Clinical Assessment and Investigation Neurosensory

Module details

Title

Clinical Assessment and Investigation Neurosensory

Type

Rotation

Module code

SPS200

Credits

10

Requirement

Compulsory

Aim of this module

This work based module will provide the trainee with the opportunity to apply their knowledge and some basic skills of clinical assessment and investigation used in the diagnosis, care and treatment of patients of all ages in a range of clinical settings and care, e.g. medical assessment, neonatal care,  integrated care, critical care and community-based services. Integral to this will be a greater understanding of the role of other related diagnostic modalities such as Radiology and Pathology. In this themed pathway this module will be particularly focused on the assessment and investigation of patients with hearing and balance problems, the central and peripheral neurological systems and those with vision difficulties as well as commonly associated co- morbid conditions.

Integral to this module is the opportunity for the trainee to gain a greater understanding of the role of other related diagnostic modalities such as Radiology and Pathology. This module will give the trainee knowledge and understanding of the interpretation and clinical decision making associated with clinical assessment and investigations in the context of differential diagnosis, together with an understanding of the principles of operation, data acquisition and quality assurance of other diagnostic service modalities.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Assist with obtaining a clinical history using a logical sequence/framework, which might include: brief biography history of presenting complaint past history smoking/alcohol use medication (prescribed and other) allergies family/social history concerns and expectations summary	Action View
# 2	Learning outcome 2	Competency Assist in a range of diagnostic and therapeutic procedures in a variety of clinical settings, recognising when results deviate from normal values/findings and appreciating the implication of results on patient treatment and care, for example: Cardiac, Vascular, Respiratory and Sleep Science Medical assessment units – point of care testing, e.g. blood and urine glucose tests. High dependency settings – blood gas analysis, preparation of monitoring and ventilator system. Community settings – spirometry, ankle brachial pressure indices measurements (leg ulcer clinics). Gastrointestinal Physiology and Urodynamic Science Endoscopy unit – assist with telemetric pH capsule placement; endoscopic placement of manometry catheter. Operating theatre – assist with 2D/3D ultrasound pre and post-op assessment, g. sphincterotomy, ’search and find‘ procedures. Diagnostic imaging – assist in the placement of small bowel manometry catheter. Ward – undertake hydrogen breath tests on non-ambulant patients, e.g. small bowel overgrowth. Assist with transrectal ultrasound (TRUS) Continence/flows clinic – fluid management advice, bladder training. Observe pressure/flow studies in patients with special needs, e.g. stoma, mobility issues, neuropathic. Neurosensory Sciences Neurological signs. Neurological monitoring and function. Life sign measures. Cognitive function and wellbeing. Screening.  See relevant rotational modules for integration of clinical experience, competence and knowledge requirements.	Action View
# 3	Learning outcome 3	Competency View and identify key anatomical landmarks and abnormal pathology related to the relevant body systems on images obtained using ionising and/or non-ionising imaging media.	Action View
# 4	Learning outcome 3	Competency Review and assist in making measurements on images on Picture Archiving Systems (PACS).	Action View
# 5	Learning outcome .....	Competency Assist in performing pathology tests with relevance to the routine investigation of relevant conditions, including the production of results, reference ranges and clinical interpretative reports, e.g. full blood count urea and electrolytes liver function test lipids cerebrospinal fluid monitoring sputum culture and sensitivity therapeutic drug monitoring, e.g. carbamazepine.	Action View
# 6	Learning outcome 5	Competency Critically evaluate the role of calibration and quality assurance in pathology and imaging departments in ensuring accuracy of test outcomes and identifying any potential errors or risks when applied in clinical practice.	Action View
# 7	Learning outcome 6	Competency Devise evidence-based diagnostic plans for presenting signs and symptoms and clinical information.	Action View
# 8	Learning outcome 6	Competency Assimilate reports from pathology and imaging investigations from patients typically referred to cardiac, vascular, respiratory and sleep or neurosensory science or gastrointestinal/urodynamic sciences present the findings for review by the clinical team and propose a differential diagnosis.	Action View
# 9	Learning outcome 6	Competency Investigate the needs and options for patients referred to physiological services within neurosensory science or gastrointestinal/urodynamic sciences or cardiac, vascular, respiratory and sleep services as relevant.	Action View
# 10	Learning outcome 6	Competency Work within multidisciplinary teams to support the investigation, treatment and management of patients with relevant conditions to neurosensory science or gastrointestinal physiology and urodynamic sciences or cardiac, vascular, respiratory and sleep services as relevant.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Use IT Systems to produce a report	DOPS
Assimilate reports from pathology and imaging investigations with diagnostic results appropriate to the theme and be able to present the finding for review by the clinical team	DOPS
Take an appropriate history using a logical sequence	OCE

