Eighty normal cheek teeth and 26 normal incisors extracted from 14 donkeys (median age 19 years) at post mortem were anatomically examined including grossly and by computerised axial tomography (CAT) imaging. Decalcified histology was performed on 54 sections from 18 teeth (8 donkeys), undeclacified histology on 16 sections from 7 donkeys and scanning electron microscopy on 10 sections from 10 teeth (3 donkeys). The dental formulae and tooth number was found to be the same as in horses with a higher prevalence (17 %) of canine teeth in female donkeys. A decrease in tooth length, pulp horn length and pulp horn width with age was illustrated, as was an increase in occlusal secondary dentine depth with age, although not all these age changes were statistically significant. Normal histological and ultrastructural features of donkey teeth were identified and found to be similar to equine findings. Enamel was found to be thicker buccally in both maxillary and mandibular cheek teeth. Quantitative measurements of transverse dentine thickness around pulp cavities, dentinal tubule diameters and densities, and enamel prism diameters were made. Left lower incisors (301) were extracted from 7 donkeys and 6 horses for micro-hardness determination of enamel, primary and secondary dentine using a Knoop Hardness indenter. No significant difference between donkey and horse incisor microhardness was demonstrated. Examination of 19 donkey skulls at post mortem examination showed donkeys to have a higher degree of anisognathia (27%) compared to horses (23%). Post mortem dental examination of 349 donkeys (median age 31) demonstrated a high prevalence of dental disease (93%) and in particular cheek teeth diastemata (85%). Furthermore, age was associated with increasing prevalence of dental disease and diastemata. Diastemata were also associated with the presence of other dental disorders and with colic-related death in affected donkeys. Quantitative measurements of 45 diastemata from 16 donkeys showed no difference in the medial and lateral width of diastemata but periodontal pockets were deeper laterally. The definition of valve and open diastemata were confirmed. Pulp exposure, dental caries and periodontal disease were examined in detail (54 skulls) at post mortem. A total of 19 teeth were extracted for further detailed examination as performed in normal anatomy. Clinical dental examinations were performed on 357 donkeys in the U.K. that were selected for age distribution, and the prevalence of dental disease in different age groups was found to increase from 28% in the youngest group (age 0-10 years) to 98% in the oldest group (age > 35 years). An increased prevalence of most dental disorders with age was demonstrated as was an association between dental disease and weight loss, poor body condition score, supplemental feeding and previous episodes of colic. Clinical dental examination of 203 working donkeys in Mexico showed similar types of dental disorders as found in the U.K. study, with dental disease present in 62%, of which 18% required urgent dental treatment. There was a significant association between age groups and dental disease, and age groups and body condition score, but there was no association between dental disease and body condition score. However, body condition score was not associated with supplemental feeding or faecal egg counts either.

Diagnosing shoulder pain conditions is a challenging area of musculoskeletal practice. Subacromial impingement syndrome (SIS) is a clinical syndrome that indicates pain and pathology involving the subacromial bursa and rotator cuff tendons within the subacromial space. The three stages of SIS are subacromial bursitis, partial thickness and full thickness rotator cuff tears. The cause of SIS is believed to be multi-factorial with both extrinsic and intrinsic factors involved in its pathogenesis. Clinicians have traditionally diagnosed SIS using a clinical examination including a subjective history followed by confirmatory clinical tests. A review of the evidence for diagnostic accuracy of clinical tests highlights that individual tests have poor diagnostic accuracy. A combination of clinical tests or a clinical examination per se may be useful at ruling out rotator cuff tears, but is less accurate