Performance In Clinical Setting Research Articles

Deciding Among Noninvasive Tools for Predicting Varices Needing Treatment in Chronic Liver Disease: An Analysis of Asian Cohort.

Both transient elastography (TE)-based and non-TE-based criteria exist for detection of varices needing treatment (VNT) in patients with asymptomatic advanced chronic liver disease (CLD). However, their performance in clinical settings at different risk thresholds of detection of VNT and in regions where elastography is not widely available is unknown. We aimed to validate existing noninvasive criteria in our patients with CLD and identify best TE- and non-TE-based criteria for VNT screening at usual risk thresholds. Patients with compensated advanced CLD (cACLD) who underwent esophagogastroduodenoscopy and TE within 3 months were included. Diagnostic performance of Baveno VI, expanded Baveno VI, platelet-model for end-stage liver disease, and platelet-albumin (Rete Sicilia Selezione Terapia-hepatitis C virus) criteria were estimated. Decision curve analysis was conducted for different predictors across range of threshold probabilities. A repeat analysis including all patients with compensated CLD (cACLD and non-cACLD) was performed to simulate absence of TE. A total of 1,657 patients (cACLD, 895; non-cACLD, 762) related to hepatitis B virus (38.2%), hepatitis C virus (33.4%), nonalcoholic steatohepatitis (14.7%), and alcohol (11.8%) were included. Baveno VI identified maximum VNT (97.3%) and had best negative predictive value (96.9%), followed by platelet-albumin criteria. Expanded Baveno VI and platelet-model for end-stage liver disease had intermediate performance. At threshold probability of 5%, Baveno VI criteria showed maximum net benefit, and platelet-albumin criteria was next best, with need for 95 additional elastographies to detect 1 additional VNT. Similar results were obtained on including all patients with compensated CLD irrespective of TE. Baveno VI criteria maximizes VNT yield at 5% threshold probability. An acceptable alternative is the platelet-albumin criteria in resource-limited settings.

Diagnostic Performance of Deep Learning-Based Coronary Computed Tomography–Angiography Automatic Reconstruction and Diagnosis System: Model Establishment and Clinical Validation

Background: We pioneered a Deep Learning-based Coronary computed tomography–angiography Automatic Reconstruction and Diagnosis System (D-CARDS) for optimizing the workflow of diagnosis in coronary artery disease. Its efficiency and performance in clinical settings were verified. Method: In the model establishment stage, D-CARDS was trained with coronary computed tomography–angiography (CCTA) imaging data from 10,410 patients divided into training, tuning, and external validation test sets in a ratio of 7:2:1. A total of 685 patients were included in the study of clinical validation. 350 CCTA cases were collected for comparison of time efficiency. Another 335 CCTA cases were selected to reveal the diagnostic performance of D-CARDS with paired invasive coronary angiography (ICA) as the reference standard. Stenosis of 50% was considered to be obstructive and 70% or more to be significantly obstructive. The diagnostic performance of D-CARDS was evaluated as the receiver operating characteristic curve (ROC) and the corresponding area under the curve (AUC) at patient, vascular and segmental bases compared to both unilateral expert and arbitrated expert results. Findings: The average time taken of CCTA procedure after scanning (post-processing and diagnostic reporting) by D-CARDS was decreased by 73.3% from an average of 16.1 min with the conventional approach to 4.3 min (p=0.000). A total of 335 patients with 1,222 vessels and 3,559 segments were included in the final comparison of diagnostic performance. D-CARDS showed greater sensitivity (89.3% and 72.4%) than arbitrated expert results(82.6% and 62.0%)for detecting stenosis at both the 50% and 70% thresholds on patient-base, whereas its specificities were lower on every bases. The AUC showed that its diagnostic performance was equivalent to that of either of a unilateral expert on patient-based analysis, although slightly inferior to the arbitrated expert results. Interpretation: D-CARDS greatly improves the efficiency of CCTA procedure. Its diagnostic performance in detecting coronary stenosis is closer to that of an attending radiologist on patient-based analysis. The system can be used to optimize CCTA workflow. Funding Statement: This study was funded by Beijing science and technology committee. (grant reference number, Z201100005620009). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institutional Review Board (IRB)/Ethics Committee. The work was conducted in a manner compliant with the Measures for the Ethical Review of Biomedical Research Involving Humans and was adherent to the tenets of the Declaration of Helsinki.

