Confidence In Clinical Practice Research Articles

Deep Learning Approaches for Imaging-Based Automated Segmentation of Tuberous Sclerosis Complex

The present study presents a novel approach for identifying epileptogenic tubers in patients with tuberous sclerosis complex (TSC) and automating tuber segmentation using a three-dimensional convolutional neural network (3D CNN). The study retrospectively included 31 TSC patients whose lesions were manually annotated from multiparametric neuroimaging data. Epileptogenic tubers were determined via presurgical evaluation and stereoelectroencephalography recording. Neuroimaging metrics were extracted and compared between epileptogenic and non-epileptogenic tubers. Additionally, five datasets with different preprocessing strategies were used to construct and train 3D CNNs for automated tuber segmentation. The normalized positron emission tomography (PET) metabolic value was significantly lower in epileptogenic tubers defined via presurgical evaluation (p = 0.001). The CNNs showed high performance for localizing tubers, with an accuracy between 0.992 and 0.994 across the five datasets. The automated segmentations were highly correlated with clinician-based features. The neuroimaging characteristics for epileptogenic tubers were demonstrated, increasing surgical confidence in clinical practice. The validated deep learning detection algorithm yielded a high performance in determining tubers with an excellent agreement with reference clinician-based segmentation. Collectively, when coupled with our investigation of minimal input requirements, the approach outlined in this study represents a clinically invaluable tool for the management of TSC.

Does a preterm labor-assessment algorithm improve preterm labor-related knowledge, clinical practice confidence, and educational satisfaction?: a quasi-experimental study.

Preterm birth is increasing, and obstetric nurses should have the competency to provide timely care. Therefore, training is necessary in the maternal nursing practicum. This study aimed to investigate the effects of practice education using a preterm-labor assessment algorithm on preterm labor-related knowledge and clinical practice confidence in senior nursing students. A pre-post quasi-experimental design with three groups was used for 61 students. The preterm-labor assessment algorithm was modified into three modules from the preterm-labor assessment algorithm by March of Dimes. We evaluated preterm labor-related knowledge, clinical practice confidence, and educational satisfaction. Data were analyzed with the paired t-test and repeated-measures analysis of variance. The practice education using a preterm-labor assessment algorithm significantly improved both preterm labor-related knowledge and clinical practice confidence (paired t=-7.17, p<.001; paired t=-5.51, p<.001, respectively). The effects of the practice education using a preterm-labor assessment algorithm on knowledge lasted until 8 weeks but decreased significantly at 11 and 13 weeks after the program, while the clinical practice confidence significantly decreased at 8 weeks post-program. The practice education using a preterm-labor assessment algorithm was effective in improving preterm labor-related knowledge and clinical practice confidence. The findings suggest that follow-up education should be conducted at 8 weeks, or as soon as possible thereafter, to maintain knowledge and clinical confidence, and the effects should be evaluated.

Concepts of Designing and Implementing Pharmacoepidemiology Studies on the Safety of Systemic Treatments in Dermatology Practice

The U.S. Food and Drug Administration and clinical guidelines use evidence from pharmacoepidemiology studies to inform prescribing decisions and fill evidence gaps left by randomized controlled trials (RCTs). The long-term safety and infrequent adverse reactions are not well-understood when RCTs are short and involve few patients, as is the case for most systemic immunomodulating drugs in dermatology. A better understanding of the design and implementation of pharmacoepidemiology studies will help practitioners assess the accuracy of etiologic findings and use them with confidence in clinical practice. Conducting pharmacoepidemiology studies follows a structured approach, which we discuss in this article: (i) a design layer connects the research question with the appropriate study design, and considering which hypothetical RCT one ideally would want to conduct reduces inadvertent investigator errors; (ii) a measurement layer transforms longitudinal patient-level data into variables that identify the study population, patient characteristics, treatment, and outcomes; and (iii) the analysis focuses on the causal treatment effect estimation. The review and interpretation of pharmacoepidemiology studies should consider issues beyond a typical review of RCTs, chiefly the lack of baseline randomization and the use of secondary data. Well-designed and well-conducted pharmacoepidemiologic studies complement dermatology practice with critical information on prescribing systemic medications.

