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McKinley, Robert K., Janice Strand, Tracey Gray, Lambert Schuwirth, Tom Alun-Jones, and Helen Miller. "Development of a tool to support holistic generic assessment of clinical procedure skills." Medical Education 42, no. 6 (April 23, 2008): 619–27. http://dx.doi.org/10.1111/j.1365-2923.2008.03023.x.
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Ting, Frederic Ivan, Jose Miguel Callueng, Jeremiah Vallente, Reya Andrea Hurtado, Arjel Ramirez, Lance Isidore Catedral, Rich Ericson King, et al. "Assessing the Quality of Life of Filipino Cancer Patients: A Survey of Filipino Oncologists." Asian Journal of Oncology 6, no. 01 (January 2020): 20–28. http://dx.doi.org/10.1055/s-0040-1703420.
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Abstract Introduction Recent trials of new drugs have placed much emphasis on survival. However, several guidelines have emphasized the need for assessing health-related quality of life (HRQoL) as part of the holistic approach in the management of cancer patients. There are currently no national governing guidelines and no existing data on the status of HRQoL assessments by Filipino oncologists, thus this study. Study Design This was a cross-sectional study that utilized a validated questionnaire. Descriptive and multivariate analyses were used to analyze the data. Results A total of 312 oncologists participated in this study. Majority were medical oncologists (41%), followed by radiation oncologists (25%), hematologists (14%), gynecologic oncologists (12%), and surgical oncologists (8%). About 96% reported that HRQoL assessment was important for clinical work; however, 58% perceived HRQoL to be a vague term and 55% felt they were insufficiently trained to assess HRQoL. About 89% reported that they will be more confident if local HRQoL assessment guidelines will be present, and 93% agreed to the use of a unified HRQoL assessment tool for Filipino cancer patients. About 85% thought that the optimal number of questions for a HRQoL assessment tool should be between 5 and 15 questions. The significant predictors of HRQoL assessment among oncologists were field of oncology and years in practice/training (p < 0.05). Conclusion Filipino oncologists perceived HRQoL patient assessments to be important in clinical practice. However, majority did not know which tool to use and did not feel sufficiently trained to assess HRQoL. The creation of a practice guideline that would facilitate the use of a unified HRQoL assessment tool for Filipino cancer patients is highly recommended.
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Bello, Ghalib A., Gerard G. Dumancas, and Chris Gennings. "Development and Validation of a Clinical Risk-Assessment Tool Predictive of All-Cause Mortality." Bioinformatics and Biology Insights 9s3 (January 2015): BBI.S30172. http://dx.doi.org/10.4137/bbi.s30172.
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In clinical settings, the diagnosis of medical conditions is often aided by measurement of various serum biomarkers through the use of laboratory tests. These biomarkers provide information about different aspects of a patient's health and overall function of multiple organ systems. We have developed a statistical procedure that condenses the information from a variety of health biomarkers into a composite index, which could be used as a risk score for predicting all-cause mortality. It could also be viewed as a holistic measure of overall physiological health status. This health status metric is computed as a function of standardized values of each biomarker measurement, weighted according to their empirically determined relative strength of association with mortality. The underlying risk model was developed using the biomonitoring and mortality data of a large sample of US residents obtained from the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). Biomarker concentration levels were standardized using spline-based Cox regression models, and optimization algorithms were used to estimate the weights. The predictive accuracy of the tool was optimized by bootstrap aggregation. We also demonstrate how stacked generalization, a machine learning technique, can be used for further enhancement of the prediction power. The index was shown to be highly predictive of all-cause mortality and long-term outcomes for specific health conditions. It also exhibited a robust association with concurrent chronic conditions, recent hospital utilization, and current health status as assessed by self-rated health.
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Gardener, A. Carole, Gail Ewing, Silvia Mendonca, and Morag Farquhar. "Support Needs Approach for Patients (SNAP) tool: a validation study." BMJ Open 9, no. 11 (November 2019): e032028. http://dx.doi.org/10.1136/bmjopen-2019-032028.
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ObjectivesPatient-identified need is key to delivering holistic, supportive, person-centred care, but we lack tools enabling patients to express what they need to manage life with a long-term condition. The Support Needs Approach for Patients (SNAP) tool was developed to enable patients with advanced chronic obstructive pulmonary disease (COPD) identify and express their unmet support needs to healthcare professionals (HCPs), but its validity is unknown. This study aimed to establish face, content and criterion validity of the SNAP tool.DesignTwo-stage mixed-methods study involving patients with advanced COPD and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers considering appropriateness, relevance and completeness of the SNAP tool. Data were analysed using conventional content analysis. Stage 2: Content and criterion validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (Chronic Respiratory Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures.Settings and participantsTwo hundred and forty patients and carers participated. Stage 1 patient and informal carer participants were recruited from two primary care practices and Stage 2 patients from 28 practices. Participating practices located in the East of England were recruited via the NIHR Clinical Research Network: Eastern.ResultsPatients and carers found the tool patient-friendly and comprehensive, with potential clinical utility. No tool items were redundant. Clear correlations were found between tool items and the majority of items in the impact measures.ConclusionsThe SNAP tool has good face, content and criterion validity. It has potential to support the delivery of holistic, supportive, person-centred care by enabling patients to identify and express their unmet support needs to HCPs.
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Isoherranen, Kirsi, Milla Kallio, Julie Jordan O`Brien, and Heli Lagus. "Clinical characteristics of lower extremity ulcers." Journal of the European Wound Management Association November 2020 21, Issue 1 Volume 21, 2020 (November 12, 2020): 51–58. http://dx.doi.org/10.35279/jewma202011.08.
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Common causes of lower-extremity ulcers are relatively easy to diagnose, but exact wound diagnosis needs always a holistic approach and a careful evaluation of the wound patient. Systematic assessment and the use of check-lists provides diagnostic tools. This review aims to provide clinicians with an overview of the different aetiologies of leg ulcer by describing the clinical characteristics of each aetiology. It also aims to provide tools for health-care providers when assessing a lower-extremity ulcer patient.
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Kyle, Tammy, and Sherry Wright. "Reflecting the Model of Human Occupation in Occupational Therapy Documentation." Canadian Journal of Occupational Therapy 63, no. 3 (August 1996): 192–96. http://dx.doi.org/10.1177/000841749606300306.
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This paper describes an innovative Screening Assessment Form developed at the Ottawa Civic Hospital. The development of the form was prompted by the need for a concise, time efficient guide that could be easily applied to a culturally diverse clientele presenting with various bio-psychosocial difficulties. The department had adopted the Model of Human Occupation as its frame of reference, however it was difficult to consistently covey the structure of the model in report writing. The challenge was to create an assessment tool which incorporated not only essential clinical information but also occupational therapy's unique holistic perspective of function.
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Afseth, Janyne, Lis Neubeck, Thanos Karatzias, and Robin Grant. "Holistic Needs Assessment in Brain Cancer Patients: A Systematic Review of Available Tools." Neuro-Oncology 20, suppl_1 (January 2018): i12. http://dx.doi.org/10.1093/neuonc/nox238.051.
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Khan, Zulaikha, Arun Chidambaram, Michaela Thomson, and Courtney Hurst. "An exploration of MDT views on key factors to consider when determining a service users required level of security." Journal of Forensic Practice 21, no. 1 (January 31, 2019): 38–49. http://dx.doi.org/10.1108/jfp-10-2018-0039.
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Purpose The purpose of this paper is to identify what key factors multi-disciplinary teams (MDT) deem as most important when making the decision to move service users from one level of security (including low, medium and high secure services) to another. The researchers used the findings from this study to further develop a tool; the assessment for level of security tool (ALS), which aims to structure and streamline this decision-making process. Design/methodology/approach Data from 18 interviews (MDT staff) were analysed using the Delphi technique (Dalkey and Helmer, 1963). This revealed a range of factors discussed when considering service users moves. Participants were asked to rate these factors in accordance with the Delphi which resulted in the removal of certain less important factors based on their scores. The researchers then compared these factors of relevance with a checklist of 16 items previously proposed by a consultant psychiatrist within the trust. This comparison allowed the researchers to highlight any similarities and differences present. Findings Findings from staff interviews revealed a range of 20 clinical factors perceived as essential to this process including procedural, relational and physical security aspects. However, variations were evident between the MDT priorities (20 items) and the originally proposed list. This emphasised the need for a tool which facilitates a holistic and streamlined approach. Practical implications The findings from this research have resulted in the development of the ALS tool comprising of 18 key factors. Originality/value It is envisaged the development of the ALS tool will not only facilitate and structure the decision-making process but also ensure a person-centred approach. This is because the ALS allows for a holistic approach based on an array of factors deemed important to that particular service user. Furthermore, the ALS tool contributes towards the paucity of published structured professional judgement tools needed to make such decisions.
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Martin, Colin R. "Commentary: Clinical Effectiveness in Nursing (2001) 5, 104–109 The development of the THROAT: The Holistic and Reliable Oral Assessment Tool (THROAT)." Clinical Effectiveness in Nursing 6, no. 1 (March 2002): 44. http://dx.doi.org/10.1054/cein.2002.0252.
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Zhang, Aihua, Hui Sun, Guangli Yan, Ping Wang, and Xijun Wang. "Metabolomics for Biomarker Discovery: Moving to the Clinic." BioMed Research International 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/354671.
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To improve the clinical course of diseases, more accurate diagnostic and assessment methods are required as early as possible. In order to achieve this, metabolomics offers new opportunities for biomarker discovery in complex diseases and may provide pathological understanding of diseases beyond traditional technologies. It is the systematic analysis of low-molecular-weight metabolites in biological samples and has become an important tool in clinical research and the diagnosis of human disease and has been applied to discovery and identification of the perturbed pathways. It provides a powerful approach to discover biomarkers in biological systems and offers a holistic approach with the promise to clinically enhance diagnostics. When carried out properly, it could provide insight into the understanding of the underlying mechanisms of diseases, help to identify patients at risk of disease, and predict the response to specific treatments. Currently, metabolomics has become an important tool in clinical research and the diagnosis of human disease and becomes a hot topic. This review will highlight the importance and benefit of metabolomics for identifying biomarkers that accurately screen potential biomarkers of diseases.
