Swallowing difficulties after acute stroke are common. Clinical bedside assessments are used frequently to detect acute dysphagia. Published studies which have assessed the natural history of swallowing using bedside assessments have only observed swallowing for a short period of time. The purpose of this investigation was to monitor the natural progression of dysphagic symptoms in stroke over three month using a clinical assessment. 26 patients consecutively admitted to the regional public hospital were assessed using a clinical assessment consisting of cranial nerve exam, observation of oral intake, water swallow test and inhalation cough challenge. The assessment was implemented within 72 hours post admission and then after one week, three weeks and three months. For this exploratory study, descriptive statistics were used to explore the data set. The results confirm that dysphagia after stroke is common and that there are improvements within three months.

Swallowing difficulties after acute stroke are common. Clinical bedside assessments are used frequently to detect acute dysphagia. Published studies which have assessed the natural history of swallowing using bedside assessments have only observed swallowing for a short period of time. The purpose of this investigation was to monitor the natural progression of dysphagic symptoms in stroke over three month using a clinical assessment. 26 patients consecutively admitted to the regional public hospital were assessed using a clinical assessment consisting of cranial nerve exam, observation of oral intake, water swallow test and inhalation cough challenge. The assessment was implemented within 72 hours post admission and then after one week, three weeks and three months. For this exploratory study, descriptive statistics were used to explore the data set. The results confirm that dysphagia after stroke is common and that there are improvements within three months.

Nursing in Indonesia is attempting to achieve a higher standard of education to enable nurses to migrate to global areas of nursing shortages. Assessment of nursing practice during undergraduate nursing education in Indonesia requires investigation to assist in achieving a higher standard of education. For assessment to occur, there are several variables reported in the literature that must be included in the process of assessment, that is assessors, students, methods and tools of measurement as well as clinical environment. It is acknowledged that those factors influence the successfulness of the clinical assessment process. The purpose of this descriptive exploratory study utilising a self report clinical instructor and student nurse questionnaire was to investigate the clinical assessment of Indonesian student nurses undertaking the professional stage of the undergraduate nursing course. Specifically, the study investigated how clinical teachers assess student nurses and how students perceive the clinical assessment process. Data were collected from four nursing institutions in Jakarta, Indonesia during July 2006. Quantitative and qualitative data analysis were undertaken to meet the purpose and objectives of the study. Quantitative data analysis utilised frequency tables, cross tabulations and ANOVA. Participants’ responses to open-ended items were analysed using content analysis procedures. The findings of this study have shown that there are many important issues surrounding the assessment of Indonesian student nurses, such as the model of assessment process employed and the characteristics of clinical instructors, students and clinical environment. From this study, it was revealed that the assessment of student nurses employed skilledv based assessment, despite the global trends towards competency-based assessment. Findings from this study also illustrate that nursing education development has been occurring in Indonesia with already half of the clinical instructor participants being educated to master’s level and most student nurse participants held diploma III qualifications prior to their Bachelor of Nursing course, which means that they want to continue their study to a higher level. However, improvement in nursing curriculum which focuses on competency-based curriculum is needed. Improvement in the nursing curriculum will lead to improvements in the nursing profession. That is a higher standards of professionalism for nursing and nurses in Indonesia. Recommendations from the study include promoting changes in curriculum, particularly regarding the assessment process to employ competency-based assessment for student nurses. This study also endorses the use of a standardized assessment in clinical setting. In addition, further research related to replication of the study at a national level and comparison of clinical assessment in other countries should be conducted.