South African speech-language therapists’ practices regarding feeding tube placement in people with advanced dementia

Studies related to tube feeding in people with dementia (PWD) remain a contested topic, neglecting the importance of speech-language therapists' (SLTs) role in dysphagia management. Furthermore, SLT practices and beliefs regarding tube feeding in people with advanced dementia in an upper-middle-income country, such as South Africa, are unexplored. This study aimed to determine the practices and beliefs of SLTs in South Africa regarding tube feeding placement in PWD. A self-compiled online survey was distributed using social media platforms and was completed by 83 South African SLTs with experience in swallowing and feeding management of PWD. Most SLTs (78.8%) strongly believed they play a vital role in the decision-making regarding feeding tube insertion in PWD. This role is often met with several challenges, such as limited support from other healthcare professionals. Speech-language therapists with more experience and increased involvement in palliative care appeared to be more confident in supporting and counselling families of PWD on tube feeding. Many SLTs still recommend tube feeding despite its known negative consequences for PWD. The findings indicate a need for continued professional development for South African SLTs on feeding decisions in advanced dementia to increase knowledge and confidence in clinical practice. Speech-language therapists require guidelines by professional bodies and further dialogue amongst healthcare professionals to guide difficult feeding decisions in people with advanced dementia.

An international survey of assessment and treatment practice for discourse in paediatric Acquired Brain Injury

Purpose Guidelines recommend routine discourse assessment and treatment in paediatric acquired brain injury (ABI) but provide little guidance for clinical practice. The degree to which this has influenced the nature of discourse assessment and treatment in clinical practice has not been examined in detail. Method Speech-language pathologists working in paediatric ABI (clients aged <18 years) in Australia, New Zealand, the UK, the USA, Canada, and the Asia Pacific region were invited to complete a survey of discourse assessment and intervention practices (n = 77). Result Clinicians from Australia and New Zealand comprised over half of a responses (53%). The largest proportion had over 10 years’ experience (60%), worked in the metropolitan area (58%), and with secondary school-age children (64%). Routine discourse assessment was undertaken by 80% of respondents, focussing on a limited range of genres. No preferred intervention approach was identified. One-quarter of clinicians routinely considered holistic factors during clinical decision-making. Limited normative data and treatment evidence, insufficient time and training were identified as clinical barriers. Conclusion Assessment practices were consistent with guidelines, yet interventions were highly variable, reflecting limited evidence, client heterogeneity, time constraints, and limited training. A biopsychosocial approach to practice was evident, yet a focus on impairment level factors was prominent. Findings support the need for standardised discourse assessment and discourse intervention methods. Translation into practice guidelines would promote consistency and confidence in clinical practice.

Learning from patients' written feedback: medical students' experiences.

ObjectivesThis study explores students' experiences of learning based on patients' written feedback, obtained through the Patient Feedback in Clinical Practice (PFCP) questionnaire.MethodsFifty-nine medical students evaluated their learning experience of receiving patients' written feedback obtained from the PFCP questionnaire. Students (N = 57) evaluated their experiences by applying a nine-question evaluation survey (Likert scale N = 3 and free-text questions N = 6) and/or participated in a semi-structured interview (N = 6 students). Data were analyzed using descriptive statistics and qualitative content analysis. ResultsThe analysis of data from the students' evaluation survey was performed using 4-point Likert scale questions presented in mean, SD and range; ability to apply patient-centred communication (3.3, 0.74, 2–4), guidance for further clinical training of clinical skills (3.2, 1.31, 1–4) and visualization of the pedagogical assignment during an encounter (3.0, 1.68, 1–4). A content analysis of the free-text questions from the students' evaluation surveys and interviews resulted in three themes: (1) confidence in clinical practice, (2) application of patient-centred communication and (3) identification of learning needs. ConclusionsThe results indicate that patients' feedback facilitated a reflective self-directed learning process with the identification of learning needs and increased awareness of the patient as a collaborative partner during the encounter. Patients' written feedback adjacent to a patient encounter is identified as a valuable additional learning tool in medical students' workplace learning. Further studies are required to explore how patients' written feedback can be operationalized in different clinical contexts, for example, in in-patient care.

