Barriers and facilitators to the implementation of family cancer history collection tools in oncology clinical practices

INTRODUCTION

This study aimed to identify barriers and facilitators to the implementation of family cancer history (FCH) collection tools in clinical practices and community settings by assessing clinicians' perceptions of implementing a chatbot interface to collect FCH information and provide personalized results to patients and providers.

OBJECTIVES

By identifying design and implementation features that facilitate tool adoption and integration into clinical workflows, this study can inform future FCH tool development and adoption in healthcare settings.

MATERIALS AND METHODS

Quantitative data were collected using survey to evaluate the implementation outcomes of acceptability, adoption, appropriateness, feasibility, and sustainability of the chatbot tool for collecting FCH. Semistructured interviews were conducted to gather qualitative data on respondents' experiences using the tool and recommendations for enhancements.

RESULTS

We completed data collection with 19 providers (n = 9, 47%), clinical staff (n = 5, 26%), administrators (n = 4, 21%), and other staff (n = 1, 5%) affiliated with the NCI Community Oncology Research Program. FCH was systematically collected using a wide range of tools at sites, with information being inserted into the patient's medical record. Participants found the chatbot tool to be highly acceptable, with the tool aligning with existing workflows, and were open to adopting the tool into their practice.

DISCUSSION AND CONCLUSIONS

We further the evidence base about the appropriateness of scripted chatbots to support FCH collection. Although the tool had strong support, the varying clinical workflows across clinic sites necessitate that future FCH tool development accommodates customizable implementation strategies. Implementation support is necessary to overcome technical and logistical barriers to enhance the uptake of FCH tools in clinical practices and community settings.

Assessing Stroke-Related Sarcopenia in Chronic Stroke: Identification of Clinical Assessment Tools-A Pilot Study

Stroke-related sarcopenia has recently been defined as the muscle atrophy consequent to stroke and assessing it following the guidelines with simple clinical tools is crucial in chronic stroke survivors. The aim of this study was to determine the characteristics of patient-friendly instruments sarcopenia in a chronic stroke sample (SG) compared to non-stroke counterparts (CG). Each participant underwent a single assessment which consisted of: SARC-F questionnaire, assessment of muscle strength (hand grip and five-times sit-to-stand test, 5STS), the calf circumference (CC) of both legs, the short physical performance battery (SPPB), and the 10 m walk test. A total of 68 participants were included (SG, n = 34 and CG, n = 34). All variables showed statistical differences (p < 0.05) between the SG and the CG, except handgrip although it showed lower values for SG. The values of the 5STS (16.26 s) and the SPPB (7 points) were below to the cutoff values for the SG. The five-times sit-to-stand test, SPPB, and gait speed can lead clinicians to detect stroke-related sarcopenia. Maximum handgrip shows a trend of low values for men and women in the SG, however, CC did not detect sarcopenia in our sample.

Comprehensive and Innovative Clinical Tools for Nurses and Parents to Help Promote Family and Sibling Adaptation in the NICU

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.

Detecting Time Concept Competence in Children with Autism Spectrum and Attention Disorders

The importance of time concept in human existence is "ancient history" celebrated in the biblical book Ecclesiastes. Indeed, our time-sensitive mechanisms are literally carved into our biology and neurology on a molecular level, gifting us with neural clocks. However, time in human consciousness is not the time indicated by physical clocks: time is a subjective reality in our psychological makeup due to the nature of the temporal neural mechanisms and unique properties of physical time. Nonetheless, subjective time requires anchoring to physical time which permeates our language, endeavors, and entire existence, a process hinging on time-related skills such as estimates and measures of passage and duration of time. Moreover, accurate time reading, a critical adaptive life-skill, is imperative for effective function in all societal activities. Because it embodies the complexity of the time construct, it is central to instruction of time concept in primary education. It is often measured in children by clock drawings, a cognitive integrative skill with errors pointing to neuroanatomical differences impacting the integrity of executive function. Time competence in children with atypical neurobiological development and high prevalence, as in autism spectrum disorders (ASD), and attention disorders (ADHD), is often compromised, calling for investigation of its function. This thematic review article aims to: 1) discuss the complexity of time concept and its underlying bio-neurological mechanisms, 2) elucidate difficulties children with ASD and those with ADHD exhibit in temporal development, and 3) demonstrate the use of a set of clinical tools in uncovering temporal competence and ecological executive function in two children with ASD, and a child with ADHD, using a clock drawing task and error analyses; children's time knowledge questionnaire; a behavior rating parent questionnaire examining ecological executive function, and parent open-ended questions related to their children's time difficulties. A discussion, directions, and a take-home message round out the article.

