A Rare Case of NUT Carcinoma of the Thyroid.

NUT carcinoma is an aggressive, poorly differentiated squamous cell carcinoma, defined by rearrangement of the NUTM1 (Nuclear Protein in Testis) gene. Diagnosis is challenging due to histologic similarities with other poorly differentiated tumors requiring advanced diagnostic techniques. There is no established treatment, and prognosis remains extremely poor. A 27-year-old woman without known medical history presented with a rapidly enlarging neck mass and compressive symptoms. Chemotherapy for presumed squamous cell carcinoma with a component of anaplastic thyroid cancer based on pathology was initiated. Next-generation sequencing revealed thyroid NUT carcinoma with high PD-L1 expression, prompting PD-1 targeted therapy. The patient expired shortly afterwards from progressive disease. NUT carcinoma of thyroid origin is an extremely rare disease. This case brings awareness to the disease, highlights the importance of advanced diagnostic techniques and complexities in managing patients with NUT carcinoma.

Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care: A cross-sectional study.

PROBLEM: Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care. BACKGROUND: There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM. AIM: To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM. METHODS: This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge. FINDINGS: Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02). DISCUSSION: Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM. CONCLUSION: Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.

Development and testing of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool.

OBJECTIVE: Develop and test a tool to measure midwives' perceptions of their role in preceptoring midwifery students. DESIGN: A multi method exploratory study design was used. POPULATION: Preceptor midwives from three maternity units in south-east Queensland Australia. METHODS: A three-phase process was used: item generation; expert review; psychometric testing including content analysis of qualitative responses. The survey was online or paper-based and included demographic details, the Clinical Preceptor Experience Evaluation Tool (CPEET) role subscale and draft tool. A focus group discussion explored the open-ended responses. FINDINGS: A large sample of preceptors (n = 164, 64.2 % response rate) participated. Factor analysis revealed a two-factor structure with 24 items accounting for 40.2 % of variance. The mean total score of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool was 103.31 (SD = 9.47). The scale was reliable (Cronbach's alpha 0.89) and valid. Test-retest reliability showed moderate to excellent temporal stability across the scale and subscales. Measures of concurrent validity showed little agreement with the CPEET tool. Qualitative analysis revealed the way midwives were taught as students had a powerful influence on their approach to teaching in practice. CONCLUSION: This tool is specifically designed to assess midwifery preceptors' perceptions of their role in student learning in practice. Psychometric testing of the MidPaACT tool confirms its reliability and validity. IMPLICATIONS FOR PRACTICE: Midwifery preceptors are a key influence on the development of students' capability as a midwife. Midwives' perceptions of their proficiency in student learning are under-reported. The MidPaACT tool provides a reliable and valid means of measuring preceptors' perceptions and identifying areas for future educational and workforce improvement.

An evaluation of the use and efficacy of behavioural therapy when treating paediatric patients with radiation therapy.

INTRODUCTION: The paediatric radiation therapy group (PRTG) provided a multidisciplinary network to support patients accessing radiation therapy (RT). This study aims to evaluate the use and efficacy of behaviour therapy practices used by the PRTG. METHODS: A retrospective cross-sectional review of general anaesthetic (GA) utilisation for paediatric patients was completed between 1 January 2010 and 30 June 2014. The PRTG incorporated behavioural therapy techniques into all appointments but offered additional play appointments to children unable to comply with the requirements of RT. This aimed to increase their compliance and minimise GA use. RESULTS: Two-hundred and seventy-four patients had 5402 occasions of service, of which 1361 were delivered under GA (25.2%). Two-hundred and fifty-seven patients met the eligibility criteria. Patients under 8 years who required GA for their entire treatment reduced for each year of increase in age (odds ratio 0.37, 95% confidence interval 0.27-0.51, P < 0.001). Participants 3 years and younger were shown not as likely to change their GA requirements with the use of play appointments. Seventy-eight per cent (83/106) of 3-8-year-olds used no GA or ceased GA during treatment. CONCLUSIONS: Most paediatric patients <3 years will gain minimal benefit to reduce GA use from additional play appointments. Children older than nine were not likely to require play appointments to be compliant with RT. Encouragingly, 53.3% of 3-8-year-olds who were categorised as full GA after CT planning did not continue to a full course of GA due to the behavioural therapy interventions of the PRTG.

Impact of women's feedback on midwifery student learning: A thematic analysis of students' reflections.

