The peritoneal dialysis orders objective structured clinical examination (OSCE): A formative assessment for nephrology fellows

2021 ◽  
pp. 089686082110005
Author(s):  
Lisa K Prince ◽  
Brian C Y’Barbo ◽  
Robert Nee ◽  
and Christina M Yuan ◽  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Examination ◽  
Item Difficulty ◽  
Standard Of Care ◽  
Objective Structured Clinical Examination ◽  
Evidence Based ◽  
Home Dialysis ◽  
Bacterial Peritonitis ◽  
Ultrafiltration Failure ◽  
Passing Score

Background: Peritoneal dialysis (PD) management is a fundamental nephrology skill, especially with the recent emphasis on home dialysis. We report a prospective multicentre cohort study of a formative objective structured clinical examination (OSCE) assessing competence in managing PD-associated bacterial peritonitis, using the unified model of construct validity. Methods: The OSCE was developed by the principal investigators and reviewed by two subject matter experts. The test committee (eight nephrologists and one PD nurse) assessed test item difficulty/relevance and determined passing score. There were 22 test items (7 evidence-based/standard-of-care questions). Passing score was 16/22 (73%). No item had median relevance less than ‘important’, and all were easy to medium difficulty. Content validity index was 0.91. Preliminary validation (16 board-certified volunteers): mean score was 19 ± 2, with 94% (15/16) passing. Kappa = 0.85 [95% confidence interval (CI) 0.77–0.94]. Cronbach’s α = 0.70. Results: Eighty-seven fellows (16 programmes) were tested; 67% passed. Fellows scored significantly less than validators: 17 ± 3 versus 19 ± 2, p < 0.001 [95% CI 1.2–3.6]. Eighty-six per cent of evidence-based/standard-of-care questions were answered correctly by validators versus 54% by fellows; p < 0.001. Ninety-three per cent of fellows recognized that sufficient criteria were present to diagnose peritonitis, but only 17% correctly indicated all three. Seventy-seven per cent recognized peritonitis-associated ultrafiltration failure, but only 17% prescribed 21 days of antibiotic treatment for gram-negative peritonitis. Eighty-five per cent of fellows surveyed agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Second-year in-training examination and OSCE scores were positively correlated (Pearson’s r = 0.57, p < 0.00). Conclusions: The OSCE may be used to formatively assess fellow proficiency in managing PD-associated peritonitis.

The use of the objective structured clinical examination (OSCE) in a practice-based health discipline: Academic and student experience in paramedicine

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Andy Bell ◽  
Jennifer Kelly ◽  
Peter Lewis
Keyword(s):  
Clinical Examination ◽  
Best Practice ◽  
Assessment Tool ◽  
Clinical Performance ◽  
Reliability And Validity ◽  
Specific Area ◽  
Training Model ◽  
Objective Structured Clinical Examination ◽  
Evidence Based ◽  
Effective Measure

Abstract:Purpose:Over the past two decades, the discipline of Paramedicine has seen expediential growth as it moved from a work-based training model to that of an autonomous profession grounded in academia.  With limited evidence-based literature examining assessment in paramedicine, this paper aims to describe student and academic views on the preference for OSCE as an assessment modality, the sufficiency of pre-OSCE instruction, and whether or not OSCE performance is a perceived indicator of clinical performance.Design/Methods:A voluntary, anonymous survey was conducted to examine the perception of the reliability and validity of the Objective Structured Clinical Examination (OSCE) as an assessment tool by students sitting the examination and the academics that facilitate the assessment. Findings:The results of this study revealed that the more confident the students are in the reliability and validity of the assessment, the more likely they are to perceive the assessment as an effective measure of their clinical performance.  The perception of reliability and validity differs when acted upon by additional variables, with the level of anxiety associated with the assessment and the adequacy of feedback of performance cited as major influencers. Research Implications:The findings from this study indicate the need for further paramedicine discipline specific research into assessment methodologies to determine best practice models for high quality assessment.Practical Implications:The development of evidence based best practice guidelines for the assessment of student paramedics should be of the upmost importance to a young, developing profession such as paramedicine.Originality/Value: There is very little research in the discipline specific area of assessment for paramedicine and discipline specific education research is essential for professional growth.Limitations:The principal researcher was a faculty member of one of the institutions surveyed.  However, all data was non identifiable at time of data collection.  Key WordsParamedic; paramedicine; objective structured clinical examinations; OSCE; education; assessment.