Development and Validation of a Risk Score for Liver Cirrhosis Prediction in Untreated and Treated Chronic Hepatitis B

BACKGROUND

Chronic hepatitis B (CHB) can progress to cirrhosis, but there are limited noninvasive tools available to estimate cirrhosis risk, including in patients receiving antiviral therapy. This study developed and validated a simple model to assess risk in CHB patients.

METHODS

The derivation cohort included 3000 CHB patients from 6 centers in the United States, with 52.60% receiving antiviral therapy. External validation was performed for 4552 CHB individuals from similar cohorts in Taiwan, with 21.27% receiving therapy. Cox proportional hazards regression analyses were used to screen predictors and develop the risk score for cirrhosis. Areas under receiver operating characteristic curves (AUROCs) were calculated for predictive value.

RESULTS

Sex, age, diabetes, antiviral treatment status/duration, hepatitis B e-antigen, and baseline alanine aminotransferase/aspartate aminotransferase levels were significantly associated with increased cirrhosis risk. A 13-point risk score was developed based on these predictors. The AUROCs for predicting cirrhosis risk were 0.82 at 3 years, 0.85 at 5 years, and 0.89 at 10 years in the derivation cohort, and 0.82, 0.79, and 0.77 in the validation cohort, respectively.

CONCLUSIONS

We developed and validated a simple cirrhosis prediction model with an independent external cohort that can be applied to both treatment-naive and treatment-experienced CHB patients in diverse settings and locations.

Management of Children With Fever at Risk for Pediatric Sepsis: A Prospective Study in Pediatric Emergency Care

Objective: To study warning signs of serious infections in febrile children presenting to PED, ascertain their risk of having sepsis, and evaluate their management. Design: Prospective observational study. Setting: A single pediatric emergency department (PED). Participants: Febrile children, aged 1 month-16 years, with >= 1 warning signs of sepsis. Interventions and Main outcome measures: Clinical characteristics, including different thresholds for tachycardia and tachypnoea, and their association with (1) delivery of pediatric sepsis 6 (PS6) interventions, (2) final diagnosis of invasive bacterial infection (IBI), (3) the risk for pediatric intensive care unit (PICU) admission, and (4) death. Results: Forty-one percent of 5,156 febrile children had warning signs of sepsis. 1,606 (34%) children had tachypnoea and 1,907 (39%) children had tachycardia when using APLS threshold values. Using the NICE sepsis guidelines thresholds resulted in 1,512 (32%) children having tachypnoea (kappa 0.56) and 2,769 (57%) children having tachycardia (kappa 0.66). Of 1,628 PED visits spanning 1,551 disease episodes, six children (0.4%) had IBI, with one death (0.06%), corresponding with 256 children requiring escalation of care according to sepsis guideline recommendations for each child with IBI. There were five additional PICU admissions (0.4%). 121 (7%) had intravenous antibiotics in PED; 39 children (2%) had an intravenous fluid bolus, inotrope drugs were started in one child. 440 children (27%) were reviewed by a senior clinician. In 4/11 children with IBI or PICU admission or death, PS6 interventions were delivered within 60 min after arriving. 1,062 (65%) visits had no PS6 interventions. Diagnostic performance of vital signs or sepsis criteria for predicting serious illness yielded a large proportion of false positives. Lactataemia was not associated with giving iv fluid boluses (p = 0.19) or presence of serious bacterial infections (p = 0.128). Conclusion: Many febrile children (41%) present with warning signs for sepsis, with only few of them undergoing investigations or treatment for true sepsis. Children with positive isolates in blood or CSF culture presented in a heterogeneous manner, with varying levels of urgency and severity of illness. Delivery of sepsis care can be improved in only a minority of children with IBI or admitted to PICU.

Acceptability of a Mobile Clinical Decision Tool Among Emergency Department Clinicians: Development and Evaluation of The Ottawa Rules App

Background

The Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule—together known as The Ottawa Rules—are a set of internationally validated clinical decision rules developed to decrease unnecessary diagnostic imaging in the emergency department. In this study, we sought to develop and evaluate the use of a mobile app version of The Ottawa Rules.