at detecting rotator cuff tears when it is present. There is consensus in the literature that particular combinations of signs and clinical features may be useful in diagnosing rotator cuff tears but not for diagnosing SIS. The vast majority of research to date examining the clinical diagnosis of SIS has been focused on individual clinical tests carried out by medical practitioners in specialist and tertiary care settings. This review has established that the majority of diagnostic accuracy studies for SIS and rotator cuff tears have had poor methodological design. This exploratory study was conducted with subjects undergoing a standardized clinical examination (index test) by a physiotherapist. The decision as to which specific tests were chosen for this research was based on supporting research within the literature and the test’s actual use within the New Zealand clinical setting. This included subjective history questions, active and passive shoulder movement tests and eleven SIS tests. Subjects were referred for a diagnostic ultrasound scan immediately following the clinical examination and results from the scan stood as the criterion reference standard. Thirty eight individuals (males n=23, females n=15) with new onset shoulder pain, who met the inclusion criteria, were assessed by a participating physiotherapist. Sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and respective 95% confidence intervals were calculated for all variables of the examination. Individual variables from the clinical examination were tested for their association with the diagnostic ultrasound scan reference criterion using Pearson Chi-Squared Exact test. Potential predictor variables were retained as potential predictors for use in the logistic regression analysis to determine the most accurate set of clinical examination variables for diagnosing SIS and the individual pathological stages of SIS. The results indicate that no historical, subjective or objective features from the clinical examination are accurate in diagnosing SIS or rotator cuff tears. The presence of night pain demonstrated a significant correlation (P<0.02) with the criterion reference standard for the presence of subacromial bursa fluid/bunching. Night pain and pain with overhead activity has a high sensitivity for subacromial bursa fluid/bunching being present. The absence of night pain and the absence of pain with overhead activity are two subjective phenomena from a clinical examination that are useful in ruling out subacromial bursa fluid/bunching being present. Night pain was also found to be the best predictor of subacromial bursa fluid/bunching being present (P<0.012). Male gender (P<0.034) was the best predictor of partial thickness rotator cuff tears while being 60 years of age or older (P<0.01) significantly correlated with full thickness rotator cuff tears. The Drop Arm Sign (P<0.01) and External Rotation Lag Sign (P<0.01) were significantly correlated with SIS and full thickness rotator cuff tears. Clinical tests for all three pathological stages of SIS and subacromial bursa fluid/bunching being present, had equivalent or if not greater diagnostic accuracy than previous report studies in the literature. The Hawkins-Kennedy Test and Neer Sign can be used in the primary care setting to rule out the presence of subacromial bursa fluid/bunching or SIS if the tests are negative. For mid to end stage SIS (rotator cuff tears) the Empty Can Test and Drop Arm Sign with their high sensitivity can be used to rule out rotator cuff tears especially to the supraspinatus tendon when the tests are negative. Despite the small sample size and other limitations of this study, the findings are an important addition to the current literature surrounding the diagnostic accuracy of clinical tests for SIS and rotator cuff tears. This is the first study to use physiotherapists as examiners and to be set in a primary care setting. The study is also the first to examine the diagnostic accuracy of a range of historical and subjective features from the clinical examination. The results found in the current study could be used by future studies as a starting point in the development of a clinical decision or prediction rule to assist clinicians in the diagnosis of SIS and rotator cuff tears.