PROBLEM: Little is known about the educational impact of providing routine, online feedback from women on midwifery student learning and clinical practice. BACKGROUND: Feedback on students' clinical performance has historically been provided by lecturers and clinical supervisors. Women's feedback is not routinely collected or evaluated for impact on student learning. AIM: To evaluate the impact of women's feedback about continuity of care experiences with a midwifery student on learning and practice. DESIGN: Descriptive, exploratory qualitative study. METHODS: All second-and third-year Bachelor of Midwifery students undertaking clinical placement between February and June 2022 at one Australian university, submitted formative, guided written reflections on de-identified women's feedback they received through their ePortfolio. Data were analysed using reflexive thematic analysis. FINDINGS: Forty-four of the 69 eligible students (64%) submitted reflections on feedback received. Three themes emerged: 1) Confidence boosting, 2) Deeply integrating Midwifery Metavalues, and 3) Enhancing commitment to continuity. Three subthemes: connection, future practice and advocacy were identified. Women's feedback positively impacts student learning and places the woman in the educational feedback loop. CONCLUSION: This study is an international first evaluating the impact of feedback from women on midwifery students' learning. Students reported greater confidence in their clinical practice, a deeper understanding of their midwifery philosophy, and an intention to advocate for, and work in, midwifery continuity models after graduation. Routine feedback about women's experiences should be embedded into midwifery education programs.

Care at Your Fingertips: Codesign, Development, and Evaluation of the Oncology Hub App for Remote Symptom Management in Pediatric Oncology.

PURPOSE: To codesign, develop, and evaluate a smartphone app that includes patient-reported measures of symptoms and real-time advice in children's cancer. METHODS: The Oncology Hub is a comprehensive approach to symptom management that includes a suite of codesigned tools and resources including clinical algorithms to determine the level of concern, symptom management advice, and resources for families of children with cancer. The evaluation involved Think Aloud interviews with parent and adolescent patients to complete tasks in the app as well as a User Experience questionnaire (score range, 0-120) and qualitative feedback. The accuracy of algorithms was determined by repeated testing of inputs and outputs over 4 weeks. RESULTS: Design and wireframes were iteratively refined through consultation with parents and adolescents confirming the final design. Beta testing evaluation was then completed by 25 participants including two adolescents. Across all participants, 84% of tasks were easy to navigate, and the Oncology Hub demonstrated high usability, usefulness, and acceptability with participants' scores ranging between 90 and 120 (mean = 112.2, standard deviation = 9.43). Qualitative feedback was positive. Testing of algorithms identified inconsistencies in understanding between clinical research and coding teams; refinements were made until the expected response notifications were returned with 100% accuracy. CONCLUSION: Technology offers new ways to think about how clinicians and families communicate and share information to harness the best of community and hospital services. Understanding how information is exchanged using health apps, and how this affects clinical workflow is critical to successful implementation, and optimizing symptom assessment and management in children with cancer.

Critical thinking development in undergraduate midwifery students: an Australian validation study using Rasch analysis.

BACKGROUND: Well-developed critical thinking skills are required to provide midwifery care that is safe, evidence-based, and woman-centred. A valid, reliable tool to measure is required the application of critical thinking in midwifery practice. The Carter Assessment of Critical Thinking in Midwifery (CACTiM) has previously been psychometrically assessed using classical methods at a single site. This study aims to further evaluate the properties of CACTiM tools using Rasch analysis in a diverse group of midwifery students and preceptors.  METHODS: The CACTiM tools were completed by undergraduate midwifery students studying at three Australian universities and their preceptors. Midwifery students' critical thinking was evaluated separately through student self-assessment and preceptor assessment and then matched. Rasch analysis was used to evaluate the validity of the tools.  RESULTS: Rasch analysis confirmed both the preceptor and student CACTiM tools demonstrated good reliability and unidimensionality. The items can differentiate between students' ability to apply critical thinking in midwifery practice. Person reliability and item reliability were above .92 for both scales indicating excellent reliability and internal consistency. Several improvements were identified to the tools, including enhanced wording to some items, and reduction to a 5-point Likert scale. Through analysis of lower-scoring items, midwifery programs can identify curricula enhancements. CONCLUSION: The CACTiM student and preceptor tools are valid and reliable measures of critical thinking in midwifery practice. The tools can assess students' critical thinking abilities and identify areas for development for individuals and across student cohorts through curricula enhancements.