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Schneider, Lara, Tim Kehl, Kristina Thedinga, Nadja Liddy Grammes, Christina Backes, Christopher Mohr, Benjamin Schubert, et al. "ClinOmicsTrailbc: a visual analytics tool for breast cancer treatment stratification." Bioinformatics 35, no. 24 (April 30, 2019): 5171–81. http://dx.doi.org/10.1093/bioinformatics/btz302.
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AbstractMotivationBreast cancer is the second leading cause of cancer death among women. Tumors, even of the same histopathological subtype, exhibit a high genotypic diversity that impedes therapy stratification and that hence must be accounted for in the treatment decision-making process.ResultsHere, we present ClinOmicsTrailbc, a comprehensive visual analytics tool for breast cancer decision support that provides a holistic assessment of standard-of-care targeted drugs, candidates for drug repositioning and immunotherapeutic approaches. To this end, our tool analyzes and visualizes clinical markers and (epi-)genomics and transcriptomics datasets to identify and evaluate the tumor’s main driver mutations, the tumor mutational burden, activity patterns of core cancer-relevant pathways, drug-specific biomarkers, the status of molecular drug targets and pharmacogenomic influences. In order to demonstrate ClinOmicsTrailbc’s rich functionality, we present three case studies highlighting various ways in which ClinOmicsTrailbc can support breast cancer precision medicine. ClinOmicsTrailbc is a powerful integrated visual analytics tool for breast cancer research in general and for therapy stratification in particular, assisting oncologists to find the best possible treatment options for their breast cancer patients based on actionable, evidence-based results.Availability and implementationClinOmicsTrailbc can be freely accessed at https://clinomicstrail.bioinf.uni-sb.de.Supplementary informationSupplementary data are available at Bioinformatics online.
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Cadogan, Cathal A., Audrey Rankin, Simon Lewin, and Carmel M. Hughes. "Application of the intervention Complexity Assessment Tool for Systematic Reviews within a Cochrane review: an illustrative case study." HRB Open Research 3 (June 1, 2020): 31. http://dx.doi.org/10.12688/hrbopenres.13044.1.
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Background: The intervention Complexity Assessment Tool for Systematic Reviews (iCAT_SR) has been developed to facilitate detailed assessments of intervention complexity in systematic reviews. Worked examples of the tool’s application are needed to promote its use and refinement. The aim of this case study was to apply the iCAT_SR to a subset of 20 studies included in a Cochrane review of interventions aimed at improving appropriate polypharmacy in older people. Methods: Interventions were assessed independently by two authors using the six core iCAT_SR dimensions: (1) ‘Target organisational levels/categories’; (2) ‘Target behaviour/actions’; (3) ‘Active intervention components’; (4) ‘Degree of tailoring’; (5) ‘Level of skill required by intervention deliverers’; (6) ‘Level of skill required by intervention recipients’. Attempts were made to apply four optional dimensions: ‘Interaction between intervention components’; ‘Context/setting’; ‘Recipient/provider factors’; ‘Nature of causal pathway’. Inter-rater reliability was assessed using Cohen’s Kappa coefficient. Disagreements were resolved by consensus discussion. The findings are presented narratively. Results: Assessments involving the core iCAT_SR dimensions showed limited consistency in intervention complexity across included studies, even when categorised according to clinical setting. Interventions were delivered across various organisational levels and categories (i.e. healthcare professionals and patients) and typically comprised multiple components. Intermediate skill levels were required by those delivering and receiving the interventions across all studies. A lack of detail in study reports precluded application of the iCAT_SR’s optional dimensions. The inter-rater reliability was substantial (Cohen's Kappa = 0.75) Conclusions: This study describes the application of the iCAT_SR to studies included in a Cochrane systematic review. Future intervention studies need to ensure more detailed reporting of interventions, context and the causal pathways underlying intervention effects to allow a more holistic understanding of intervention complexity and facilitate replication in other settings. The experience gained has helped to refine the original guidance document relating to the application of iCAT_SR.
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Mohd Razali, Mas Rizalynda, Yan Chew Chong, Nur Zarifah Mustapha, Yi Xu, Salimah Mohd Ayoob, Mei Ling Lim, and Fazila Aloweni. "Identifying patients with high risk of readmission from the patient navigators’ perspectives: a descriptive qualitative study." Proceedings of Singapore Healthcare 26, no. 3 (December 26, 2016): 166–71. http://dx.doi.org/10.1177/2010105816685340.
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Background: Unplanned readmission incurs additional cost to patients and contributes to the rising healthcare cost of our nation. Although numerous studies have investigated the predicting factors that contribute to hospital readmission, the majority of the studies focused on clinical and patient-related factors, and were not from the perspectives of clinicians such as patient navigators (PNs). Aim: To understand factors that predict patients’ readmission risks from the PNs’ perspectives. Method: Using purposive sampling, PNs with a minimum of 10 years of clinical experience in the adult acute-care setting participated in the focus group interviews. Thematic analysis was adopted. Findings: All 10 PNs agreed that the readmission risk assessment tool was useful as a guide to assess patients’ risk of readmission; however, they also mentioned the use of clinical judgement and experience while assessing their patients. Three themes emerged from this study: (1) looking beyond medical-related issues; (2) social and community support; (3) functional status of patients. Conclusion: Predicting patients’ risk of readmission is closely tied to the patients’ current medical conditions and caregiving needs. Ensuring individualised readmission risk assessment and identifying social issues early are key in ensuring a holistic discharge planning.
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Chhajer, Bimal, Vikram Singh, Girija Kumari, and Mahendra Lohmor. "Effect of Yoga Based Lifestyle Intervention on Coronary Artery Disease Patients." Biomedical and Pharmacology Journal 11, no. 3 (September 6, 2018): 1275–89. http://dx.doi.org/10.13005/bpj/1489.
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This study was designed to evaluate the impact of yoga based lifestyle intervention on coronary artery disease (CAD) patients. This multi-centric prospective study was held in the Saaol heart center in different cities (Delhi, Kolkata, Bangalore, Chennai, and Mumbai) of India from 1995 to 2015. In this study, total 5,000 CAD patients having co-morbidity of obesity, hypertension, and diabetes were enrolled. A yoga-based lifestyle modification counseling (consist the essential components; cardiac education, plant-based balanced diet, regular walk, yoga, and meditation) was administrated to study subjects and clinical assessment was done using Saaol safety wheel as a holistic tool. In the beginning, lifestyle modification counseling was provided every month for one year and after one year the counseling was repeated for every six months with clinical assessment till the end of the study. The results of this study demonstrate a significant improvement in angina with reduction of New York Heart Association (NYHA) angina classification score from 3.08±0.56 (mean±SD) to 2.45±0.70 and also reduce the intake of anti-anginal drugs from 4.36±1.35 to 3.82±1.20. In this study, a significant improvement was also observed in heart attack protection score from 56.68±13.53 to 104.13±14.55. After the adherence to yoga-based lifestyle modification counseling components and Saaol safety wheel, 98% study subjects showed the significant improvements in clinical outcomes (BMI, blood pressure, and lipid parameters) and cardiac patients reduced the risk of heart attack and cardiac events. This study concludes that yoga-based lifestyle intervention is a non-invasive effective treatment method to control and prevent cardiac risk factors in CAD patients. This type of holistic approach may help to reduce the rate of cardiac events and heart attacks but there is further long-term multicentric randomized controlled trials are required for better clinical outcomes.
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Shivers, Jennifer, Joseph Amlung, and Theresa Cullen. "An HIT Ecosystem Capability Maturity Model for System-Wide Implementation, Management, and Governance." ACI Open 04, no. 02 (July 2020): e102-e107. http://dx.doi.org/10.1055/s-0040-1715171.
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Abstract Background An effective health system is dependent on the people, processes, and technology required to support its successful use. Technology, including essential health information technology (HIT) components, is not enough to successfully support quality patient care delivery. Without a strong support structure, HIT tools and data alone will fail to meet the desired goal of quality patient care that achieves health equity. Multiple factors, including governance processes, policies, and standards, are critical for the development, implementation, and consistent and effective use of clinical HIT systems and the resulting data. A comprehensive model that provided support for a holistic assessment of the HIT ecosystem could not be identified. The Facility HIT Ecosystem Capability Maturity Model (ECMM) was designed in response to this need. Objectives This project was designed to create and propose a comprehensive framework for self-assessment and support of a maturation pathway for a facility's comprehensive HIT ecosystem, including governance processes, policies, and standards. Methods Iterative methods based on agile and human-centered design practices were used to create and validate the framework and its contents. Results The ECMM and toolkit support a health care facility's clinical or technical leadership, including chief medical officers, chief information officers, and chief medical/health/nursing informatics officers, in identifying and assessing policies, processes, and capabilities surrounding HIT. This framework supports iterative evaluation and step-ladder style progression and goal setting to achieve desired capabilities, both at the local level and at the level of supporting organizations. Reviewer feedback was used to provide iterative tool improvement and refinement. Conclusion The proposed HIT maturity model toolkit showed potential as a tool to help empower health care facilities and their leadership to advance their HIT ecosystem.
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Quick, Tom J., and Hazel Brown. "Evaluation of functional outcomes after brachial plexus injury." Journal of Hand Surgery (European Volume) 45, no. 1 (October 9, 2019): 28–33. http://dx.doi.org/10.1177/1753193419879645.
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Major nerve injuries such as those of the brachial plexus present a significant challenge for both rehabilitation and evaluation of outcome. With these often complex and multi-faceted injuries, correct selection of outcome measures is important. Healthy nerve function in humans heightens our interactions with the world, creating quality and enjoyment through our experiences of movement and touch. Therefore, assessments should be holistic and representative of all of these features. This article considers the assessment and evaluation of all of the features of nerve injury: sensorimotor, sensation (including that of pain), function and the psychosocial aspects. Current practice is described and combined with clinical experience and research findings to provide suggestions and recommendations for the selection of the most appropriate tools for use with this patient group.