Diagnosing shoulder pain conditions is a challenging area of musculoskeletal practice. Subacromial impingement syndrome (SIS) is a clinical syndrome that indicates pain and pathology involving the subacromial bursa and rotator cuff tendons within the subacromial space. The three stages of SIS are subacromial bursitis, partial thickness and full thickness rotator cuff tears. The cause of SIS is believed to be multi-factorial with both extrinsic and intrinsic factors involved in its pathogenesis. Clinicians have traditionally diagnosed SIS using a clinical examination including a subjective history followed by confirmatory clinical tests. A review of the evidence for diagnostic accuracy of clinical tests highlights that individual tests have poor diagnostic accuracy. A combination of clinical tests or a clinical examination per se may be useful at ruling out rotator cuff tears, but is less accurate at detecting rotator cuff tears when it is present. There is consensus in the literature that particular combinations of signs and clinical features may be useful in diagnosing rotator cuff tears but not for diagnosing SIS. The vast majority of research to date examining the clinical diagnosis of SIS has been focused on individual clinical tests carried out by medical practitioners in specialist and tertiary care settings. This review has established that the majority of diagnostic accuracy studies for SIS and rotator cuff tears have had poor methodological design. This exploratory study was conducted with subjects undergoing a standardized clinical examination (index test) by a physiotherapist. The decision as to which specific tests were chosen for this research was based on supporting research within the literature and the test’s actual use within the New Zealand clinical setting. This included subjective history questions, active and passive shoulder movement tests and eleven SIS tests. Subjects were referred for a diagnostic ultrasound scan immediately following the clinical examination and results from the scan stood as the criterion reference standard. Thirty eight individuals (males n=23, females n=15) with new onset shoulder pain, who met the inclusion criteria, were assessed by a participating physiotherapist. Sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and respective 95% confidence intervals were calculated for all variables of the examination. Individual variables from the clinical examination were tested for their association with the diagnostic ultrasound scan reference criterion using Pearson Chi-Squared Exact test. Potential predictor variables were retained as potential predictors for use in the logistic regression analysis to determine the most accurate set of clinical examination variables for diagnosing SIS and the individual pathological stages of SIS. The results indicate that no historical, subjective or objective features from the clinical examination are accurate in diagnosing SIS or rotator cuff tears. The presence of night pain demonstrated a significant correlation (P<0.02) with the criterion reference standard for the presence of subacromial bursa fluid/bunching. Night pain and pain with overhead activity has a high sensitivity for subacromial bursa fluid/bunching being present. The absence of night pain and the absence of pain with overhead activity are two subjective phenomena from a clinical examination that are useful in ruling out subacromial bursa fluid/bunching being present. Night pain was also found to be the best predictor of subacromial bursa fluid/bunching being present (P<0.012). Male gender (P<0.034) was the best predictor of partial thickness rotator cuff tears while being 60 years of age or older (P<0.01) significantly correlated with full thickness rotator cuff tears. The Drop Arm Sign (P<0.01) and External Rotation Lag Sign (P<0.01) were significantly correlated with SIS and full thickness rotator cuff tears. Clinical tests for all three pathological stages of SIS and subacromial bursa fluid/bunching being present, had equivalent or if not greater diagnostic accuracy than previous report studies in the literature. The Hawkins-Kennedy Test and Neer Sign can be used in the primary care setting to rule out the presence of subacromial bursa fluid/bunching or SIS if the tests are negative. For mid to end stage SIS (rotator cuff tears) the Empty Can Test and Drop Arm Sign with their high sensitivity can be used to rule out rotator cuff tears especially to the supraspinatus tendon when the tests are negative. Despite the small sample size and other limitations of this study, the findings are an important addition to the current literature surrounding the diagnostic accuracy of clinical tests for SIS and rotator cuff tears. This is the first study to use physiotherapists as examiners and to be set in a primary care setting. The study is also the first to examine the diagnostic accuracy of a range of historical and subjective features from the clinical examination. The results found in the current study could be used by future studies as a starting point in the development of a clinical decision or prediction rule to assist clinicians in the diagnosis of SIS and rotator cuff tears.

Thesis (MPhil)--University of Stellenbosch, 2011. / Introduction: Objective Structured Clinical Examination (OSCE) examiner training is widely employed to address some of the reliability and validity issues that accompany the use of this assessment tool. An OSCE skills course was developed and implemented at the Stellenbosch Faculty of Health Sciences and the influence thereof on participants (clinicians) was evaluated. Method: Participants attended the OSCE skills course which included theoretical sessions concerning topics such as standard-setting, examiner influence and assessment instruments, as well as two staged OSCEs, one at the beginning and the other at the end of the course. During the latter, each participant examined a student role-player performing a technical skill while being video recorded. Participants‟ behaviour and assessment results from the two OSCEs were evaluated, as well as the feedback from participants regarding the course and group interviews with student role players. Results: There was a significant improvement in inter-rater reliability as well as a slight decrease in inappropriate examiner behaviour, such as teaching and prompting during assessment of students. Furthermore, overall feedback from participants and perceptions of student role-players was positive. Discussion: In this study, examiner conduct and inter-rater reliability was positively influenced by the following interventions: examiner briefing; involvement of examiners in constructing assessment instruments as well as viewing (on DVD) and reflection, by examiners, of their assessment behaviour. Conclusion: This study proposes that the development and implementation of an OSCE skills course is a worthwhile endeavour in improving validity and reliability of the OSCE as an assessment tool.