scholarly journals Biocompatible Peritoneal Dialysis Fluids: Clinical Outcomes

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Yeoungjee Cho ◽  
Sunil V. Badve ◽  
Carmel M. Hawley ◽  
Kathryn Wiggins ◽  
David W. Johnson
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Membrane Integrity ◽  
Developed Countries ◽  
Continuous Exposure ◽  
Bicarbonate Buffer ◽  
Home Dialysis ◽  
Ultrafiltration Failure ◽  
Low Glucose ◽  
Randomised Controlled

Peritoneal dialysis (PD) is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis) and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes.

scholarly journals Implementation of Objective structured clinical examination (OSCE) as a tool to evaluate the development of clinical reasoning in physical therapy students and level of satisfaction with its use

2021 ◽  
Vol 70 (2) ◽  
pp. e90746
Author(s):  
Nicole Figueroa-Arce ◽  
Paola Figueroa-González ◽  
Luis Gómez-Miranda ◽  
Ruvistay Gútierrez-Arias ◽  
Viviana Contreras-Pizarro
Keyword(s):  
Physical Therapy ◽  
Clinical Examination ◽  
Clinical Reasoning ◽  
Clinical Skills ◽  
Objective Structured Clinical Examination ◽  
Satisfaction Survey ◽  
Physical Therapy Students ◽  
Cross Sectional ◽  
Level Of Satisfaction ◽  
Passing Score

Introduction: Clinical reasoning involves critical thinking and decision-making in clinical situations. It can be evaluated using Objective structured clinical examination (OSCE), which measures clinical skills associated with the development of clinical reasoning. Objective: To describe the implementation of an OSCE to evaluate the clinical skills associated with the development of clinical reasoning in physical therapy students, and to determine their level of satisfaction with this strategy. Materials and methods: Cross-sectional descriptive study carried out in 159 physiotherapy students from Universidad Andres Bello, Chile, enrolled in the Reasoning in Physical therapy course. The OSCE had 11 stations and a student satisfaction survey was administered. Data normality was determined using the Shapiro-Wilk test. Descriptive statistics (percentages, medians, and interquartile ranges (IQR)) were used for data analysis. Results: The median global score was 142 points (IQR:132-150) and 61.1% of the students obtained a passing score (≥ 134 points). Stations in which most students had a passing score were S3, S5 and S7 (with standardized patients): 78.62%, 96.85% and 85.53%, respectively. Regarding the satisfaction survey, 36.48% and 59.12% of the students agreed and strongly agreed with using tools that assess their clinical skills. Conclusions: The OSCE was successfully designed and implemented to evaluate the clinical skills associated with the the development of clinical reasoning in the study population, and most of them reported a high level of satisfaction with its use; this confirms OSCE is an excellent methodology to train and evaluate physical therapy students.

Intraperitoneal Hyaluronan Production in Stable Continuous Ambulatory Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2) ◽  
pp. 131-137 ◽  
Author(s):  
Kunihiro Yamagata ◽  
Chie Tomida ◽  
Akio Koyama
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Morphological Changes ◽  
Stable States ◽  
Creatinine Concentration ◽  
Permeable Membrane ◽  
Bacterial Peritonitis ◽  
Marker Proteins ◽  
Ultrafiltration Failure ◽  
Encapsulating Peritonitis

