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Wu, Xi Vivien. "Holistic clinical assessment for undergraduate nursing students." Doctoral thesis, Högskolan i Jönköping, Hälsohögskolan, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-29937.
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A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education. The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted. The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability. In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.
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Chen, Tao. "The development of a holistic and quantitative tool for the assessment and improvement of survey quality." Thesis, Edinburgh Napier University, 2011. http://researchrepository.napier.ac.uk/Output/4404.
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There are a variety of guidelines and methods available to measure and assess survey quality. Most of these are based on qualitative descriptions. In practice, they are not easy to implement and it is very difficult to make comparisons between surveys. Hence there is a theoretical and pragmatic demand to develop a mainly quantitative based survey assessment tool. This research aimed to meet this need and make contributions to the evaluation and improvement of survey quality. Acknowledging the critical importance of measurement issues in survey research, this thesis starts with a comprehensive introduction to measurement theory and identifies the types of measurement errors associated with measurement procedures through three experiments. Then it moves on to describe concepts, guidelines and methods available for measuring and assessing survey quality. Combining these with measurement principles leads to the development of a quantitative based statistical holistic tool to measure and assess survey quality. The criteria, weights and subweights for the assessment tool are determined using Multi-Criteria Decision-Making (MCDM) and a survey questionnaire based on the Delphi method. Finally the model is applied to a database of surveys which was constructed to develop methods of classification, assessment and improvement of survey quality. The model developed in this thesis enables survey researchers and/or commissioners to make a holistic assessment of the value of the particular survey(s). This model is an Excel based audit which takes a holistic approach, following all stages of the survey from inception, to design, construction, execution, analysis and dissemination. At each stage a set of criteria are applied to assess quality. Scores attained against these assessments are weighted by the importance of the criteria and summed to give an overall assessment of the stage. The total score for a survey can be obtained by a combination of the scores for every stage weighted again by the importance of each stage. The advantage of this is to construct a means of survey assessment which can be used in a diagnostic manner to assess and improve survey quality.
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Setari, Anthony Philip. "CONSTRUCTION AND VALIDATION OF A HOLISTIC EDUCATION SCHOOL EVALUATION TOOL USING MONTESSORI ERDKINDER PRINCIPLES." UKnowledge, 2016. http://uknowledge.uky.edu/edsc_etds/12.
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The purpose of this study was to construct a holistic education school evaluation tool using Montessori Erdkinder principles, and begin the validation process of examining the proposed tool. This study addresses a vital need in the holistic education community for a school evaluation tool. The tool construction process included using Erdkinder literature to justify the development of each item through the use of an item matrix, ultimately leading to the development of the 23 item formative Montessori Erdkinder School Evaluation Survey. The validation process included a series of three Rasch Rating Scale Model analyses with data from a sample school. The validation process used item anchoring estimates from the earlier analyses in the later analyses and included determining the tool’s dimensionality, reliability, item fit, possible differential item functioning, and comparing the order of item difficulty levels to the holistic model of Maslow’s hierarchy of needs. Results of the study showed that six items had issues with fit and would need to be revised, and that the items in the cognitive and moral facet will need to be revised to better match Maslow’s model. This study provides the foundation for the development of a holistic education evaluation or accreditation system, and constructed a resource that could be directly implemented in schools.
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Bosman, Michelle. "Assessment of the effectiveness of electronic gatekeeping as a utilization management tool at Groote Schuur Hospital." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30151.
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BACKGROUND: Utilization management ensures the appropriateness of laboratory testing by reducing the performance of tests which can be reasonably avoided with no adverse effects for the patient. Electronic gatekeeping, a utilization management tool, was introduced at Groote Schuur in 2010. Criteria were based on the minimum retesting interval, healthcare location, level of experience and discipline of the requesting clinician and specific ICD-10 codes.
METHODS: A retrospective observational study assessing the effectiveness of electronic gatekeeping at Groote Schuur Hospital (Cape Town, South Africa), by comparing the test request volumes by using absolute test numbers and pre-defined ratios in the year prior to gatekeeping, to the two years following implementation. A secondary aim is to apply selected ratios to the other national academic hospitals to determine the potential for cost saving. RESULTS: At the medical wards of Groote Schuur Hospital there was an overall decrease in number and cost of tests of 24% per inpatient day for 2011. The most dramatic difference in cost is seen for chloride (91%) followed by HbA1c (90%), FT3 (89%) and CRP (82%). The application of ratios to Groote Schuur Hospital show a decrease in 2011 in all ratios apart from PCT: FBC+WCC (0.003 vs 0.002) and Mg: Ca (0.86 vs 0.84). AST: ALT remained the same at 0.55. This suggests overall effectiveness of the eGK rules although there is ongoing panel requesting. If the GSH eGK rules were to be applied at all other national academic hospitals, it could translate into a potential cost saving of $13 411 873.96 (R103 196 838.80) per annum.
CONCLUSIONS: Electronic gatekeeping is an effective utilization management tool at Groote Schuur Hospital. It is relatively easy to implement and manage, and when combined with additional tools has the potential to result in larger reductions of unnecessary tests, cost savings and improved patient outcome.
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Amorighoye, Lucky Eyituoyo. "Developing an assessment tool for measuring total quality management in SASOL's Steam Station Plant / L.E. Amorighoye." Thesis, North-West University, 2009. http://hdl.handle.net/10394/4304.
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Gillespie, Stephanie Marie 1958. "Reliability and validity of the Clinical Neurologic Assessment (CNA) Tool in children with head trauma." Thesis, The University of Arizona, 1990. http://hdl.handle.net/10150/278494.
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The Clinical Neurologic Assessment (CNA) Tool is a 21 item instrument designed to assess subtle neurologic changes that often accompany head trauma. This descriptive study was designed to test the reliability and validity of the CNA in children with head trauma. Interrater reliability of the CNA was assessed by determining Cohen's Kappa values for each item. Kappa values ranged from .74 to 1.00. Internal consistency of the CNA was assessed using Cronbach's alpha. The total CNA alpha was estimated to be .98 with subscale alphas ranging from .89 to .96. Concurrent and construct validity of the CNA were also assessed. Concurrent validity was estimated by determining Pearson's Product-Moment Correlation Coefficients for the CNA and the Glasgow Coma Scale (GCS) (r = .93; p = .001). Pearson's correlation coefficients were also estimated based on severity of head trauma (r = .57 to .74; p ≤ .017) and the age of the subject (r = .89 to .99; p ≤ .001). Construct validity was assessed using exploratory factor analysis which demonstrated a three factor solution. These factors reflected the following: a general overview of the level of consciousness, overall body and extremity position and movement, and muscle tone of the extremities.
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Mbongwe, Bontle. "Developing a clinical assessment tool for screening lead exposure levels during pregnancy and after delivery." Thesis, University of Pretoria, 2013. http://hdl.handle.net/2263/25722.