Healthcare education is continually evolving to reflect therapeutic advances in patient management. Society demands assurances regarding the ongoing competence of HCPs including pharmacists. The use of OSCEs to evaluate competence of medical staff as well as nurses is well documented in the literature however evidence of its use with undergraduate pharmacy students is still sparse.

A avaliação completa do sistema estomatognático é essencial para o diagnóstico e plano de tratamento ortodôntico. Não se devem apenas avaliar aspectos estáticos da oclusão, mas também os funcionais, pois estes últimos podem mostrar-se alterados e envolver um ou mais componentes do sistema estomatognático, entre eles, a articulação temporomandibular (ATM). Uma das alterações encontradas com freqüência é o deslocamento de disco articular, o que pode interferir no prognóstico e, eventualmente, comprometer o resultado do tratamento ortodôntico. Na tentativa de contribuir para o reconhecimento dessas alterações, este estudo teve como finalidade avaliar a concordância entre dois examinadores calibrados em relação ao diagnóstico de deslocamento de disco articular, comparar a percepção dos pacientes aos ruídos com os dados do exame clínico e eletrovibratografia, além de checar a possível equivalência entre o exame clínico e eletrovibratografia, como métodos de detecção do deslocamento de disco articular. A amostra foi composta por 60 voluntários, divididos igualmente em 4 grupos com 15 participantes cada, definidos por meio do exame clínico e agrupados segundo o gênero e a presença ou ausência de estalo. O exame clínico foi realizado por dois examinadores treinados. A eletrovibratografia foi realizada por um único operador treinado, e empregou-se o programa SonoPAK (Bioresearch Inc.). Para análise dos resultados de concordância entre ambas as técnicas e entre os examinadores, foi utilizado o coeficiente kappa. Os resultados mostraram excelente concordância inter examinadores na realização do exame clínico, concordância satisfatória entre os relatos de ruídos referidos pelos pacientes quando comparados ao exame clínico e eletrovibratografia e concordância também satisfatória entre os dois métodos estudados. / The complete evaluation of the stomatognathic system is essential to the diagnostic and orthodontic treatment plan. It should not evaluate only the occlusal static aspects, but the functional aspects, because the latter could be altered and one or more components of the stomatognathic system could be involved, including the Temporomandibular Joint (TMJ). One of the frequently found alterations founded frequently is the articular disc displacement, which could affect in the prognostic, and, eventually the result of the orthodontic treatment. Trying to contribute to recognize these alterations, the purpose of this study was to evaluate the findings of two calibrated examiners on disk displacement diagnosis, to compare the patients joint sounds perception to the to the results found by the clinical examination and electrovibratography, and beyond that check the possible matching between the clinical examination and the electrovibratography as methods of disc displacement detection. The sample was composed of 60 patients, divided equally into 4 groups of 15 participants each, defined by clinical examination and grouped according to gender and to the presence or absence of the sound (click). The clinical examination was made by two trained examiners. The electrovibratography was made by only one only operator and the SonoPAK software was used (Bioresearch Inc.). The kappas coefficient was used to analyze of the results. They showed that the examiners findings were very close in the clinical examination, partially close on the joint sounds report told by the patients when compared to the clinical examination and eletrovibratography and reasonable equivalence between the two methods studied.