The use of eportfolios in pre-registration health professional clinical education: An integrative review.

INTRODUCTION: ePortfolios are increasingly used in health professional clinical education. However, the nature of ePortfolios varies greatly amongst programs, as does the software, purpose, and institutional cost. OBJECTIVES: An integrative review of the literature was conducted to determine how ePortfolios are being used in pre-registration health programs to enhance clinical learning. DATA SOURCES: A systematic search of relevant databases (Cumulative Index of Nursing and Allied Health Literature, Education Resources Information Center, Cochrane, Medline, ProQuest, PubMed, Turning Research Into Practice, and Web of Science) was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Retrieved papers were assessed using the Critical Appraisal Skills Programme tool and findings were analysed. REVIEW METHODS: A total of 272 records were identified. Thirty papers were assessed in detail. Five themes were identified by content analysis; feedback and communication; student-centred learning; experiences and competencies; access, attitudes, and digital literacy; and technological support. CONCLUSIONS: ePortfolios offer a range of pedagogical benefits. Clinical learning is enhanced by student-focused ePortfolio design which includes clear learning outcomes; development of relationships with peers and instructors via ongoing communication and feedback; use of templates; links to time-saving applications; and guided, assessed reflections. Poor technological support, negative attitudes by clinical supervisors, unreliable access, instructor-focused design, and excessive or repetitive documentation in ePortfolio design hindered clinical learning.

Systematic review of interventions to enhance preceptors' role in undergraduate health student clinical learning.

AIM: Evaluate interventions to prepare preceptors for their role in undergraduate health student clinical education. BACKGROUND: Preceptor training and development are crucial to quality clinical learning experiences for undergraduate health students. The efficacy of education interventions designed for preceptors and use of reliable, valid outcome measures are unclear. DESIGN: A systematic literature review informed by PRISMA Guidelines. METHODS: Major databases CINAHL, Medline and Google Scholar were searched between January 2010 and November 2021. 1253 articles were initially retrieved. Removal of duplicates and screening by title, abstract and keywords yielded 156 papers. Twenty-one papers fulfilled the inclusion criteria and were assessed using an adapted 'Critical Appraisal Checklist for Reports of Educational Interventions' and the New World Kirkpatrick Model. RESULTS: Most interventions were developed for the nursing profession and evaluated using pre-post-test (86%) or post-test only (5%). Two studies were considered high quality. Most studies (81%) reported positive short-term impact on preceptor knowledge, skills, attitudes and confidence. Two thirds (62%) of included studies measured preceptor behaviour change. No study measured impact related to quality of health care. Small sample sizes limited inferential analyses. Psychometric testing of tools to measure preceptor outcomes was inconsistent and validity and reliability were not reported in most studies. CONCLUSIONS: Structure and content of interventions were diverse and lacked rigour in outcome measurement. Most interventions demonstrated some positive impact on preceptor development. Objective measures determining longer term impact or how enhanced preceptor development translated into quality clinical student learning support was lacking. Future research should consider how best to measure the impact of educational interventions on broader outcomes such as quality of client care.

International consensus definition of critical thinking in midwifery practice: A Delphi study.

PROBLEM: Currently there is no discipline-specific definition of critical thinking in midwifery practice. BACKGROUND: Critical thinking in midwifery practice is the cornerstone for safe, evidence based, and woman centred clinical decision-making. Available definitions of critical thinking in other disciplines do not align with midwifery practice which is distinctive, multidimensional and complex. AIM: To develop an international consensus definition of critical thinking in midwifery practice. METHODS: A two round Delphi study was used. Thirty-two international midwifery experts contributed to the first round which was qualitative in nature. Twenty one of these experts then ranked the relevance and clarity of concepts from round one. FINDINGS: A consensus definition of critical thinking in midwifery practice was achieved. The expert panel identified and defined 14 'Habits of Mind' and 12 Skills that are the core of critical thinking in midwifery practice. Skills included; analysis, constructive application and contextualisation of best available evidence, problem solving, discriminating, predicting, evaluation of care, collect and interpret clinical cues, collaboration/ negotiation, reflexivity, facilitates shared decision-making, communication, and transforming knowledge. Habits of Mind included; intellectual curiosity, reflective, holistic view, intellectual integrity, flexibility, questioning/challenging, participatory, open mindedness, listening with understanding and empathy, cultural humility, woman centred, being brave, confidence, and creativity. DISCUSSION/CONCLUSION: This study is an international first and delineates characteristics of critical thinking in midwifery. Development of a consensus definition provides a common and shared understanding of the skills and attributes required for critical thinking in midwifery practice and can also be applied in education and research.

