Exploring the Content Validity of the Unified Wilson Disease Rating Scale: Insights from Qualitative Research

INTRODUCTION

Wilson disease (WD) is a rare metabolic disorder of impaired copper transport manifesting in hepatic, neurological, and psychiatric symptoms. To evaluate the clinical symptoms of WD in clinical trials, a group of clinicians created the Unified Wilson Disease Rating Scale (UWDRS). Content validity of this scale has not been established. The aim of this study was to evaluate the content validity of the UWDRS Part II from the patient perspective.

METHODS

This study utilized multiple qualitative research methods including concept elicitation interviews, concept/instrument mapping, and cognitive debriefing interviews.

RESULTS

Concept elicitation interviews with a sample of patients with WD and one or more neurological signs/symptoms identified several signs, symptoms, and impacts related to neurological dysfunction, strengthening our understanding of the importance of the neurological aspects of the WD patient experience. Mapping neurological concepts to Part II and III items of the UWDRS showed complete coverage of all salient neurological concepts and near complete coverage of all neurological concepts reported by patients in concept elicitation interviews. Item debriefing of Part II of the UWDRS revealed that patients generally found the items clear and personally relevant to their experience with WD.

CONCLUSION

Overall, the findings from this study provide evidence for the content validity of the UWDRS Part II and supportive evidence for the content validity of Part III. The UWDRS should be used in conjunction with additional clinical outcomes assessments, specifically those evaluating the hepatic and psychiatric signs/symptoms of WD, to provide a comprehensive evaluation of the WD patient experience.

Gender Differences: Confirmatory Factor Analysis of the ADOS-II

PURPOSE

Recent research has suggested that autism may present differently in girls compared to boys, encouraging the exploration of a sex-differential diagnostic criteria. Gender differences in diagnostic assessments have been shown on the ADOS-II, such that, on average, females score significantly lower than males on all scales and are less likely to show atypicality on most items related to social communicative difficulties. Yet, gender differences in the latent structure of instruments like the ADOS-II have not been examined systematically.

METHODS

As such, this secondary data analysis examined 4,100 youth diagnosed with autism (Mage = 9.9, 813 female & 3287 male) examined item response trends by gender on the ADOS-II Module 3.

RESULTS

Multi-Group Confirmatory Factor Analysis results show that the factor loadings of four ADOS-II items differ across the genders. One SCD item and one RRB item are strongly related to the latent factor in the female group, while two RRB items have larger factor loadings in the male group.

CONCLUSION

The assumption of an identical latent factor structure for the ADOS-II Module 3 for males and females might not be justifiable. Possible diagnostic implications are discussed.

The cognitive processes employed by undergraduate nursing OSCE assessors: A qualitative research study

OBJECTIVES

The Objective Structured Clinical Examination (OSCE) is an assessment format commonly used to assess undergraduate nursing students. However, in spite of its prominence, relatively little research has been conducted into how OSCE assessors form judgements about student performances, and whether divergent processes of judgement formation have the potential to negatively impact the inter-rater reliability (IRR) of awarded scores. This qualitative study aimed to uncover the cognitive processes which assessors employ when assessing OSCE performances.

DESIGN, SETTING, PARTICIPANTS

In order to investigate this, a convenience, purposive sample of 12 assessors watched four videos of students completing single-station OSCEs: two videos of blood pressure measurement, and two of naso-gastric tube insertion.

METHODS

Assessors were asked to "think aloud" while watching the videos, and also participated in a semi-structured interview about their assessment practices.

RESULTS

Thematic analysis of the qualitative data revealed three themes: observation, processing, and integration. Within each theme, a number of sub-themes were identified, which explain the cognitive mechanisms used by assessors when watching, judging and grading student performances.

CONCLUSIONS

Notably, the presence of these mechanisms was not uniform across the sample, indicating that assessors utilise different approaches when viewing and interpreting the same performances. This has the potential to threaten the IRR of awarded scores, and thus the validity of decisions made on the basis of those scores.

Scoping Review of Programmatic Well-Being Interventions and Outcomes to Support Pharmacy Students

OBJECTIVES

Recent literature highlights various well-being initiatives implemented across pharmacy programs; however, there is much heterogeneity in their implementation and limited studies assessing the impact and success of these initiatives on pharmacy students' well-being. The purpose of this scoping review was to identify the effectiveness of strategies implemented by pharmacy schools to improve the well-being of pharmacy students.

FINDINGS

In total, 23 studies were included, and well-being strategies were categorized into 3 groups: organizational wellness programs, curriculum design and educational course activities, and specific relaxation or meditation activities. Strategies included yoga meditation, structured mindfulness courses, and self-directed mindfulness with digital smartphone applications. The majority of studies assessed outcomes of stress, burnout, and mindfulness, though other well-being domains such as resilience and belonging emerged. Some also assessed perceptions and acceptability of the interventions through qualitative approaches.

SUMMARY

Despite the heterogeneity of interventions and outcome measures, this review provides a comprehensive scope of well-being domains, assessment tools, interventions, and approaches targeted at pharmacy students and highlights the strongest evidence for interventions on reducing stress. Pharmacy programs can benefit from approaches at both the organization level and those fostering individual accountability by exposing students to a variety of self-help well-being strategies that develop protective factors and motivate them to sustain well-being practices themselves as a shared approach. This scoping review addresses a critical gap by gaining an understanding of the current landscape of well-being initiatives and their effectiveness to better guide pharmacy programs on strategies that are most likely to improve student well-being.

Post-intensive care syndrome follow-up system after hospital discharge: a narrative review

BACKGROUND

Post-intensive care syndrome (PICS) is the long-lasting impairment of physical functions, cognitive functions, and mental health after intensive care. Although a long-term follow-up is essential for the successful management of PICS, few reviews have summarized evidence for the efficacy and management of the PICS follow-up system.

MAIN TEXT

The PICS follow-up system includes a PICS follow-up clinic, home visitations, telephone or mail follow-ups, and telemedicine. The first PICS follow-up clinic was established in the U.K. in 1993 and its use spread thereafter. There are currently no consistent findings on the efficacy of PICS follow-up clinics. Under recent evidence and recommendations, attendance at a PICS follow-up clinic needs to start within three months after hospital discharge. A multidisciplinary team approach is important for the treatment of PICS from various aspects of impairments, including the nutritional status. We classified face-to-face and telephone-based assessments for a PICS follow-up from recent recommendations. Recent findings on medications, rehabilitation, and nutrition for the treatment of PICS were summarized.

CONCLUSIONS

This narrative review aimed to summarize the PICS follow-up system after hospital discharge and provide a comprehensive approach for the prevention and treatment of PICS.

Vosoritide Therapy in Children with Achondroplasia: Early Experience and Practical Considerations for Clinical Practice

INTRODUCTION

Vosoritide is the first precision medical therapy approved to increase growth velocity in children with achondroplasia. Sharing early prescribing experiences across different regions could provide a framework for developing practical guidance for the real-world use of vosoritide.

METHODS

Two meetings were held to gather insight and early experience from experts in Europe, the Middle East, and the USA. The group comprised geneticists, pediatric endocrinologists, pediatricians, and orthopedic surgeons. Current practices and considerations for vosoritide were discussed, including administration practicalities, assessments, and how to manage expectations.