Learning outcomes

1. Record and integrate a patient history with the outcome of clinical examination and determine appropriate diagnostic investigations for patients commonly referred to cardiac, vascular, respiratory and sleep OR gastrointestinal, urodynamic science OR audiology, neurophysiology, or ophthalmic and vision science diagnostic services in conjunction with the wider clinical team.
2. Assist in performing a range of diagnostic and therapeutic procedures, recognising abnormal results/findings and appreciating the implication of results on patient treatment and care.
3. Identify key anatomical landmarks on images obtained using ionising and non-ionising imaging media in the investigation of patients with cardiovascular, respiratory, sleep OR with gastrointestinal and lower urinary tract (LUT) disorders OR conditions resulting in referral to audiology, neurophysiology, or ophthalmic and vision science services, and describe the limitations and impact of results on patient diagnosis, treatment and care.
4. In a supportive role assist in performing pathology tests which patients with cardiovascular, respiratory, sleep OR with gastrointestinal and LUT disorders OR conditions resulting in referral to audiology, neurophysiology, or ophthalmic and vision science services will commonly undergo as part of an individual diagnostic plan.
5. In a supportive role assist in performing safety checks, calibration and quality assurance of imaging and pathology equipment using local, national or international standards.
6. Devise a diagnostic plan for a patient based on the presenting symptoms and clinical information available, and indicate what the next steps might be (diagnostic or therapeutic), dependent on the outcome of the initial results from a mix of diagnostic modalities.

Learning outcomes

1. Describe how different auditory, visual, central and peripheral neurological and other related specialist assessments and investigations can contribute to a holistic patient approach in the diagnosis, management, prognosis  and care.
2. Describe how different assessments and investigations are used by non- specialist neurosensory centres in the assessment of patients who have auditory, visual, central and peripheral neurological disorders, e.g. healthcare for older people; neonatal care (NICU and SCBU), integrated care, critical care, primary care, independent sector.
3. Describe how different auditory, visual, central and peripheral neurological assessments and investigations can be combined in differential diagnosis of disease, or disability.
4. Explain the basis of ionising and non-ionising imaging using screening and diagnostic applications to assess pathologies in neurosensory referrals to  a radiology service, e.g. head CT/MRI; ultrasound.
5. Explain the legislation and physical principles behind radiation with matter.
6. Discuss and evaluate the digital processing of 2D and 3D images in neurosensory pathologies.
7. Explain the principles and application of routine pathology tests, including normal ranges, requested as part of the investigation of patients referred for investigation within the neurosensory pathway.
8. Recognise recent advances in biomarkers and pharmacogenomics and  the impact of these new technologies in audiology, neurophysiology, ophthalmic and vision diagnostics, and treatments.
9. Describe the key anatomical landmarks of the auditory, visual, central and peripheral neurological pathways using imaging media.
10. Describe how calibration, safety testing and quality assurance procedures (including the legislative aspects of use of radiation) are applied in diagnostic imaging and pathology services, relating these to the processes used in physiological science services.
11. Discuss the need for and processes used in safety testing and quality assurance of imaging equipment.
12. Describe the patient pathways relating to common pathological conditions associated with auditory, visual, central and peripheral neurological health issues.
13. Discuss the major contributor and risk factors in auditory, visual, central and peripheral neurological health issues.
14. Describe the normal function and major abnormalities or common pathologies of physiological control mechanisms that give rise to referrals for imaging in patients undergoing neurosensory pathway treatment[s] and/or care.
15. Describe cellular, tissue and system responses to diseases occurring in auditory, visual, central and peripheral neurological disorders, concentrating on disorders of growth, tissue responses to injury, cell death, inflammation, neoplasia, normal and abnormal immune responses, atheroma, thrombosis, embolism and infarction.
16. Describe the basis of common diseases and infections arising in auditory, visual, central and peripheral neurological disorders.
17. Discuss the role of inter-professional team working in the diagnosis and treatment of patients.