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Goodyear-Smith, Felicity, Margot Darragh, and Jim Warren. "VeCHAT: a proof-of-concept study on screening and managing veterans." Journal of Primary Health Care 13, no. 1 (2021): 75. http://dx.doi.org/10.1071/hc20070.
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ABSTRACT INTRODUCTIONNew Zealand veterans may have complex mental and physical complaints related to multiple exposures to war environments. They are entitled to, but often do not, access a range of physical, mental health and social services funded through Veterans’ Affairs New Zealand. eCHAT (electronic Case-finding and Help Assessment Tool) is a self-completed electronic holistic screen for substance misuse, problem gambling, anger control, physical inactivity, depression, anxiety, exposure to abuse; and assesses whether help is wanted for identified issues. AIMA proof-of-concept study was conducted to develop a modified version of eCHAT (VeCHAT) with remote functionality for clinical assessment of mental health and lifestyle issues of contemporary veterans, and assesses acceptability by veterans and Veterans’ Affairs staff, and feasibility of implementation. METHODSWe used a co-design approach to develop VeCHAT. Veterans’ Affairs and service organisations invited veterans to remotely complete VeCHAT and a subsequent short online acceptability survey. Veterans’ Affairs medical and case manager staff underwent semi-structured interviews on feasibility and acceptability of VeCHAT use. RESULTSThirty-four veterans completed VeCHAT. The tool proved acceptable to veterans and Veterans’ Affairs staff. Key emergent themes related to tool functionality, design, ways and barriers to use, and suggested improvements. Veterans’ Affairs staff considered VeCHAT use to be feasible with much potential. DISCUSSIONCapacity of Veterans’ Affairs to respond if their engagement with veterans increases and employment of VeCHAT is scaled up, is unknown. Work is needed to assess how introducing VeCHAT as a standard procedure might influence Veterans’ Affairs case management processes.
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Olivier, Pieter A., Boel De Paepe, Eleonora Aronica, Florieke Berfelo, Roos Colman, Anthony Amato, Dalia Dimitri, et al. "Idiopathic inflammatory myopathy." Neurology 93, no. 9 (July 29, 2019): e889-e894. http://dx.doi.org/10.1212/wnl.0000000000008005.
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ObjectiveTo determine interrater variability in diagnosing individual muscle biopsy abnormalities and diagnosis.MethodsWe developed a scoring tool to analyze consensus in muscle biopsy reading of an ad hoc workgroup of international experts. Twenty-four samples from patients with suspected idiopathic inflammatory myopathy (IIM) were randomly selected, providing sections that were stained with standard histologic and immunohistochemical methods. Sections were made available on an online platform, and experts were queried about myopathologic features within 4 pathologic domains: muscle fibers, inflammation, connective tissue, and vasculature. A short clinical presentation of cases was included, and experts were asked to give a tentative diagnosis of polymyositis, dermatomyositis, inclusion-body myositis, antisynthetase syndrome–related myositis, immune-mediated necrotizing myopathy, nonspecific myositis, or other disease. Fleiss κ values, scoring interrater variability, showed the highest agreement within the muscle fiber and connective tissue domains.ResultsDespite overall low κ values, moderate agreement was achieved for tentative diagnosis, supporting the idea of using holistic muscle biopsy interpretation rather than adding up individual features.ConclusionThe assessment of individual pathologic features needs to be standardized and harmonized and should be measured for sensitivity and specificity for subgroup classification. Standardizing the process of diagnostic muscle biopsy reading would allow identification of more homogeneous patient cohorts for upcoming treatment trials.
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Chalkidou, Anastasia, Jamie Erskine, Thomas Macmillan, and Stephen Keevil. "OP105 Factors Affecting Horizon Scanning For Hospital-Based Health Technology Assessment." International Journal of Technology Assessment in Health Care 35, S1 (2019): 25–26. http://dx.doi.org/10.1017/s0266462319001508.
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IntroductionThe strategic MedTech investment for the expansion of a central London paediatric hospital must sustain its ambitions to remain a state-of-the-art hospital, whilst implementing recent and future MedTech innovations and taking into account spatial and financial limitations. Horizon scanning (HS) is an important health technology assessment (HTA) tool to achieve these goals. To this end, we developed a methodology to help decide the suitability of investing in the following imaging-based MedTech: a hybrid theatre incorporating a biplane, intra-operative MRI (iMRI), multi-detector computed tomography (CT) scanners, and an EOS imaging system and predict the complementary technologies required for the decade to come. These technologies not only require adequate spatial resources but a significant upfront capital investment.MethodsThree sources of information were used: i) a literature search, selected journals and other horizon scanning resources that examined current efficiency, safety, and cost-effectiveness for the proposed technologies, ii) expert elicitation in the form of user-group meetings and one-to-one discussions with clinical and service management teams and iii) hospital data consisting of audit and information from capital equipment bids.ResultsWith the exception of limited comparative data on iMRI (mainly including adults), little evidence exists to support investment in the proposed technologies. However, the decision of whether to adopt these technologies was influenced not only by existing evidence on the proposed technologies and associated cost but other factors such as local disease burdens, hospital staff requirements (training, expertise), space requirements for the new MedTech, and its impact on organizing healthcare services and hospital workflows. Complementary technologies associated with radiation monitoring image visualization and control were identified.ConclusionsStrategic MedTech investment requires a holistic approach that assigns equal weight to information arising by expert elicitation and hospital audit data with existing literature evidence. The decision for adoption is heavily influenced by the clinical expertise and hospital workflows.
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Holliday, Catherine. "OP29 Building A Global, Public Repository Of Patient Experience Data." International Journal of Technology Assessment in Health Care 35, S1 (2019): 7. http://dx.doi.org/10.1017/s0266462319001004.
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IntroductionThe Patient Experience, Expectations and Knowledge (PEEK) protocol was developed so that a holistic, comprehensive, independent, proactive and systematic approach could be taken to inform decisions made in the context of health technology assessment and other parts of the health sector. Each PEEK study is made publicly available which over time will result in a global repository of patient experience data.MethodsThe PEEK protocol is a single protocol that can be implemented across disease areas and includes a quantitative and qualitative component. The quantitative component is based on a series of validated tools that provide baseline health and demographic data for the study population. The qualitative component is the result of two years of protocol testing to develop a structured interview that solicits comprehensive and holistic patient experience data, and provides participants with the opportunity to provide advice on their future expectations.ResultsPEEK studies in breast cancer, bladder cancer, lung cancer, spinal muscular atrophy, atopic dermatitis, chronic kidney disease, chronic heart failure and mitochondrial disease have been completed in the Australian context (www.cc-dr.org/peek). Holistic patient experience themes are presented commencing with symptoms and diagnosis experience, through to communication, information, treatments experienced and quality of life. Information is also available in relation to participant's expectations of future treatment, care, information and communication. The result is a freely available repository of patient experience data that anyone in the sector can access to complement clinical and economic evidence.ConclusionsThe process of providing patient feedback and real-world evidence in the context of health technology assessment is often ad-hoc. The lack of consistency means that it has been difficult to assess the impact of patient engagement and feedback in the context of health technology assessment. The PEEK protocol and program is an example of a systematic, independent and holistic approach to patient experience and real-world evidence data collection that provides the sector with an opportunity to proactively engage the community in decisions that are made about treatment, care and support.
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Wu, Elise, James Pellissier, Leana Bellanca, Raphael Normand, Robert Hughes, and Aran Ratciffe. "OP48 A Contextual Model For Evaluating The Value Of Multi-Indication Drugs." International Journal of Technology Assessment in Health Care 34, S1 (2018): 18–19. http://dx.doi.org/10.1017/s0266462318001009.
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Introduction:An increasing number of anti-cancer medications are indicated for multiple tumors. Existing pharmacoeconomic evaluations routinely examine the cost-effectiveness (CE) and budget impact (BI) of such drugs by indication, as and when each indication is reviewed. The impact of indication-specific conclusions on the holistic value of such medications across all indicated patients is not currently evaluated, yet is important to stakeholders including health technology assessment (HTA) agencies, payers and patients. We introduce a holistic framework that considers the value of multiple indications together at a product level. Application of this approach is illustrated via an example across multiple indications for a novel, targeted anti-cancer therapy (pembrolizumab) in Canada.Methods:Previously-HTA-evaluated indication-specific CE and BI models serve as the foundation for this multi-indication model. Comparing to standard of care (SoC) per indication, the model evaluates the potential BI, clinical outcomes and CE of pembrolizumab among the individual indications along with the overall multi-indication patient population from the perspective of a third-party payer. For the contextual model, incremental costs and quality-adjusted life years (QALYs) were weighted using indication populations derived from national incidence rates.Results:The indication-specific incremental cost-effectiveness ratios (ICER) from CE analyses of ipilimumab-treated advanced melanoma, ipilimumab-naïve advanced melanoma, second-line non-small cell lung cancer (NSCLC), first-line NSCLC and fourth-line classical Hodgkin lymphoma range from USD 52 K to USD 163 K per QALY. Accounting for the relative contributions of the various sizes of indication-specific patient populations results in an overall ICER for pembrolizumab vs. SoC of USD 100 K.Conclusions:A holistic model can provide stakeholders with a tool to evaluate the overall value of multi-indication drugs. Results enable an understanding of the outcomes and economic consequences of treatment with pembrolizumab versus SoC by both individual indications and across all indications. Insights from this contextual approach will enable data from less-developed clinical trials to be considered when previously they might have gone unevaluated by decision-makers.