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Lead is a toxic heavy metal associated with adverse health effects ranging from developmental neurotoxicity to reproductive effects. While lead affects people of all ages, infants and children are the most vulnerable and susceptible to the neuro-developmental effects of lead exposure. Maternal blood lead concentrations that do not produce clinical toxicity on pregnant women have been linked to adverse offspring development. Observed reproductive effects to low lead levels during pregnancy include the risk of spontaneous abortions, effects on birth weight and preterm birth. There are particular concerns with regard to reductions in IQ scores. Research evidence suggests that an incremental increase in blood lead levels of 1 µg/dL is associated with approximately 1 IQ point deficit. Of particular concern is that currently no threshold has been observed or exists for developmental neurotoxicity to the chronic low lead exposures levels. While the developed countries have built evidence for lead exposure sources, have identified the most vulnerable groups to lead exposure, and have instituted control actions for lead exposure, it is not the case in developing countries such as Botswana. Currently, there is very little knowledge about the potential sources of lead exposure among different population groups not only in Botswana but also in most developing nations. There is also an evident limited knowledge on the behaviours and practices of different population groups that could potentially expose them to lead in developing countries. This thesis explores the following questions: i) Are there specific risk behaviours and practices peculiar to pregnant women in Botswana that could potentially expose them to lead? ii) What are the environmental lead concentration levels and their potential to expose pregnant women? iii)What are the blood lead concentrations at each stage of pregnancy and after delivery in Botswana and, iv) Can we use the information from these three questions to predict lead exposure levels during pregnancy and after delivery? v) Can we use the new information to a develop a policy dissemination brief to inform policy on lead exposure sources in Botswana, develop guidelines for health professionals for assessing and screening lead exposure levels during pregnancy and after delivery, develop an awareness leaflet for lead education? To address the specific risk behaviour and practices of pregnant women, a comprehensive validated risk assessment questionnaire was administered among 142 pregnant women during the first trimester of pregnancy (defined as 8-12 weeks) in four villages of different geographical settings and nomenclature (small/rural, major and semi urban). For purposes of this work the validation process involved obtaining information (from experts in the field and communities) relevant to the purposes of the study and to confirm that the tools employed for collection of data in all trimesters were suitable in terms of both construct and content. Data was collected between September 2009 and February 2010. To address potential environmental sources of lead exposure during pregnancy soil (n=28), water (n=28) and traditional cosmetic clay - letsoku (n=3) samples were collected in November 2010, February 2011 and May 2011 from the homes and in the vicinity of the study population to determine lead concentrations. To know baseline blood lead levels at each stage of pregnancy, blood samples were collected from September 2009 to February 2011 from pregnant women between weeks 8-12 (first trimester, n=137), 20-24 (second trimester n=126) and weeks 34-36 (third trimester n=106). Blood lead levels of women who completed the entire study from trimester on until after delivery (n=63) were then used to construct blood lead prediction models using statistical models. Pregnant women in the study area ingested non-food items such as soil, match sticks, pencil, chalk and animal feed such as bone meal (86%). Women applied used and unused car oils (in particular brake fluid) and other harmful substances for “treatment of skin conditions and for beautification purposes (74%). Older women (defined as 35 years in this study) were at a significantly higher risk to ingest soils (p<0.01). Mean (±SEM) lead concentrations in water exceeded the WHO drinking water quality standards nineteen fold (0.19±0.019 ppm (n=28) Major villages, had significantly higher Pb concentrations (p<0.05) in soils and water compared to small villages. Mean blood lead levels (±SEM) for the first, second and third trimesters were 1.96(±0.14)µg/dL, 2.49(±0.17) µg/dL, 2.66(±0.19) µg/dL respectively. Blood lead levels increases from the first to third trimester ranged from 1.6-5%. Blood lead concentrations significantly differed among locations (p<0.01). The highest concentrations were observed in women from smaller villages that were poorer (p<0.02). Pica, multiple risk behaviours/practices (engaging in two or more risk behaviours/practices), trimester of pregnancy, poor food supplementation and diet were predictors of blood lead levels ≥ 2µg/dL. There was a dose response relationship between supplement intake and an increase in blood lead levels. These findings suggest that pregnant women and their unborn babies could potentially be exposed to lead because of the environment in which they live, their economic status, lifestyle, behaviors and practices. Drinking water is a potential threat for lead exposure, not only among pregnant women, but other vulnerable groups such as infants and children. This study is the first in Botswana and one of the few in Africa to investigate lead exposure sources at each stage of pregnancy and after delivery. It is also the first to identify new potential lead exposure behaviors and practices such as the application of auto oils by pregnant women for treatment of skin diseases. The findings suggest the need to train health workers and equip them with the skills and knowledge to assess and screen women who could potentially be exposed to lead. Further, pregnant women need to be sensitized on potential lead exposure sources, to prevent lead poisoning. This study has been able to use the results to develop a policy brief for disseminating the results to decision makers, guidelines for utilization by health workers to screen lead exposure levels and an awareness leaflet for pregnant women. These have been validated and pretested at community and Government levels.Thesis (PhD)--University of Pretoria, 2013.
School of Health Systems and Public Health (SHSPH)
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Catlin, Casey C. "Values Across the Lifespan Questionnaire (VALQUEST)| Development of a New Values Assessment Tool for Use with Older Adults." Thesis, University of Nevada, Reno, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13420927.
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Human values are a perennially important and popular topic in psychology. In Acceptance and Commitment Therapy (ACT), values are one of the six core processes have been shown to contribute to psychological flexibility (the ability consciously to contact the present moment fully and without needless defense, and to persist in or change behavior(s) in pursuit of one’s chosen values). Values in ACT may be conceptualized as a compass guiding a person’s behaviors in a direction. Values are also an important topic in geropsychology, often in the context of healthcare values and preferences. Even outside of healthcare settings, the aging process itself makes values work relevant. As we age, we must adapt to changing environments, diminishing cognitive and physical abilities, shrinking social circles, inevitable losses, and increased exposure to ageism. As the population demographics of the U.S. and other nations continues to shift toward older ages, there is a growing need for better treatments and assessment tools related to values that are suitable for use with older adults.
The Values Across the Lifespan Questionnaire, or VALQUEST, was developed to explore a new and more concrete yet flexible approach for values assessment that could meet the needs of older adults specifically and adults more generally. The VALQUEST was administered to 488 adults (253 over the age of 55) along with other relevant measures. Factor analysis led to a reduction in items, an improved scoring system, and evidence for a three-factor structure consistent with the design of the measure. The VALQUEST showed compelling evidence of concurrent validity with its large correlations with a well-studied measure of values, the Valued Living Questionnaire (VLQ: Wilson, Sandoz, Kitchens, & Roberts, 2010). Construct validity was evidenced through VALQUEST’s significant and consistent correlations with theoretically related measures of psychological flexibility, committed action, depression, and life satisfaction.
The VALQUEST adds the unique components of values identification (specifying and quantifying specific values from a provided list of exemplars) and assessment of the intrinsic or extrinsic motivation behind the values. In comparing the VALQUEST with the VLQ and measures of psychological flexibility and committed action as correlates of depression and life satisfaction, the VALQUEST was consistently related and often accounted for additional variance beyond well-established measures in these areas. Study limitations include collecting data at a single time point, leaving temporal reliability and measure reactivity unknown.