Indicative content

Assessments and investigations using imaging

• Screening and diagnostic radiology equipment
  • Technology developments and advances of differential diagnosis
• Diagnostic imaging
• Imaging with lasers
  • Image display and reconstruction techniques
  • Clinical application   and   the   basics   of   normal   and   pathological appearances within the image
  • The physics and mathematics of image formation; radiological  image
  • CT scanning
  • X-rays, magnetic fields, lasers and ultrasound
• Key anatomical features; film viewing
  • Features of a normal MRI scan, CT scan
  • Auditory pathway
  • Visual pathway
  • Neurological pathways
• Techniques in the CNS MRI assessment
  • Use of different weighted, diffusion and functional MRI
• CT technique and advances; reporting
• Ultrasound scan/imaging of soft tissue area
  • Transducers for measuring pressure and flow
• Digital imaging, different forms of scanning laser, e.g. optical coherence tomography
• Patient safety management in imaging Quality assurance
  • Image quality and artefacts
• Risk assessment techniques
  • Electrical safety, fault conditions, laser safety
  • Biological safety: equipment contamination, cleaning, cross- contamination; handling procedures and protocols
  • Physical effects of radiation

 Patient pathways

• Auditory, visual, central and peripheral neurological pathway disorders
  • Hearing impairment
  • Neurological infections, disease, or disorders
  • Degeneration, demyelination, re-innervation
• Impact of visual impairment
  • Visual perception
  • Visual; contrast; visual field;
  • Colour vision
  • Hearing, vision and neuromuscular disorders
  • Social disability; effect on lifestyle; effect of age, gender
• Basis of auditory, visual, central and peripheral neurological viral, bacterial infections, disease and trauma on assessment, diagnosis, management and prognosis
  • Audiology
  • Discharge, perforation, otitis media, age-related hearing loss, noise
  •  Neurophysiology
    • Diabetics, epilepsy, sleep apnoea, Parkinson’s disease, tumours, cerebral palsy

• Ophthalmic and Vision Science
  • Macular degeneration; cataracts; diabetic retinopathy; low vision; glaucoma

Team working

• Team formation and functions
• Role of single-discipline and multiprofessional teams
  • in the care and management of patients
  • in the delivery of services
• Effective interprofessional team working

Activities

The clinical experiential learning for this module should take place in a range of healthcare environments/services that contribute to the screening, primary prevention, diagnosis, treatment and rehabilitation of patients commonly referred to cardiac, vascular, respiratory and sleep OR gastrointestinal and urodynamic science OR audiology, neurophysiology and ophthalmic and vision science services. Trainees should also be encouraged by their trainer to gain wider experience that spans other local, novel procedures within their work place.

Clinical experiential learning should span both primary and secondary care and should include at least three different experiences gained across a range of ages, selected from the list below:

 Secondary care

• Medical assessment unit
• Neonatal care unit
• Intensive care unit or operating theatre
• Endoscopy unit
• Healthcare for older people service, which may include sensory, cognitive function and wellbeing

 Primary care

• General practice
• Community services
• Walk-in/Drop-in centres
• District nursing
• Health visiting
• Postnatal clinics
• One-stop sexual health clinics

 Other healthcare providers

• Independent sector, including hearing acuity, visual acuity, colour acuity
• Social services
• Other support services, g. drug and alcohol services

Following each experience trainees should reflect on the experience and discuss with their supervisor: (a) the patient experience in the setting; (b) the potential for improvement in service delivery to enhance the patient experience and outcomes; and (c) implications for their own future professional practice.

Trainees are also expected to:

• Assist experienced imaging staff in the safety checks, calibration and quality assurance of imaging equipment using local, national or international standards, and discuss the relevant health and safety policies for the imaging department with your trainer.
• Assist experienced pathology staff in routine maintenance, calibration and quality assurance checks on pathology test instrumentation using local, national or international standards, and gain experience of using a range of laboratory equipment, which could include pipettes, balances, centrifuges, refrigerators, water baths, incubators, pH meters, freezers, radioactive counters, sample preparation units and automated and semi-automated analysers.