RESULTS

A crucial step in the management of achondroplasia is to determine if adequate multidisciplinary support is in place. Training for families is essential, including practical information on administration of vosoritide, and how to recognize and manage injection-site reactions. Advocated techniques include establishing a routine, empowering patients by allowing them to choose injection sites, and managing pain. Patients may discontinue vosoritide if they cannot tolerate daily injections or are invited to participate in a clinical trial. Clinicians in Europe and the Middle East emphasized the importance of assessing adherence to daily injections, as non-adherence may impact response and reimbursement. Protocols for monitoring patients receiving vosoritide may be influenced by regional differences in reimbursement and healthcare systems. Core assessments may include pubertal staging, anthropometry, radiography to confirm open physes, the review of adverse events, and discussion of concomitant or new medications-but timing of these assessments may also differ regionally and vary across institutions. Patients and families should be informed that response to vosoritide can vary in both magnitude and timing. Keeping families informed regarding vosoritide clinical trial data is encouraged.

CONCLUSION

The early real-world experience with vosoritide is generally positive. Sharing these insights is important to increase understanding of the practicalities of treatment with vosoritide in the clinical setting.

An examination of the validity of neuropsychological and physical testing batteries in Latin-American adults aged over 55 years

BACKGROUND

Valid and reliable measurements are necessary to understand and monitor age-related changes.

AIMS

To describe the factor structure and provide validity evidence of a neuropsychological and a physical testing batteries using factor analysis.

METHODS

We performed a secondary analysis of data from the Epidemiology and Development of Alzheimer's Disease (EDAD) project. Community-dwelling adults aged 55 to 85 years underwent comprehensive physical and neuropsychological assessments. An exploratory factor analysis was performed on both assessment batteries. The models were later confirmed with a random subsample using confirmatory factor analysis.

RESULTS

Data from 238 adults (163 females and 75 males) was included. The neuropsychological model revealed a four-factor structure formed by "Executive Functioning", "Verbal Memory", "Logical Memory", and "Labeling And Reading" (Extraction Sums of Squared Loadings [ESSL] = 56.41% explained variance; Standardized Root Mean Square Residual [SRMSR] = 0.06; Comparative Fit Index [CFI] = 0.98). The physical model was formed by a two-factor structure including "Health-related Fitness and "Functional Fitness" (ESSL = 50.54% explained variance; SRMSR = 0.07; CFI = 0.93).

DISCUSSION

To our knowledge, this is the first study to analyze the structure of comprehensive testing batteries for the Latin-American older adults. Our analysis contributes to the understanding of theoretical constructs that are evaluated in the EDAD project.

CONCLUSION

Our findings provide validity evidence for simplified and reduced testing batteries, which imply shorter testing times and fewer resources.

Management of Chronic Pain by Occupational Therapist: A Description of Practice Profile

Background. Current state of knowledge regarding occupational therapy's contribution to chronic pain (CP) management has evolved over the past decade. Yet, has this been transferred to clinical practice? Purpose. Describe the current state of practice of CP management-specific occupational therapy. Method. An online survey was sent to occupational therapists working with CP patients. Findings. Of the 90 respondents (11.9%), 42.2% worked in primary care and 52.2% in secondary care. They reported that their primary role aimed at enabling occupation and providing vocational rehabilitation. The Canadian Model of Occupational Performance and Engagement (CMOP-E) (87.8%), semi-structured interview (86.7%), and education on energy conservation (65.6%) and postural hygiene (60.0%) were the most frequently reported conceptual model, assessment, and intervention methods. Implications. Results illustrate the diversity of current occupational therapy practice in CP management and suggest opportunities for improvement to ensure best practices are adopted, by emphasizing an occupation-based vision of health and well-being.

Are the sensorimotor control capabilities of the hands the factors influencing hand function in people with schizophrenia?

BACKGROUND

Previous works reported people with schizophrenia experienced inferior hand functions which influence their daily participation and work efficiency. Sensorimotor capability is one of indispensable elements acting in a well-executed feed-forward and feedback control loop to contribute to hand performances. However, rare studies investigated contribution of sensorimotor ability to hand functions for people with schizophrenia. This study aimed to explore hand function in people with schizophrenia based on the perspective of the sensorimotor control capabilities of the hands.

METHODS

Twenty-seven people at the chronic stage of schizophrenia were enrolled. The following assessment tools were used: the Purdue Pegboard Test (PPT) and the VALPAR Component Work Sample-8 (VCWS 8) system for hand function; the Self-Reported Graphic version of the Personal and Social Performance (SRG-PSP) scale for functionality; and the Semmes-Weinstein Monofilaments (SWM), the pinch-holding-up-activity (PHUA) test and the Manual Tactile Test (MTT) for the sensory and sensorimotor parameters. The Clinical Global Impression-Severity (CGI-S) scale and the Extrapyramidal Symptom Rating Scale (ESRS) were used to grade the severity of the illness and the side-effects of the drugs. Spearman's rank correlation coefficient was used to analyze associations among hand function, functionality, and sensorimotor capabilities. A multiple linear regression analysis was used to identify the determinants of hand function.

RESULTS

The results indicated that both hand function and sensorimotor capability were worse in people with schizophrenia than in healthy people, with the exception of the sensory threshold measured with the SWM. Moreover, the sensorimotor abilities of the hands were associated with hand function. The results of the regression analysis showed that the MTT measure of stereognosis was a determinant of the PPT measure of the dominant hand function and of the performance on the VCWS 8, and that the ESRS and the MTT measure of barognosis were determinants of the performance on the assembly task of the PPT.

CONCLUSIONS

The findings suggested that sensorimotor capabilities, especially stereognosis and barognosis, are crucial determinants of hand function in people with schizophrenia. The results also revealed that the side effects of drugs and the duration of the illness directly affect hand function.

CLINICAL TRAIL REGISTRATION

ClinicalTrials.gov , identifier NCT04941677, 28/06/2021.

Exploring occupation-based practice among occupational therapists in hospitals and rehabilitation institutions

BACKGROUND

While occupational therapists value occupation-based practice, they appear to spend less time on this approach and more time on impairment-based practices. Several barriers are reported for the occupation-based approach.

AIM

To explore different aspects of occupation-based practice among occupational therapists working in hospitals and rehabilitation institutions, and to examine associations between sociodemographic factors, barriers, and occupation-based practice.

MATERIALS AND METHODS

A cross-sectional survey was conducted. Participants were occupational therapists working in hospitals and rehabilitation institutions in Norway. The data were analysed with descriptive statistics and logistic regression.

RESULTS

The therapists (n = 124) valued occupation-based practice and reported using it frequently and to a large extent. Relatively small proportions of their practice (26% assessments and 38% interventions) were classified as occupation-based. Lack of time, space and equipment were reported as large barriers. Lack of time and lack of equipment were associated with low self-reported level of occupation-based practice.

CONCLUSIONS

The participants valued occupation-based practice, while the reported assessment and intervention methods were mainly not occupation-based. Several barriers were reported, and some were associated with less use of occupation-based practice.

SIGNIFICANCE

The results can be used to raise awareness of occupational therapists' use of occupation-based practice and barriers to this approach.

A comparison of the assessments used in campus-based years at the College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia

STUDY PURPOSE

Multiple assessment tools are used to assess future doctors' knowledge, clinical skills, and professional attitudes. In the present research, the difficulty level and discriminating ability of different types of written and performance-based assessments designed to measure the knowledge and competency of medical students were compared.

METHODS

The assessment data of 2nd & 3rd-year medical students (the academic year 2020-2021) in the College of Medicine at Imam Abdulrahman Bin Faisal University (IAU) were retrospectively reviewed. Based on end-of-the-year overall grades, students were divided into high and low scorers. Both groups were compared by independent sample t-test for their mean scores achieved in each type of assessment. Difficulty level and discriminating ability of the assessments were also explored. MS Excel and Statistical Package for Social Sciences (SPSS version 27) were used for analysis. Area under the curve was calculated through ROC analysis. A p-value <0.05 was believed significant.