Globalising artificial intelligence for improved clinical practice.

Artificial intelligence (AI) technologies are facilitating the work of modern healthcare organisations to leverage the power of big data in clinical practice. In most cases, AI-based systems improve clinical decision-making using multiple layers of information and pre-specified algorithms. In addition, recent AI technologies like machine learning can learn from existing data and perform predictive operations resulting in a robust performance in clinical settings. Such innovations are likely to serve the healthcare industry by minimising human error, savings costs, and maximising informed decision-making. However, critical challenges may affect the applications of AI in clinical settings, which include the effects on patient-provider communication, safety and efficacy of health services, and humane aspects of caregiving.

Concurrent Validity and Reliability of the Core Lexicon Measure as a Measure of Word Retrieval Ability in Aphasia Narratives

Purpose General agreement exists in the literature that clinicians struggle with quantifying discourse-level performance in clinical settings. Core lexicon analysis has gained recent attention as an alternative tool that may address difficulties that clinicians face. Although previous studies have demonstrated that core lexicon measures are an efficient means of assessing discourse in persons with aphasia (PWAs), the psychometric properties of core lexicon measures have yet to be investigated. The purpose of this study was (a) to examine the concurrent validity by using microlinguistic and macrolinguistic measures and (b) to demonstrate interrater reliability without transcription by raters with minimal training. Method Eleven language samples collected from PWAs were used in this study. Concurrent validity was assessed by correlating performance on the core lexicon measure with microlinguistic and macrolinguistic measures. For interrater reliability, 4 raters used the core lexicon checklists to score audio-recorded discourse samples from 10 PWAs. Results The core lexicon measures significantly correlated with microlinguistic and macrolinguistic measures. Acceptable interrater reliability was obtained among the 4 raters. Conclusions Core lexicon analysis is potentially useful for measuring word retrieval impairments at the discourse level. It may also be a feasible solution because it reduces the amount of preparatory work for discourse assessment.

Design and Content Validation of Three Setting-Specific Assessment Tools for Advanced Pharmacy Practice Experiences

Objective. To develop and validate three assessment tools to measure student performance in clinical settings during required advanced pharmacy practice experiences (APPEs). Methods. Each assessment tool was developed by subject-matter experts and validated using three sources of evidence. Proposed content underwent a job-task analysis by external APPE preceptors, evaluating each outcome in terms of importance and frequency of opportunity for student demonstration. After implementation, tool performance was evaluated using a measure of item applicability and student achievement. Finally, a two-step grade verification process was developed and grade acceptance by preceptor was determined. A priori benchmarks for acceptable tool performance were established for each strategy. Results. The job-task analysis was completed by 131 preceptors (52% response), with items achieving a composite score from 1.08 to11.83 (possible range: 1=most valuable, 25=least valuable). The mean item applicability ranged from 91.3% to 94.1% (n=849 student assessments) during the first year. Preceptors accepted the tool-generated grade in 798 (94%) assessments. Conclusion. Data from three evaluation strategies provide evidence of effective design and use of three unique APPE setting-specific student assessment tools. Pharmacy programs can adopt similar methodologies to develop and validate their assessment tools.

Impact of Background Noise Fluctuation and Reverberation on Response Time in a Speech Reception Task.

Purpose This study examines the effects of reverberation and noise fluctuation on the response time (RT) to the auditory stimuli in a speech reception task. Method The speech reception task was presented to 76 young adults with normal hearing in 3 simulated listening conditions (1 anechoic, 2 reverberant). Speechlike stationary and fluctuating noise were used as maskers, in a wide range of signal-to-noise ratios. The speech-in-noise tests were presented in a closed-set format; data on speech intelligibility and RT (time elapsed from the offset of the auditory stimulus to the response selection) were collected. A slowing down in RTs was interpreted as an increase in listening effort. Results RTs slowed down in the more challenging signal-to-noise ratios, with increasing reverberation and for stationary compared to fluctuating noise, consistently with a fluctuating masking release scheme. When speech intelligibility was fixed, it was found that the estimated RTs were similar or faster for stationary compared to fluctuating noise, depending on the amount of reverberation. Conclusions The current findings add to the literature on listening effort for listeners with normal hearing by indicating that the addition of reverberation to fluctuating noise increases RT in a speech reception task. The results support the importance of integrating noise and reverberation to provide accurate predictors of real-world performance in clinical settings.

