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Revised FDI criteria for evaluating direct and indirect dental restorations—recommendations for its clinical use, interpretation, and reporting
ObjectivesThe FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document.Materials and methodsAn expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision.ResultsSome categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1–4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match).ConclusionThe most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling.Clinical relevanceThe improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.
Journal Article
A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools
Deep brain stimulation involves using a pacemaker-like device to deliver constant electrical stimulation to problematic areas within the brain. It has been used to treat over 40,000 people with Parkinson's disease and essential tremor worldwide and is currently undergoing clinical trials as a treatment for depression and obsessive-compulsive disorder. This article will provide an historical account of deep brain stimulation in order to illustrate the plurality of interests involved in the development and stabilization of deep brain stimulation technology. Using Latour's notion of immutable mobiles, this article will illustrate the importance of clinical assessment tools in shaping technological development in the era of medical device regulation. Given that such tools can serve commercial and professional interests, this article suggests that it is necessary to scrutinise their application in research contexts to ensure that they capture clinical changes that are meaningful for patients and their families. This is particularly important in relation to potentially ethically problematic therapies such as deep brain stimulation for psychiatric disorders.
Journal Article
Narrative comments in internal medicine clerkship evaluations: room to grow
The use of narrative comments in medical education poses a unique challenge: comments are intended to provide formative feedback to learners while also being used for summative grades. Given student and internal medicine (IM) grading committee concerns about narrative comment quality, we offered an interactive IM Grand Rounds (GR) session aimed at improving comment quality. We undertook this study to determine the quality of comments submitted by faculty and post-graduate trainees on students' IM Clerkship clinical assessments, and to explore the potential impact of our IM-GR. Archived comments from clerkship cohorts prior to and immediately following IM-GR were reviewed. Clinical clerkship assessment comments include three sections: Medical Student Performance Assessment (MSPE), Areas of Strength, and Areas for Improvement. We adapted a previously published comment assessment tool and identified the performance domain(s) discussed, inclusion of specific examples of student performance, evidence that the comment was based on direct observations, and, when applicable, the inclusion of actionable recommendations. Scoring was based on the number of domains represented and whether an example within that domain was provided (maximum score = 10). Analysis included descriptive statistics, t-test, and Pearson correlation coefficients. We scored 697 comments. Overall, section ratings were MSPE 2.51 (SD 1.52, range 0-9), Areas of Strength 1.53 (SD 1.09, range 0-6), and Areas for Improvement 1.27 (SD 1.06, range 0-8). Significant differences were noted after Grand Rounds only in the MSPE mean scores. Within domains, trends toward increased use of specific examples in the post-GR narratives were noted. Assessment of both the breadth and depth of the included comments revealed low-quality narratives offered by our faculty and resident instructors. A focused session on best practices in writing narratives offered minimal change in the overall narrative quality, although we did notice a trend toward the inclusion of explanative examples.
Journal Article
Assessment of undergraduate nursing students from an Irish perspective: Decisions and dilemmas?
Assessment of clinical competence plays a pivotal role in the education of undergraduate nursing students in preparation for registration. The challenges that face preceptors are represented in the international literature yet few studies have focused on the factors that influence the decision-making process by preceptors when students under-perform or appear to be borderline status in relation to clinical practice. This study explored the lived experiences of the preceptors during the assessment process using a phenomenological approach. This was a qualitative study that utilised a phenomenological approach to explore the lived experiences of the preceptors in relation to student assessment of those students who were incompetent and underperformed in clinical practice. Three categories emerged from the findings: First impressions, Emotional turmoil of failing a clinical assessment and competing demands in the workplace. It is proposed that employing a tripartite approach would enhance the assessment process to ensure a more robust and decision-sharing mechanism. This would support decisions that are made in the cases of incompetent or borderline nursing students and increase the objectivity of the competency assessment to ameliorate the emotional turmoil that is experienced by preceptors.
•Many emotional, difficulties exist for preceptors in the assessment of competence processes.•Innovative, supportive and collaborative mechanisms are recommended to incorporate a tri-partite approach to enhance the accountability and responsibility the decision-making processes.•A review of the preceptorship education programme to enhance confidence and competence among preceptors in the assessment process.