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Morton, Emma, Rachelle Hole, Greg Murray, Simone Buzwell, and Erin Michalak. "Experiences of a Web-Based Quality of Life Self-Monitoring Tool for Individuals With Bipolar Disorder: A Qualitative Exploration." JMIR Mental Health 6, no. 12 (December 4, 2019): e16121. http://dx.doi.org/10.2196/16121.
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Background Self-monitoring of symptoms is a cornerstone of psychological interventions in bipolar disorder (BD), but individuals with lived experience also value tracking holistic outcomes, such as quality of life (QoL). Importantly, self-monitoring is not always experienced positively by people with BD and may have lower than expected rates of engagement. Therefore, before progressing into QoL tracking tools, it is important to explore user perspectives to identify possible risks and benefits, optimal methods to support engagement, and possible avenues to integrate QoL self-monitoring practices into clinical work. Objective This study aimed to conduct a qualitative exploration of how individuals with BD engaged with a Web-based version of a BD-specific QoL self-monitoring instrument, the QoL tool. Methods A total of 43 individuals with BD engaged with a self-management intervention with an optional Web-based QoL self-assessment tool as part of an overarching mixed method study. Individuals were later interviewed about personal experiences of engagement with the intervention, including experiences of gauging their own QoL. A thematic analysis was used to identify salient aspects of the experience of QoL self-monitoring in BD. Results In total, 4 categories describing people’s experiences of QoL self-monitoring were identified: (1) breadth of QoL monitoring, (2) highlighting the positive, (3) connecting self-monitoring to action, and (4) self-directed patterns of use. Conclusions The findings of this research generate novel insights into ways in which individuals with BD experience the Web-based QoL self-assessment tool. The value of tracking the breadth of domains was an overarching aspect, facilitating the identification of both areas of strength and life domains in need of intervention. Importantly, monitoring QoL appeared to have an inherently therapeutic quality, through validating flourishing areas and reinforcing self-management efforts. This contrasts the evidence suggesting that symptom tracking may be distressing because of its focus on negative experiences and positions QoL as a valuable adjunctive target of observation in BD. Flexibility and personalization of use of the QoL tool were key to engagement, informing considerations for health care providers wishing to support self-monitoring and future research into Web- or mobile phone–based apps.
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Fauntroy, Victoria, Marcie Fyock, Jena Hansen-Honeycutt, Esther Nolton, and Jatin P. Ambegaonkar. "Using the Selective Functional Movement Assessment for the Evaluation of Dancers’ Functional Limitations and Dysfunctions: A Critically Appraised Topic." Journal of Sport Rehabilitation 28, no. 8 (November 1, 2019): 891–96. http://dx.doi.org/10.1123/jsr.2018-0054.
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Clinical Scenario: Dancers participate in a functionally demanding activity. Athletic participation typically requires the completion of a preparticipation examination, which involves a functional movement screen offering insight into potential injury recognition. The Selective Functional Movement Assessment (SFMA) was created to measure the status of movement–pattern-related pain and dysfunction using regionally interdependent movement to aggravate symptoms and exhibit limitations and dysfunctions. Still, a functional assessment has not been identified to recognize potential dysfunctions or limitations in this population. Clinical Question: Does the use of the SFMA improve overall evaluation of dancers by providing more information on a dancer’s overall functional ability and limitations? Summary of Key Findings: The literature search discovered 12 studies and 3 books in which 4 studies were included (2 case reviews, 1 case report, and 1 original research study) based on the inclusion and exclusion criteria. Three of the studies provided clinical case studies utilizing the SFMA to improve the patient’s dysfunctions, whereas 1 study examined the intrarater and interrater reliability of the SFMA. In 3 studies, participants displayed less movement dysfunction. The authors from 3 of the studies agreed the SFMA was a valuable tool for clinicians to use during evaluations, as it provided a more holistic view of the patient, discovering dysfunctional movement patterns that may better identify the source of injury. Clinical Bottom Line: Low-quality evidence, defined as poorly designed case studies, case series, and cohort studies, exist that supports improvement of overall evaluations when utilizing the SFMA. Although the studies were considered low-quality evidence, each included study displayed an effective use of the SFMA as an overall evaluation that correctly identified dysfunctional movement patterns. Strength of Recommendation: Grade C evidence exists that the SFMA contributes to the functional evaluation used in dancers.
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Mateo-Ortega, Dolors, Joaquín T. Limonero, Jorge Maté-Méndez, Elba Beas, Jesús González-Barboteo, Elisabeth Barbero, Sara Ela, and Xavier Gómez-Batiste. "Development of a tool to identify and assess psychosocial and spiritual needs in end-of-life patients: The ENP-E scale." Palliative and Supportive Care 17, no. 04 (October 16, 2018): 441–47. http://dx.doi.org/10.1017/s1478951518000652.
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AbstractObjectiveThe goal of this study is to describe the development of a new tool, the Psychosocial and Spiritual Needs Evaluation scale Instrumento de Evaluación de Necesidades Psicosociales y Espirituales del Enfermo al Final de Vida (ENP-E), designed to assess the psychosocial needs of end-of-life (EOL) patients. And, secondarily, to describe the face validity and psychometric properties of this instrument in the Spanish-speaking context.MethodThe scale was developed through a seven-stage process: (1) literature review; (2) expert panel establishment; (3) discussion and agreement on the most relevant dimensions of psychosocial care; (4) description of key indicators and consensus-based questions to evaluate such dimensions; (5) assessment of the scale by external palliative care (PC) professionals; (6) evaluation by patients; and (7) analysis of scale's psychometrics properties. To assess content validity, 30 PC professionals and 20 patients evaluated the questionnaire. To determine psychometric properties, 150 participants completed these scales: the ENP-E; the Hospital Anxiety and Depression Scale; item 15 from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative; and the Distress Thermometer.ResultAll respondents evaluated the tool as “excellent.” In terms of construct validity, the internal consistency (Cronbach's alpha = 0.74) and temporal stability (test-retest r = 0.74, p < 0.1) were both adequate. On the factorial analysis, four factors (emotional-wellbeing, social support, spiritual, and information) explained 58.4% of the variance. This scale has a sensitivity of 76.3%, specificity of 78.9%, and the cutoff is 28.Significance of resultsTo provide quality PC to EOL patients, it is essential to determine the psychosocial factors that influence well-being. This requires the use of reliable and specific instruments. The ENP-E is a novel tool that provides a systematic, holistic assessment of the psychosocial needs of EOL patients. Its routine use would allow clinicians to monitor such needs over time. This would, in turn, permit comprehensive, highly individualized interventions to improve effective PC approach.
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Veronese, Guido, and Alessandro Pepe. "Psychometric Properties of the Subjective Wellbeing Assessment Scale—French Version (SWBAS-18F): A Study With Young Refugees and Internally Displaced People in Nigerien Refugee Camps." Journal of Psychoeducational Assessment 38, no. 7 (May 15, 2020): 900–919. http://dx.doi.org/10.1177/0734282920920138.
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The aim of our research was to identify an easy-to-administer instrument for evaluating wellbeing in an at-risk population of young internal displaced people and young refugees in sub-Saharan Africa ( N = 462). To this end, we adapted the French-language 17-item version of the Subjective Wellbeing Assessment Scale (SWBAS—French version) and evaluated its factor structure, using a combination of exploratory factor analysis and confirmatory factor analysis. We observed five underlying factors (positive functioning, negative functioning, human insecurity, school domain, and social domain) and 17 items. Participants’ scores on the positive functioning, negative functioning, and social domain subscales were associated with their levels of psychological distress, and the statistical outcomes provided support for practical adoption of the instrument. The SWBAS-17F may, therefore, represent user-friendly instruments that practitioners might use alongside adaptations of more traditional diagnostic tools to obtain a complete and holistic assessment of refugees, asylum seekers, and internally displaced people.
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Tow, Kelly E., Claudia Rogge, Thomas Lee, Peter Caputi, and Simon R. Knowles. "Validation of a Digital Support App to Assess Inflammatory Disease Activity and Mental Health Patient-Reported Outcomes (PROs): A Pilot Investigation." Gastroenterology Research and Practice 2019 (February 17, 2019): 1–9. http://dx.doi.org/10.1155/2019/7618468.
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Background. Real-time collection of mental health and disease activity patient-reported outcomes (PROs) are essential to assist clinicians in delivering optimal holistic health care. The aim of this pilot study was to validate a digital support tool (DST) delivered via a tablet device in an outpatient setting to assess IBD activity and psychological distress.Methods. 48 individuals (26 females; average age: 40.04) with IBD completed the DST and a paper-based survey in a hospital IBD outpatient setting. PROs for disease activity and psychological distress (Kessler K10) were compared to paper-based gold-standard measures of disease activity (Partial Mayo Index or Harvey Bradshaw Index completed by the clinician) and psychological distress (Depression Anxiety Stress Scale; completed by the patient). Patient feedback regarding usability and acceptance of the DST was also collected.Results. DST patient-derived disease activity scores were significantly correlated with clinician assessment of disease activity (p<0.01). Patient DST-derived psychological well-being scores were also significantly correlated with the gold-standard measure of psychological distress (p<0.05). Patients found the DST to be easy to use and identified a willingness to follow through with the recommendations provided by the DST in relation to their psychological distress scores.Conclusions. The pilot study demonstrates the value in collecting disease activity and psychological distress PROs via a DST in an outpatient setting. Disease activity and psychological distress PROs were found to correlate significantly with gold standard measures. The findings provide preliminary support for the value of embedding digital technology into clinical care to promote patient engagement and optimal holistic healthcare.
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Hatfield, Rachée, Rupa Ghosh-Berkebile, Denise Schimming, Kristine Browning, Kristina Mathey, and Dori Klemanski. "Developing a survivorship specific curriculum for an advanced practice provider fellowship." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 14. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.14.