Objective Several cytokines and proteins are excreted intraperitoneally during the course of peritonitis and stable states in continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also regarded as a marker of peritoneal healing during bacterial peritonitis. We examined here, intraperitoneal HYA production in stable CAPD patients and compared the results to those of the peritoneal equilibration test (PET), the length of time on dialysis, and other marker proteins. Design We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals. Setting CAPD unit in Hitachi General Hospital. Patients The subjects were 46 stable CAPD patients who underwent 104 PETs. Results A correlation was found between the length of time on dialysis and the amount of HYA excretion in the 4-hr-dwell dialysate ( r = 0.403, p < 0.001). A positive but weak correlation was found between the dialysate-to-plasma ratio of the creatinine concentration and dialysate HYA excretion ( r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both the concentration of HYA (>349.2 ng/mL) and the amount of HYA (>743.6 μg/4-hr dwell). Five patients exceeded 1000 μg of HYA excretion in the 4-hr-dwell dialysate, 4 of whom showed an abrupt increase of HYA excretion to more than 1000 μg/4-hr dwell, and discontinued CAPD within 6 months due to ultrafiltration failure. Two of these 4 patients were diagnosed with sclerosing encapsulating peritonitis at autopsy. Conclusion Intraperitoneal HYA production increased with both higher permeable membrane and the length of time on CAPD. Monitoring of HYA in the peritoneal dialysate may be useful as a marker to assess functional and morphological changes in the peritoneum in long-term CAPD patients.

The passing score in the Objective Structured Clinical Examination

1996 ◽  
Vol 30 (5) ◽  
pp. 345-348 ◽  
Author(s):  
H Morrison ◽  
H McNally ◽  
C Wylie ◽  
P McFaul ◽  
W Thompson
Keyword(s):  
Clinical Examination ◽  
Objective Structured Clinical Examination ◽  
Passing Score

scholarly journals Better Outcomes of Peritoneal Dialysis in Diabetic Patients in Spite of Risk of Loss of Autonomy for Home Dialysis

2014 ◽  
Vol 34 (7) ◽  
pp. 775-780 ◽  
Author(s):  
P. Cotovio ◽  
A. Rocha ◽  
M.J. Carvalho ◽  
L. Teixeira ◽  
D. Mendonça ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Hazard Ratio ◽  
Drop Out ◽  
University Hospital ◽  
Diabetic Patients ◽  
Home Dialysis ◽  
Technique Survival ◽  
Ultrafiltration Failure ◽  
Loss Of Autonomy ◽  
Technique Failure

IntroductionDiabetes mellitus is a leading cause of chronic renal failure, challenging therapy strategies. Patients with diabetes may benefit from peritoneal dialysis (PD) but higher technique failure is feared. Our purpose was to critically evaluate clinical outcomes of this modality in diabetics, in order to find quality improvement strategies in these risk patients.MethodsA registry-based study of 432 incident patients, 23% with diabetes, from a university hospital PD program was performed. Traditional methods (Kaplan-Meier, Cox models) and innovative survival analysis, taking competing risks into account, were performed, as well as exploring the trends in cohorts according to the decade of PD start.ResultsIn spite of the detrimental effect of diabetes in patient survival compared to non-diabetics (77%, 52% vs 86%, 71%, at 2 and 4 years, respectively; p < 0.0001) the hazard ratio (HR) for death decreased in the more contemporary cohort (0.303, 95% confidence interval (CI) 0.150 – 0.614, p < 0.001). It is noteworthy that diabetes was not associated with lower technique survival: 74%, 51% vs 79%, 57%, at 2 and 4 years, respectively ( p = not significant (NS)). On multivariate analysis, diabetes was an independent predictor for mortality, but not for technique failure. The hazard ratio (HR) for technique failure also decreased in the more recent cohort (0.566, 95% CI 0.348 – 0.919, p = 0.021). Among reasons for transfer to hemodialysis, proportion of ultrafiltration failure was similar between groups (26% vs 22%, p = NS), but drop-out due to loss of autonomy occurred more in the group with diabetes (23% vs 5%, p = 0.004), mainly due to ischemic stroke. The hospitalization rate was also higher in diabetic patients (1.39 vs 0.84 episodes per patient-year (E/PY), p = 0.004) but the peritonitis rate was not increased (0.53 vs 0.61 E/PY, p = NS).ConclusionPD was an effective long-term renal replacement therapy in diabetics, without higher rates of technique failure, ultrafiltration failure or peritonitis. Better outcomes were achieved in the contemporary cohort. The menace of autonomy loss due to stroke and higher hospitalization rates enhance the need for assisted PD strategies and better control of comorbidities.

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