98 ‘AOSim’: A Decision-Making Simulation Course for Acute Oncology Nurses

Simulation-based education (SBE) as a learning tool is becoming more prevalent, as is the recognition of the importance of non-technical skills. With this insight comes a desire to improve clinical practice using these techniques. ‘AOSim’ has arisen from an intrinsic desire to achieve this from within an Acute Oncology Service (AOS). Wishes to improve confidence, decision-making and teamwork have guided the design and implementation of a novel simulation course in this field.The purpose of the course has been guided by the candidates. The hope is to be able to provide a safe learning environment to explore decision-making, improve confidence in clinical practice and strengthen teamwork.The course design was informed by direct stakeholder analysis. Pre-course surveys aided in planning the course and scenario design. The course would run over half a day and comprise three scenarios, each followed by a debrief. The candidates invited were nurses working in the local AOS and the AOS coordinator. Each scenario was designed with a particular focus in mind; ‘Respectful Challenging’, ‘Clinical Prioritisation’ and ‘Treatment Escalation’. The clinical context of the scenarios was based on oncology to provide a familiar environment for the candidates. This would also enable the focus to be paid to the non-technical skills related to the aims of the course. The scenarios were to be run in a high-fidelity setting using a mixture of role players, mannikins and plants. Faculty roles had been assigned prior to the course date.A course overview was sent to the candidates including the planned date for running the course to allow the candidates to plan for handover of their clinical duties; this allowed protected time for the course to run. ‘AOSim’ was run in a simulation suite in the high-fidelity setting with an experienced faculty. The candidates were introduced to the simulated environment and the importance of psychological safety was explained. The three scenarios ran as planned to include subsequent informative debriefs. Immediate and post-course feedback were positive, particularly with increased confidence levels and team-working ability. This has led to aspirations to run the course again for a different candidate group in the future.

The experiences of adult nursing students completing a placement during the COVID-19 pandemic.

The emergency measures implemented by the Nursing and Midwifery Council in response to the COVID-19 pandemic provided nursing students in their final 6 months of study with the opportunity to complete a paid consolidation clinical placement and thus increase their personal responsibility for the care they delivered under supervision. To explore the experiences of third-year nursing students who completed their final clinical placement during the COVID-19 pandemic. Semi-structured interviews were conducted via a virtual platform. Three themes were identified: the importance of support mechanisms, the development of confidence, and innovative learning opportunities. Students reported improved confidence in the transition period to registered practitioner and felt well supported, which enabled them to take greater responsibility. This study provided insight into the experience of nursing students during the COVID-19 pandemic, and found that support mechanisms, and a sense of belonging, helped to increase their confidence in clinical practice.

Musculoskeletal Education: An Assessment of the Value of the American Academy of Pediatrics Musculoskeletal Boot Camp Course in Improving Clinical Confidence of Pediatricians Managing Common Musculoskeletal Conditions

In 2016, the American Academy of Pediatrics Section on Orthopaedics established an annual Musculoskeletal (MSK) Boot Camp course to fill the gaps in MSK knowledge, performance, and outcomes for pediatricians and primary care doctors. A standardized one-day curriculum of key MSK topics was developed including short lectures, hands-on workshops, debates, live webinars, and Q&A sessions. A survey was created to evaluate attendee confidence related to diagnosing 20 common MSK conditions in children and adolescents at the beginning and end of the course. Confidence in diagnosing the conditions was gauged using a 6-point Likert-type scale. A two-sample t test was used to compare overall confidence score pre- and post-seminar. In addition, each subtopic was analyzed. The average pre-seminar confidence score was 3.92 versus 4.86 post-seminar. All categories demonstrated a statistically increased confidence score post-seminar (P < .0001). Live MSK continuing education for pediatricians is effective in improving confidence in clinical practice.