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14 Background: Holistic oncology care combines cancer treatment with supportive care to meet the physical and psychosocial needs of the cancer survivor. Advanced Practice Providers (APPs) are prepared to deliver high-quality, comprehensive oncology care and are vital to survivorship care as the number of cancer survivors continues to rise. At a Midwest Comprehensive Cancer Center (CCC), an APP oncology-specific fellowship is an innovative year-long postgraduate clinical training program. For the first time, a 2 week rotation through this CCC’s survivorship department will be piloted to provide the fellow with a basic immersion into survivorship care. Methods: APP oncology fellowship graduates completed an open ended survey. They were asked to reflect on their experiences during the fellowship and provide feedback on how to improve course content, and resources that are essential to the delivery of survivorship care. APPs within the survivorship department and the APP fellowship lead educator were asked what objectives they thought were important to be met. Results: APPs fellowship graduates desired to learn more about the philosophy of survivorship care, latent and long term side effect management, creation and delivery of a treatment summary and survivorship care plan (TS/SCP), and specific strategies for executing a meaningful survivorship care visit. Networking with oncology providers was also important. Survivorship department APPs and the fellowship lead thought it was important to know how to do a holistic and supportive care assessment, create a TS/SCP, interpret and manage a distress screening tool and make appropriate supportive care referrals. Conclusions: Cancer survivorship is an integral part of holistic oncology care. As the number of cancer survivors continues to increase, so does the need for supportive care services throughout the cancer continuum. Feedback from those surveyed was used to help develop a survivorship specific curriculum for APP oncology fellows. Educating future APPs in the principles of survivorship care and available supportive care services will result in expert clinicians in survivorship care, and improve overall well-being and quality of life of cancer survivors.
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Tabor, Gillian, Kathryn Nankervis, John Fernandes, and Jane Williams. "Generation of Domains for the Equine Musculoskeletal Rehabilitation Outcome Score: Development by Expert Consensus." Animals 10, no. 2 (January 25, 2020): 203. http://dx.doi.org/10.3390/ani10020203.
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Outcome measures (OMs) are a requirement of professional practice standards in human and canine physiotherapy practice for measurement of health status. Measures such as pain and functional capacity of specific regions are used to track treatment impact and can be used to develop optimal management strategies. To achieve comparable patient care in equine physiotherapy, OMs must be incorporated into practice; however, no reliable and valid OMs exist for equine rehabilitation. This study utilised the experience and opinion of a panel of experts working in the equine rehabilitation sphere to gain consensus on the core areas (domains) to be included in a model, to lead to an OM scale for horses undergoing rehabilitation. The Delphi method and content validity ratio testing was used to determine agreement with domains reaching the critical value required for inclusion. The expert panel agreed on ten domains to be included in the OM scale: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. An OM with these domains would provide a holistic objective assessment tool which could be used by equine rehabilitation professionals in clinical practice.
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Li, Jiahua, Oltjon Albajrami, Min Zhuo, Chelsea E. Hawley, and Julie M. Paik. "Decision Algorithm for Prescribing SGLT2 Inhibitors and GLP-1 Receptor Agonists for Diabetic Kidney Disease." Clinical Journal of the American Society of Nephrology 15, no. 11 (June 9, 2020): 1678–88. http://dx.doi.org/10.2215/cjn.02690320.
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Diabetic kidney disease and its comorbid conditions, including atherosclerotic cardiovascular disease, heart failure, diabetes, and obesity, are interconnected conditions that compound the risk of kidney failure and cardiovascular mortality, and exponentiate health care costs. Sodium glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP-1 RA) are novel diabetes medications that prevent cardiovascular events and kidney failure. Clinical trials exploring the cardiovascular and kidney outcomes of SGLT2i and GLP-1 RA have fundamentally shifted the treatment paradigm of diabetes. Clinical guidelines for diabetes management recommend a more holistic approach beyond glycemic control and emphasize heart and kidney protection of SGLT2i and GLP-1 RA. However, the adoption of prescribing SGLT2i and GLP-1 RA for patients with diabetes and high cardiovascular and kidney risk has been slow. In this review, we provide a decision-making tool to help clinicians determine when to consider SGLT2i and GLP-1 RA for heart and kidney protection. First, we discuss a comprehensive risk assessment for patients with diabetic kidney disease. We compare the effectiveness of SGLT2i and GLP-1 RA for different risk categories. Then, we present a decision algorithm using cardiovascular and kidney failure risk stratification and the strength of current evidence for the use of SGLT2i and GLP-1 RA. Lastly, we review the adverse effects of SGLT2i and GLP-1 RA and propose mitigation strategies.
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Atkinson-Clement, Cyril, Alban Letanneux, Guillaume Baille, Marie-Charlotte Cuartero, Lauriane Véron-Delor, Camille Robieux, Manon Berthelot, et al. "Psychosocial Impact of Dysarthria: The Patient-Reported Outcome as Part of the Clinical Management." Neurodegenerative Diseases 19, no. 1 (2019): 12–21. http://dx.doi.org/10.1159/000499627.
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Background: Dysarthria in neurological disorders can have psychosocial consequences. The dysarthric speaker’s perspective towards the disorder’s psychosocial impact is essential in its global assessment and management. For such purposes, assessment tools such as the Dysarthria Impact Profile (DIP) are indispensable. Objective: We aimed to confirm the relevance of using the DIP to quantify the psychosocial consequences of dysarthria in neurological diseases. Methods: We studied 120 participants, 15 healthy controls and 105 patients with different kinds of dysarthria induced by several neurological disorders (Parkinson’s disease [PD], Huntington’s disease, dystonia, cerebellar ataxia, progressive supranuclear palsy [PSP], multiple system atrophy, lateral amyotrophic sclerosis). All participants underwent a cognitive evaluation and a speech intelligibility assessment and completed three self-reported questionnaires: the 36-Item Short Form Health Survey, the Voice Handicap Index (VHI), and the DIP. Results: The psychometric properties of the DIP were confirmed, including internal consistency (α = 0.93), concurrent validity (correlation with the VHI: r = –0.77), and discriminant validity (accuracy = 0.93). Psychosocial impact of dysarthria was revealed by the DIP for all patients. Intelligibility loss was found strongly correlated with the psychosocial impact of dysarthria: for a similar level of intelligibility impairment, the DIP total score was similar regardless of the pathological group. However, our findings suggest that the psychosocial impact measured by the DIP could be partially independent from the severity of dysarthria (indirectly addressed here via speech intelligibility): the DIP was able to detect patients without any intelligibility impairment, but with a psychosocial impact. Conclusions: All patients reported a communication complaint, attested by the DIP scores, despite the fact that not all patients, notably PD, ataxic, and PSP patients, had an intelligibility deficit. The DIP should be used in clinical practice to contribute to a holistic evaluation and management of functional communication in patients with dysarthria.
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Fuccillo, E., A. M. Saibene, M. P. Canevini, and G. Felisati. "Olfactory disorders in coronavirus disease 2019 patients: a systematic literature review." Journal of Laryngology & Otology 134, no. 9 (September 2020): 754–63. http://dx.doi.org/10.1017/s0022215120002005.
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AbstractObjectiveRecent scientific literature has widely described a possible major role of smell dysfunction as a specific symptom of coronavirus disease 2019. This systematic review may provide a more holistic approach to current knowledge of the disease.MethodsA systematic review was completed using Embase, PubMed and Web of Science databases that considered original articles focused on olfactory evaluation in coronavirus disease 2019 patients, published between March and May 2020, in English language.ResultsFrom the 483 research papers initially identified, 32 original studies were selected, comprising a total of 17 306 subjects with a laboratory confirmed diagnosis of coronavirus disease 2019. Individual study sample sizes ranged from 6 to 6452 patients. This comprehensive analysis confirmed that olfactory disorders represent an important clinical feature in coronavirus disease 2019, with a prevalence of 11–100 per cent in included patients, although there was heterogeneity in terms of assessment tools and population selection criteria.ConclusionThe results indicate that an accurate clinical evaluation should be carried out using structured questionnaires and tests with olfactory substances.
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Hildebrand, Emily E., Rich Patterson, Nunzia Esposito, and Maura Gaffney. "A Tiered Approach for Integrating Patient Outcome Measures into the Curriculum." Athletic Training Education Journal 16, no. 2 (April 1, 2021): 159–68. http://dx.doi.org/10.4085/1947-380x-20-97.
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Context Knowledge and understanding of effective practices for integration of patient-reported outcome measures (PROMs) within athletic training curricula are necessary to bridge the gaps between didactic application, content assessment, and clinical implementation. Objective To provide athletic training educators with a tiered approach to implement content and assessments related to PROMs in the athletic training curriculum. Background An emphasis in the athletic training community is the need to incorporate patient-oriented evidence that matters into clinical practice. One way of achieving this transfer of knowledge is incorporating PROMs into athletic training curriculum. The 2020 Commission on Accreditation of Athletic Training Education (CAATE) Standards include PROMs and strategies to evaluate them for use in clinical practice to improve patient care. Thus, stakeholders responsible for students' education must have the knowledge and ability to properly address these standards in order for students to utilize these skills as future athletic trainers. Description This article offers an approach for educators to teach and assess PROMs within their athletic training curriculum. Clinical Advantages By utilizing an effective teaching approach for the implementation of PROMs, educators, preceptors, and students may collectively integrate these validated tools accurately into patient care to provide a more holistic practice. In addition, using a tiered approach will increase understanding and confidence for athletic trainers who have identified barriers and may not have prior clinical experience in the implementation of PROMs with patient care. Conclusions The knowledge and use of PROMs are expected of students in CAATE-accredited athletic training programs. In order to ensure and enhance the transfer of knowledge from the didactic setting to clinical practice, the use of a tiered approach may benefit athletic training educators as they integrate this content into coursework. In turn, perhaps future clinicians may be more apt to value the benefits of PROMs.
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Connor, Martin, Laurie Springford, and Stefano Giuliani. "Transition Risk Assessment Score to Stratify Health Care Needs and Interventions in Adolescents with Anorectal Malformations: A Pilot Study." European Journal of Pediatric Surgery 27, no. 04 (November 30, 2016): 361–67. http://dx.doi.org/10.1055/s-0036-1593980.