Associations Of Personality Traits With The Capacity-Performance Discrepancy Of Functional Outcome In Patients With Schizophrenia.

ObjectiveFunctional capacity, which indicates one’s ability to perform everyday living tasks, contributes to real-world functional performance in patients with schizophrenia. However, functional capacity is sometimes not comparable with functional performance in clinical settings. We hypothesized that specific personality traits are related to this capacity-performance discrepancy of functional outcome.MethodsThe measures in this study were the UCSD Performance-based Skills Assessment Brief (UPSA-B) for functional capacity, the Social Functioning Scale (SFS) for functional performance, and the Temperament and Character Inventory-140 (TCI-140) for personality traits. A total of 94 stable outpatients with schizophrenia were divided into four groups based on combinations of their UPSA-B and SFS cut-off points, as follows: a high capacity and high performance (HH) group, a high capacity but low performance (HL) group, a low capacity but high performance (LH) group, and a low capacity and low performance (LL) group.ResultsThere were no significant differences in demographics among the four groups. The LH group showed a significantly lower harm avoidance level than the LL group. The HL group showed a significantly lower persistence level than the HH group.ConclusionLower harm avoidance may enhance functional performance, and lower persistence can limit functional performance, regardless of the primary levels of functional capacity in patients with schizophrenia. Novel and individualized psychosocial treatments considering the individual’s personality traits seem to be helpful for maximizing their functional performance in the community.

Challenges of pre-clinical testing in orthopedic implant development

The market for orthopedic implants is growing rapidly with the increasing prevalence of orthopedic diseases in an aging society. Different designs and materials have been developed over the years and have, in general, shown excellent results in pre-clinical testing. However, there have been incidences of serious complications when novel implants or materials are put into clinical use, with some well-known cases being metallosis in patients implanted with metal-on-metal hip replacements and osteolysis from polyethylene wear debris generated in hip and knee joint replacements. Unforeseen factors related to new designs, materials and surgical techniques can lead to different outcomes for pre-clinical testing and clinical use. While often an excellent indicator of a device's performance in clinical settings, pre-clinical testing does sometime fail to predict critical flaws in implant development. This article aims to explore the gaps in the current approach to testing. The ISO international standard of pre-clinical testing should be modified to more adequately capture actual clinical use of the implant and simulate daily activities. This article will also introduce modern methods for implant development, such as FEM, 3D printing and computer-aided orthopedic surgery, which can be widely applied to improve pre-clinical testing procedures and reduce the incidence of surgical malalignment by analyzing biomechanical performance, planning surgical procedure and providing surgical guide.

Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study

ObjectivesAlthough effective performance in clinical settings requires the integration between theory and practice, there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings. This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings. MethodsA qualitative study was adopted with a conventional content analysis approach. Fifteen nursing and paramedic's students, faculty members and experienced nursing staff participated in the study. Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10. ResultsFive main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e. non-standard practices in clinical settings; lack of trust in clinical competence; lack of perceived professional support; insufficiencies in teaching and learning process; and differences between doing things in simulated and real clinical situations. ConclusionTransferring theory into practice in a structured manner requires professional support in the workplace, trust and the opportunity for direct experience, using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios.

Hospital Nurses' Perceived Patient Safety Culture and Adverse Nurse Outcomes in Korea.

Hospital nurses are likely to be the first to observe patient safety issues in clinical settings, and thus it is important to include their views on patient safety culture. However, there are few studies addressing the influence of nurses' perceived patient safety culture on adverse nurse outcomes as quality of care. This study was to identify the relationship between nurses' perceptions of patient safety culture and adverse nurse outcomes in Korea. This cross-sectional study was included 299 nurses at two tertiary hospitals. Hierarchical linear regression was conducted to examine the impact of patient safety culture on adverse nurse outcomes among hospital nurses. The mean score of patient safety culture and adverse nurse outcomes were 3.50 out of 5 points and 3.07 out of 4 points respectively. In hierarchical linear regression, hospital work environment, the attitude of supervisor/manager, and hospital climate/culture of patient safety culture predicted adverse nurse outcomes after adjusting for general characteristics. It is crucial for healthcare facilities to assess or evaluate their current patient safety culture perceptions on a regular basis. Furthermore, provision workshops and staff training on changing behaviors and perceptions regarding patient safety activities can improve nursing performance in clinical settings.