Altering ureide transport in nodulated soybean results in whole-plant adjustments of metabolism, assimilate partitioning, and sink strength.

Legumes develop a symbiotic relationship with bacteria that are housed in root nodules and fix atmospheric di-nitrogen (N2) to ammonia. In soybean (Glycine max (L.) Merr.) nodules, the final products of nitrogen (N) fixation are amino acids, and the ureides allantoin and allantoic acid that also serve as the major long-distance N transport forms. Recently, we have shown that increased expression of UPS1 (ureide permease 1) in soybean nodules results in enhanced ureide export from nodules with positive effects on N fixation and seed yield. Here, we demonstrate that changes in the ureide transport processes trigger alterations in allantoin and allantoic acid pools and partitioning throughout the transgenic plants. They further result in adjustments in amino acid availability in, and translocation to, root and shoot sinks. In addition, leaf carbon (C) capture, assimilation and allocation to sinks are improved, accommodating the increased nodule function, and root and shoot growth. Overall, we demonstrate that enhanced ureide partitioning in nodulated soybean leads to a complex rebalancing of N and C acquisition, metabolism, and transport processes with positive consequences for above- and below-ground vegetative biomass, and whole-plant N and C gains.

Adrenal Myelolipoma Masquerading as an Adrenal Malignancy.

An adrenal myelolipoma presenting with suspicious features may pose a diagnostic challenge to surgeons and endocrinologists. In this case report of an adult patient with undiagnosed congenital adrenal hyperplasia presenting with bilateral adrenal masses, we review his radiographic and clinical findings which were highly suspicious for adrenal malignancy. Features of adrenal myelolipoma that may resemble malignant lesions are reviewed. This case report highlights important features of adrenal myelolipoma that the surgeon and endocrinologist should be aware of. The importance of avoiding overtreating adrenal myelolipomas presenting as tumors of uncertain malignant potential is crucial.

Evaluation of a First Peoples-led, emotion-based pedagogical intervention to promote cultural safety in undergraduate non-Indigenous health professional students.

BACKGROUND: Undergraduate health students learn cultural safety in complex and emotional ways. Pedagogies that account for these complexities must be developed and evaluated. OBJECTIVES: To evaluate a First Peoples-led emotion-based pedagogical intervention on non-Indigenous health professional students' development towards cultural safety. DESIGN: A pre-post mixed-methods intervention design. SETTING AND PARTICIPANTS: All undergraduate health students undertaking a semester-long First Peoples cultural safety course (n = 395) were invited to participate. METHODS: The intervention involved students' written reflections and comfort (1 = very uncomfortable to 5 = very comfortable) with workshop content, using a gawugaa-gii-mara (head, heart, hands) form. The educator analysed student responses collected on the form, to prompt discussion in a series of four workshops. Students also completed the online 20-item Student Emotional Learning in Cultural Safety Education Instrument (SELCSI) which has two scales, Witnessing and Comfort. gawugaa-gii-mara responses were thematically coded. Paired sample t-tests examined differences over time. Eta squared determined effect size. RESULTS: There were 102 matched pre-post-intervention surveys. Both SELCSI scales had excellent internal consistency (Witnessing α = 0.80, Comfort α = 0.92). A statistically significant difference was observed between students' mean scores on the Witnessing scale prior to the course (M = 47.10, SD = 6.51) compared to post-course (53.04, SD = 4.80), t(95) = 8.70, p < 0.001 (two-tailed) with a large effect size (d = 0.88). Most Comfort scale items increased but were not statistically significant. Data from the gawugaa-gii-mara intervention (n = 162 written responses) revealed students were challenged by self-reflexivity. There was a disconnect between what students had learnt (gawugaa), what they had felt (gii) and how this would be applied in professional practice (mara). CONCLUSIONS: The First Peoples-led, emotions-based pedagogical intervention was brief, meaningful and effective. As students grappled with their emotional connection to self-reflexivity as well as their ability to translate new knowledge into culturally safe practice, these offer important avenues for future research.

Systematic review of tools to measure preceptors' perceptions of their role in undergraduate health clinical education.