Zircônia ultra translúcida: Revisão de literatura

INTRODUÇÃO: A zircônia ultra translúcida (5Y-PSZ) possui propriedades ópticas superiores comparadas aos sistemas cerâmicos convencionais, proporcionando uma ampla aplicação na Odontologia estética. OBJETIVO: O presente estudo teve como objetivo apresentar informações relevantes sobre a cerâmica 5Y-PSZ. MATERIAL E MÉTODO: Foi realizada uma busca na literatura com artigos que avaliaram especificamente a zircônia ultra translúcida na base de dados PubMed, os artigos selecionados abrangiam o período entre 2010 e 2020, além de utilizar artigos mais antigos a fim de contextualizá-la. RESULTADOS: Os trabalhos selecionados descrevem as propriedades ópticas, mecânicas e aplicações clinicas da 5Y-PSZ. A literatura mostra que a composição química deste material proporciona translucidez maior que as demais zircônias e sua resistência flexural permite seu uso em restaurações unitárias posteriores e anteriores. CONSIDERAÇÕES FINAIS: A adesão não parece um empecilho para indicação desta zircônia em áreas não retentivas, e isso a torna um material promissor para aplicabilidade em laminados cerâmicos adotando-se uma abordagem mais conservadora. No entanto, como a 5Y-PSZ foi desenvolvida recentemente, ainda se faz necessário mais estudos que avaliem suas propriedades e diferentes situações clínicas para que o dentista eleja este material com confiança na prática clínica.

Assessment of a patient-reported outcome measure in men with prostate cancer who had radical surgery: a Rasch analysis

ObjectivesTo evaluate the psychometric properties (and identify specific anomalies to be resolved) of urinary and sexual function scales of the Symptom Tracking and Reporting (STAR) instrument for use in clinical...

A National Pre-Pandemic Survey of Patient-Reported Health Confidence and Implications for Post-Pandemic Practice.

Patient-reported health confidence is a valuable indicator of effective patient-clinician communication, which improves outcomes and reduces costly care use. This national survey examines health confidence attainment in the United States before the COVID pandemic strained health care resources. Health confidence was low for both the percentage of respondents who were financially secure (36%) and financially insecure (18%). Persons enrolled in employer- and union-sponsored plans, who had the highest household income, did not report higher levels of health confidence. Health policy should support the measurement and monitoring of health confidence in clinical practice to improve population health and maximize resource efficiency.

Student midwives' self-assessment of factors that improve or reduce confidence in clinical practice during a 1-year training period in Zimbabwe

Background/Aims Several studies demonstrate that midwifery students do not feel confident in their ability to practice independently post-qualification, both globally and in Zimbabwe. To build competence, it is critical that midwives are encouraged to assess factors that improve or reduce their confidence in clinical practice. This study aimed to explore factors enhancing or reducing midwifery students' confidence in clinical practice in Zimbabwe, following a 1-year training course. Methods A total of 300 midwifery students from 22 government midwifery training schools in Zimbabwe participated in a cross-sectional survey that assessed self-confidence at completion of a 1-year training course. Students responded to the question ‘What factors improved or reduced your confidence in clinical area during training?’ Thematic analysis was used to describe and interpret students' responses. Results The main theme taken from students' answers was that resource availability in the clinical learning environment is key. There were four sub-themes: (1) the midwifery education programme, (2) teaching-learning methodologies, (3) clinical instructor/supervisor professional behaviour, and (4) student fear and insecurity. Conclusions Confidence development is a process to be cultivated and nurtured in students during midwifery training. Student midwives are faced with multiple factors inherent to an unsupportive clinical learning environment, which negatively impacts their confidence. These include shortages of resources and the attitudes and teaching practices of supervisors or instructors. Focus should be given to creating a supporting clinical learning environment, to improve students' confidence and competence.

Experiences of internationally qualified registered nurses enrolled in a bridging program in Australia: A pilot study

BackgroundThe recruitment of internationally qualified registered nurses (IQNs) is one strategy to meet Australia’s healthcare needs. New Australian Standards require some IQNs to complete an approved bridging program run by an eligible higher education institution in Australia. Little is known about the experiences of the IQNs enrolled in these bridging programs or their intention to remain in the workforce. AimThe aim of this pilot study was to investigate the experiences of IQNs enrolled in an approved bridging program and explore their intention to remain and seek employment in the Australian healthcare system. MethodsStudents enrolled in the Graduate Certificate in Australian Nursing program for internationally qualified registered nurses at a regional Australian university were invited to participate. A longitudinal, mixed-methods, exploratory design was used. Participants completed the Six-dimension Scale of Nursing Performance (Schwirian, 1978) and the Casey-Fink Graduate Nurse Experience Survey (Casey et al., 2004) pre, and post-program, and also participated in post-program focus groups. FindingsThe program met participant expectations, provided confidence in clinical practice and perceived competence, particularly in the leadership domain. However, the cultural differences and expectations in nursing and academia experienced by participants require further investigation and intervention. Over time, the participants experienced stress related to social and financial issues, with the greatest concern around gaining employment. All participants indicated their intention to remain and seek employment in the Australian healthcare system. DiscussionIQNs enrolled in approved bridging programs intend to remain in the workforce. Consideration of how to support IQNs experiencing social and financial stress, and achieve successful employment post program is warranted. ConclusionA transition to professional practice program may support the integration of IQNs into the Australian healthcare workforce.