Relief from pain and distressing symptoms associated with a life limiting illness is an issue relevant to all Canadians. Provision of high quality care for persons nearing the end of life may improve the health and quality of life of the person and affects the health and well-being of members of their informal support network including family, friends, and caregivers. Palliative care, a person-centered approach to care for persons faced with a life limiting illness and their informal support network, focuses on the ‘total person’ or ‘whole self’ addressing the multifaceted complex needs of each person on an individualized basis. Palliative care is recognized by the World Health Organization (WHO) to be “achieved through prevention and relief of suffering by means of early identification, comprehensive assessment, and treatment of pain and physical, psychosocial, or spiritual problems” (World Health Organization [WHO], 2010). The palliative care philosophy prioritizes self-determination of the person and supports their engagement in the care planning and decision making process across the illness trajectory. Approximately one fifth of persons who die annually experience unrelieved suffering (Doyle & Woodruff, 2013). Persons nearing the end-of-life face can face a wide range of challenges that may include: uncontrollable pain and physical symptoms, unresolved and emotionally distressing psycho-social issues, and fear of one’s own mortality and of an unknown future. Nearly two thirds of Canadians who die each year may benefit from palliative care (Canadian Hospice Palliative Care Association [CHPCA], 2010), however only approximately one in eight of those persons are able to access palliative care services (Carstairs & Beaudoin, 2000). Comprehensive clinical assessment supports clinicians to make evidence-informed decisions and promotes a person-centered approach to care planning. The interRAI Palliative Care assessment instrument (interRAI PC) is a comprehensive standardized assessment instrument, designed for use by facility and community based palliative care services, with applications that include care planning, outcome measurement, quality monitoring, and resource allocation (Hirdes et al., 1999; Steel, et al., 2003; Gray, et al., 2009; Hirdes et al., 2008). Using pilot data gathered from the interRAI PC, this thesis examines the potential use of interRAI PC assessment data, and in particular how evidence from the interRAI PC Clinical Assessment Protocols (CAPs) has the potential to inform individualized care plan development for persons with a life limiting illness. This thesis begins with a scoping literature search that describes palliative care in a Canadian context and explores care planning with the interRAI PC. This is followed by three research based chapters (Chapters 6, 7, and 8) that include analysis based on pilot data gathered between 2006 and 2011 using the interRAI PC assessment instrument. Community dwelling persons with a life limiting illness receiving palliative home care services in six geographic locations across Ontario, Canada, were included in these analyses. Persons with a life limiting illness residing in institutional or hospice facilities, or in jurisdictions outside of Ontario, were excluded. Analyses were performed using SAS Version 9.2 with an alpha level of p< 0.05 for all statistical tests unless otherwise stated. The University of Waterloo’s Office of Research Ethics granted ethics clearance for this research (ORE# 19424) November 29th, 2013. The first research chapter (Chapter 6) describes how clinicians may use the interRAI PC Clinical Assessment Protocols (CAPs) to inform care planning. It includes an overview of the suite of eight CAPs and provides a background description of the CAP development process. Discussion addresses the unique distributional characteristics of each CAP and describes a hierarchical triggering structure. Following, chapter six which provides an overview of the interRAI PC CAPs from a broad perspective; chapter seven (the second research chapter) takes a more in-depth focus investigating the Dyspnea CAP. Dyspnea was selected as the symptom of focus because it is the one of the most commonly triggered CAPs affecting nearly half of the sample palliative home care population used in this thesis and is reported to be one of the most distressing symptoms affecting both the person faced with a life limiting illness and their informal caregivers (Ng &von Gunten, 1998; Potter, Hami, Bryan, & Quigley, 2003; Dellon et al., 2010; Kroenke, Johns, Theobald, Wu, & Tu 2013). Chapter seven examines the Dyspnea CAP and describes the prevalence of dyspnea. This chapter demonstrates the relationship between dyspnea and prognosis as well as other clinical factors. Moreover, how the presence of dyspnea changes over time is examined and person-level characteristics, some of which are potentially amenable to change, that affect the risk for dyspnea over time are identified. In addition, risk and protective factors for persons who over time developed new dyspnea symptoms and for those who recovered from dyspnea are examined. Recognizing that a hallmark of the palliative care philosophy is its aim to provide the highest quality of care and support for both the person nearing the end of life and members of their care network including their informal caregivers, the third research chapter (Chapter 8) examines distress experienced by both the caregiver and the care recipient as a unit of care. As quality palliative care may increase satisfaction with care, improve global quality of life for client and their caregiver, reduce physical symptoms like dyspnea, decrease signs of depression or anxiety, and improve access to health care resources (Kane, Bernstein, Wales, Leibowitz, & Kaplan, 1984; Melin-Johansson, Axelsson, Gaston-Johansson, & Danielson, 2010) the association between the presence of dyspnea and distress experienced by members of the caregiver-client unit of care is examined to illustrate how dyspnea relates to distress, a major problem affecting over half of the caregiver-client units of care. Together, findings from this thesis show that if one or more interRAI PC CAPs are triggered then the clinician should take notice. Data from the interRAI PC and more specifically from the interRAI PC CAPs examined in this thesis provide evidence on their potential to inform greater understanding of the complex needs of palliative home care clients. Better understanding of the interRAI PC CAPs and identification of patterns in CAP triggering structure suggest symptoms where clinicians may focus increased attention. To address the accumulative complex needs of persons who are faced with a life-limiting illness and the needs of their caregivers, resource allocation focused on evidence gathered from a comprehensive standardized assessment instrument should be prioritized.