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Introduction Anorectal malformations (ARMs) are a complex collection of congenital disorders of the anus, rectum, and genitourinary system with possible active morbidities beyond adolescence. Aims To create the first evidence-based inclusive transition risk assessment score (TRAS) to stratify health care needs and interventions in teenagers with ARM transitioning to adult health care. Method MEDLINE, EMBASE, and the Cochrane Library were searched electronically for original articles containing published scoring systems evaluating children with ARM from January 1, 1990 to December 31, 2013. Current published scoring systems identified were weighted to create a novel score (TRAS) to objectively assess the most common active problems present in teenagers with ARM: fecal, urinary, and sexual functions; quality of life; and psychosocial well-being. The TRAS was applied to patients visiting our tertiary anorectal clinic in the period from January 2014 to March 2016. Patients were rescored on each visit to the clinic. Results Total 21 separate scoring systems were identified in the literature, with 3 scoring systems incorporated into the TRAS. The score divided patients into “low” (0–4), “medium” (5–10), and “high” (11–35) risk categories. The TRAS was used to assess 14 adolescents with ARMs during the study period; 14 patients had a single TRAS, 7 had two TRAS, and 3 had three TRAS assessments. At first visit 14 patients with a median age of 13 were assessed with TRAS ranging from 2 to 13 (M = 5, SD 3.33, 95% CI 3.08–7.68). At second visit seven patients with a median age of 15 were assessed with TRAS ranging from 2 to 12 (M = 6.43, SD 3.51, 95% CI 3.19–9.67). At third visit three patients with a median age of 16 were assessed with TRAS ranging from 6 to 12 (M = 8.33, SD 3.21, 95% CI 0.35–16.32). There was no significant difference (p > 0.05) between a patient's TRAS at different visits. Conclusion Preliminary data suggest that the TRAS is a holistic and effective clinical tool to help to objectively stratify ARM patients, identify active problems, and select those who may require intensive multidisciplinary input and interventions during the transition to adult health care services.
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Hill, Martin, and Mary Lynn Everson. "Indicators likely to contribute to clinical and functional improvement among survivors of politically-sanctioned torture." Torture Journal 29, no. 3 (January 20, 2020): 5–26. http://dx.doi.org/10.7146/torture.v29i3.115202.
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Introduction: Heartland Alliance Marjorie Kovler Center (Kovler Center) is a torture treatment program located in Chicago, Illinois. Established in 1987, Kovler Center provides medical, mental health, and social services, as well as coordination with legal services, to a diverse population of survivors. Historically, Kovler Center used clinical measurement instruments to assess depression, anxiety and posttraumatic stress, but staff was challenged with finding the best way to assess and ultimately measure changes in functional domains. The purpose of this paper is to describe (1) the Kovler Center framework, philosophical pillars, and model of treatment; (2) the comprehensive outcome evaluation program, including the Marjorie Kovler Center Well-Being Questionnaire (MKC WBQ); and (3) the results and implications to date. Methods: Kovler Center measured outcome data utilizing three instruments including a well-being tool and supplemented the data with a satisfaction survey. These instruments were administered at intake and re-administered at six-month intervals up to 24 months. Results/Discussion: With nine years of data, Kovler Center can now provide valid and reliable findings in diagnostic and functional changes, with 86.6% of its clients reporting fewer symptoms of anxiety and depression, 83.1% reporting fewer symptoms of trauma, and significant improvement in employment status, housing status, and physical health after receiving services for 24 months. Indicatorssignificantly correlated with clinical improvement at 24 months include stable housing, stable employment, region from where survivors came, number of days between initial assessment and program admittance, number of services (medical, psychological, social) received while in the program, number of medical problems diagnosed with while in the program, and number of psychological problems diagnosed with while in the program. From the Generalized Linear Mixed Models (GLMM) analysis, the total number of psychological problems and whether or not the participant had a secure legal status while in the program were demonstrated to explain the variance in anxiety, depression, and PTSD. Females were more likely to experience depression while in the program compared to males, and participants from the Middle East were more likely to experience symptoms of depression and PTSD compared to participants from Africa. Conclusions: Since, medical, psychological, and social indicators are demonstrated to correlate with or predict clinical outcomes, this highlights the need for comprehensive and holistic treatment programs for survivors of torture.
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Parker, Mary, and Veenu Gupta. "Audit: children & young peoples's services depression pathway Tees, Esk & Wear Valley Trust wide compliance." BJPsych Open 7, S1 (June 2021): S341. http://dx.doi.org/10.1192/bjo.2021.894.
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BackgroundThis complete cycle consists of an audit assessing compliance with the evidence based person-centred pathway of care for Depression in Children and Young People across the Trust, completion of an action plan and re-audit of progress, aiming to improve patient care. The pathway was derived from NICE Quality Standard 48/Clinical Guideline 28, updated for NICE Guideline 134 (2019) and includes comprehensive assessment considering comorbidities, social, educational and family context, parent/carer Mental Health assessment and plan for treatment including psychological therapies as first line treatment in mild depression.MethodThe Audit tool was compiled from the above evidence based pathway and NICE guidance. Each of the 26 community teams were requested to select 5 cases on the pathway who had completed a minimum of 6 treatment sessions (final sample size n = 61). The results were analysed for compliance against the pathway and compared with previous results by the clinical audit team.ResultThe results showed areas of good practice, maintained and improved on re-audit, with over 90% compliance in key evidence based areas regarding consideration of comorbidity, social and educational context and 100% compliance in offering psychological interventions.Improvement was obtained in some areas highlighted in the previous audit e.g. poor recording of ICD 10 diagnosis in medical records, 19%, improved to 30%, and less than 40% recording of symptom tracking via the RCADS (Revised Children's Anxiety and Depression Scale) monitoring improved to over 50%. There had been a failure to record identification or referral to other pathways/services for mild depression in the 16-18 age group with 0% compliance; this improved to 82% and 100% respectively.Areas still needing improvement were highlighted including recording of weekly monitoring of medication side-effects for first 4 weeks (43%) and a referral of parent/carers to mental health services after identifying issues (40%).Response to the audit also improved significantly from 29% of teams not responding in the initial audit to a limitation of only 1 of 26 (4%) at re-audit.ConclusionThis audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced areas of good practice in holistic assessment and use of psychological therapies and importantly highlighted areas of significant improvement needed including initial monitoring of medication response and referral onwards of parents/carers with mental health issues. Continuous improvement in patient care is planned via a targeted action plan, and further re-audit.
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Lamarca, Angela, Lindsay Carnie, Dinakshi Shah, Kate Vaughan, Zainul Abedin Kapacee, Lynne McCallum, Marc Abraham, et al. "Prospective observational study of prevalence, assessment and treatment of pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC): PanDA." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 196. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.196.
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196 Background: PEI in patients with advanced pancreatic cancer is well documented, but there is a lack of consensus regarding optimal screening. Methods: Eligible patients for this observational study (NCT03616431) were those diagnosed with aPC referred for consideration of palliative therapy who consented to evaluation by a research dietitian. In addition to symptom and full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair climb test), full nutritional blood panel, faecal elastase (FE) and 13C mixed triglyceride breath test (for diagnostic cohort (DiC)) were performed. Primary objectives: prospective assessment of PEI prevalence (dietitian-assessed; demographic cohort (DeC)), and to design (using breath test as gold standard; DiC) and validate (follow-up cohort (FuC)) the most suitable screening tool for PEI in patients with aPC. Logistic and Cox regression were used for statistical analysis (Stat v.12). Results: Between 1st July 2018 and 30th October 2020, 112 eligible patients [50 (DeC), 25 (DiC), 37 (FuC)]. Prevalence of PEI in the DeC was 64.0% (PEI-related symptoms were flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)); 70.0% of patients required pancreatic enzyme replacement therapy and 74.0% had anorexia (low appetite); 44.0% and 18.0% had low vitamin D and vitamin A levels, respectively. Designed PEI screening panel (DiC; 19 patients with breath test completed) included FE [normal/missing (0 points); low (1 point)] and MUAC [normal/missing ( > percentile 25 for age/gender) (0 points); low (2 points)] and identified patients at high-risk (2-3 total points) of PEI [vs. low-medium risk (0-1 total points)]. When patients from DeC and DiC) were analysed together, those classified as “high-risk of PEI” according to the screening panel had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03-3.36); p-value 0.040) when adjusted for other prognostic factors, including presence of PEI symptoms (mHR 2.28 (95% CI 1.19-4.35); p-value 0.013). The screening panel was tested in the FuC; 78.38% were classified as patients at “high-risk of PEI”; of these, 89.6% were confirmed to have PEI by the dietitian. The panel was feasible for use in clinical practice, (64.8% of patients completed fully the assessments required) and acceptability was high (87.5% of patients would do it again). The majority of patients (91.3%) recommended that all future patients with aPC should have dietitian input. Conclusions: PEI is present in the majority of patients with aPC, and early dietetic input is important to provide a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel could be used to prioritise patients at higher risk of PEI requiring urgent dietitian input. Its prognostic role needs further validation. Clinical trial information: NCT03616431.
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Thabrew, Hiran, Simona D'Silva, Margot Darragh, Mary Goldfinch, Jake Meads, and Felicity Goodyear-Smith. "Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial." Journal of Medical Internet Research 21, no. 12 (December 3, 2019): e13911. http://dx.doi.org/10.2196/13911.
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Background Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS Objective This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Trial Registration Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422.
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Lenarz, Thomas, Lida Muller, Hanna Czerniejewska-Wolska, Hector Vallés Varela, César Orús Dotú, Marcin Durko, Alicia Huarte Irujo, et al. "Patient-Related Benefits for Adults with Cochlear Implantation: A Multicultural Longitudinal Observational Study." Audiology and Neurotology 22, no. 2 (2017): 61–73. http://dx.doi.org/10.1159/000477533.