OBJECTIVE: Evaluate tools used to measure preceptors' perceptions of their role in the clinical education of health undergraduate students. BACKGROUND: Measurement of preceptors' perceptions of their role in students' learning in practice lacks consistency. The preceptor role makes an important contribution to quality clinical education. DESIGN: A systematic literature review informed by PRISMA Guidelines. DATA SOURCES: Major databases CINAHL, ProQuest, Nursing and Allied Health, Medline, Health Reference Centre, Joanna Briggs Institute, PsychInfo and Google Scholar were searched. REVIEW METHODS: The search strategy yielded a total of 166 papers. Screening for inclusion resulted in 28 papers for critical appraisal and review. RESULTS: Twenty-two individual tools were identified. Fourteen were named. Nine tools were new, study-specific and untitled. Eight tools were informed by previous research. A third of studies were appraised as being of good quality. A lack of consistency in measures, use of small convenience samples and reliance on self-reported outcomes limited the generalisability of findings. CONCLUSIONS: Two tools were suitable measures of preceptors' perceptions of their role or an appropriate measure for preceptor effectiveness in students' learning in practice. These tools were tested on the nursing profession only. Ensuring quality in clinical education requires consideration of experiences of key stakeholders and standard measurement of perspectives, effectiveness and preparedness to achieve quality clinical learning outcomes for students.

The Impact of a Breastfeeding Promotion Intervention on Rapid Weight Gain among African American Infants.

BACKGROUND/OBJECTIVE: To evaluate the impact of exclusive breastfeeding (EBF) on rapid weight gain (RWG) among infants of African American women enrolled in a breastfeeding promotion intervention. METHODS: African American mothers in the 2nd or 3rd trimester who consented and attended four 30-minute breastfeeding promotion sessions prospectively provided breastfeeding and physical measurements at birth, four-, six-, and twelve-months. RESULTS: Mean age of mothers was 28.74±6.0 years, range 15-42 years, 62(38.8%) primiparous, 59 (36.9%) had ≤high school diploma, and 68 (42.5%) annual income <$15,000. Exclusive breastfeeding at birth, three, and six months were 104 (62.7%), 44 (34.4%), and 21 (17.9%). Rapid weight gain at four months and six months were 42 (36.2%) and 77 (74.8%). Difference in rapid weight gain at four months for babies breastfed up to three months vs. those who were not was significant, p<.04. Maternal demographics did not predict RWG in multiple regression modelling. The incidence of overweight at 12 months for babies who experienced RWG at four months vs. those who did not was significantly different, p<.001. CONCLUSION: Exclusive breastfeeding for six months was associated with reduced risk of RWG in early infancy.

Dung beetles show metabolic plasticity as pupae and smaller adult body size in response to increased temperature mean and variance.

Though organisms may use thermal plasticity to cope with novel temperature regimes, our understanding of plastic responses is limited. Research on thermal plasticity has traditionally focused on the response of organisms to shifts in mean temperatures. However, increased temperature variation can have a greater impact on organismal performance than mean temperature alone. In addition, thermal plasticity studies are often designed to investigate plasticity in response to more extreme temperatures despite the fact that organisms make physiological adjustments to diurnal temperature fluctuations that they experience. Using pupae of the dung beetle Onthophagus taurus, we investigated the potential for plasticity in response to increasing temperature mean and variance using thermal regimes that were well within the species critical thermal limits. We reared 40 beetles from egg to pupae (n = 20) or adults (n = 20) at one of nine incubation treatments, including all combinations of three mean temperatures (22, 24, 26 °C) and three amplitudes of fluctuation (±2, ±4, ±8 °C). To measure thermal plasticity of pupae, we quantified CO2 production across a range of temperatures (i.e., 15, 20, 25, and 30 °C) for 20 beetles per treatment. The relationship between CO2 production and temperature provides an estimate of energetic costs at a given temperature (i.e., using the intercept) and thermal sensitivity (i.e., using the slope). We reared the remaining O. taurus in each treatment (n = 20) to adulthood and then recorded mass (g) to determine body size, a proxy for fitness. Pupae exhibited thermal plasticity in response to the additive and interactive effects of temperature mean and variance. Pupae reared in the warmest and most variable treatment (26 ± 8 °C) showed the greatest decrease in overall metabolism compared to all other treatments, and adult beetles from this treatment (26 ± 8 °C) were also significantly smaller than adult beetles from any other treatment. We found that both temperature mean and variance contributed to thermal plasticity of pupae and had consequences for adult body size, a trait related to dung beetle fitness. Importantly, the temperatures we used in our treatments are not extreme and are likely well below the critical thermal maxima of the species, demonstrating that organisms can make adjustments to temperatures they experience across diurnal or seasonal timescales.