No description available.

abstract: Item response theory (IRT) and related latent variable models represent modern psychometric theory, the successor to classical test theory in psychological assessment. While IRT has become prevalent in the assessment of ability and achievement, it has not been widely embraced by clinical psychologists. This appears due, in part, to psychometrists' use of unidimensional models despite evidence that psychiatric disorders are inherently multidimensional. The construct validity of unidimensional and multidimensional latent variable models was compared to evaluate the utility of modern psychometric theory in clinical assessment. Archival data consisting of 688 outpatients' presenting concerns, psychiatric diagnoses, and item level responses to the Brief Symptom Inventory (BSI) were extracted from files at a university mental health clinic. Confirmatory factor analyses revealed that models with oblique factors and/or item cross-loadings better represented the internal structure of the BSI in comparison to a strictly unidimensional model. The models were generally equivalent in their ability to account for variance in criterion-related validity variables; however, bifactor models demonstrated superior validity in differentiating between mood and anxiety disorder diagnoses. Multidimensional IRT analyses showed that the orthogonal bifactor model partitioned distinct, clinically relevant sources of item variance. Similar results were also achieved through multivariate prediction with an oblique simple structure model. Receiver operating characteristic curves confirmed improved sensitivity and specificity through multidimensional models of psychopathology. Clinical researchers are encouraged to consider these and other comprehensive models of psychological distress. / Dissertation/Thesis / Ph.D. Psychology 2011

No description available.

The purposes of this study were: (1) to determine whether there was a correlation between a quantitative assessment of postural sway , and a clinical assessment of postural stability, in patients diagnosed with idiopathic Parkinson's disease (PD); (2) to plot individual diurnal changes in postural sway characteristics of PD patients over an eight-hour time period; (3) to plot day to day changes in individual postural sway characteristics of PD patients: (4) to determine whether there was a difference in the postural sway characteristics of parkinsonians, with and without vision; (5) to determine whether there was a difference in the postural sway characteristics of the same individuals when using either Sinemet or Oeprenyl. Three male PD patients were recruited into this study. Each subject stood on a stable force platform (AMT1 OR6-5-1). Measurements included the standard deviations of the coordinates of the centre of pressure (COP) in the anterior-posterior (a-p) and lateral (lat) directions, the mean velocity of sway, and area of sway. These dependent measures were evaluated in a "quiet standing" condition, once with the eyes open (EO) and once with the eyes closed (EC). These procedures were carried out ten times over the course of an eight hour day. Each subject was tested two days while taking eight hour day. Each subject was tested two days while taking Sinemet, and two days while on the Deprenyl regimen. Secondly, at two periods of each test day, each patient was evaluated using the postural assessment section of the Sears Parkinson's Assessment Form (SPAF). The results were: (1) group analyses and individual analyses established the evidence of significant correlations between both the quantitative measures of postural sway (force platform) and the qualitative assessment tool (SPAF): (2) significant variability was evident in the analysis of individual data plots: (3) no statistically significant differences were observed tor any subject when measured from day to day; (4) generally, vision was a stabilizing factor in postural control, however, this was quite variable for each subject; (5) significant improvements in postural stability were observed with the introduction of Deprenyl for one out of three subjects. These findings are discussed in terms of their clinical and behavioral importance, with specific reference to Physiotherapy. / Thesis / Master of Science (MS)