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Objectives: To assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits. Design: This was a prospective, multicenter, repeated-measures study. Self-assessment of performance at preimplantation and postimplantation at 1, 2, and 3 years using standardized, validated, local language versions of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), and the Health Utilities Index Mark 3 (HUI3) was performed. Outcomes were analyzed using a longitudinal mixed-effects model incorporating country effect. Patient demographics were explored for associations with change over time. Subjects: Two hundred ninety-one routinely treated, unilateral CI recipients, aged 13-81 years, from 9 clinics across 4 countries. Results: Highly significant improvements were observed for all outcome measures (p < 0.0001). Postimplantation, mean outcome scores remained stable beyond 1 year, with notable individual variability. A significant association for one or more outcomes with preimplantation contralateral hearing aid use, telephone use, age at implantation, implantation side, preimplantation comorbidities, dizziness, and tinnitus was observed (p < 0.004). Conclusions: Longitudinal benefits of CI treatment can be measured using clinically standardized self-assessment tools to provide a holistic view of patient-related benefits in routine clinical practice for aggregated data from multinational populations. Self-reported outcomes can provide medical-based evidence regarding CI treatment to support decision-making by health service providers.
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Dritsakis, Giorgos, Dimitris Kikidis, Nina Koloutsou, Louisa Murdin, Athanasios Bibas, Katherine Ploumidou, Ariane Laplante-Lévesque, Niels Henrik Pontoppidan, and Doris-Eva Bamiou. "Clinical validation of a public health policy-making platform for hearing loss (EVOTION): protocol for a big data study." BMJ Open 8, no. 2 (February 2018): e020978. http://dx.doi.org/10.1136/bmjopen-2017-020978.
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IntroductionThe holistic management of hearing loss (HL) requires an understanding of factors that predict hearing aid (HA) use and benefit beyond the acoustics of listening environments. Although several predictors have been identified, no study has explored the role of audiological, cognitive, behavioural and physiological data nor has any study collected real-time HA data. This study will collect ‘big data’, including retrospective HA logging data, prospective clinical data and real-time data via smart HAs, a mobile application and biosensors. The main objective is to enable the validation of the EVOTION platform as a public health policy-making tool for HL.Methods and analysisThis will be a big data international multicentre study consisting of retrospective and prospective data collection. Existing data from approximately 35 000 HA users will be extracted from clinical repositories in the UK and Denmark. For the prospective data collection, 1260 HA candidates will be recruited across four clinics in the UK and Greece. Participants will complete a battery of audiological and other assessments (measures of patient-reported HA benefit, mood, cognition, quality of life). Patients will be offered smart HAs and a mobile phone application and a subset will also be given wearable biosensors, to enable the collection of dynamic real-life HA usage data. Big data analytics will be used to detect correlations between contextualised HA usage and effectiveness, and different factors and comorbidities affecting HL, with a view to informing public health decision-making.Ethics and disseminationEthical approval was received from the London South East Research Ethics Committee (17/LO/0789), the Hippokrateion Hospital Ethics Committee (1847) and the Athens Medical Center’s Ethics Committee (KM140670). Results will be disseminated through national and international events in Greece and the UK, scientific journals, newsletters, magazines and social media. Target audiences include HA users, clinicians, policy-makers and the general public.Trial registration numberNCT03316287; Pre-results.
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Fourie, S., W. Czuber-Dochan, and C. Norton. "N27 What people want! Exploring inflammatory bowel disease patients’ perspectives on healthcare professionals addressing sexual well-being." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S669—S670. http://dx.doi.org/10.1093/ecco-jcc/jjz203.1010.
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Abstract Background Inflammatory bowel disease (IBD) affects every aspect of one’s life, yet no routine assessment for the impact on sexuality is made. Our aim was to explore patients’ perspective on healthcare professionals (HCPs) addressing sexuality/sexual well-being concerns. Methods This was a qualitative narrative study. Inclusion criteria were any sexual orientation and with known IBD for longer than 18 months. Data were collected via semi structured interviews and anonymous narrative accounts submitted via Google Forms. Thematic analysis was used to analyse the data. Results Fourteen adults, 4 male and 10 female, took part. Eleven participants were from the UK, one from the USA of America and one for South Africa. The following main themes and subthemes were identified: I cannot imagine talking about my sex life (a difficult topic; there is not enough time), Those who talked about sex, talked badly (nobody volunteered information; badly handled conversations), Still living whilst unwell (sex is an important part of my life; sex issues break down relationships, medicalised body), IBD ruined my sex life (feeling unattractive; feelings of shame and embarrassment), I feel unheard (HCPs don’t open the discussion; sex not taken seriously), I’m a person, not my IBD (holistic approach to care; time, space and ways to talk about sex). The findings reflect the importance of sexual well-being to those living with IBD, the experiences of such conversations, barriers to conversations with HCPs on sexual well-being, and suggestions on how HCPs should address their unmet needs. The importance of discussing intimacy and sexuality was emphasised, as participants felt their sexual well-being was considerably affected by IBD. The majority reported that HCPs did not initiate discussions on sexual well-being, nor did they understand the impact of IBD on sexual well-being, with a distinct accent on the perceived lack of a holistic approach to their care. Therefore, participants made suggestions for practice, such as provision of information related to sexual well-being in the form of leaflets, additionally to HCPs raising the issue. Conclusion Our findings indicate that communicating on sexuality/sexual well-being is a problematic area of IBD care. HCPs must be cognisant of the sexual well-being concerns and needs of those living with IBD, who want this topic discussed routinely, as part of a holistic approach to their clinical care.
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Woolf, Claudia, Leanne Kaplan, Sharon L. Naismith, David Burke, Louisa Margaret Norrie, and Loren Mowszowski. "344 - Study protocol for a feasibility RCT of Club Connect, a healthy brain ageing cognitive training program for older adults with depression." International Psychogeriatrics 32, S1 (October 2020): 104. http://dx.doi.org/10.1017/s1041610220002446.
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Background:Current treatments for Major Depression are only moderately effective. In fact, 20-30% do not achieve full recovery despite multiple interventions. Interestingly, while it is well recognised that cognitive impairment is associated with Major Depression, available treatments do not address cognitive impairment. In this regard, cognitive training (CT) represents a promising intervention, however CT is not typically offered in public health settings.Aim:To evaluate the feasibility of a blinded, randomised controlled trial of group-based CT in a hospital sample of older adults with clinically significant depressive symptoms or history of a major depressive episode within the last five years, and in doing so, to adapt and translate research findings to the clinical setting.Methods:40 older adults, aged at least 65 years, with depression or a history of depression, and without dementia were randomly allocated to Club Connect, a 10-week group-based healthy brain ageing CT program, or a waitlist, treatment-as-usual control group. Baseline assessment including review by a psychogeriatrician and a brief neuropsychological assessment was completed within a fortnight of the intervention starting, and follow-up assessment was completed within a fortnight of the intervention ceasing. Primary outcomes included feasibility of trial design, tolerability of the intervention, and acceptability of random allocation and data collection procedures (as perceived by both participants and clinicians). We also examined the most sensitive clinical outcomes and measurement tools to inform larger scale trials.Significance:The current health, social and economic costs of late-life depression, especially in those with concomitant cognitive impairment, renders the holistic treatment of depression in older adults a public health priority. CT represents an efficacious therapeutic intervention in this regard, however, there appears to be a paucity of CT programs being offered in public health settings. This trial represents the first step in addressing the ‘implementation gap’ that exists between care that is known to be effective and care that is delivered. We must recognise the need to evaluate not only health outcomes, but also to perform formative evaluations that assess the extent to which implementation is effective in order to optimise intervention benefits, to prolong sustainability, and to promote dissemination of findings.
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Ismail, Mohd Syafiq, Olufemi Aoko, Sandeep Sihag, Eimear Connolly, Joseph Omorogbe, Serhiy Semenov, Neil O'Morain, et al. "Lower gastrointestinal symptoms and symptoms-based triaging systems are poor predictors of clinical significant disease on colonoscopy." BMJ Open Gastroenterology 7, no. 1 (March 2020): e000221. http://dx.doi.org/10.1136/bmjgast-2018-000221.
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IntroductionLower gastrointestinal symptoms (LGS) are a common cause of referral to the gastroenterology service. International guidelines are available to prioritise referrals. Some studies have reported that symptoms alone are a poor marker of clinically significant disease (CSD) but symptoms remain the main way to prioritise referrals in routine clinical practice.Aims/backgroundTo correlate LGS with colonoscopy findings in an unselected patient cohort and to investigate whether using National Institute for Health and Care Excellence (NICE) guidelines improve risk stratification.MethodColonoscopy data over a 2-year period were obtained from our endoscopy database. Only patients with assessment of symptoms as their primary indication for colonoscopy were included. Patient records were retrospectively reviewed. Exclusion criteria: known inflammatory bowel disease (IBD), familial cancer syndromes, polyp and colorectal cancer (CRC) surveillance, and prior colonoscopy within 5 years. Demographics, symptoms and colonoscopy findings were recorded and analysed.Results1116 cases were reviewed; 493 (44%) males, age 54.3 years (16–91). CSD occurred in only 162 (14.5%); CRC 19 (1.7%), high-risk adenoma 40 (3.6%), inflammation 97 (8.7%) (IBD 65 (5.8%), microscopic colitis 9 (0.8%) and indeterminate-inflammation 23 (2%)), angiodysplasia 6 (0.5%). Diarrhoea gave the highest diagnostic yield for CSD of 5.3% (OR 3.15, 95% CI 2.2 to 4.7, p<0.001), followed by PR bleeding, 2.9% (OR 1.9, 95% CI 1.24 to 2.9, p=0.003). Weight loss gave the lowest diagnostic yield of 0.4%; (OR 0.79, 95% CI 0.28 to 2.24, p=0.65). 592 (53%) and 517 (46%) fitted the NICE guidelines for CRC and IBD, respectively. Using NICE positivity improved detection but overall yield remained low 3% vs 0.4% (OR 7.71, 95% CI 1.77 to 33.56, p=0.0064) for CRC, and 9% vs 2.8% (OR 3.5, 95% CI 1.99 to 6.17, p<0.0001) for IBD.ConclusionsThe overall prevalence of CSD in our unselected symptomatic patients is low (14.5%). A holistic approach including combining symptoms and demographics with novel tools including stool biomarkers and minimally invasive colonoscopy alternatives should be applied to avoid unnecessary colonoscopy.