RESULTS

In each type of written assessment, the high scorer group achieved significantly higher scores compared to the low scorers. Among performance-based assignments (except the PBLs), scores did not differ significantly between high and low scorers. The difficulty level of performance-based assessments was "easy" whereas it was "moderate" for written assessments (except the OSCE). The discriminating ability of performance-based assessments was "poor" whereas it was "moderate/excellent" for written assessments (except the OSCE).

CONCLUSION

Our study results indicate that written assessments have excellent discriminatory ability. However, performance-based assessments are not as difficult and discriminatory as written assessments. The PBLs are relatively discriminatory among all performance-based assessments. Key messages What is already known on this topic At Imam Abdulrahman Bin Faisal University, written and performance-based assessments both are graded on criterion-referenced scales. The student's grades at the end of the year are an aggregate of his/her scores in written and performance-based assessments. What this study adds Our study results show that performance-based assessments are not as difficult and discriminatory in differentiating between high and low scorers as written assessments. How this study might affect research, practice or policy Performance-based assessments should be made a hurdle exam (pass or fail) for the students to move to the next level, or students must pass each assessment component (written and performance-based) separately.

Psychosocial factors addressed by occupational therapists in hand therapy: A mixed-methods study

BACKGROUND

Occupational therapists address occupations, performance skills, and client factors that interfere with the successful occupational engagement in everyday activities, including psychosocial factors. However, due to the biomechanical model focus within hand therapy clinics, provision of a holistic care plan remains challenging for occupational therapists. If a client's psychosocial functioning is not addressed, progress toward a full recovery may be limited.

PURPOSE

The purpose of this study was to identify how occupational therapists who are certified hand therapists (CHTs), address and provide interventions to clients with psychosocial factors that negatively impact function.

STUDY DESIGN

Mixed-Method.

METHODS

CHTs completed an electronic survey (n = 117) followed by a virtual focus group (n = 9). Survey data analysis included descriptive and correlational statistics to highlight frequencies, ranges, and relationships between the participant demographics and the selection of assessment and the intervention approaches. Thematic analysis guided the qualitative coding of the focus group transcripts.

RESULTS

Of the 117 survey respondents, 79% reported frequent use of the biomechanical approach. The most frequently administered assessment included the Quick-Disabilities of the Arm, Shoulder, and Hand (n = 45; 40.9%). Five themes emerged from the focus groups: hand dysfunction impacts roles and routines; client rapport building takes time; CHT hesitation to address psychosocial factors; standardized assessments need to evaluate psychosocial factors that impact client function; and education and communication are critical intervention approaches.

CONCLUSIONS

Occupational therapy practitioners primarily utilize the biomechanical approach and are less likely to assess or treat psychosocial factors that impact a client's function. However, participants reported a need for a standardized assessment to identify the psychosocial factors that impact their clients' functional performance. Further research is warranted to increase the measurement and the use of holistic theoretical models of practice, assessments, and intervention approaches.

How infant food likes become established as knowledge: Parental food assessments during infant mealtimes in the home

Early infancy is a critical period for the development of food likes and dislikes, but very little is known about the role of the social context and parent-child interaction within this process, and even less about what happens in the home environment. The current paper addresses this issue by examining how and when parents utter food assessments about their infants' eating practices during mealtimes in the home, and the practices through which infant likes become established as knowledge. A data corpus of 77 video-recorded infant mealtimes from six infants (aged 5-9 months) and their parents was analysed using discursive psychology, with a specific focus on the use of object-side and subject-side assessments. Data were recorded in English-speaking family homes in Scotland and Sweden. The analysis highlights three key findings: (1) infants' interactional rights to assess food are invoked during first tastes, (2) infants' food likes are established through anchoring in family food preferences and as shared knowledge among family members, and (3) infants' potential food dislikes are challenged by parents using object-side assessments and claims about previous likes. Parents thus play a crucial role in the establishment of infant food likes through the formulation of subject-side category assessments during early infant mealtimes. The research suggests that more focus should be placed on examining infant eating practices as collaborative and interactional events in everyday contexts.

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students' perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10805-023-09472-w.

Bimanual movements in children with cerebral palsy: a systematic review of instrumented assessments

BACKGROUND

Assessment of bimanual movements, which are frequently impaired in children with cerebral palsy, is highly challenging in clinical practice. Instrumented measures have been developed to evaluate and help to understand impaired upper limb movement during bimanual tasks in these children. The aim of this review was to report instrumented measurement tools (3D motion analysis, sensors, etc.) used for bimanual task movement analysis, and the metrological properties of the measures in children with cerebral palsy.

METHODS

A systematic review was conducted (Prospero CRD42022308517). PubMed, Web of Science, Cochrane and Scopus databases were searched with relevant keywords and inclusion/exclusion criteria. Article quality and biomechanical methods were evaluated with a customized scale and metrological properties with the COSMIN checklist.

RESULTS

In total, 452 children, mostly with unilateral cerebral palsy, mean age 10.9 (SD 3.2) years, underwent quantitative bimanual assessments in the 31 included studies (mean quality score 22/32 points [SD 4.7]). The tools used were 3D motion analysis (n = 26), accelerometers (n = 2), and other instruments (cube, digitizer, etc.) (n = 3). Children performed 1-5 bimanual tasks in laboratory settings, mostly activities of daily living or game scenarios. Analyses focused mostly on spatiotemporal variables, 6 of which were specifically developed for bilateral measures (task completion time, goal synchronization, movement overlap time, interlimb coupling, continuous relative phase and asynchrony). These instrumented measurements had moderate to good discriminant and convergent validity, but reliability and responsiveness assessments were lacking.

CONCLUSIONS

A large number of quantitative bimanual assessments involving different tools, bimanual tasks and specific variables developed to evaluate bimanual function were found. Development of other relevant variables and validation of these tools are needed to further determine their usefulness, both as research outcomes and to guide therapies in clinical practice. Future research, involving younger children and real-life assessments, will improve our understanding of bimanual function in children with cerebral palsy.

Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize

PURPOSE

To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia.

METHODS

Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales.

RESULTS

For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96).

CONCLUSION

The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.

Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures

PURPOSE

Mental disorders are among the leading causes of disability among adolescents aged 10-19 years. However, data on prevalence of mental health conditions are extremely sparse across low- and middle-income countries, even though most adolescents live in these settings. This data gap is further exacerbated because few brief instruments for adolescent mental health are validated in these settings, making population-level measurement of adolescent mental health especially cumbersome to carry out. In response, the UNICEF has undertaken the Measurement of Mental Health Among Adolescents at the Population Level (MMAP) initiative, validating open-access brief measures and encouraging data collection in this area.

METHODS

This protocol presents the MMAP mixed-methods approach for cultural adaptation and clinical validation of adolescent mental health data collection tools across settings. Qualitative activities include an initial translation and adaptation, review by mental health experts, focus-group discussions with adolescents, cognitive interviews, synthesis of findings, and back-translation. An enriched sample of adolescents with mental health problems is then interviewed with the adapted tool, followed by gold-standard semistructured diagnostic interviews.

RESULTS

The study protocol is being implemented in Belize, Kenya, Nepal, and South Africa and includes measures for anxiety, depression, functional limitations, suicidality, care-seeking, and connectedness. Analyses, including psychometrics, will be conducted individually by country and combined across settings to assess the MMAP methodological process.