The VALQUEST is a viable measure that can be used now and can be easily modified for future purposes. The present study provides a "proof of concept" for the strategy deployed to create VALQUEST. While originally conceived with older adults as a special population of interest, the values measurement approach can readily be applied to values measurement development with other groups, such as specific cultural groups, military veterans, medical students, and so on. It could also be used to assess broad values, not separated by life domains; or many additional domains beyond the three in the current version. Subparts of the VALQUEST would be well-suited for use in time series designs assessing the dynamic interplay between values and other variables in daily life using ecological momentary assessment. The VALQUEST provides unique qualitative information about individual values while still maintaining a low response burden and collecting quantitative data, opening up many new areas of research into human values.
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Toro, Brigitte. "The design, development and testing of a sagittal plane observational gait assessment tool for clinical practice." Thesis, University of Salford, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413461.
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Rasetshwane, Itumeleng. "Evaluating The Psychometric Properties of the Clinical Assessment Tool Used in The Midwifery Programme In Botswana." Diss., University of Pretoria, 2021. http://hdl.handle.net/2263/78119.
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Background: Clinical assesssment tools play an essential role in clinical practice and assessment. Clinical assessment tools have to be evaluated for pyschometric properties to enhance objectivity and fairness when evaluating students. Reliability and validity are considered the main psychometric properties of clinical assessment tools. However, determining the psychometric properties of clinical assessment tools still remains a major problem. Hence, some tools are designed and used without adequate assessment of their reliability and validity. There is no evidence of the psychometric properties, mainly internal consistency, reliability and content validity of the clinical assessment tool used in Midwifery Programme in Botswana.
Aim/Purpose: The aim of the study was to evaluate the internal consistency reliability and content validity psychometric properties of the clinical assessment tool used in the Midwifery Programme in Botswana.
Design: A methodological design was used to evaluate the internal consistency reliability and content validity psychometric properties of the clinical assessment tool used in the Midwifery Programme in Botswana.
Research process: Data was collected from the completed clinical assessment tools which were used to assess midwifery students registered for intrapartum care (MID 421) in semester 2 and intrapartum care practicum (MID 543) in semester 4 in 2019, from the midwifery training schools, n=114. Data collected from these clinical assessment tools was captured and analyzed using the downloaded IBM® Statistical Package for the Social Sciences (SPSS) software, version 25. Inter-item analysis and the corrected item–total correlation were calculated to determine the internal consistency reliability of the clinical assessment tool used in midifery programme. Cronbach’s alpha was used to determine the reliability of the entire clinical assessment tool. The Subject Matter Expects in midwifery working in the academic field and those working in the Nursing and Midwifery Council in Botswana, were used to evaluate the content validity regarding the relevance and clarity of the competencies in the clinical assessment tool. The Content Validity Index (CVI), Item Content Validity Index (I-CVI), Content Validity Ratio (CVR), the overall scale (S-CVI/Ave) and Scale Content Validity Index using Universal Agreement (S-CVI-UA) were calculated to determine the content validity of the clinical assessment tool used in the Midwifery Programme in Botswana.
Results: The results of this study with regard to internal consistency reliability, revealed an overall Cronbach’s alpha of the clinical assessment tool of 0.837. The results of this study, with regard to content validity, revealed an overall CVR of 0.95 and an overall CVI of 0.97. The I-CVI value of the competencies for content validity ranged from 0.8 to 1. The S-CVI/Ave and the S-CVI/UA values of the competencies for content validity were 0.97 and 0.75 respectively.
Conclusion: The clinical assessment tool used in the Midwifery Programme in Botswana is reliable and valid. However, there is a need to review some of the competencies to improve its internal consistency reliability and content validity.
Keywords: Clinical Assessment, Clinical Assessment Tool, Midwifery Training Institutions, Midwifery Students, Midwifery Programme, Botswana, Reliability, Validity, Psychometric Properties.Dissertation (MNSc)--University of Pretoria, 2021.
Nursing Science
MNSc
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Fogarty, Diane. "Universal Design for Learning| A New Clinical Practice Assessment Tool Toward Creating Access and Equity for ALL Students." Thesis, Loyola Marymount University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10623437.
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To examine to what extent current general education pre-service teachers within a teacher preparation program at a private institution of higher education know and understand the principles of Universal Design for Learning (UDL), expert focus groups were conducted. General education program syllabi were examined for UDL content and found to be lacking in such content. General education pre-service teachers videotaped lessons were reviewed for UDL content and were also found to be inadequate in demonstrating knowledge and understanding of Universal Design for Learning principles. Focus groups comprised of university fieldwork instructors and teacher education experts were asked to review and give feedback on a current clinical observation tool being utilized. Feedback indicated that the current tool was insufficient for measuring pre-service teachers’ knowledge and understanding of UDL. Further, the current tool was not anchored to the UDL framework or any other teaching framework. In service to contributing to the field of teacher preparation, a new clinical practice tool grounded in Universal Design for Learning was created.
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Phuma, Ellemes Everret. "Development of neonatal nursing care clinical competency-based assessment tool for Nurse-midwife technicians in CHAM nursing colleges, Malawi." University of the Western Cape, 2015. http://hdl.handle.net/11394/5079.
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Philosophiae Doctor - PhDLiterature has shown that Malawi is experiencing a shortage of qualified healthcare providers, with the greatest burden on maternal and neonatal health. The majority of health service providers are Nurse-Midwife Technicians (NMT), contributing to 87% of the nursing and midwifery workforce. However, research has shown that the NMTs lack the ability to transfer skills into different clinical settings. It was not known what competencies were taught in Christian Health Association of Malawi colleges to equip the NMTs with clinical competence in neonatal nursing practice and how the clinical teachers assisted these NMTs to acquire the competencies. Furthermore, there was no documentation on the availability of a clinical competency-based assessment tool to validate the NMTs’ achievement of clinical competence in neonatal nursing. The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate NMTs’ achievement of clinical competence in CHAM nursing colleges. The competency, outcomes and performance assessment (COPA) model and the skills acquisition model were the conceptual frameworks used as the foundation of the study. The study adopted a sequential mixed method approach in which both qualitative and quantitative methods were utilized. Data collection was conducted using focus group discussions, document review and cross-sectional survey. The design and development model developed by Reeves (2006) and steps to development of assessment tools identified by the Department of Training and Workforce Development (2012) guided the study and development of the competency-based assessment tool. The study was conducted in eight CHAM nursing colleges. The researcher employed purposive, convenient and proportional stratified sampling to select the participants. Ethics clearance was obtained from the University of Western Cape and the National Health Sciences Ethical Research Committee in Malawi, prior to data collection. The data collection involved 31 midwifery clinical teachers and 140 third year students for the FGD and 48 midwifery clinical teachers and 195 third year students for the cross section survey. Document analysis was conducted at all the eight nursing colleges. The qualitative data was analysed using content analysis with Atlas.ti 7 and the quantitative data was analysed using descriptive analysis with SPSS 22. The research findings showed that the NMTs were taught basic nursing skills to enable them provide basic care to the health newborn baby. However, there were inadequate clinical assessments done to validate the NMT’s achievement of clinical competence in this setting. In addition, the clinical teachers used skills checklists to evaluate the NMTs clinical performance on specific procedures. The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments as well as tracking of the NMT’s clinical performance in this setting. It is recommended that training institutions should reinforce mechanisms to track the students’ clinical experience and performance assessments using this tool to ensure quality student outcomes. Furthermore, the clinical teachers should be oriented on the use of the developed assessment tool for familiarisation; thereby enhancing consistency and objectivity in the students’ performance assessments.