Massage and Medicine: An Interprofessional Approach to Learning Musculoskeletal Anatomy and Enhancing Personal Wellness.

To investigate the impact of a unique curriculum combining learning of surface anatomy and massage therapy for medical and physician assistant students. The authors conducted a randomized controlled trial in 2014 at University of Iowa Carver College of Medicine with 20 first-year students who viewed 4 hours of educational videos and participated in 11 hours of hands-on massage practice and 20 first-year students who only viewed the educational videos. Participants completed pre- and postcourse assessments of knowledge, attitudes, and personal wellness and completed a validated assessment of four dimensions of personal wellness. Hands-on group participants outscored the online-only group in postcourse knowledge assessments of surface anatomy and massage therapy principles (P < .05). Students in the hands-on group reported higher agreement with statements about perceived knowledge and beliefs about referrals and advising patients regarding massage therapy (P < .05). Students also frequently reported greater comfort administering physical examinations. Hands-on group participants had statistically significant improvements in psychological wellness during the study (P = .03), whereas online-only participants had a slight decrease (P = .09). Physical wellness was also slightly improved in the hands-on group (P = .06). Findings show that integrating surface anatomy and massage therapy in an experiential course resulted in significant gains in knowledge of anatomy, understanding about interprofessional health care roles, increased confidence in clinical practice, and improved wellness. Accordingly, further development of learning experiences that incorporate basic science, interprofessional education, and techniques that promote student wellness should be encouraged.

Closing the Gap: Experienced Simulation Educators' Role and Impact on Everyday Health care.

Introduction:Trained simulation educators (SEs) usually work both at simulation centers and in everyday health care, and thus, they possess dual expertise. Experienced SEs are known to grow confident with their expanding experience, but evidence is scarce about how this affects their development as clinical professionals. The aim of this study was to explore how experienced SEs describe their role within the context of everyday health care.Methods:An explorative descriptive study including 14 semistructured interviews and 27 questionnaires was conducted with 41 experienced SEs. An inductive thematic analysis was used to identify and analyze patterns describing SEs' perceptions of the influence of their educational work on everyday health care.Results:The SEs' descriptions of their encounters during everyday clinical work, which were affected by the fact that they had experience of facilitating simulation training, were gathered into three main themes with three of their own subthemes: education (educational needs, routines/guidelines, and being a resource), nontechnical skills (communication, feedback, and leadership/coworkership), and clinical proficiency (situational insight, role model, and confidence in clinical practice). The insights gained and actions taken as clinical professionals are all intended to be implemented with the ultimate aim of safe patient care.Discussion:All the aspects of the SEs' work are perceived to be successfully translated into clinical practice and can be summarized by the main themes of education, nontechnical skills, and clinical proficiency as delineated by this study. These themes are demonstrated at the individual, team, and organizational levels through increased competence and confidence.

The Portuguese Rheumatoid Arthritis Impact of Disease (RAID) score and its measurement equivalence in three countries: validation study using Rasch Models

