to appraise the use of temporary malignant melanoma tattoos within an OSCE framework. Method: Within an 11-station OSCE, a temporary malignant melanoma tattoo was developed and applied to SPs in a 'skin lesion' OSCE station. A questionnaire captured the opinions of the candidate, SP and examiners, and the degree of perceived realism of each station was determined. Standard post hoc OSCE analysis determined the psychometric reliability of the stations. Results: The response rates were 95.9 per cent of candidates and 100 per cent of the examiners and SPs. The 'skin lesion' station achieved the highest realism score compared with other stations: 89.0 per cent of candidates felt that the skin lesion appeared realistic; only 28 per cent of candidates had ever seen a melanoma before in training. The psychometric performance of the melanoma station was comparable with, and in many instances better than, other OSCE stations. Discussion: Transfer tattoo technology facilitates a realistic dermatology OSCE station encounter. Temporary tattoos, alongside trained SPs, provide an authentic, standardised and reliable experience, allowing the assessment of integrated dermatology clinical skills.

Validity of a Quantitative Clinical Measurement Tool of Trunk Posture in Idiopathic Scoliosis

STUDY DESIGN: Concurrent validity between postural indices obtained from digital photographs (two-dimensional [2D]), surface topography imaging (three-dimensional [3D]), and radiographs. OBJECTIVE: To assess the validity of a quantitative clinical postural assessment tool of the trunk based on photographs (2D) as compared to a surface topography system (3D) as well as indices calculated from radiographs. SUMMARY OF BACKGROUND DATA: To monitor progression of scoliosis or change in posture over time in young persons with idiopathic scoliosis (IS), noninvasive and nonionizing methods are recommended. In a clinical setting, posture can be quite easily assessed by calculating key postural indices from photographs. METHODS: Quantitative postural indices of 70 subjects aged 10 to 20 years old with IS (Cobb angle, 15 degrees -60 degrees) were measured from photographs and from 3D trunk surface images taken in the standing position. Shoulder, scapula, trunk list, pelvis, scoliosis, and waist angles indices were calculated with specially designed software. Frontal and sagittal Cobb angles and trunk list were also calculated on radiographs. The Pearson correlation coefficients (r) was used to estimate concurrent validity of the 2D clinical postural tool of the trunk with indices extracted from the 3D system and with those obtained from radiographs. RESULTS: The correlation between 2D and 3D indices was good to excellent for shoulder, pelvis, trunk list, and thoracic scoliosis (0.81>r<0.97; P<0.01) but fair to moderate for thoracic kyphosis, lumbar lordosis, and thoracolumbar or lumbar scoliosis (0.30>r<0.56; P<0.05). The correlation between 2D and radiograph spinal indices was fair to good (-0.33 to -0.80 with Cobb angles and 0.76 for trunk list; P<0.05). CONCLUSION: This tool will facilitate clinical practice by monitoring trunk posture among persons with IS. Further, it may contribute to a reduction in the use of radiographs to monitor scoliosis progression.

Identification of mental illness in police cells: a comparison of police processes, the brief jail mental health screen and the jail screening assessment tool

The study investigated current police practices employed to identify those with a mental illness in police custody, and to evaluate the predictive utility of the Brief Jail Mental Health Screen (BJMHS) and the Jail Screening Assessment Tool (JSAT). One hundred and fifty detainees were recruited from two police stations in Melbourne, Australia. Measures included the Structured Clinical Interview for DSM-IV-TR, BJMHS and JSAT. Axis-I disorders were compared with police decisions regarding identification of mental illness based on their usual practices. Participants were classified as requiring referral for further mental health evaluation according to the screening tools. Results indicated that current police practices produced high false negatives, with many of those experiencing mental illness not identified. There was no significant difference in performance between BJMHS (AUC =0.722) and JSAT (AUC =0.779) in identifying those with a serious mental illness (p=0.109). However, JSAT performed significantly better at identifying any Axis-I disorder, excluding substance use disorders, as compared with BJMHS (AUC =0.815, vs AUC =0.729; p=0.018). Given the high prevalence of mental illness among detainees, there is a pressing need to introduce standardised screening tools for mental illness in police custody. This can assist the police in managing detainees appropriately and securing mental health services as required.

Clinical assessment of the efficacy of low-level laser therapy on muscle pain in women with temporomandibular dysfunction, by surface electromyography

The use of low-level laser (LLL) may be an useful tool to promote reduction of muscular pain caused by TMD. Aim: This study evaluated the immediate efficacy of low-level laser therapy on women reporting pain and diagnosed with temporomandibular dysfunction (TMD). Methods: Diode laser (GaAlAs) at 790 nm wavelength (infrared spectrum) was applied as experimental treatment. Irradiations of 1.5 J/cm2 were made at 4 points of the temporomandibular joint (TMJ) and of 3 J/cm2 at 3 points in the temporal muscle. An electromyographic (EMG) evaluation of the masseter and anterior temporal was done at the following intervals: before, immediately after, 5 min and 20 min after laser application. Results: Comparison of the electrical activity at the times of measurement revealed a statistically significant difference in masseter muscles before (P=0.025) and immediately after (P=0.013) LLLT. Conclusions: Both masseter and temporal muscles showed a reduction in the measured EMG activities at all times after LLLT, and the temporal muscle showed higher EMG activity than the masseter muscle at all the evaluation times. LLLT caused significant immediate relaxation of the masseter muscles.

Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation Long-Term Results of a Prospective Trial (National Clinical Trial 00254683)

BACKGROUND: Neoadjuvant chemoradiation (CRT) therapy may result in significant tumor regression in patients with rectal cancer. Patients who develop complete tumor regression have been managed by treatment strategies that are alternatives to standard total mesorectal excision. Therefore, assessment of tumor response with positron emission tomography/computed tomography (PET/CT) after neoadjuvant treatment may offer relevant information for the selection of patients to receive alternative treatment strategies. METHODS: Patients with clinical T2 (cT2) through cT4NxM0 rectal adenocarcinoma were included prospectively. Neoadjuvant therapy consisted of 54 grays of radiation and 5-fluorouracil-based chemotherapy. Baseline PET/CT studies were obtained before CRT followed by PET/CT studies at 6 weeks and 12 weeks after the completion of CRT. Clinical assessment was performed at 12 weeks after CRT completion. PET/CT results were compared with clinical and pathologic data. RESULTS: In total, 99 patients were included in the study. Twenty-three patients were complete responders (16 had a complete clinical response, and 7 had a complete pathologic response). The PET/CT response evaluation at 12 weeks indicated that 18 patients had a complete response, and 81 patients had an incomplete response. There were 5 false-negative and 10 false-positive PET/CT results. PET/CT for the detection of residual cancer had 93% sensitivity, 53% specificity, a 73% negative predictive value, an 87% positive predictive value, and 85% accuracy. Clinical assessment alone resulted in an accuracy of 91%. PET/CT information may have detected misdiagnoses made by clinical assessment alone, improving overall accuracy to 96%. CONCLUSIONS: Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2012;35013511. (C) 2011 American Cancer Society.

Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy

Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients' risk for CHD.