ICAP-NEPI Project Malawi
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Buls, Samantha. "Assessing Utility of a Lifestyle-based Tool in the Clinical Setting as a Primordial Prevention Strategy: The Healthy Heart Score." Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1534587822628017.
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Vivanti, Angela Patricia. "Screening and identification of dehydration in older people admitted to a geriatric and rehabilitation unit." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16635/.
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The diagnosis of dehydration in the older person admitted to hospital has been associated with increased morbidity and mortality. In spite of the high US hospital mortality and morbidity rates associated with dehydration (although presumably not the only contributing factor), no standardised or validated approach to assess or easily screen for dehydration in the hospital setting is reported in the international literature. Therefore, a series of studies was undertaken to assess the extent of this, and to identify other gaps in the current literature. The first study estimated the dehydration prevalence amongst older people upon admission to geriatric and rehabilitation unit in the Australian setting to estimate the morbidity burden in the Australian context. The second study assessed the application of dilution and bio-electrical impedance (BIA) techniques as alternative means to assess dehydration in the clinical setting. The third study undertook to validate against total body water the parameters required to confirm dehydration and to identify those that contribute little to discrimination. The final study integrated the information from the first two studies to identify a clinically practical, sensitive and specific screen suitable for the identification of those at risk of dehydration in a geriatric and rehabilitation unit. Older people aged 60 years or over admitted to the Geriatric and Rehabilitation Unit (GARU) of a tertiary teaching hospital in Brisbane. Australia, were eligible for participation in the study. Individuals were excluded if: involuntarily admitted, informed consent was not obtained, younger than 60 years or fitted with a pacemaker (due to contraindication with the use of BIA). Of 82 GARU participants approached, 43 fulfilled the inclusion criteria and consented, 21 declined and 18 were ineligible. Thirty-five (35) of the 43 were able to be involved in the assessment of prevalence. The studies in this thesis provide original insights into dehydration including prevalence, body water contents, useful clinical assessment and screening parameters. Results showed that dehydration prevalence amongst older people is substantially underreported in the Australian geriatric and rehabilitation unit setting (17.1%) when compared to the reported through coding from the medical record (5.3%). The presence of dehydration has frequently been measured in healthy populations by assessing total body water loss through short-term weight change. Gold standard dilution and bio-electrical impedance techniques were used to assess body water as the assessment of dehydration by weight change has practical and ethical limitations in the clinical setting for either research or assessment applications. Gold standard dilution studies and the bio-electrical impedance technique were not confirmed to be either practical or valid alternates to assess dehydration in the clinical setting. Weight and body mass index (BMI) confounded the association between body water and dehydration. Good agreement (78-87%) of global clinical dehydration assessment (clinical assessment) was confirmed between the study's medical officer and the consultants of the Geriatric and Rehabilitation Unit (GARU) and thus become the alternate dependant variable. Although the optimal combination of parameters for clinical dehydration assessment was unable to be elucidated, clinically significant changes upon mild dehydration were more apparent with physical as opposed to biochemical parameters. BMI confounded the association between dehydration and some physical measurements, such as the drop in systolic blood pressure on standing and skin turgor. Of all the clinical assessment and screening variables explored, tongue dryness was validated and represents a practical, sensitive (64%) and specific (62%) dehydration screen suitable for use with all older people in a geriatric and rehabilitation unit setting. Dehydration was established to be more prevalent amongst older Australians admitted to hospital than previously acknowledged or identified by hospitals. The finding identifies dehydration as a significant clinical issue considering the ageing Australian population, limited health resources and the association of dehydration with increased morbidity and mortality. The validation of the simple dehydration screen will contribute to the identification and treatment of dehydration. Although the highest sensitivity and specificity is always desired for screening, it is not always achieved. Moderate sensitivity results in more people being identified at risk by the screen than confirmed to be dehydrated through clinical assessment. Moderate specificity results in the screen's failure to identify those who would be clinically assessed with dehydration. Moderate sensitivity and specificity necessitates the assessment of more people than those with the condition and results in other people with the condition of interest not being identified. Each situation is reduced with increasing levels of sensitivity and specificity. A valid and simple dehydration screen provides future opportunities to confirm improved clinical (prevent adverse events, improve or stabilise disease), cost (reduce intensity of care, hospital stay) and client (death, disability) outcomes as a result of improved identification and timely and appropriate treatment. New insights are provided into individual clinical assessment measures as well as valid and reliable screening. A number of recommendations and future dehydration studies are discussed. The key recommendation for future studies is to discern between intracellular and intravascular volume depletion to enable investigation of an homogenous sample. Further studies are needed to also establish optimal dehydration prevention methods (e.g. awareness and positioning of fluids, beverage carts) and provide evidence that hydration support enhances primary (e.g. morbidity and mortality) and secondary (e.g. cognitive or functional measures, quality of life) health outcomes. Through responsive systems in health delivery, dehydration amongst older hospitalised people can be identified, better managed if present, and avoided with suitable treatment.
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Knott, Linda. "Exploring the acceptability and usefulness of the Impact of Symptoms Questionnaire (IoSQ)." Thesis, University of Exeter, 2013. http://hdl.handle.net/10871/15089.