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Leirós Rodríguez, Raquel, Mª Elena Arce Fariña, and José Luis García Soidán. "Estudio piloto para la valoración del equilibrio en mujeres adultas con un elemento cinemático (Balance assessment in adult women with a cinematic element: a pilot study)." Retos, no. 28 (March 25, 2015): 90–93. http://dx.doi.org/10.47197/retos.v0i28.34899.
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En este trabajo se valora el equilibrio a través de una amplia gama de condiciones de valoración cinemáticas para poder contrastarlos posteriormente con pruebas de equilibrio vigentes en la práctica clínica. Todo ello con el objetivo de conseguir una medida holística del equilibrio e identificar con mayor fiabilidad qué sistemas subyacentes están más presentes en cada una de las pruebas. Se valoraron un total de 30 mujeres con una media de edad de 63.07 años (DT = 6.06) con un instrumento de medición cinemático triaxial a la altura de la apófisis espinosa de L4 durante la realización de diferentes pruebas de equilibrio estático y dinámico. Los resultados mostraron que a medida que las tareas solicitadas aumentaban en complejidad, las variaciones de velocidad se hacían más amplias y complejas. A su vez, se encontraron correlaciones con la edad y el resultado obtenido previamente en la prueba Timed Up & Go, lo que confirma la correspondencia entre las variaciones de velocidad del tronco y el estado de los sistemas de control postural. Este instrumento se ha reafirmado como una herramienta de valoración única por su capacidad de reconocer y registrar el comportamiento natural del cuerpo en combinación con su bajo coste. Ambos aspectos lo hacen potencialmente útil en la práctica clínica de diferentes especialidades médicas. Ampliar la muestra del estudio así como cotejar los datos extraídos de las mediciones cinemáticas con otras variables fisiológicas y antropométricas, se sugieren como posibles mejoras en investigaciones futuras.Abstract. This paper assesses the balance through a wide range of kinematic conditions assessment for later compare them with existing balance tests in clinical practice. The goal was to achieve a holistic measure of balance and more reliably identify what underlying systems are present in each of the tests. A total of 30 women with a mean age of 63.07 years (SD = 6.06) were evaluated with a triaxial instrument at the height of the spinous process of L4 while performing different tests of static and dynamic balance kinematic measurement. The results showed that as the required tasks increased in complexity, speed variations became larger and more complex. In turn, correlations were found with age and the result obtained previously in the Timed Up & Go test, confirming the correspondence between the velocity variations of the trunk and the state of postural control systems. This instrument has been reaffirmed as a single assessment tool for its ability to recognize and record the natural behavior of the body in combination with low cost. Both aspects make it potentially useful in clinical practice in different medical specialties. Larger study sample and collate data from the kinematic measurements with other physiological and anthropometric variables are suggested as possible improvements in future research.
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Müller-Busch, Chr H. "Holistic pain assessment." Pain 30 (1987): S315. http://dx.doi.org/10.1016/0304-3959(87)91690-3.
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Mandalika, S., and PR Singhania. "Holistic health assessment tool for patients on maintenance hemodialysis." Indian Journal of Nephrology 22, no. 4 (2012): 269. http://dx.doi.org/10.4103/0971-4065.101246.
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McIlfatrick, Sonja, and Felicity Hasson. "Evaluating an holistic assessment tool for palliative care practice." Journal of Clinical Nursing 23, no. 7-8 (September 17, 2013): 1064–75. http://dx.doi.org/10.1111/jocn.12320.
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Nielsen, Carsten Munch, Britta Stenholt, Kirsten Lomborg, and Ida Torunn Bjørk. "Praktiske færdigheder i professionsrettede sundhedsuddannelser." Dansk Universitetspædagogisk Tidsskrift 8, no. 15 (September 1, 2013): 60–73. http://dx.doi.org/10.7146/dut.v8i15.7846.
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Artiklen har fokus på, hvordan læring af praktiske færdigheder kan understøttes og evalueres. Forfatterne er i forbindelse med en litteraturgennemgang blevet opmærksomme på, at der i såvel sygeplejerskeuddannelsen som i lægeuddannelsen arbejdes med at skærpe et analytisk perspektiv på og finde systematiske metoder, som kan give støtte til læring og evaluering af praktiske færdigheder. Artiklen argumenterer for potentialerne i at udvikle et såkaldt globalt vejlednings- og evalueringsinstrument, der er knyttet til læring af praktiske færdigheder. Et globalt instrument er kendetegnet ved at være generisk (kan anvendes til forskellige praktiske procedurer), holistisk (inddrager såvel humanistiske som proceduremæssige og tekniske elementer), multiprofessionelt (kan anvendes af forskellige professioner), multigraderet (kan anvendes af såvel novicer som erfarne praktikere) og multimodalt (kan anvendes i forskellige kontekster). I artiklen præsenteres og diskuteres potentialerne i to globale instrumenter eller modeller til læring og evaluering af praktiske færdigheder. De to modeller er The Leicester Clinical Procedure Assessment Tool og Model for praktisk færdighedsudøvelse. Med artiklen vil vi gerne invitere til fagdidaktiske drøftelser med andre universiteter og professionshøjskoler om at videreudvikle globale undervisnings- og evalueringsinstrumenter. Bag dette ligger også et ønske om at få en dybere indsigt i de praktiske handlingers natur. Målet med at udvikle et globalt vejlednings- og evalueringsredskab er at styrke de studerendes kompetencer til at udføre praktiske handlinger med kvalitet samt at give dem redskaber til at tilegne sig nye praktiske færdigheder i deres fremtidige karriere. The article focuses on how the learning of practical skills can be supported and evaluated. In connection with a literature review, the authors became aware of efforts to find an analytical perspective and a systematic method that can support learning and evaluation of practical skills in both nursing and medicine. The article argues in favour of the benefits of developing a so-called global instrument in teaching and formative evaluation. Two potential models are presented and discussed: The Leicester Clinical Procedure Assessment Tool and The Model of Practical Skill Performance. The authors hope this research will stimulate interest in other research settings. Collaboration is needed both on the development of global instruments that help students strengthen competence and improve their performance, and on the development of a deeper understanding of the nature of practical skills.
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Aravossis, Konstantinos G., Vasilis C. Kapsalis, Grigorios L. Kyriakopoulos, and Theofanis G. Xouleis. "Development of a Holistic Assessment Framework for Industrial Organizations." Sustainability 11, no. 14 (July 19, 2019): 3946. http://dx.doi.org/10.3390/su11143946.
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The evaluation and selection among the best production practices beyond the conventional linear models is, nowadays, concerned with those holistic approaches drawn toward environmental assessment in industry. Therefore, researchers need to develop an analysis that can evaluate the performance of industrial organization in the light of their environmental viewpoint. This study implemented a pilot co-integrated scheme based on an innovative in-house Holistic Assessment Performance Index for Environment (HAPI-E) industry tool while assimilating the principles of circular economy through the Eco-innovation Development and Implementation Tool (EDIT). For the latter, nine qualitative indicators were motivated and enriched the weighting criteria of the questionnaire. The decomposition of the complexity and preferences mapping was accompanied by a multi-criteria holistic hierarchical analysis methodology in order to synthesize a single index upon a need-driven scoring. This multi-criteria decision approach in industry can quantify the material and process flows, thus enhancing the existing knowledge of manipulating internal resources. The key-criteria were based on administrative, energy, water, emissions, and waste strategies. Subsequently, the HAPI-E industry tool was modeled on the food industry, being particularly focused on pasta-based industrial production. Then, the parameters of this tool were modeled, measured, and evaluated in terms of the environmental impact awareness. The magnitude of necessary improvements was unveiled, while future research orientations were discussed. The HAPI-E industry tool can be utilized as a precautionary methodology on sustainable assessment while incorporating multifaceted and quantification advantages.
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Hostland, C., R. Sadiq, G. Lovegrove, and D. Roberts. "HEALTH2: A Holistic Environmental Assessment Lay Tool for Home Health." Canadian Journal of Civil Engineering 42, no. 4 (April 2015): 241–49. http://dx.doi.org/10.1139/cjce-2014-0228.
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Although the adverse health effects of poor indoor air quality on occupants from mold and dampness in indoor environments are well described, there is no reliable empirical tool to evaluate indoor mold and dampness levels in the home for use by the medical profession and health safety regulatory bodies. The economic impact to society approaches $40 billion a year in North America alone from the cost of health care and workplace lost productivity. Mobilizing corrective action necessitates an acceptable home environment evaluation method. This paper proposes a reliable empirical model and tool, the Holistic Environmental Assessment Lay Tool for Home Healthiness, and develops guidelines for its use as a tool to evaluate and rank mold and dampness related indoor environmental conditions associated with known respiratory health outcomes. HEALTH2 was calibrated using theoretical homes and then validated using data from 269 home evaluations where occupant health and the home environment factors were collected. Results suggest the model can be used as an early detection tool to assist in determining indoor environment risk factors associated with respiratory illness from mold and dampness. Empirical modeling and this tool can assist environmental professionals in determining improvement scenarios beyond general industry prescription and assist regulatory bodies in setting home health guidelines. The HEALTH2 model challenges the dominant view and suggests that damp and moldy environments are measurable and the impact to society is sufficient to necessitate prompt medical and regulatory action.
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Chen, Danfang, Sebastian Thiede, Timo Schudeleit, and Christoph Herrmann. "A holistic and rapid sustainability assessment tool for manufacturing SMEs." CIRP Annals 63, no. 1 (2014): 437–40. http://dx.doi.org/10.1016/j.cirp.2014.03.113.
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