Accuracy of self-monitoring: does experience, ability or case difficulty matter?

The ability to self-monitor one's performance in clinical settings is a critical determinant of safe and effective practice. Various studies have shown this form of self-regulation to be more trustworthy than aggregate judgements (i.e. self-assessments) of one's capacity in a given domain. However, little is known regarding what cues inform learners' self-monitoring, which limits an informed exploration of interventions that might facilitate improvements in self-monitoring capacity. The purpose of this study is to understand the influence of characteristics of the individual (e.g. ability) and characteristics of the problem (e.g. case difficulty) on the accuracy of self-monitoring by medical students. In a cross-sectional study, 283 medical students from 5years of study completed a computer-based clinical reasoning exercise. Confidence ratings were collected after completing each of six cases and the accuracy of self-monitoring was considered to be a function of confidence when the eventual answer was correct relative to when the eventual answer was incorrect. The magnitude of that difference was then explored as a function of year of seniority, gender, case difficulty and overall aptitude. Students demonstrated accurate self-monitoring by virtue of giving higher confidence ratings (57.3%) and taking a shorter time to work through cases (25.6seconds) when their answers were correct relative to when they were wrong (41.8% and 52.0seconds, respectively; p<0.001 and d>0.5 in both instances). Self-monitoring indices were related to student seniority and case difficulty, but not to overall ability or student gender. This study suggests that the accuracy of self-monitoring is context specific, being heavily influenced by the struggles students experience with a particular case rather than reflecting a generic ability to know when one is right or wrong. That said, the apparent capacity to self-monitor increases developmentally because increasing experience provides a greater likelihood of success with presented problems.

Invitro comparison of wear characteristics of PyroCarbon and metal on bone: Shoulder hemiarthroplasty.

There are concerns regarding glenoid erosion with metal shoulder hemiarthroplasty. PyroCarbon may offer an alternative because of favorable wear characteristics and preservation of the glenoid. The purpose of this study was to assess invitro bone wear characteristics of PyroCarbon relative to cobalt chromium alloy hemiarthroplasty in a shoulder wear simulator. Wear of PyroCarbon and cobalt chromium prostheses articulating with bone were characterized by means of bone wear penetration rate, changes to surface roughness, and wear particle analysis. PyroCarbon prostheses produced significantly less damage to bone and were less damaged by the bone than cobalt chromium prostheses. Cobalt chromium testing was halted at approximately 320,000 cycles because the bone was consumed. Wear testing of PyroCarbon specimens continued through five million cycles. Linearized bone penetration rate, bone volume loss rate, and surface roughness for cobalt chromium test specimens were 30 times greater than for PyroCarbon. Results demonstrate significantly less damage to bone in simulated shoulder function testing for PyroCarbon hemiarthroplasty implants relative to conventional cobalt chromium implants. Our study supports use of PyroCarbon in humeral head hemiarthroplasty as a viable alternative to conventional metal hemiarthroplasty. Further investigation of PyroCarbon performance in clinical settings is warranted.