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Background: Clinical and physiotherapy professional guidelines advocate enquiry into, and documentation of the impact of musculoskeletal pain on a range of psychosocial and functional aspects of life. However, there is no clinical tool to assist this process. The Impact of Symptoms Questionnaire (IoSQ) is patient-completed and was developed to meet the needs of outpatient physiotherapists. It explores the impact of health conditions on patients’ beliefs/concerns and their ability to undertake work/caring responsibilities and activities of daily living; and to enjoy their usual hobbies or activities. It also enquires into the impact on mood and relationships. It comprises a “Yes” or “No” response for each of the five domains with the option of providing written comments. There are also four numerical rating scales. A discharge version determines if patients’ needs and expectations have been addressed. However, the acceptability and usefulness of the IoSQ has not been explored in a department naive to its development. Project purpose Two studies were undertaken, to explore: the role of the IoSQ for enhancing documentation of psychosocial and functional assessment; and the perceptions of staff and patients regarding the acceptability and clinical value of the IoSQ Research questions Enquiry into the primary research question, “Is the introduction of the Impact of Symptoms Questionnaire to a physiotherapy outpatient department acceptable and clinically useful for patients and staff?” was undertaken through secondary questions which explored: patients’ experiences of psychosocial and functional assessment before and after the introduction of the IoSQ; the role of the IoSQ for the provision of documentation; evidence for staff and patients engaging with the IoSQ; and staff and patients’ experiences of using the IoSQ. Project design and methods: A pragmatic mixed model project was undertaken in a department comprising predominantly post-surgical orthopaedic patients. Study 1 explored current practice; study 2 explored the impact of introducing the IoSQ, with minimal training as to its role or use. Methods for both studies comprised sequential audits of patients’ notes, and surveys and focus groups for patients and staff. Results: The audits (study 1, n=60; study 2, n=55) highlighted that documentation by physiotherapists for assessing the impact across all five domains remained low at about 20%, with 40% of the notes in both studies not providing evidence of enquiry into any of the domains. Only one set of notes provided physiotherapist evidence that a domain was still affected at discharge. Study 2 showed that patients consistently completed the IoSQ with 62.6% of the domains being affected at assessment and 19% of the domains being unresolved at discharge, affecting 64.1% of the patients. Survey feedback (study 1, n=19/60; study 2, n=33/55) identified that patients felt it was important to assess the broader impact of a health problem and staff and patients indicated that the IoSQ was relevant to the presenting conditions and was easy to use. This was further explored in the three focus groups (patients, n=3 studies 1 and 2; physiotherapists n=8, study 2) where frustration with validated outcome questionnaires in current use was expressed. However, patients felt they took responsibility for raising issues, even when the IoSQ was provided. Patients and staff felt that if physiotherapists were able to engage with the IoSQ better, it could help to provide structure and prompts to identify patients’ questions or concerns about their condition and the functional impact. The potential for patients to describe the impact in their own words was particularly valued as well as its potential, to improve rapport and more effectively match expectations It was also demonstrated that the IoSQ can enhance documentation of the impact of health problem - from the patient’s perspective. Conclusion: Patients engaged well with the IoSQ and it has potential to be a useful tool to facilitate identification and discussion of the broader psychological, social and functional impact of a health problem. However, staff would need additional training to facilitate discussion with the completed forms and patients, and further research would be required to determine its impact on patient outcomes.
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Cress, Eileen M., O. G. Wooliver, L. T. Evans, C. M. DePaoli, J. M. Stafford, and W. Andrew Clark. "Assessment Of Using A Life-Logging Wearable Camera As A Tool For Determining Dietary Intake In Free Living Non-Communicative Individuals." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/2514.
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Isele, Dorothea Regina [Verfasser]. "The role of Adverse Childhood Experiences (ACEs) in clinical disorders : A new assessment tool and evaluation of links with borderline personality symptoms / Dorothea Regina Isele." Konstanz : Bibliothek der Universität Konstanz, 2016. http://d-nb.info/1112605045/34.
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Martin, Jenine M. "Corelations between the SCAN-C test for auditory processing disorders in children-revised and the clinical evaluation of language fundamentals, third edition language assessment tool." Cincinnati, Ohio : University of Cincinnati, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=1054742639.
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MARTIN, JENINE M. "CORRELATIONS BETWEEN THE SCAN-C TEST FOR AUDITORY PROCESSING DISORDERS IN CHILDREN-REVISED AND THE CLINICAL EVALUATION OF LANGUAGE FUNDAMENTALS, THIRD EDITION LANGUAGE ASSESSMENT TOOL." University of Cincinnati / OhioLINK, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1054742639.
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Gaete, Celis María Isabel [Verfasser], and Manfred [Akademischer Betreuer] Cierpka. "EMOTIONAL BODILY EXPERIENCE, DEPRESSIVITY AND EATING DISORDER SYMPTOMS. THE ROLE OF CULTURE. A new Assessment Tool for Clinical Applications. / María Isabel Gaete Celis ; Betreuer: Manfred Cierpka." Heidelberg : Universitätsbibliothek Heidelberg, 2017. http://d-nb.info/1180985265/34.
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May, L. "Towards developing an outpatient assessment tool of LSL that incorporates clinical evaluation and the impact on patient and family in terms of Health Related Quality of Life." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1532786/.
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Introduction: There is wide variation in how lumbosacral lipoma (LSL) is assessed in the clinical setting; furthermore, there is little data regarding the impact that LSL has on the Health Related Quality of Life (HRQL) of children. Secondly, there is limited information regarding the relationship between LSL type, and clinical and HRQL outcomes. This thesis aims to: 1. Develop an assessment tool for use in the out-patient setting, which would provide a standardised method by which to objectively assess outcomes of interventions including surgery, and allow comparison and audit across different neurosurgical units. 2. Identify the key HRQL factors that affect the child and parent. 3. Identify if there is a relationship between LSL type, and clinical and HRQL outcomes. Method: 1. A systematic review was undertaken to identify the assessment criteria in children with LSL. 2. A cross sectional analysis of a cohort of 54 children with LSL aged between 5 and 18 years of age was performed. 3. The results from points 1 and 2 were combined to develop an objective assessment tool. 4. HRQL was assessed using a number of generic questionnaires and by asking the children and parents directly, what was important to them in terms of their disease. The results were combined to ensure all aspects of the impact of LSL were identified, including the effect of the disease on the well-being of parents. 5. The relationship between LSL type, and clinical and HRQL outcomes was systematically analysed in a cohort of 54 children, to examine the association between these symptoms and the type of LSL. Results: 1. It was evident from the systematic review that there was no consistency in the literature regarding assessment methods for this group of children. Based on this review and the prospective study, an objective tool was developed that can be easily useable in the clinical setting. 2. The clinical issues most significantly associated with HRQL were mobility, pain and urology. Urology issues were not identified by self-report from the questionnaire results, but from verbal self-reporting. 3. The transitional group have a higher risk of clinical abnormalities and deterioration and the dorsal group the least, in the majority of clinical outcomes. There was a trend for children with transitional lipomas to have a lower HRQL and the dorsal group to have the highest HRQL, on the majority of measures. Discussion: In addition to a standardised clinical assessment tool, an appropriate HRQL questionnaire and a standardised pain assessment tool will be utilised to provide a holistic assessment of children with LSL. The study results suggest children could be risk stratified according to LSL type, with more intensive initial investigations and potential interventions in children with transitional lipomas.
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Gilbert, Annie. "Élaboration et évaluation d’un test de concordance de script pour mesurer le raisonnement clinique infirmier relatif à l’usage optimal des médicaments en centre d’hébergement." Mémoire, Université de Sherbrooke, 2015. http://hdl.handle.net/11143/6864.
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Résumé : L’administration de la médication en centre d’hébergement (CH) constitue une activité qui amène l’infirmière à résoudre des problèmes complexes dans un contexte d’incertitude. Elle exige un raisonnement clinique rigoureux pour lequel il n’existe pas d’instrument de mesure valide et fidèle. Le but de cette étude était d’élaborer un test de concordance de script (TCS) pour mesurer le raisonnement clinique infirmier relatif à l’usage optimal des médicaments en CH et pour documenter sa validité et sa fidélité.