DISCUSSION

This protocol contributes to closing the data gap on adolescent mental health conditions by providing a rigorous process of cross-cultural adaptation and validation of data collection approaches.

Service user experiences of mental health assessments: a systematic review and thematic synthesis of qualitative literature

BACKGROUND

Successive governments have placed service users' experiences at the heart of mental health services delivery and development. However, little is known about service users' experiences of assessments and there is some evidence that assessments can cause harm.

AIMS

To synthesise the qualitative literature on service users' experiences of undergoing mental health service assessments.

METHODS

Literature was systematically searched, screened and extracted, following PRISMA guidelines. Several search strategies were employed, including electronic database searches, handsearching, and forward and backward citation tracking, to identify literature which contained data on service users' experiences of mental health assessments. Thematic synthesis was used to derive a set of themes underpinning these experiences.

RESULTS

Of the 10,137 references screened, 47 were identified as relevant to the review. Two main themes were identified: the importance of humanising assessment processes and experiences of service user agency, with each theme containing four sub-themes.

CONCLUSIONS

Findings highlight key factors determining service user experience. We identify key practice implications, contextualised within the literature on trauma-informed approaches and conclude that trauma-informed approaches may aid understanding and improvement of people's assessment experiences. Further research into the experiences of people from Black and minority ethnic communities is indicated.

LEGO®-based communication assessment in virtual general surgery residency interviews

Purpose

Effective communication skills are a critical quality and skill that is highly sought after for surgeons which largely impacts patient outcomes. Residency programs design their interview processes to select the best candidates. LEGO®-based activities have been frequently used to enhance communication skills and team building. This study investigates the effectiveness and reliability of a novel LEGO®-based communication assessment in interviews for surgical residencies and the feasibility of implementing it in a virtual setting.

Methods

This study conducted a retrospective analysis of a LEGO®-based communication assessment at the program's 2020/2021 residency interviews. Each applicant was assessed on a different model. The total scores were analyzed for consistency among raters and correlated to faculty interviews. Furthermore, the impact of the assessment structure, scoring criteria, and range of models' difficulties on the total scores were explored.

Results

A total of 54 categorical and 55 preliminary applicants interviewed on 2 days. The assessment on different models and had no impact on applicants' total scores for either categorical and preliminary groups (p = 0.791 and 0.709, respectively). The communication components of the assessment showed high consistency between the raters. The two applicant groups displayed a statistically significant difference (p = 0.004) in the communication evaluation and model accuracy components. Total scores did not correlate with the faculty interviews of standardized questions in either group.

Conclusion

This novel LEGO®-based communication assessment showed high reliability and promising results as a tool to assess communication and problem solving for residency interviews that can be readily implemented in a virtual setting.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-022-00021-4.

IPCC's current conceptualization of 'vulnerability' needs more clarification for climate change vulnerability assessments

In this Short Communication, we raise the concern that the existing conceptualization of 'vulnerability', introduced in the IPCC Fifth Assessment Report (AR5), is not facilitative for standalone vulnerability assessments and that this conceptualization has not been well accepted by the vulnerability researchers. We identify three key reasons for low adoption of the AR5 conceptualization in climate change vulnerability assessments, and urge the IPCC Working Group II to clarify how the current conceptualization of 'vulnerability' can facilitate standalone climate change vulnerability assessments. We propose treating 'exposure' not only as a precondition for vulnerability but also as a secondary driver of vulnerability to capture the influence of differential exposure.

Reminiscences on Public Health Law and JLME

This contribution marks a dual milestone at the intersection of public health law and JLME: my 50th publication of a substantive manuscript in the 50th anniversary of the Journal in 2022. In recognition of these coinciding landmarks, this installment of the Public Health Law column for JLME features observations and reflections of the field based largely on prior publications.

To like or not to like: Negotiating food assessments of children from families with a low socioeconomic position

The present study explored how primary school-aged children from families with a low socioeconomic position produce 'likes' and 'dislikes' of foods during everyday family meals, and how these (dis)likes are understood and treated by their parents. It is crucial to understand how food preferences develop in the course of everyday life, as it is known that there are socioeconomic disparities in food preference and consumption, and that children from families with a low socioeconomic position have relatively poorer diets. Deploying an interactional approach to food preference, video recordings of 79 evening meals in families with a low socioeconomic position were analyzed using discursive psychology and conversation analysis. The analysis highlighted that children's food likes and dislikes were treated differently by their parents. While likes were routinely not responded to, agreed with or further elaborated, dislikes were predominantly oriented to as food refusals or treated as inappropriate, or non-genuine claims. Children's food assessments, i.e., likes and dislikes, were often disattended by parents when they appeared to be food preference displays. By contrast, assessments that accomplished social actions like refusals and complaints were more often responded to. The analysis also revealed the importance of distinguishing between assessments about food items in general, that were not currently being eaten, and assessments of food eaten here-and-now. All in all, the study evidences that and how assessment sequences open up interactional spaces where children and parents orient to and negotiate relative rights and responsibilities to know, to assess and to accomplish specific actions. Implications for food preference research are discussed.

Consistency of thresholds for eutrophication assessments, examples and recommendations

International harmonisation of management goals for eutrophication processes in coastal waters, requiring reduction of discharges and depositions of nutrients and organic matter, needs coordinated assessments and measures. This is especially necessary in open areas, connected by currents and mixing processes with trans-boundary exchanges. Management goals, defined nationally as local thresholds for nutrients and chlorophyll-a, had been applied recently (2006-2014) within international eutrophication assessments in the North Sea (OSPAR) and Baltic Sea (HELCOM). Consistency of thresholds for nitrogen nutrients and chlorophyll-a concentrations is tested by mixing diagrams and correlations between nitrogen nutrients (total and inorganic nitrogen) and chlorophyll-a. Results indicate mean consistent relations, but single deviations as in the continental coastal water of the North Sea surpassed means by a factor up to 5 for chlorophyll-a in relation to inorganic nitrogen. Thresholds differed across national borders significantly. Correlations of thresholds and assed data reflect the degree of regional deviations by comparison. Consistency of regionally applied thresholds can be achieved stepwise, by application of regionally correlated means, by adaptation to mixing and parameter relations, and finally by relations of thresholds to natural background concentrations. By this, consistency of international assessments can be improved generally, allowing coordinated management of open coastal waters.

Assessment on the Diagnostic Capacity for Parasitic Diseases of Health Facilities - China, 2019

What is already known about this topic?

Morbidity and prevalence of several major parasitic diseases have been declining in China. To reduce the disease burden of parasitic diseases and protect public health security, conducting accurate diagnoses following timely treatment is important.

What is added by this report?

In the national competition held in 2019, the overall accuracy rates of participants for theoretical knowledge and slides interpretation for parasitic diseases were 80.44% and 66.87%, respectively. Significant differences in the accuracy rates of detecting schistosomiasis or malaria existed between endemic areas and non-endemic areas, respectively.

What are the implications for public health practice?

The study results will help policymakers and health managers to identify the gaps in parasitic diseases, help to strengthen diagnostic capacity, and improve quality of control programs.

[Current aspects of neurogenic dysfunctions of the lower urinary tract in multiple sclerosis]

BACKGROUND

In the clinical management of patients with multiple sclerosis (MS), the challenge is to make an early diagnosis and initiate adequate treatment of neurogenic disorders of the lower urinary tract (NLUTD). Various national guidelines provide practical recommendations which are sometimes discordant.

OBJECTIVE

To develop a simple evidence-based algorithm for detecting NLUTD in patients with MS that could be taken as a principle for deriving therapeutic consequences.