School and educational support programmes for paediatric oncology patients and survivors: A systematic review of evidence and recommendations for future research and practice.

OBJECTIVES: The Psychosocial Standards of Care (PSSC) in paediatric oncology prescribe the minimum standards for education support. It is unknown, however, if published education support programmes for children with cancer meet the PSSC standards for education support. Successful implementation of standards for education support is challenging but may be achieved with guidance. We aimed to (1) review education support programmes for childhood cancer patients and survivors against the PSSC standards and (2) provide practical recommendations for future research and implementation of education support programmes. METHODS: We searched PsycINFO, PubMed, CINAHL, EMBASE, and Educational Resources Information and Center databases. We reviewed the education support programmes using five evaluation criteria derived from the PSSC and summarised the structure of identified programmes. We examined the features and limitations of programmes that met all evaluation criteria. RESULTS: We identified 20 education support programmes in paediatric oncology, including peer programmes (n = 3), teacher programmes (n = 5), and school re-entry programmes (SRPs n = 12). We found that three SRPs met all evaluation criteria and that SRP components were timed according to the child's position on the cancer trajectory (e.g., diagnosis and treatment, school re-entry, and follow up throughout schooling). The supporting evidence of the programmes, however, is unclear due to the lack of adequately designed studies. CONCLUSIONS: SRPs provide a promising structure for future education support programmes. We recommend strategies for developing and evaluating education support that adheres to the PSSC and adapts to international and local contexts.

Evaluation of a Pharmacist-Managed Hypertension Clinic in a Rural Primary Care Setting.

OBJECTIVE: To describe clinical pharmacy services provided in a rural North Carolina primary care clinic and assess the impact of these services on systolic and diastolic blood pressures in patients with uncontrolled hypertension. METHODS: This single-center, retrospective study evaluated change in systolic and diastolic blood pressures from baseline, percentage of patients with blood pressure reductions, percentage at The Eight Joint National Committee (JNC 8) goal blood pressure, percentage at care gap closure defined as obtaining a blood pressure <140/90 mm Hg, and time to reach care gap closure. RESULTS: The mean change in systolic blood pressure was -20.1 mm Hg (14.716-25.418, P < .0001) and the mean change in diastolic blood pressure was -8.8 mm Hg (5.449-12.117, P < .0001). Eighty percent of patients experienced blood pressure reductions from baseline, 51% met their respective JNC 8 goal blood pressure, and 48% met care gap closure. The average time to reach care gap closure was 23 weeks. CONCLUSION: When embedded within a primary care clinic in a rural setting, a pharmacist-managed hypertension clinic significantly improved both systolic and diastolic blood pressures of patients with uncontrolled hypertension.

Validation of the MidACE tool - Students' perceptions of the Midwifery Academic role in clinical environments.

BACKGROUND: Situating Midwifery Academics in clinical environments can have an important impact on students' clinical learning. Students' perceptions of this support role in the clinical environment using standardised measures has been under-investigated. AIMS: To develop and test a tool that measures midwifery students' perceptions of the Midwifery Academic role on clinical learning and development of professional knowledge, skills and clinical capability. METHODS: A staged process for tool development included draft item generation, review by expert panel for face and content validity and pilot testing with a convenience sample of undergraduate midwifery students. Dimensionality, internal consistency and test-retest reliability were evaluated. RESULTS: Two hundred and seventy-nine midwifery students completed an online survey (74% response rate). Responses on the ten-item tool loaded strongly on one factor, explaining 69.6% of variance. Cronbach's alpha (0.94) and test-retest reliability (intraclass coefficient=.92; 95%CI .89-.95) were good. Most students agreed that the Midwifery Academic role supported the integration of midwifery theory and practice and critical self-reflection. Areas for improvement included working in partnership with preceptors; assessing students' development; and increased presence in the clinical environment. CONCLUSIONS: This study established reliability and validity of the Midwifery Academic in Clinical Environments (MidACE) tool. Students perceived Midwifery Academics could contribute further to their professional knowledge, skills and clinical capability through a strong collaborative presence in the clinical environment.