A major focus in nursing education is on the judgement of clinical performance, and it is a complex process due to the diverse nature of nursing practice. Difficulties in the development of valid and reliable assessment measures in nursing competency continue to pose a challenge in nursing education. A holistic approach in the assessment of competency comprises knowledge, skills and professional attitudes, wherein the notion of competency incorporates professional judgement and management skills in the clinical situation. Therefore, the thesis aims to develop a holistic clinical assessment tool with a reasonable level of validity and reliability to meet the needs of clinical education. The conceptual framework underlying this research is formed by establishing a theoretical connection between the practice of learning, and of pedagogy and assessment. This research consists of five studies. In Study I, a systematic review was conducted to explore the current assessment practices and tools for nursing undergraduates. In Studies II, III and IV, a qualitative approach with focus group discussions was adopted to explore the views of final-year undergraduate nursing students, preceptors, clinical nurse leaders and academics on the clinical assessment. Based on the multiple perspectives, it therefore addresses concerns in clinical assessment. In Study V, a holistic clinical assessment tool was developed, for which a psychometric testing was conducted. The systematic review indicated that limited studies adequately evaluate the psychometric properties of the assessment instrument. The qualitative studies have raised an awareness of professional and educational issues in relation to clinical assessment. Workload, time, availability of resources, adequate preparation of preceptors, and availability of valid and reliable clinical assessment tools were deemed to influence the quality of students’ clinical learning and assessment. In addition, the presence of support systems and formal educational programs for preceptors influenced their preparation and self-confidence. Nursing leaderships in hospitals and educational institutions have a joint responsibility in shaping the holistic clinical learning environment and making holistic clinical assessment for students. The involvement of all stakeholders in the development of a valid and reliable assessment tool for clinical competency is also essential to the process. The Holistic Clinical Assessment Tool (HCAT) was developed by the author based on the systematic review, qualitative findings and the core competencies of registered nurse from the professional nursing boards. The HCAT consists of 4 domains and 36 assessment items. Furthermore, testing of the psychometric properties indicated that the HCAT has satisfactory content validity, construct validity, internal consistency and test-retest reliability. In conclusion, the HCAT is meritorious in that it carries the potential to be used as a valid measure to evaluate clinical competency in nursing students, and provide specific and ongoing feedback to enhance the students’ holistic clinical learning experience. The HCAT not only functions as a tool for self-reflection for the students, but also guides the preceptors in clinical teaching and assessment. In addition, the HCAT can be used for peer-assessment and feedback. It is imperative that the clinical and academic institutions establish various levels of ongoing support for both students and preceptors in the process of clinical assessment.

Os implantes dentários representam uma opção de tratamento com alta previsibilidade de sucesso e sobrevivência. Os excelentes resultados geralmente estão relacionados à estabilidade da crista óssea e à saúde dos tecidos peri-implantares de suporte. O material utilizado para confecção do conector protético parece ter um papel importante no resultado clínico dos implantes em longo prazo. O objetivo deste estudo foi avaliar longitudinalmente parâmetros clínicos dos tecidos peri-implantares em pacientes reabilitados com próteses unitárias cimentadas sobre conectores de titânio ou zircônia. Foram selecionados 20 participantes que foram reabilitados com implantes dentários e coroas protéticas cimentadas sobre conectores de zircônia (n=10; região anterior da maxila) ou conectores de titânio (n=10; região posterior da maxila/mandíbula). Os parâmetros clínicos: profundidade de sondagem, nível clínico de inserção, recessão gengival, sangramento à sondagem e reabsorção óssea marginal foram coletados nos períodos T0 = baseline (instalação da prótese), T1 = 12 meses, T2 = 24 meses e T3 = 36 meses de função mastigatória. Nenhuma complicação clínica foi observada em ambos os conectores, com taxa de sucesso de 100%. Tanto os materiais avaliados quanto os períodos de investigação propostos apresentaram efeito relativo significante nos parâmetros clínicos avaliados (p &lt; 0,05). Não houve diferença significante em relação à reabsorção óssea marginal total, entre os dois materiais, após 36 meses. Os resultados sugerem manutenção da saúde peri-implantar ao longo do tempo, em ambos os grupos / Dental implants represent a treatment option with high success and survival predictability. The great results usually are related to bone crest stability and peri-implant supporting tissues health. The material used to produce the prosthetic connector seems to play an important role on the long term of implant clinical outcome. The objective of this study was to evaluate longitudinal clinical parameters of peri-implant tissues in patients rehabilitated with unitary prostheses cemented on titanium or zirconia connectors. Were selected twenty participants rehabilitated with dental implants and cemented crowns on zirconia connectors (n = 10, anterior maxilla) or titanium connectors (n = 10, posterior maxilla/ mandible). The clinical parameters: probing depth, connective tissue attachment level, gingival recession, bleeding on probing and marginal bone resorption, were collected in the periods of masticatory function: T0 = baseline (prosthesis installation), T1 = 12 months, T2 = 24 months and T3 = 36 months. No clinical complication was observed in both connectors, with a 100% success rate. The evaluated materials and the investigated periods had a significant relative effect on the clinical parameters evaluated (p &lt; 0.05). There was no significant difference on the total marginal bone resorption between the two materials, after 36 months. The results suggests maintenance of peri-implant health over time, in both groups