MATERIAL AND METHODS

A prospective multicenter study was initiated as a direct result of two multidisciplinary conferences. The aim was to identify statistically and clinically relevant parameters for the routine diagnosis of NLUTD in patients with MS. Urodynamic abnormalities served as the gold standard. At three subsequent consensus conferences, the results of the study were discussed, a diagnostic algorithm was developed and consensus was reached on a first-line treatment.

RESULTS AND DISCUSSION

The proposed algorithm enables the detection of NLUTD in patients with MS with the help of four statistically significant predictors: 1) the residual urine volume, 2) the number of urinary tract infections (UTI) within the last 6 months, 3) the standardized micturition frequency and 4) the presence/absence of urinary incontinence. The newly developed algorithm has proved to be efficient with the following results: approximately 75% of the patients do not need a urodynamic examination for a first-line treatment decision. In 25% of cases, urodynamic examinations are essential for an adequate treatment decision. Routine assessments include the patient medical history, residual urine volume measurement, a micturition diary and a uroflowmetry (optional).

A Tutorial for the Design and Use of Assessment-Based Instruction in Practice

Assessment-based instruction can increase the efficacy and efficiency of skill acquisition by using learner data to select an intervention procedure from a comparison of potential interventions. Although there are many published examples of assessments that guide the selection of skill-acquisition procedures, there are limited resources available to practitioners to guide the development of assessments for use in practice. This article describes a sequence of steps that Board Certified Behavior Analysts can follow to design and use assessment-based instruction in practice. These steps include (a) pick a topic to evaluate, (b) identify interventions to include in the assessment, (c) identify target behavior, (d) select an experimental design, (e) select a skill and targets, (f) equate noncritical procedures across conditions, (g) design templates for data collection, (h) conduct the assessment, and (i) use assessment results to guide practice. Included in these steps are examples and materials for how to conduct components of assessment-based instruction.

Nurses and Patients' Perspectives on Spiritual Health Assessment

Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.

Video Commentary: Rapid-Fire Assessment of Surgical Cognitive Skills

OBJECTIVE

We describe the use of "Video Commentary", an assessment using a set of operative videos, to assess trainees' surgical cognitive skills (operative knowledge, spatial awareness, and surgical insight).

DESIGN & SETTING

The Video Commentary assessment has been routinely administered to Postgraduate Year (PGY) 1-5 general surgery residents since 2014 as part of a biannual multistation, OSCE-type exam at Mayo Clinic, Rochester, MN. Video Commentary is a rapid-fire, 6-minute assessment, where trainees watch a series of 20 to 30 second operative video clips and comment on them as they play. Each clip varies in procedure, approach, difficulty, and complexity. The combination of video clips differs according to trainees' PGY level except for a few videos that overlap among PGY groups. The name of the procedure is provided at the beginning of each clip with a countdown timer showing in the corner of the screen. A comprehensive checklist is used to score trainees' performance in real-time.

DISCUSSION

Assessment of trainees of different levels and staff surgeons show a positive correlation with the experience level (p = 0.0001). The assessment provides a safe alternative to assess trainees in the operating room and encourages them to become more effective communicators. With the use of technology, large video databases can be created to provide just-in-time tailored feedback to the trainees.

CONCLUSIONS

Video Commentary can serve as a time and resource-efficient assessment of trainees' surgical cognitive skills and insight. The use and demand of real-time commentary on operative videos may provide a viable approach to help surgeon educators determine trainees' baseline, progression, and readiness to advance.

Dysphagia in adult myopathies

Dysphagia (impaired swallowing) is not a rare problem in various neuromuscular disorders, both in the pediatric and the adult patient population. On many occasions such patients are first presented to other medical specialists or health professionals. Disorders of deglutition are probably underrecognized in patients with a neuromuscular disease as a result of patient's and doctor's delay. This review will focus on dysphagia in adults suffering from a myopathy. Dysphagia in myopathies usually affects the oropharyngeal phases which rely mostly on voluntary muscle activity of the mouth, pharynx and upper esophageal sphincter. Dysphagia is known to contribute to a reduction of quality of life and may also lead to increased morbidity and mortality. The review includes an overview on symptomatology and tools of assessments, and elaborates on dysphagia in specific hereditary and acquired myopathies.

A short report of satisfaction levels amongst Irish trainees in psychiatry with out of hours and emergency assessments

OBJECTIVES

On-call and crisis psychiatry is a very challenging aspect of psychiatric training. This study aimed to describe the experiences of psychiatric trainees on-call in hospitals, emergency departments and psychiatric units in Ireland.

METHODS

In total, 193 psychiatric trainees in Ireland were emailed a survey in 2017. The survey included questions regarding the duties expected of the trainee, frequency of on-call obligations, un-rostered hours worked, level of senior support, assessment facilities available and doctors' satisfaction with the on-call experience.

RESULTS

Overall, 68 trainees responded to the survey. In total, 35% of respondents reported dissatisfaction with their experience of on-call and crisis psychiatry, 46% reported that they were not provided with training in risk assessment and 21% of respondents stated that there was not a suitable room available to perform their assessments.

CONCLUSIONS

This survey has raised important issues facing those on the frontline of psychiatric services in Ireland. Of particular concern are resource issues faced by trainees and the need for further training and support related to risk assessment when on-call. Remedying these issues may lead to a decreased rate of dropout as well as a safer and better environment for patients and doctors alike.

Writing exceptional (specific, student and criterion-focused) rubrics for nursing studies

Effective assessment of nurses in higher education is dependent on the interpretation and demonstration of learning outcomes by students and educators/academics. Rubrics can effectively communicate unit learning outcomes to students and may contribute towards the academic rigour of nursing courses, when assessment criteria are articulated clearly and consistently to both students and educators/academics. This paper aims to describe the different types and uses of rubrics, as well as outline the steps required to develop exceptional rubrics whilst using the literature as a basis for suggestions. Well written rubrics can facilitate consistency of marking across a student cohort, which may result in decreased student anxiety regarding assessment expectations, uniformity of assessment style and layout and may ensure that educators/academics across a teaching team are interpreting assessment criteria, consistently. Exceptional rubrics can empower students to success in academic assessments.

Effectiveness of Small Group Discussions for Teaching Specific Pharmacology Concepts

Small group discussions are used in medical education to reinforce learning and to promote the application of knowledge. Small group discussions can involve a variety of tasks, such as critical thinking, self-directed learning, problem-solving, and brainstorming. The objective of this study is to find out if small group discussions can improve students' learning of specific pharmacology topics and students' performance on assessments. In the present study, small group discussions were utilized for six unique topics in the pharmacology course, and knowledge-based tests were administered before and after small group discussions to examine their efficacy. Statistically significant improvement in knowledge gains was observed for antimicrobials and neuropharmacology topics, but not for anticancer agents. Students' performance in topics that had group discussions was better on summative assessments compared with the overall performance on the summative assessment in the pharmacology (study group; summer 2018). Students' (study group; summer 2018) overall grade on the summative assessment of the pharmacology course was better than overall pharmacology grade on the summative assessment of students who had no group discussions (control group; winter 2018). Students' perceptions of the small group discussions were satisfactory, suggesting group discussions may be an enjoyable way to improve students' performance in some pharmacology topics.

High prevalence of prenatal alcohol exposure detected by breathalyzer in the Republic of the Congo, Africa

OBJECTIVE

Assess the prevalence of prenatal alcohol exposure in the Republic of the Congo by measuring breath alcohol concentration (BrAC) levels using a breathalyzer device.

METHODS

Pregnant women were assessed for alcohol use with a breathalyzer reading during two prenatal visits and during labor and delivery.

