Owen Carter

Discriminant validity of the Hospital Anxiety and Depression Scale, Beck Depression Inventory (II) and Beck Anxiety Inventory to confirmed clinical diagnosis of depression and anxiety in patients with chronic obstructive pulmonary disease.

The objective of this study was to investigate the discriminant validity of commonly used depression and anxiety screening tools in order to determine the most suitable tool for patients with chronic obstructive pulmonary disease (COPD). COPD patients (n = 56) completed the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). These scores were compared to confirmed clinical diagnoses of depression and anxiety using the Mini Neuropsychiatric Interview. HADS depression subscale (HADS-D) sensitivity/specificity was 78/81%; BDI-II 89/77%; HADS anxiety subscale (HADS-A) 71/81%; and BAI 89/62%. HADS-D sensitivity/specificity was improved (100/83%) with the removal of Q4 ‘I feel as if I am slowed down’ and adjusted cut-off (≥5). Removal of BDI-II Q21 ‘Loss of interest in sex’ with adjusted cut-off ≥12 resulted in similar improvement (100/79%). No problematic items were identified for HADS-A or BAI. Previously reported low sensitivity/specificity of the HADS for COPD patients was not replicated. Furthermore, simple modifications of the HADS-D markedly improved sensitivity/specificity for depression. BDI-II, HADS-A and BAI produced acceptable sensitivity/specificity unmodified. Pending further research for COPD patients we recommend continued use of the HADS-A with standard cut-off (≥8) and removal of Q4 of the HADS-D with lower cut-off ≥5.

Plain packaging for cigarettes improves retail transaction times

Australia implemented generic packaging laws on 1 December 2012.1 Similar legislation under consideration in the UK is vigorously opposed by national retail groups. Dubious tobacco industry funded studies predict tobacco transaction times will increase by 15-45 s and selection errors by 5-25%,2 3 costing retailers nationwide £37m (€43m;

Clinical Placement Before or After Simulated Learning Environments?: A Naturalistic Study of Clinical Skills Acquisition Among Early-Stage Paramedicine Students

57.5m) a year.4 Conversely, independent peer reviewed …

Testing children’s ability to correctly use the “Shadow Rule” for sun protection

Background There is conflicting evidence surrounding the merit of clinical placements (CPs) for early-stage health-profession students. Some contend that early-stage CPs facilitate contextualization of a subsequently learned theory. Others argue that training in simulated-learning experiences (SLEs) should occur before CP to ensure that students possess at least basic competency. We sought to investigate both claims. Methods First-year paramedicine students (n = 85) undertook 3 days of CP and SLEs as part of course requirements. Students undertook CP either before or after participation in SLEs creating 2 groups (Clin→Sim/Sim→Clin). Clinical skills acquisition was measured via direct scenario-based clinical assessments with expert observers conducted at 4 intervals during the semester. Perceptions of difficulty of CP and SLE were measured via the National Aeronautics and Space Administration Task Load Index. Results Students’ clinical assessment scores in both groups improved significantly from beginning to end of semester (P < 0.001). However, at semester’s end, clinical assessment scores for the Sim→Clin group were statistically significantly greater than those of the Clin→Sim group (P = 0.021). Both groups found SLEs more demanding than CP (P < 0.001). However, compared with the Sim→Clin group, the Clin→Sim group rated SLE as substantially more time-demanding than CP (P = 0.003). Conclusions Differences in temporal demand suggest that the Clin→Sim students had fewer opportunities to practice clinical skills during CP than the Sim→Clin students due to a more limited scope of practice. The Sim→Clin students contextualized SLE within subsequent CP resulting in greater improvement in clinical competency by semester’s end in comparison with the Clin→Sim students who were forced to contextualize skills retrospectively.

Quantification of opportunities for early-stage paramedicine students to practice clinical skills during clinical placements compared with an equal dose of simulation-based workshops

Introduction: The “Shadow Rule” (SR) is a useful, immediate indicator of sunburn risk following the mnemonic “Short shadow? Seek shade!” However, some question people’s ability to discern when their shadows are shorter or longer than them. Methods: N = 76 10-year-old children were taught the SR and then asked to estimate their sun-cast shadow length relative to their height and whether this meant they should seek shade. Children were then asked to estimate a doll’s shadow length at 10 systematically randomised angles. Results: Children experienced greatest difficulty judging their shadows’ lengths when they were equal to their height. At all other angles, they demonstrated high accuracy and 92 % of the time on average could correctly interpret the SR. Conclusions: Ten-year-old children appear capable, and by extension adults too, of applying the SR. Future research is now required to establish if education about the SR will translate into sun protection behaviour change.

The weighty issue of Australian television food advertising and childhood obesity

Introduction A reported advantage of simulation-based learning environments (SLE) over clinical placements (CPs) is that the former can provide a greater number and breadth of opportunities to practice level-appropriate clinical skills compared with the random patient presentations provided during the latter. Although logical and widely accepted as fact, we find no published evidence to demonstrate the magnitude, nor indeed veracity, of this assumption. We therefore sought to quantify the clinical skills practiced by entry-level paramedicine students attending a well-selected CP compared with an equal dosage of SLE. Methods N=37 first-year paramedicine students completed activity diaries during 3 days of CP and 3 days of SLE. Opportunities to practice clinical skills were quantified and coded as either: level-appropriate, beyond-level or of non-discipline relevance. Results During SLE, the average student was exposed 226 times to 11 level-appropriate clinical procedures. During CP the average student was exposed 48 times to 24 clinical procedures, the majority relevant to paramedicine (63%), but a minority level-appropriate (38%). Students’ opportunities for supervised, ‘hands on’ practice represented only 10% of exposures in either SLE or CP but in terms of raw numbers of level-appropriate opportunities, SLE provided more than CP (n=23 vs 2). Discussion Our results confirm that SLE provides substantially more opportunities than CP for students to practice level-appropriate skills and is therefore more appropriate for repetitive practice. However, CP is likely to remain useful to students for practicing interpersonal skills and contextualisation of knowledge within the broader health system. Educators should therefore carefully articulate learning objectives before choosing between SLE and CP.