Après l’optimisation, le TCS comprenait 55 items répartis dans 20 vignettes cliniques. Il a été mis à l’essai auprès d’étudiantes en sciences infirmières (n=76) et d’infirmières expertes (n=10). Le test a été rempli une seconde fois (test-retest) par 35 étudiantes. La moyenne des scores obtenue par les étudiantes novices est de 55,6 ± 7,7 tandis que celle obtenue par les infirmières expertes est de 63,7 ± 8,0. Les tests statistiques appliqués ont démontré une différence significative dans la moyenne des deux groupes (p < 0,02). La valeur du coefficient alpha de Cronbach de l’ensemble du TCS est de 0,65. Un coefficient de corrélation intraclasse (CCI) a été calculé pour évaluer la stabilité temporelle de l’instrument de mesure. Son résultat est de 0,618 (p = 0,000).
Le TCS conçu dans le cadre de cette étude a besoin d’être modifié afin d’obtenir un meilleur indice de fidélité. Les autres résultats statistiques démontrent que le TCS est capable de distinguer les niveaux d’expertise. Cette étude vient s’ajouter aux autres études ayant évalué le raisonnement clinique et confirme l’importance de suivre les directives fondées sur les données probantes pour développer un TCS.Abstract : The administration of prescribed medication in long-term care facilities is a task that requires the nurse to solve complex problems in a context of uncertainty. It demands a rigorous clinical reasoning for which there is no valid and reliable measurement tool. The purpose of this study was to develop a script concordance test (SCT) to measure nursing clinical reasoning regarding the optimal use of medication in long-term care facilities and to document its validity and reliability. After optimization, the SCT was made up of 55 items divided in 20 clinical vignettes. It has been tested on nursing students (n = 76) and expert nurses (n = 10). The test was completed a second time (test re-test) by 35 students. The mean score obtained by the novice students is 55.6 ± 7.7 while the one obtained by the expert nurses is 63.7 ± 8.0. The applied statistical tests showed a significant difference in the average of the two groups (p < 0.02). The Cronbach alpha coefficient for the entire SCT is 0.65. An inter-class correlation coefficient (ICC) was calculated to assess the temporal stability of the measuring tool. The result is 0.618 (p = 0.000). The SCT developed as part of this study needs to be modified in order for it to be more reliable. The other statistical results demonstrate that the SCT is able to differentiate between levels of expertise. This study adds to previous studies that evaluated clinical reasoning and confirms the importance of following guidelines that rely on evidence-based data to develop a SCT.
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Horsman, Susan. "Symptoms and quality of life assessment in ambulatory oncology: the evaluation of a clinical assessment tool." Master's thesis, 2009. http://hdl.handle.net/10048/570.
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This study addressed gaps in the literature regarding the lack of information about the degree and extent of the relationships among symptom burden, specific symptoms, and health-related quality of life (HRQL). The sample included 89 adults receiving care for colorectal cancer in an outpatient setting. Data for this cross-sectional study were collected over a four month period using the Modified Ambulatory Care Flow Sheet (MACFS), the Rotterdam Symptom Checklist- Modified, numerical rating scales for pain and coping, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30. Results showed that the MACFS was reasonably valid and internally consistent and that symptom burden and number of symptoms were significantly abut weakly correlated with HRQL. Specific symptoms most significantly correlated with HRQL were insomnia, fatigue, pain, nausea and vomiting. Findings support the use of the MACFS to assess symptoms and HRQL in the study population.
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Horsman, Susan Elisabeth Anne. "Symptoms and quality of life assessment in ambulatory oncology the evaluation of a clinical assessment tool /." 2009. http://hdl.handle.net/10048/570.
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Thesis (M.N.)--University of Alberta, 2009.A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Nursing, Faculty of Nursing. Title from pdf file main screen (viewed on September 20, 2009). Includes bibliographical references.
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CHENG, I.-TING, and 鄭伊婷. "Develop a Kinect-Based Computer Assessment Tool for Clinical Observation of Postural Movement." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/21944331579474735146.
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碩士國立臺中教育大學
教育資訊與測驗統計研究所碩士在職專班
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This study investigates how Kinect body sensors could be used for clinical observation on sensory integration. The participants were 218 four to six year-old preschoolers who were assessed for their abilities under three categories, namely, prone extension posture, supine flexion and balance, by using a Kinet-based skeleton tracking system. The data were analyzed by using the predictions and classification functions of artificial neural network. A standard of evaluation index was developed based on the assessment data and the ratings of specialists were set as the criterion. A computer assessment rating system for the clinical observation of sensory integration functions was developed to attain automatic detection, shorten the assessment time and increase cost effectiveness. The results can be summarized as follows: 1.There was a significant gender difference in two assessment categories, prone extension posture and balance, where the girls were found to perform better than the boys. In constrast, there was no significant gender difference in supine flexion. 2.A significant age difference was found in supine flexion. The results showed that the participants in each age group behaved differently. There was no significant age difference for prone extension posture and balance. 3.The measures of reliability, including the accuracy rates of clinical observation for the three assessment categories (75.41% to 92.59%), the correlation coefficients (0.4578 to 0.8454) and the kappa coefficients (0.4999 to 0.8801), all demonstrated that a high consistency between our computerized assessment tool and the ratings of specialists was attained
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Franco, Camila Ament Giuliani dos Santos. "Clinical Communication Skills: The Use of Portfolio as a Tool for Learning and Assessment." Tese, 2019. https://hdl.handle.net/10216/121185.
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Franco, Camila Ament Giuliani dos Santos. "Clinical Communication Skills: The Use of Portfolio as a Tool for Learning and Assessment." Doctoral thesis, 2019. https://hdl.handle.net/10216/121185.
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Mokebe, Kozana David. "Life Cycle Assessment (LCA) technique as a holistic tool for environmental impact and economic analysis of a co-pulping process." Diss., 2008. http://hdl.handle.net/2263/28144.