ASSESSMENT OF NURSING STUDENT PERFORMANCE IN CLINICAL SETTINGS - USEFULNESS OF RATING SCALES FOR SUMMATIVE EVALUATION

Aim: The aim of the study was to investigate the use and effectiveness of a valid and reliable rating scale for summative clinical evaluation of student performance. Design: A descriptive cross-sectional study. Methods: The study was carried out at two Slovak universities in the academic years of 2015 and 2016. The study sample included performance evaluations of 82 students made by different lecturers using the Nursing Student Clinical Performance Evaluation Scale (NSCPES), before the practical component of their final examinations. The students' performances were repeatedly evaluated by five lecturers. This evaluation was compared with the grade point for the students' clinical performance obtained in the practical component of their final examinations. The data were analysed using descriptive statistics, Pearson's chi-square test, Cohen's Kappa, factor analyses, and the p-value < 0.05 was taken to indicate statistical significance for all comparisons. Results: Significant positive correlations were noted between two evaluations - before the final examinations using the NSCPES rating scale, and standard clinical assessment during the final examinations (r = 0.334; p ≤ 0.01). The value of Cohen's Kappa was very low (0.04) and insignificant (p = 0.32), indicating low agreement between the two evaluations. The Slovak version was not conceptually consistent with the original version. In the Slovak version, two originally independent domains (professionalism and ethical principles) were merged into one variable - responsibility and professionalism. Conclusion: The multidimensional nature of clinical practice necessitates the use of a complex of assessment measures. A valid and reliable tool may allow an objective evaluation of nursing student performance in clinical settings. The Nursing Student Clinical Performance Evaluation Scale is useful for summative evaluation of student performance, allowing teachers and clinical mentors to rate performance over time, and to note patterns of performance.

A Novel Pediatric Residency Coaching Program: Outcomes After One Year.

The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement. The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback. Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before. Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.

Measurement of clinical nurse performance: Developing a tool including contextual items

Assessment of nurse performance plays an important role in guaranteeing high quality clinic care to achieve desired patient outcomes. Many tools measuring nurse performance in clinical settings have different dimensions of nurse skills. The objective of this research is to develop and test a new performance assessment tool incorporating applicable task and contextual performance items to measure clinical nurse’s performance. Thirty-eight performance items were derived from previously cited literature and some tools that were in use. A questionnaire containing all items under eight categories was designed to reveal the appropriateness levels of the items. It was distributed to 233 clinical nurses from different hospitals in one city, who were asked to score them on a seven-point scale. The results indicate that although clinical skill and professional skill are the most important categories, the most scored item is “Working systematically” (mean = 6.07, s.d. = 0.89) in contextual category.

A Ballistographic Approach for Continuous and Non-Obtrusive Monitoring of Movement in Neonates.

Continuously monitoring body movement in preterm infants can have important clinical applications since changes in movement-patterns can be a significant marker for clinical deteriorations including the onset of sepsis, seizures, and apneas. This paper proposes a system and method to monitor body movement of preterm infants in a clinical environment using ballistography. The ballistographic signal (BSG) is acquired using a thin and a film-like sensor that is placed underneath an infant. Manual annotations based on video-recordings served as a reference standard for identifying movement. We investigated the performance of multiple features, constructed from the BSG waveform, to discriminate movement from no movement based on data acquired from 10 preterm infants. Since routine cardiorespiratory monitoring is prone to movement artifacts, we also compared the application of these features on the simultaneously acquired cardiorespiratory waveforms, i.e., the electrocardiogram, the chest impedance, and the photoplethysmogram. The BSG-based-features consistently outperformed those based on the routinely acquired cardiorespiratory waveforms. The best performing BSG-based feature-the signal instability index-had a mean (standard deviation) effect size of 0.90 (0.06), as measured by the area under the receiver operating curve. The proposed system for monitoring body movement is robust to noise, non-obtrusive, and has high performance in clinical settings.

Dynamic physiological responses to the incremental shuttle walk test in adults

Abstract Introduction: Understanding the normal dynamic physiological responses to the incremental shuttle walk test might enhance the interpretation of walking performance in clinical settings. Objective: To assess dynamic physiological responses to the incremental shuttle walk test and its predictors in healthy adults. Methods: We assessed the simultaneous rates of changes of Δoxygen uptake/Δwalking velocity (ΔVO 2 /ΔWV), Δheart rate/Δoxygen uptake (ΔHR/ΔVO 2 ), Δventilation/Δcarbon dioxide production (ΔVE/ΔVCO 2 ), and Δtidal volume/Δlinearized ventilation (ΔVT/ΔlnVE) during the incremental shuttle walk test in 100 men and women older than 40 years. Fat and lean body masses (bioimpedance) were also evaluated. Results: We found that the dynamic relationships were not sex-dependent. Participants aged ≥ 70 presented declines in ΔVO 2 /ΔWV slope compared to those aged 40-49 (215 ± 69 vs. 288 ± 84 mL.min-1.km.h-1). Obese participants presented shallower slopes for ΔVO 2 /ΔWV (2.94 ± 0.90 vs. 3.84 ± 1.21 mL.min-1.kg-1.km.h-1) and ΔVT/ΔlnVE (0.57 ± 0.20 vs. 0.67 ± 0.26). We found negative influence of fat body mass on ΔVT/ΔlnVE (R2 = 0.20) and positive influence of lean body mass on ΔVO 2 /ΔWV (R2 = 0.31), ΔHR/ΔVO2 (R2 = 0.25), and ΔVT/ΔlnVE (R2 = 0.44). Conclusion: Dynamic relationships during walking were slightly influenced by age, but not sex-dependent. Body composition played an important role in these indices. Our results may provide better interpretation of walking performance in patients with chronic diseases.