This thesis examines the perceptions and experiences of pre-registration nursing students with dyslexia in one university in relation to one specific assessment: the Objective Structured Clinical Examination (OSCE). In September 2013, all United Kingdom pre-registration nursing training moved to degree level university programmes. Universities must also ensure that all nursing students meet the fitness to practise criteria laid down by the Nursing and Midwifery Council (NMC, 2015). Current national higher education policy aims to widen participation; this includes those with disabilities. Statistics show that 10% of students attending university in England have a declared disability, the main one being dyslexia. The study university has its own widening participation policy, with 19% of its children’s nursing students currently registered as having dyslexia. The Nursing and Midwifery Council (2010) states that all pre-registration nursing programmes should contain a variety of assessment strategies, to ensure students meet the academic and clinical standards required by the professional nursing and midwifery register. One of the final assessments at the study university, as with many other medical and nursing degrees, is the Objective Structured Clinical Examination, a method of assessment that requires students to perform clinical assessments and answer questions within standardised conditions, within a set time limit. This study aims to explore the ways in which nursing students with dyslexia perceive and experience the OSCE as an assessment method, and to draw conclusions on ways to develop it further. Using a two-phase mixed methods approach, a purposive sample of 24 nursing students in year 3 of their course, was approached to participate in an online questionnaire, with 12 responding. Six students participated further in object elicitation interviews, which were analysed using a ‘Framework’ method. The findings highlight the unique OSCE journeys of study participants, the impact of dyslexia on the individual and the OSCE assessment process. The thesis offers discussion and recommendations around the OSCE as an ‘inclusive’ teaching and assessment method, considering how the design of curricula and assessments assists in recognising students’ individualism and in reducing potential issues. It is the first study to consider the OSCE with regard to such students and offers an opening for future studies focussing on learning difficulties and OSCE assessments within nursing.

A avaliação completa do sistema estomatognático é essencial para o diagnóstico e plano de tratamento ortodôntico. Não se devem apenas avaliar aspectos estáticos da oclusão, mas também os funcionais, pois estes últimos podem mostrar-se alterados e envolver um ou mais componentes do sistema estomatognático, entre eles, a articulação temporomandibular (ATM). Uma das alterações encontradas com freqüência é o deslocamento de disco articular, o que pode interferir no prognóstico e, eventualmente, comprometer o resultado do tratamento ortodôntico. Na tentativa de contribuir para o reconhecimento dessas alterações, este estudo teve como finalidade avaliar a concordância entre dois examinadores calibrados em relação ao diagnóstico de deslocamento de disco articular, comparar a percepção dos pacientes aos ruídos com os dados do exame clínico e eletrovibratografia, além de checar a possível equivalência entre o exame clínico e eletrovibratografia, como métodos de detecção do deslocamento de disco articular. A amostra foi composta por 60 voluntários, divididos igualmente em 4 grupos com 15 participantes cada, definidos por meio do exame clínico e agrupados segundo o gênero e a presença ou ausência de estalo. O exame clínico foi realizado por dois examinadores treinados. A eletrovibratografia foi realizada por um único operador treinado, e empregou-se o programa SonoPAK (Bioresearch Inc.). Para análise dos resultados de concordância entre ambas as técnicas e entre os examinadores, foi utilizado o coeficiente kappa. Os resultados mostraram excelente concordância inter examinadores na realização do exame clínico, concordância satisfatória entre os relatos de ruídos referidos pelos pacientes quando comparados ao exame clínico e eletrovibratografia e concordância também satisfatória entre os dois métodos estudados. / The complete evaluation of the stomatognathic system is essential to the diagnostic and orthodontic treatment plan. It should not evaluate only the occlusal static aspects, but the functional aspects, because the latter could be altered and one or more components of the stomatognathic system could be involved, including the Temporomandibular Joint (TMJ). One of the frequently found alterations founded frequently is the articular disc displacement, which could affect in the prognostic, and, eventually the result of the orthodontic treatment. Trying to contribute to recognize these alterations, the purpose of this study was to evaluate the findings of two calibrated examiners on disk displacement diagnosis, to compare the patients joint sounds perception to the to the results found by the clinical examination and electrovibratography, and beyond that check the possible matching between the clinical examination and the electrovibratography as methods of disc displacement detection. The sample was composed of 60 patients, divided equally into 4 groups of 15 participants each, defined by clinical examination and grouped according to gender and to the presence or absence of the sound (click). The clinical examination was made by two trained examiners. The electrovibratography was made by only one only operator and the SonoPAK software was used (Bioresearch Inc.). The kappas coefficient was used to analyze of the results. They showed that the examiners findings were very close in the clinical examination, partially close on the joint sounds report told by the patients when compared to the clinical examination and eletrovibratography and reasonable equivalence between the two methods studied.