Journal Article
Current advances in digital cognitive assessment for preclinical Alzheimer's disease
There is a pressing need to capture and track subtle cognitive change at the preclinical stage of Alzheimer's disease (AD) rapidly, cost‐effectively, and with high sensitivity. Concurrently, the landscape of digital cognitive assessment is rapidly evolving as technology advances, older adult tech‐adoption increases, and external events (i.e., COVID‐19) necessitate remote digital assessment. Here, we provide a snapshot review of the current state of digital cognitive assessment for preclinical AD including different device platforms/assessment approaches, levels of validation, and implementation challenges. We focus on articles, grants, and recent conference proceedings specifically querying the relationship between digital cognitive assessments and established biomarkers for preclinical AD (e.g., amyloid beta and tau) in clinically normal (CN) individuals. Several digital assessments were identified across platforms (e.g., digital pens, smartphones). Digital assessments varied by intended setting (e.g., remote vs. in‐clinic), level of supervision (e.g., self vs. supervised), and device origin (personal vs. study‐provided). At least 11 publications characterize digital cognitive assessment against AD biomarkers among CN. First available data demonstrate promising validity of this approach against both conventional assessment methods (moderate to large effect sizes) and relevant biomarkers (predominantly weak to moderate effect sizes). We discuss levels of validation and issues relating to usability, data quality, data protection, and attrition. While still in its infancy, digital cognitive assessment, especially when administered remotely, will undoubtedly play a major future role in screening for and tracking preclinical AD.
Journal Article
Impact of Emergency Medicine Consultants and Clinical Advisors on a NHS 111 Clinical Assessment Service
ObjectiveTo compare outcome of clinical advice given by emergency physicians (EPs) versus non-physician clinical advisors (NPCAs) on a UK National Health Service 111 centre.MethodThis was a prospective study conducted between July 2016 and February 2017. We targeted calls in which call handlers using standard NHS 111 clinical decision support software would have advised the caller to attend a hospital ED. These calls were passed to a clinical assessment service (CAS) and reviewed by either an EP (July to November 2016) or an NPCA (December 2016 to February 2017).ResultsDuring the preintervention year, 80.2% of callers were advised to attend the ED within 1 or 4 hours, 1.2% were referred to out of hours (OOH) primary care and 0.3% to self-care. During the study, call handlers designated 2606 calls as needing to attend the ED in 1 or 4 hours and passed these on to the clinical advisors. There was a reduction of 75%–81% in cases advised to attend the ED in both intervention groups; EPs advised 396 of 1558 callers (25.4%) to attend ED; NPCAs advised 194 of 1048 callers (18.5%) to attend ED. For calls not requiring the ED, EPs recommended self/home care management in 38.1% of these calls, NPCAs recommended self-care for 15.7% (difference=22.4%; 95% CI 19.0% to 25.7%). EPs recommended 4.5% to attend OOH primary care, while NPCAs recommended OOH primary care for 42.1% (difference=37.6%, 95% CI 34.3% to 40.8%).ConclusionsA CAS within NHS 111 using clinicians decreases referrals to the ED. EPs use fewer services and resources. Further work needs to be undertaken to determine the workforce skill mix for an NHS 111 CAS.
Journal Article
Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning
ABSTRACTBackgroundThe ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia. MethodTwenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication. ResultsFour categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues. ConclusionThe NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.
Journal Article
Psychometric properties of a clinical assessment tool in the postgraduate midwifery programme, Botswana
Background The psychometric properties of a clinical assessment tool used in the postgraduate midwifery programme in Botswana have not been evaluated. A lack of reliable and valid clinical assessment tools contributes to inconsistencies in clinical assessment in midwifery programmes. Objectives This study aimed to evaluate the internal consistency and content validity of a clinical assessment tool used in the postgraduate midwifery programme in Botswana. Method For internal consistency, we calculated the total-item correlation and Cronbach’s alpha coefficient. For content validity, subject matter experts completed a checklist to evaluate the relevance and clarity of each competency in the clinical assessment tool. The checklist included questions with Likert-scale responses, indicating the level of agreement. Results The clinical assessment tool had a good reliability, with a Cronbach’s alpha of 0.837. The corrected item total correlation values ranged from –0.043 to 0.880 and the Cronbach’s alpha (if item deleted) ranged from 0.079 to 0.865. Overall content validity ratio was 0.95, and content validity index was 0.97. Item content validity indices ranged from 0.8 to 1.0. The overall scale content validity index was 0.97 and the scale content validity index using universal agreement was 0.75. Conclusion The clinical assessment tool used in the postgraduate midwifery programme in Botswana has acceptable reliability. Most of the competencies included in the clinical assessment tool were relevant and clear. Certain competencies need to be reviewed to improve the reliability and validity of the clinical assessment tool. Contribution The clinical assessment tool currently used in the postgraduate midwifery programme in Botswana had acceptable internal consistency reliability and validity.
Journal Article