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As the pressure on the chemical and process industries to improve environmental and economic performance increases, the need to move away from narrow system definitions and concepts in environmental system management is becoming more apparent. Life Cycle Assessment (LCA) has been a gaining wider acceptance as a holistic tool that enables quantification of environmental interventions and evaluation of the improvement options throughout the life cycle of process, product or activity. The stringent environmental legislation, especially in developing countries has warranted the need for intensive research in this field. Moreover, the capital cost for mitigation of emissions have put enormous pressure on the industries to reduce the overall process economic performance. This has not exempted the Pulp and Paper industry, being the producers of highly variable emissions quality and quantity are the prime candidates for the application of the technique. The application of the LCA in process selection has been necessitated by the fact that sometimes a technology intended to reduce wastes has created unanticipated impacts in other media and/or stages of the life cycle. Thus, LCA has been developed as a means to identify and deal with these impacts before they can occur. It differs from other pollution prevention techniques in that it views all the resource and energy inputs to a product (Life Cycle Inventory), as well as the associated wastes, health and ecological burdens (Impact Assessment), and evaluates opportunities to reduce environmental impacts (Improvement Analysis) from cradle to grave. LCA is often confused with other assessment tools, such as life cycle cost (LCC) or sometimes referred to as "environmental life cycle costing." This study was conducted at Mondi Packaging South African-Piet Retief Mill, a producer of linerboard, since this site has ample opportunity to minimse the environmental burden presented by operation of both Copeland Reactor and Boilers with significant emissions of SOx and NOx, and water effluent. The current mill strategy that is based on tight procurement specification of raw material is unsustainable. The environmental and economic performance analysis for this study followed from a mass balance of the pulp plant, power station, and paper machine as well as black liquor incinerating plant, and it was found that the most significant emissions come from pulp and steam generating processes. These emissions can be reduced by improving the mill energy efficiency and optimizing the Copeland scrubber absorption efficiency. The optimization of the Copeland scrubbing system will surely lead to improved environmental performance, however, the furnace stacks have to be modified to include the scrubbing system for absorption of SOx and NOx.Dissertation (MEng (Chemical Engineering))--University of Pretoria, 2008.
Chemical Engineering
unrestricted
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Ahmed, Sharif. "Automation of a DXA-based finite-element tool for clinical assessment of hip fracture risk." 2016. http://hdl.handle.net/1993/31886.
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Dual Energy X-ray Absorptiometry (DXA)-based finite element (FE) modelling has emerged as a potential tool for better assessment of osteoporotic hip fracture risk. Automation of this complex and computationally-intense procedure is the prime requirement for its clinical applicability. The aim of this study was to develop a fully automatic DXA-based finite element tool and assess its discrimination ability and short-term repeatability. The proximal femur was automatically segmented from clinical hip DXA scan and the subject-specific FE model was constructed for simulating sideways fall. Hip fracture risk indices (HFRIs) were calculated using two ways (along a femur cross-section and over a region of interest, ROI). Hip fracture discriminability increased when moved from femur cross-section based to ROI based HFRI calculation. A significant increase in hip fracture discriminability from baseline femoral neck and total hip bone mineral density (BMD) was achieved with ROI based HFRIs. Promising short-term repeatability was observed for HFRIs (coefficient of variation, CV, 3~3.5%). After removing representative poor cases, CVs were less than 3%. These preliminary results establish the potential of the proposed automatic tool for hip fracture risk assessment and justify large-scale clinical evaluation of its ability to predict incident hip fractures.February 2017
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Kalsi-Ryan, Sukhvinder. "The Quadriplegia Hand Assessment Tool (Q-HAT): The development of a clinical assessment measure of the hand for the cervical spinal cord injured individual." 2006. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=442137&T=F.
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"The use of hypertonic saline challenge and sputum induction as an assessment tool in clinical studies in paediatric asthma." 2005. http://library.cuhk.edu.hk/record=b5896399.
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Tsang Wing Tai.Thesis (M.Phil.)--Chinese University of Hong Kong, 2005.
Includes bibliographical references (leaves 132-157).
Abstracts in English and Chinese.
Contents --- p.i
Abstract - English --- p.iv
Abstract - Chinese --- p.vi
Statement of Originality --- p.viii
Acknowledgements --- p.ix
List of Figures --- p.x
List of Tables --- p.xii
Abbreviations --- p.xiii
Chapter Chapter 1: --- Objectives and planning of studies in this thesis --- p.1
Chapter Chapter 2: --- Literature Reviews
Chapter 2.1 --- Definition of asthma --- p.2
Chapter 2.2 --- Diagnosis and classification of asthma in children --- p.5
Chapter 2.3 --- Assessment of asthma in school-age children --- p.7
Chapter 2.4 --- The use of HSCSI in clinical trial --- p.27
Chapter 2.5 --- Problems of sputum induction in children --- p.32
Chapter 2.6 --- Conclusion --- p.34
Chapter Chapter 3: --- HSCSI - Methodology and Materials
Chapter 3.1 --- Introduction --- p.35
Chapter 3.2 --- HSCSI - Methodology --- p.37
Chapter 3.3 --- Protocol for combined HSCSI --- p.45
Chapter 3.4 --- Practical considerations in HSCSI --- p.49
Chapter 3.5 --- Expression of airway response --- p.50
Chapter 3.6 --- Safety issue in HSCSI --- p.52
Chapter 3.7 --- Approach in our studies --- p.54
Chapter 3.8 --- Sputum processing --- p.55
Chapter 3.9 --- Interpretation of sputum differential cell counts --- p.68
Chapter 3.10 --- Conclusion --- p.73
Chapter Chapter 4: --- Factors predicting successful sputum induction
Chapter 4.1 --- Introduction --- p.74
Chapter 4.2 --- Methods --- p.76
Chapter 4.3 --- Results --- p.80
Chapter 4.4 --- Discussion --- p.82
Chapter 4.5 --- Conclusion --- p.88
Chapter Chapter 5: --- Use of once-daily fluticasone propionate in children with stable asthma -Study on airway inflammatory markers
Chapter 5.1 --- Introduction --- p.89
Chapter 5.2 --- Methods --- p.92
Chapter 5.3 --- Results --- p.97
Chapter 5.4 --- Discussion --- p.101
Chapter 5.5 --- Conclusion --- p.105
Chapter Chapter 6 --- Assessment of cough frequency in children with stable asthma -Study on airway inflammatory markers
Chapter 6.1 --- Introduction --- p.106
Chapter 6.2 --- Cough Monitoring Machine LR 102 --- p.109
Chapter 6.3 --- Methods --- p.114
Chapter 6.4 --- Results --- p.119
Chapter 6.5 --- Discussion --- p.123
Chapter 6.6 --- Conclusions --- p.127
Chapter Chapter 7 --- Overall summary and conclusion --- p.128
References --- p.132
Appendix I Assessment form 226}0ؤ HSCSI
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Haigh, Jacquelyn, Christine A. Dearnley, and Fiona S. Meddings. "The impact of an enhanced assessment tool on students’ experience of being assessed in clinical practice: a focus group study." 2007. http://hdl.handle.net/10454/14704.
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YesAs part of a CETL funded project (ALPS 2006) 29 student midwives and their link lecturers were given an electronic version of a clinical portfolio on hand held computers (PDAs). These devices were used during an eight week clinical practice placement to record tripartite assessment interviews and to facilitate grading of the placement. Three focus groups conducted at the end of the placement explored the concept of clinical practice assessment and the impact of the electronic portfolio on the students’ experience of clinical practice and its assessment. Data was analysed from an activity theory perspective in that the electronic assessment tool was viewed as an artefact mediating situated knowing about student assessment in a particular socio-historical context. Findings suggest that students perceive clinical assessment as contested with different assessors having different understandings of it. However the electronic devise facilitated changes to the assessment tool. These changes promoted a shared understanding of the assessment process which was pragmatic and acceptable to students and clinicians. The significance of this study is that it highlights the role of assessment tools in creating a shared understanding of the assessment process rather than simply articulating that understanding.