RESULTS

Among 662 pregnant women consented and screened with a breathalyzer, 192 (29.0%) had a positive BrAC during 1st trimester. During the second assessment, approximately 69% (132) of the 192 pregnant women had a second positive BrAC. A third assessment during labor and delivery identified 60 women (31%) with a third positive BrAC. About 19% (36) of the 192 pregnant women had positive BrACs at all three times. Among women who were positive on the first and second assessments, 30% had a BrAC that was above 0.07, which is almost equivalent of binge drinking (four or more standard drinks in about 2 h). The mean BrAC reading decreased as the pregnancy progressed.

CONCLUSIONS

The results of this study utilizing a unique exposure detection methodology suggest that the use of BrAC may be a useful objective option to detect and quantify alcohol consumption during pregnancy. The prevalence of alcohol use identified during pregnancy in the Republic of the Congo was increased over 20% when compared to maternal reports from a previous study. Nearly one of every five women identified at the first prenatal visit continued drinking throughout pregnancy. Urgent measures are needed to reduce alcohol consumption among this population of pregnant women.

The Overt Aggression Scale Modified (OAS-M) for clinical trials targeting impulsive aggression and intermittent explosive disorder: Validity, reliability, and correlates

While aggressive behavior is common, and a disorder of impulsive aggression has been defined in the DSM-5 (Intermittent Explosive Disorder: IED), there are no currently FDA approved interventions to reduce these behaviors. One obstacle to the development of interventions to treat aggression is the paucity of psychometrically valid measures to assess aggressive behavior in the context of clinical trials, especially those in the outpatients setting. While there are many assessment of trait aggression, very few attempt to assess current aggressive behavior over time and/or in individuals not in a closed setting. The Overt Aggression Scale Modified (OAS-M) was developed to fill this void and this paper reviews its development along with presenting new data on its validity, reliability, and correlates with related constructs. Overall, the OAS-M is a valid and reliable measure of state (e.g., week to week) aggression, has good psychometric properties, and shows evidence of change in clinical trials of agents with putative anti-aggressive efficacy.

The Multidimensional Structure of Problem Gambling: An Evaluation of Four Gambling Categorization Instruments from an International Online Survey of Gamblers

To examine the underlying dimensionality and structure of problem gambling using a comprehensive range of problem gambling assessments from an international online survey of gamblers. A total of 12,521 gamblers from 105 countries were recruited through banner advertising placed on a popular online gambling portal to take an online survey. Although participants were recruited online, the majority of the sample (71.6%) gambled only at land-based venues in the past 12 months. A total of 5081 individuals completed all items from the four problem gambling assessments. Participants were allocated to answer one of the four problem gambling assessments and the remaining unique items from the three other problem gambling assessments. The order of assessments were counterbalanced. Two optimal scaling procedures were independently employed to estimate the number of dimensions within the data: exploratory categorical principal component bootstrap analysis and multidimensional scaling. Nonlinear canonical correlation was then used to establish how well each of the four assessment instruments captured the identified dimensions. A final confirmatory principal component analysis was run to understand and characterise the nature of the dimensions that were identified. Both the categorical principal component bootstrap analysis and multidimensional scaling indicated the data was multidimensional, with four dimensions (including a single dominant dimension) providing the best characterisation of the data. The nonlinear canonical correlation analysis found that the Problem and Pathological Gambling Measure and the National Opinion Research Center DSM-IV Screen for Gambling Problems operationalization of the Diagnostic and Statistical Manual of Mental Disorders Four (DSM-IV) criteria best captured these multiple dimensions. Confirmatory principal component analysis suggest a core experience of generic problem gambling symptomology and three other components: "financial problems", "health and relationship issues", and "difficulty controlling gambling". Problem gambling symptomology appears to be multi-dimensional. Certain assessments capture this heterogeneity better than others and thereby provide a more complete and accurate assessment of this construct.

The TechSAge Minimum Battery: A multidimensional and holistic assessment of individuals aging with long-term disabilities

BACKGROUND

People with disabilities acquired in early to mid-life are living longer, contributing to growing numbers of older adults who are aging with disability, an understudied population likely to be underserved.

OBJECTIVES

This paper demonstrates the usefulness of the TechSAge Minimum Battery as a holistic assessment of health for people aging with disabilities.

METHODS

Survey data of socio-demographic and health characteristics were collected from 176 older adults with long-term vision, hearing, and/or mobility disabilities. A series of descriptive and bivariate analyses were conducted to illustrate the heterogeneity of the sample. An in-depth analysis of the subsample with vision difficulty was conducted to highlight the tool's value in assessing detailed contextual information for a specific disability.

RESULTS

Prevalence of health conditions (M = 4.1; SD = 2.5), prescription medications (M = 4.1; SD = 3.9), and serious functional difficulties (M = 1.6; SD = 0.85) indicated a fair degree of comorbidity, but with considerable variation in number and type among individuals. Subjective health ratings were high overall, but lower scores were correlated with additional comorbidities (r = -0.31-0.40, p =<.001). Analyses of the subsample with vision difficulty demonstrated heterogeneity in functional capacity, degree of impairment, duration, and use of supportive aids.

CONCLUSIONS

Findings highlighted the heterogeneity among people aging with disability and demonstrated the importance of capturing multi-dimensional factors inclusive of an individual's capacity, context, and personal factors, which the Minimum Battery provides in an integrated assessment. Potential healthcare applications of the tool are discussed with implications for bridging aging and disability services.

Common Data Element for Unruptured Intracranial Aneurysm and Subarachnoid Hemorrhage: Recommendations from Assessments and Clinical Examination Workgroup/Subcommittee

BACKGROUND

Clinical studies of subarachnoid hemorrhage (SAH) and unruptured cerebral aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing meta-analyses. The overall goal of the National Institute of Health/National Institute of Neurological Disorders and Stroke Unruptured Intracranial Aneurysms (UIA) and subarachnoid hemorrhage (SAH) Common Data Elements (CDE) Project was to provide common definitions and terminology for future unruptured intracranial aneurysm and SAH research.

METHODS

This paper summarizes the recommendations of the subcommittee on SAH Assessments and Clinical Examination. The subcommittee consisted of an international and multidisciplinary panel of experts in UIA and SAH. Consensus recommendations were developed by reviewing previously published CDEs for other neurological diseases including traumatic brain injury, epilepsy and stroke, and the SAH literature. Recommendations for CDEs were classified by priority into "core," "supplemental-highly recommended," "supplemental" and "exploratory."

RESULTS

We identified 248 variables for Assessments and Clinical Examination. Only the World Federation of Neurological Societies grading scale was classified as "Core." The Glasgow Coma Scale was classified as "Supplemental-Highly Recommended." All other Assessments and Clinical Examination variables were categorized as "Supplemental."

CONCLUSION

The recommended Assessments and Clinical Examination variables have been collated from a large number of potentially useful scales, history, clinical presentation, laboratory, and other tests. We hope that adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.

BOMET-QoL-10 questionnaire for breast cancer patients with bone metastasis: the prospective MABOMET GEICAM study

Background

Bone metastasis (BM) is the most common site of disease in metastatic breast cancer (MBC) patients. BM impacts health-related quality of life (HRQoL). We tested prospectively the psychometric properties of the Bone Metastasis Quality of Life (BOMET-QoL-10) measure on MBC patients with BM.

Methods

Patients completed the BOMET-QoL-10 questionnaire, the Visual Analogue Scale (VAS) for pain, and a self-perceived health status item at baseline and at follow-up visits. We performed psychometric tests and calculated the effect size of specific BM treatment on patients´ HRQoL.