Magister Curationis - MCur / The Objective Structured Clinical Examination (OSCE) is a formative and summative assessment method used in several health science disciplines. The primary focus of this research study was to explore and describe the experiences of student midwives of the OSCE as used in a specific university context and determine how effective it is in preparing student midwives for clinical practice. However the researcher acknowledges the value of the OSCA (Objective Structured Clinical Assessment), which was not used in the context where the study was conducted. Due to the scarcity of academic literature in South Africa and internationally regarding the experiences of student midwives of OSCE assessments, this research study attempted to increase evidence of students’ experiences for improving the OSCE as an assessment method at a school of nursing used in this study. Research purpose: The purpose of the study was to explore and describe student midwives’ experiences of the Objective Structured Clinical Examination, at the SoN, at a university in the Western Cape, and ascertain whether it prepared them adequately for clinical practice. Research design: A qualitative approach with an exploratory descriptive design was used for the investigation of the student midwives' experiences of this assessment method. Sample: Purposive sampling was utilised to select third year Bachelor of Nursing students, who completed the OSCE during semester one in 2014, at a University in the Western Cape. Nine participants were interviewed. Data collection: The data collection was obtained through semi-structured interviews. Data analysis: The data analysis was done manually using the Thomas (2003) data analysis process. Saturation was reached after nine interviews, when no new relevant knowledge was being acquired. Findings: OSCE preparation was supported by theory and clinical learning opportunities. The OSCE environment was found to be challenging and stressful. Alignment of OSCE stations to clinical skills, theory, clinical practice and appropriateness of time allocation. Students had differing views about their level of confidence and competence. Recommendations: Although the OSCE is a valued instrument in the summative assessment of midwifery students, attention must be given to the careful planning of the OSCE environment and the use of simulation techniques. Adequate support for students is essential, and adherence to a standard method of facilitation in clinical learning, in the skills laboratory, is crucial to fairness in learning and assessment. The direct input from valuable stakeholders in clinical training, such as educators and clinical supervisors, must be considered in order to identify ways to improve the OSCE.

Magister Curationis - MCur / The Objective Structured Clinical Examination (OSCE) is widely accepted as an effective means of assessing clinical competence and nursing skills. However, little is known the stress amongst first year nursing students associated with the first OSCE in all universities. In view of the paucity of literature available on stress associated with the OSCE, this study determined the perception of stress by the first year nursing students' associated with their first OSCE at this university. A quantitative, descriptive survey design is employed. The instrument used is an adapted form of an existing self-administered Perceived Stress Scale (PSS) questionnaire. This measures perception of stress, factors causing stress and the incidence of stress. Of the total of 213 first year nursing students who were invited to be part of the study, 82 completed the questionnaires. This represents a response rate of 38%. The data was analysed using Statistica 13. Descriptive statistics are used do the calculations. The results are presented in percentages and tables.The findings indicate that more than half (n=54), of the respondents experienced moderate stress levels. For these respondents, the most prevalent factor causing stress was the insufficient time to complete the OSCE. Ninety three percent (93%) (n=74) of the respondents perceived the incidence of stress at a moderate level. There was a statistically significant difference between those who perceived factors causing stress at a low level and those who perceived factors causing stress at a moderate level. Based on the findings of the study on perception of stress during the OSCE, it is recommended that practice session assessments should be conducted throughout the year to help to reduce stress for students during the OSCE. A follow-up qualitative research study should also be conducted in the same setting so the students’ experiences of stress during the first OSCE can be explored in depth. Although the relatively small sample of this study (38%) means the results cannot be generalised, this study does contribute to the literature on the stress experienced during the OSCE.