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Xaba, Nompumelelo Pearl. "The assessment of the facilitation of the clinical training component of an undergraduate nursing programme at a University of Technology." Thesis, 2015. http://hdl.handle.net/10321/1319.
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Submitted in fulfillment for the requirements of M Technology : Nursing, Department of Nursing, Durban University of Technology, Durban, South Africa, 2015.Background All nursing students need to undergo clinical training for them to be competent practitioners when they qualify. According to the South African Nursing Council (SANC) training facilities are accredited only if the clinical training component is effective. Therefore, it is important that students are accompanied in order for them to grow professionally and have values as future health care professionals. In nursing education, a student throughout the nursing training course receives instruction both theoretically and clinically in the subjects prescribed in the curriculum by the SANC. Clinical instruction is effected through clinical teaching and learning, which is a requirement by the nursing regulatory body, the SANC. For an undergraduate programme a student has to spend a minimum of 1000 hours per year in clinical placement to meet programme outcomes. It is the responsibility of all nursing schools, colleges and universities to ensure that each student meets these requirements. For this to be effective it has to be facilitated by lecturers and clinical instructors, through teaching and learning strategies to enable students to perform the clinical skill with knowledge and eventual competence. Therefore, clinical instructors are there to ensure that the students are competent in all skills, such as cognitive, affective as well as psychomotor skills. This will be beneficial to the programme in reduction of rates of failure and dropout and again by producing competent practitioners. A positive relationship and collaboration between the clinical training institutions and clinical placement facilities is vital for student achievement, especially because the clinical instructors assist students in correlating theory and practice. This study sought to assess the clinical training component of an undergraduate programme at this UoT in KwaZulu Natal. Findings may inform an improved clinical instruction programme as no such study had been undertaken. Methods A qualitative and quantitative design was used to explore feelings, perceptions as well as experiences of staff and student nurses with regard to clinical training component. Stratified random sampling was used to select student nurses according to levels of training and questionnaires were used to collect data. All permanently employed staff who had been working over six months were selected since they were directly or indirectly involved in the clinical facilitation. A focus group interview was conducted for the clinical instructors and questionnaires were used for the lecturers to collect data. Themes and sub-themes emerged and on analysis they were compared to the findings from the quantitative survey. Results and discussion The results revealed that collaboration of clinical placement facilities and training institutions is important for student’s support since all parties are able to communicate freely and students benefit. Students stated that they did not get enough support since the clinical facilitators were short staffed and they were also allocated to facilities that were far from the campus. The respondents cited problems during clinical accompaniments as there were very high expectations by staff members in the placement areas regarding student support. Lecturers were also expected to involve themselves in clinical accompaniment to bridge theory-practice gap. The employment of mentors will assist in student support as the mentors will be at placement areas and the staff and students easily contact them. Conclusion From the interviews the researcher managed to come up with important aspects that should be included in an accompaniment tool when developed, which should be user friendly to both lecturers and clinical facilitators. It will thus assist students with critical skills including critical thinking when performing any patient related nursing skill. It was recommended that the UoT management support staff by attending to their concerns including finding more clinical placement facilities close to the campus.
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Silva, André Eduardo Rebolo da. "Utilização de uma ferramenta informática no planeamento cirúrgico de implantes dentários : SAC Assessment Tool." Master's thesis, 2017. http://hdl.handle.net/10400.14/23923.
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A SAC Assessment Tool é uma ferramenta informática lançada pelo International Team for Implantology em 2007 com o objetivo de auxiliar os Médicos Dentistas no diagnóstico e no plano de tratamento de uma reabilitação com implantes dentários. Neste estudo, foi utilizada a vertente de avaliação cirúrgica desta ferramenta informática, em pacientes eventualmente candidatos a uma reabilitação com implantes dentários, com os seguintes objetivos: analisar e caraterizar a desdentação parcial e validar esta ferramenta informática enquanto sistema de suporte à decisão clínica.
Numa primeira fase, efetuou-se uma análise descritiva das zonas desdentadas de pacientes desdentados parciais da Clínica Universitária, particularmente ao nível da classificação da desdentação parcial de Kennedy e do American College of Prosthodontics, utilizando a SAC Assessment Tool.
Numa segunda fase, foram selecionados de forma aleatória 30 casos clínicos, dos quais foram recolhidos dados da anamnese, modelos de estudo, fotografias intra-orais e radiografias panorâmicas. Todos os dados foram analisados, com e sem acesso à SAC Assessment Tool por um Médico Dentista que se considerou como “Gold-standard” para efeitos de análise comparativa, e por um grupo de três Médicos Dentistas com experiência clínica e formação pós-graduada inferior. Os dados foram analisados através dos testes de concordância estatística – teste estatístico K (Fleiss Kappa), coeficiente de inter-relação de classes (ICC) e proporção de concordância. Obtiveram-se então os seguintes resultados: maior prevalência de indivíduos na faixa etária dos 56-83 anos (63,32%) e medicamente comprometidos (53,00%); 51,66% dos casos são Classes III de Kennedy na arcada superior e 40,00% são Classes I de Kennedy na arcada inferior; a Classe IV de desdentação parcial é a mais prevalente (65,00%); apenas 22,00% dos pacientes apresentam uma boa higiene oral; 50,66% dos casos são de grau de complexidade elevado, 30,66% são de grau intermédio e 18,66% de grau baixo. Há um aumento significativo de concordância quando os Avaliadores comparados com um perito, utilizam a SAC para realizar o diagnóstico de diversas áreas desdentadas, mostrando que a SAC é uma ferramenta bastante útil e eficaz para utilização na prática clínicaThe SAC Assessment Tool is an informatics software launched by the International Team for Implantology in 2007 aiming to help dentists in the diagnose and treatment plan in an oral rehabilitation with dental implants. The current study evaluated the surgical assessment of the SAC Assessment Tool with the main objective of analyse and characterize the partial edentulism and validate the informatics tool as a clinical decision support system. In the 1st phase, was performed a descriptive analysis of the partial edentulous patients at the University Clinic using the SAC Assessment Tool. In the 2nd phase, were random selected 30 clinical cases and clinical records, study models, intra and extra-oral photos and panoramic radiographies were obtained. All data were analysed with and without SAC Assessment Tool by a “Gold-standard” and compared with 3 reviewers with clinical experience and postgraduate qualification. All data were analysed using statically agreement tests (Fless Kappa), inter-class correlation (icc) and agreement rate. The following results were obtained: there was a major prevalence of individuals with higher age (56-83 years) – 63,32% and medical status compromised 53,00%; 51,66% of the clinical cases were superior Kennedy’s Class III and 40,00% were inferior Kennedy’s Class I; As regards the Classification of Partial Edentulism, Class IV were the most prevalent (65,00%); only 22,00% of the patients had a good oral hygiene; 50,66% were Complex cases, 30,66% were Advanced and 18,66% were Straightforward. There was a higher agreement when Reviewers and Gold standard use the SAC Assessment Tool and compared their evaluation. The results showed that the SAC Classification is a very useful informatics tool that helps in clinical practice.