Results

Almost 70% of the 172 patients reported symptoms, 23.3% experienced irruptive pain, and over half were receiving chemotherapy. BOMET-QoL-10 proved to be a quick assessment tool performing well in readability and completion time (about 10 min) with 0–1.2% of missing/invalid data. Although BOMET-QoL-10 scores remained fairly stable during study visits, differences were observed for patient subgroups (e.g., with or without skeletal-related events or adverse effects). Scores were significantly correlated with physician-reported patient status, patient-reported pain, symptoms, and perceived health status. BOMET-QoL-10 scores also varied prospectively according to changes in pain intensity.

Conclusions

BOMET-QoL-10 performed well as a brief, easy-to-administer, useful, and sensitive HRQoL measure for potential use for clinical practice with MBC patients.

Trial registration

NCT03847220. Retrospectively registered on clinicaltrials.gov (February the 20th 2019).

Psychometric properties of the German Version of the Pediatric Evaluation of Disability Inventory (PEDI-G): A factor analysis

BACKGROUND

Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure.

AIM

To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment.

MATERIAL AND METHODS

An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale.

RESULTS

262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living.

CONCLUSION

The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland.

Assessing Spiritual Well-Being in Residential Aged Care: An Exploratory Review

With the emerging incorporation of spiritual care into the allied health stream, there is a need for a clear and validated process of spiritual review that can be understood across multidisciplinary teams. The aim and purpose of this paper was to critically review the literature regarding spiritual screening, history-taking and assessment, and explore the merits of developing a brief instrument focussed on assessing and improving the spiritual well-being of consumers within residential aged care. Following an exploratory review of the literature, the results indicate that effective processes are noted regarding the triage and identification of the needs and spiritual assessment of consumers; however, many of these tools are overly religious in content, unwieldy in size, or not specifically aimed at identifying the immediate crisis confronting the consumer. It is recommended that an assessment instrument be developed which is communicable across all allied health practitioners (including spiritual carers), which may contribute towards a taxonomy of common consumer conditions, and which will enable the development and delivery of more targeted care plans.

What do care home managers believe constitutes an 'assessment for frailty' of care home residents in North-West London? A survey

Background

Frail individuals are at risk of significant clinical deterioration if their frailty is not identified and managed appropriately. Research suggests that any interaction between an older person and a health or social care professional should include an assessment for frailty. Many older care home residents are frail when admitted, but we have little knowledge of whether or how this is assessed. The aim of this paper is to understand and establish the characteristics of the reported ‘assessments for frailty’ used in care homes with nursing (nursing homes) across North-West London. This will help understand what an ‘assessment for frailty’ of care home residents mean in practice in North-West London.

Methods

Telephone contact was made with every Care Quality Commission (CQC) (independent regulator of health and adult social care in England) regulated nursing home across North-West London [n = 87]. An online survey was sent to all that expressed interest [n = 73]. The survey was developed through conversations with healthcare professionals, based on literature and tested with academics and clinicians. Survey responses were analysed using descriptive statistics. The Mann-Whitney U test was used for statistical analyses.

Results

24/73 nursing homes completed the survey (33%). Differences in the characteristics of reported ‘assessments for frailty’ across nursing homes were evident. Variation in high level domains assessed (physical, social, mental and environmental) was observed. Nurses were the most common professional group completing assessments for frailty, with documentation and storage being predominantly paper based. A statistically significant difference between the number of assessments used in corporate chain owned nursing homes (3.9) versus independently owned nursing homes (2.1) was observed (U = 21, p = .005).

Conclusions

Great variation existed in the characteristics of reported ‘assessments for frailty’ in nursing homes. Our study suggests that not all physical, social, mental and environmental domains of frailty are routinely assessed: it appears that frailty is still primarily viewed only in terms of physical health. The consequences of this could be severe for patients, staff and healthcare settings. Research illustrates that frailty is a broad, multifactorial health state and, as such, an overall ‘assessment for frailty’ should reflect this.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1083-5) contains supplementary material, which is available to authorized users.

Nonsynostotic plagiocephaly: a child health care intervention in Skaraborg, Sweden

Background

The aim was to evaluate the intervention’s effect on prevention and reversal of nonsynostotic plagiocephaly.

Methods

Thirty-eight intervention group nurses were educated about nonsynostotic plagiocephaly and asked to follow guidelines; 18 control group nurses were not. In a longitudinal single-blinded clinical intervention, parents brought infants to well-child visits according to the national schedule. Cranial shape was assessed in 176 intervention and 92 control group infants at 2-, 4-, and 12-month visits.

Results

Asymmetry at two months reversed by four months four times more often in intervention than control subgroup infants (OR = 4.07, p = 0.02) when adjusted for parent awareness of written information from their nurse. Asymmetry at two months reversed by 12 months fivefold when parents were aware of written information (OR = 0.19, p = 0.04). The risk for persistent asymmetry at 12 months was lower for intervention than control group infants (RR = 0.35, p = 0.03). Of infants with no asymmetry at two months, 25% in intervention and 22% in control group developed brachycephaly.

Conclusions

The intervention contributed to early reversal and reducing infants’ risk for persistent asymmetry. Parents’ awareness of written information contributed to reversal. Preventing brachycephaly was difficult. Further research is needed.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1405-y) contains supplementary material, which is available to authorized users.

Ambulatory care preceptors' perceptions on SOAP note writing in advanced pharmacy practice experiences (APPEs)

INTRODUCTION

Descriptions of SOAP note requirements and assessment methods used during advanced pharmacy practice experiences (APPEs) are limited in the literature. This study aimed to gather information from preceptors regarding SOAP note writing and assessment methods utilized during ambulatory care APPEs.

METHODS

A survey was developed and distributed to ambulatory care preceptors with data collected via Qualtrics and analyzed using descriptive statistics, Fisher's exact test to assess the significance for associations between dependent and independent variables, and the Gamma test to assess dependent variables in grading habits and feedback types.

RESULTS

The survey response rate was 62% with 75% of preceptors having students write SOAP notes during APPEs. A majority of preceptors (84%) do not formally grade SOAP notes with full-time faculty being more likely to grade and provide written feedback. Half of the preceptors perceived students as either prepared or very prepared to write SOAP notes but the majority felt that students struggle with the assessment portion of the note. There were significant differences between schools in the percentage of preceptors that formally grade SOAP notes, ranging from 2 to 45%.

CONCLUSIONS

Preceptors' perception of student preparedness to write SOAP notes on ambulatory APPEs was similar, despite assessment methods varying widely.

Assessing trauma in a transcultural context: challenges in mental health care with immigrants and refugees

The growing numbers of refugees and immigrants from conflict-prone areas settling throughout the world bring several challenges for those working in the mental health care system. Immigrants and refugees of all ages arrive with complex and nuanced mental health histories of war, torture, and strenuous migration journeys. Many of the challenges of addressing the health care needs for this growing population of immigrants and refugees are often unfamiliar, and thus practices to address these challenges are not yet routine for care providers and health care organizations. In particular, complex trauma can make mental health assessments difficult for health care organizations or care providers with limited experience and training in transcultural or trauma-informed care. Using a transcultural approach can improve assessment and screening processes, leading to more effective and high-quality care for immigrant and refugee families experiencing mental health disorders.