Assessing physical therapist students\u2019 self-efficacy: measurement properties of the Physiotherapist Self-Efficacy (PSE) questionnaire

BackgroundApart from skills, and knowledge, self-efficacy is an important factor in the students’ preparation for clinical work. The Physiotherapist Self-Efficacy (PSE) questionnaire was developed to measure physical therapy (TP) students’ self-efficacy in the cardiorespiratory, musculoskeletal, and neurological clinical areas. The aim of this study was to establish the measurement properties of the Dutch PSE questionnaire, and to explore whether self-efficacy beliefs in students are clinical area specific.MethodsMethodological quality of the PSE was studied using COSMIN guidelines. Item analysis, structural validity, and internal consistency of the PSE were determined in 207 students. Test-retest reliability was established in another sample of 60 students completing the PSE twice. Responsiveness of the scales was determined in 80 students completing the PSE at the start and the end of the second year. Hypothesis testing was used to determine construct validity of the PSE.ResultsExploratory factor analysis resulted in three meaningful components explaining similar proportions of variance (25%, 21%, and 20%), reflecting the three clinical areas. Internal consistency of each of the three subscales was excellent (Cronbach’s alpha > .90). Intra Class Correlation Coefficient was good (.80). Hypothesis testing confirmed construct validity of the PSE.ConclusionThe PSE shows excellent measurement properties. The component structure of the PSE suggests that self-efficacy about physiotherapy in PT students is not generic, but specific for a clinical area. As self-efficacy is considered a predictor of performance in clinical settings, enhancing self-efficacy is an explicit goal of educational interventions. Further research is needed to determine if the scale is specific enough to assess the effect of educational interventions on student self-efficacy.

Coaching nursing students with attention deficit hyperactivity disorder in clinical settings: A case study

Up to 18% of undergraduate students have some form of learning disability, with Attention Deficit Hyperactivity Disorder (ADHD) being the most common subtype. Some of these students enter nursing programs. Post-secondary institutions are developing processes to help students overcome traditional academic challenges, however, the demands of clinical practice courses are not easily modified. Effective performance in clinical settings requires nursing students to develop sophisticated executive functions for organization, prioritization, and managing distractions, all of which present considerable challenges for students with ADHD. We present a case study to illustrate the coaching intervention we adapted from the education literature for a nursing student with ADHD who was struggling in clinical practice courses. The most effective coaching strategies helped the student to harness his energy and enhance focus on the task at hand.

On the impact of domain expertise on query formulation, relevance assessment and retrieval performance in clinical settings

The large volumes of medical information available on the web may provide answers for a wide range of users attempting to solve health-related problems. While experts generally utilize reliable resources for diagnosis search and professional development, novices utilize different (social) web resources to obtain information that helps them manage their health or the health of people who they care for. A diverse number of related search topics address clinical diagnosis, advice searching, information sharing, connecting with experts, etc. This paper focuses on the extent to which expertise can impact clinical query formulation, document relevance assessment and retrieval performance in the context of tailoring retrieval models and systems to experts vs. non-experts. The results show that medical domain expertise 1) plays an important role in the lexical representations of information needs; 2) significantly influences the perception of relevance even among users with similar levels of expertise and 3) reinforces the idea that a single ground truth does not exist, thereby leading to the variability of system rankings with respect to the level of user’s expertise. The findings of this study presents opportunities for the design of personalized health-related IR systems, but also for providing insights about the evaluation of such systems.