PurposeThe Rheumatoid Arthritis Impact of Disease (RAID) score assesses seven impact domains of interest for people with RA. This study aimed to test patients’ understanding of the Portuguese RAID and evaluate its cross-cultural validity for use in Portugal.MethodsThis was a mixed methods study comprising two phases: (i) cognitive debriefing to determine patient’s comprehension of the Portuguese RAID and (ii) cross-cultural validation using Rasch analysis. Construct validity was determined by fit to the model, invariance culture (compared with France and UK datasets) and evidence of convergent and divergent validity.ResultsPatients’ input (n = 38) led to minor changes in the phrasing of two items to ensure conceptual equivalence between the Portuguese and the original RAID. In Rasch analysis (n = 288), two items ‘Sleep’ and ‘Physical well-being’ in the Portuguese dataset did not adequately fit the model specifications, suggesting multidimensionality (sleep—not necessarily associated with RA) and redundancy (physical well-being overlapping with functional disability). Despite the imperfections, the scale had high internal consistency, evidence of convergent and divergent validity and invariance to culture (compared to France n = 195 and UK n = 205 datasets). The scale was well targeted for patients with different levels of disease impact.ConclusionsThe RAID has been successfully adapted into Portuguese and it can be used with confidence in clinical practice. Further research will be required to ensure it captures the full range of sleep problems in RA. Meanwhile, data across the three countries (Portugal, France and the UK) are comparable except for the two items (sleep and physical well-being).

The Appraisal of Nursing Practice: Instrument Development and Initial Testing.

We describe the development of the Appraisal of Nursing Practice (ANP) and present initial psychometric data. Although measures of new nurses' confidence in clinical practice exist, psychometrically sound observational tools that assess a broad range of nursing competencies are needed. Based on the Quality and Safety Education for Nurses competencies, the 37-item ANP covers person-centered care, teamwork and collaboration, evidence-based practice/quality improvement, safety, informatics, professionalism, and overall satisfaction (with the new nurse's functioning). Cognitive interviewing was used to refine the items. Assessment of interrater reliability and a field test in a new nurse residency program were conducted. Interrater reliability and internal consistency reliability were generally acceptable. Scores increased significantly for nurses as they moved through a nurse residency program. The ANP can help nursing administrators identify areas where nurse residents are building needed competencies versus areas that need more work to achieve desired competency outcomes.

Effective patient safety education for novice RNs: A systematic review

Background and objective: The need is great for identifying effective evidence-based strategies that focus on increasing novice RN confidence for the application of skills used to care for patients safely. The purpose of this systematic review is to explore effective continuing education strategies that target novice RNs’ professional development, enhance clinical confidence, and focus on patient safety.Methods: The EBSCOhost database search was set to find recently published papers within the last ten years, sorted by relevance from January 2007 through August 2017. This search yielded twelve studies deemed eligible for inclusion by the databases CINAHL, Communication &amp; Mass Media Complete, Education Full Text (H.W. Wilson), Health &amp; Wellness Resource Center, and Science Direct. Commonalities and distinguishing features among the strategies are examined.Results: This systematic review identified 12 articles that describe effective training strategies aimed at improving novice RNs’ clinical practice confidence and skill. A thematic analysis of the data was used to systematically gain knowledge about strategies used to educate novice RNs working in the hospital setting. The majority of strategies employed a number of different types of simulation and reported varying degrees of success for improving novice RN ability to care for patients safely. Simulation, virtual reality, preceptored clinical experiences, and interdisciplinary experiences were found to be effective education strategies enhancing novice RN’s skill for providing safe care. Didactic instruction had positive results, but was not as effective as simulation for novice RNs learning safe patient care. Finally, written instruction was not as effective as simulation, and hard copy supplements provided no added value to novice RNs learning safe patient care.Conclusions: Findings from this review are foundational to address calls from the Institute of Medicine (IOM) and the National League for Nursing (NLN) to reform and support post-graduate nursing education. The development of novel education and training targeting novice RNs in the hospital setting is essential, but more research is needed to enhance safe patient care.

Autonomy, Mentorship, and Feedback: The Core of Clinical Education in Athletic Training

Clinical education provides the backbone for the socialization process for athletic trainers. It is the chance for students to engage in the role, within a real-time learning environment that allows for not only the adoption of knowledge, skills, and critical decision making, but also the profession’s foundational behaviors of professional practice. Recent criticisms of the current education model, in which the degree is conferred, center on the lack of critical thinking and confidence in clinical practice for newly-credentialed athletic trainers, as many suggest there is concern for the abilities of students to transition to practice smoothly. We offer three areas of focus for clinical education experiences for students (autonomy, mentorship, and feedback), believing this could support the development of independent thinking and confidence in skills. Our discussions are focused on the evidence available, as well as personal experiences as educators and program administrators.