This paper presents findings from an assessment of current mental health services focusing on current practices and experiences with immigrant and refugee patients and families. The difficulties in developing shared understandings about mental health can hinder the therapeutic process; therefore, it is imperative to ensure an effective assessment right from the beginning, yet there is limited use of existing cultural formulation tools from the DSM-IV or DSM-5. The paper outlines current practices, approaches, challenges, and recommendations shared by mental health care providers and program leaders in addressing the mental health care needs of immigrants and refugees. The results from this study demonstrate that there are many challenges and inconsistencies in providing transcultural, trauma-informed care. Respondents emphasized the need for a thorough yet flexible and adaptive approach that allows for an exploration of differences in cultural interpretations of mental health. Our study concluded that ensuring a mindful, reflexive, transcultural, and trauma-informed health care workforce, and a learning environment to support staff with education, resources, and tools will improve the health care experiences of immigrants and refugees in the mental health care system.

Application of 3D-printed and patient-specific cast for the treatment of distal radius fractures: initial experience

BACKGROUND

Distal radius fracture is common in the general population. Fracture management includes a plaster cast, splint and synthetic material cast to immobilise the injured arm. Casting complications are common in those conventional casting technologies. 3D printing technology is a rapidly increasing application in rehabilitation. However, there is no clinical study investigating the application of a 3D-printed orthopaedic cast for the treatment of bone fractures. We have developed a patient-specific casting technology fabricated by 3D printing. This pioneering study aims to use 3D-printed casts we developed for the treatment of distal radius fractures, to provide the foundation for conducting additional clinical trials, and to perform clinical assessments.

METHOD

Ten patients with ages between 5 and 78 years are involved in the clinical trial. Patients are applied 3D-printed casts we developed. Orthopaedic surgeons carried out a six-week follow-up to examine clinical outcomes. Two questionnaires were developed for the assessment of clinical efficacy and patients' satisfaction. These questionnaires are completed by physicians and participating patients.

RESULTS

A 3D-printed cast creates a custom-fitted design to maintain the fractured bone alignment. No loss of reduction is found in all patients. Compartment syndrome and pressure sores are not present. Patient comfort gets positive scores on the questionnaire. All (100%) of the patients opt for the 3D-printed cast instead of the conventional plaster cast.

DISCUSSION

A patient-specific, 3D-printed cast offers a proper fit to immobilise an injured arm and holds the fracture reduction appropriately. A custom-fitted structure reduces the risk of pressure-related complications due to the high and concentrated local stress. The ventilated and lightweight design minimises interference with a patient's daily activities and reduces the risk of cutaneous complications. Patients express a strong preference for using a 3D-printed cast instead of a plaster cast. Limitations of the novel cast include a slight odour after heavy sweating and the relatively high cost due to the limitations of current 3D printing technologies.

CONCLUSIONS

This pioneering study is the first clinical trial on the application of a 3D-printed cast for the treatment of forearm fractures. The novel casting technology heals the fracture effectively without casting complications. The 3D-printed cast is patient-specific and ventilated as well as lightweight, and it features both increased patient comfort and satisfaction.

Evaluation of feedback given to trainees in medical specialties

The aim of this study was to evaluate the quality of feedback provided to specialty trainees (ST3 or higher) in medical specialties during their workplace-based assessments (WBAs). The feedback given in WBAs was examined in detail in a group of 50 ST3 or higher trainees randomly selected from those taking part in a pilot study of changes to the WBA system conducted by the Joint Royal Colleges of Physicians Training Board. They were based in Health Education Northeast (Northern Deanery) and Health Education East of England (Eastern Deanery). Thematic analysis was used to identify commonly occurring themes. Feedback was mainly positive but there were differences in quality between specialties. Problems with feedback included insufficient detail, such that it was not possible to map the progression of the trainee, insufficient action plans made and the timing of feedback not being contemporaneous (feedback not being given at the time of assessment). Recommendations included feedback should be more specific; there need to be more options in the feedback forms for the supervisor to compare the trainee's performance to what is expected and action plans need to be made.

Control versus Complexity: Approaches to the Carbon Dioxide Problem at IIASA

Control versus Complexity: Approaches to the Carbon Dioxide Problem at IIASA. In the 1970s and 1980s the International Institute for Applied Systems Analysis (IIASA) hosted several research projects, workshops and conferences in order to discuss the implications of rising carbon dioxide concentrations in the Earth's atmosphere. A number of distinguished scholars, some of whom later became prominent protagonists within the United Nations' Intergovernmental Panel on Climate Change (IPCC) and sustainability communities more generally, participated in these debates. Since those at IIASA did not engage in obviously related fields such as geophysics or climatology, there is a need to explain how, and via which contexts the issue entered the institute's agenda. This article examines this historical context and contrasts two competing paradigms that emerged at IIASA in order to assess and respond to the carbon dioxide question: The first approach was related to the organisation's research projects on the future of energy systems, which drew on physics, engineering, economics and applied system dynamical modeling; the second approach drew earlier research into ecological management and complex dynamical systems theory, and argued for the use of multiple methods to assess the carbon dioxide question. The first approach invoked ideas of techno-economical control mechanisms, the second resulted in a more embedded framing of climate change as one of a larger complex of issues relating to sustainable development. Based on resources from IIASA's research repositories and institutional archive, this study retraces these competing discourse framings and outlines the specific research and modeling strategies, policies, and cultural and technological imaginaries related to them.

Assisting Hand Assessment and Children's Hand-Use Experience Questionnaire -Observed Versus Perceived Bimanual Performance in Children with Unilateral Cerebral Palsy

AIMS

To explore the differences, relationship, and extent of agreement between the Assisting Hand Assessment (AHA), measuring observed ability to perform bimanual tasks, and the Children's Hand-Use Experience Questionnaire (CHEQ), assessing experienced bimanual performance.

METHODS

This study investigates a convenience sample of 34 children (16 girls) with unilateral cerebral palsy aged 6-18 years (mean 12.1, SD 3.9) in a cross-sectional design.

RESULTS

The AHA and CHEQ subscales share 8-25% of their variance (R²). Bland-Altman plots for AHA and all three CHEQ subscales indicate good average agreement, with a mean difference approaching zero but large 95% confidence intervals. Limits of agreement were extremely wide, indicating considerable disagreement between AHA and CHEQ subscales.

CONCLUSION

AHA and CHEQ seem to measure different though somewhat related constructs of bimanual performance. Results of this investigation reinforce the recommendation to use both instruments to obtain complementary information about bimanual performance including observed and perceived performance of children with unilateral cerebral palsy.

MCQ-construction improves Quality of Essay Assessment among undergraduate dental students

A well-constructed essay is indicative of deep strategic understanding and is considered a valid assessment tool in many dental schools. It has been suggested that constructing MCQs could be an effective learning tool for students while at the same time contribute towards a pool of well-constructed MCQs that could stand up to scrutiny at high-stakes examinations. This study aimed to compare the quality of essays written by students trained and untrained in MCQ construction. The null hypothesis was that construction of MCQs did not result in higher grades achieved in "closed-book" time-limited assessment conditions. A Test cohort (n=48) of undergraduate dental students were taught and constructed MCQs during their preclinical prosthodontics course. The Control cohort (n=48) consisted of students who underwent the same course 1 year prior. The same question was administered to both cohorts without the students׳ knowledge. Answers were de-identified and randomized for grading by a blinded expert prosthodontic examiner not involved in the teaching of the students. Based on a passing grade of 50 and a maximum grade of 100, the Test cohort exhibited significantly improved essay quality, scoring a mean grade of 73.0±8.0, compared to a mean grade of 63.6±11.8 achieved by the control cohort (p<0.001). The null hypothesis was rejected. Under the conditions of this double-blind study, MCQ-construction resulted in better essays written by students under examination conditions.