Objective

The primary objective of this study was to determine acceptability of The Ottawa Rules app among emergency department clinicians. The secondary objective was to evaluate the effect of publicity efforts on uptake of The Ottawa Rules app.

Methods

The Ottawa Rules app was developed and publicly released for free on iOS and Android operating systems in April 2016. Local and national news and academic media coverage coincided with app release. This study was conducted at a large tertiary trauma care center in Ottawa, Canada. The study was advertised through posters and electronically by email. Emergency department clinicians were approached in person to enroll via in-app consent for a 1-month study during which time they were encouraged to use the app when evaluating patients with suspected knee, foot, or neck injuries. A 23-question survey was administered at the end of the study period via email to determine self-reported frequency, perceived ease of use of the app, and participant Technology Readiness Index scores.

Results

A total of 108 emergency department clinicians completed the study including 42 nurses, 33 residents, 20 attending physicians, and 13 medical students completing emergency department rotations. The median Technology Readiness Index for this group was 3.56, indicating a moderate degree of openness for technological adoption. The majority of survey respondents indicated favorable receptivity to the app including finding it helpful to applying the rules (73/108, 67.6%), that they would recommend the app to colleagues (81/108, 75.0%), and that they would continue using the app (73/108, 67.6%). Feedback from study participants highlighted a desire for access to more clinical decision rules and a higher degree of interactivity of the app. Between April 21, 2016, and June 1, 2017, The Ottawa Rules app was downloaded approximately 4000 times across 89 countries.

Conclusions

We have found The Ottawa Rules app to be an effective means to disseminate the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule among all levels of emergency department clinicians. We have been successful in monitoring uptake and access of the rules in the app as a result of our publicity efforts. Mobile technology can be leveraged to improve the accessibility of clinical decision tools to health professionals.

The Spanish Adaptation of the Palliative Performance Scale (Version 2) Among Cancer Patients at the End of Life: Psychometric Properties

BACKGROUND

Palliative Performance Scale (PPS) is a reliable tool to assess performance status in cancer patients receiving palliative care (PC). Spanish validated and culturally adapted tools are needed.

OBJECTIVES

The objectives are to develop PPS translation and cross-cultural adaptation into Spanish and to assess its psychometric properties.

DESIGN

Translation process with cross-cultural adaptation to produce Spanish Palliative Performance Scale (PPS-SPANISH).

SETTINGS

PC Team at one University hospital in Spain.

PARTICIPANTS

Fifteen advanced cancer patients (60 assessments) were included for PPS translation and validation and 250 patients for cross-sectional analysis. All participants were recruited at oncology ward, emergency area, and outpatient clinic by PC team professionals. Informed consent was given. Average age was 66.4 ± 13 years (60% men).

METHODS

The process is designed in three steps. In Step 1, PPS translation and reverse translation into Spanish (three bilingual speakers) and linguistic complexity measurement were performed. In Step 2, readability and intelligibility assessment was carried out. In Step 3, a pilot study was conducted to assess test-retest reliability followed by a cross-sectional study to measure internal consistency. Inclusion criteria were the same for two samples. Demographic data were also analyzed by descriptive statistics.

RESULTS

Following cultural, linguistic, and grammatical adaptation, PPS-SPANISH was readable and reliable. The analysis of the test-retest reliability after 48 hours showed intraclass correlations >0.60. Cronbach's alpha coefficient was 0.99 (0.988-0.992). There was high agreement with other functional assessment tools (Barthel Index and Karnofsky Performance Status Index).

CONCLUSIONS

PPS-SPANISH showed reliability and validity, and it is suitable to assess performance status in cancer patients receiving PC.

Clinical tools designed to assess motor abilities in children with cerebral palsy

OBJECTIVE

This systematic review aimed to list the tools used by rehabilitation professionals to test motor abilities in children with cerebral palsy (CP), to determine if these tools have psychometric properties specifically measured for CP, and to identify the main characteristics of these tools.

METHOD

Web of Science, PEDro, PubMed/MEDLINE, Science Direct, and SciELO databases were searched to identify the tools. PubMed/MEDLINE was then searched to identify the studies assessing those tools' psychometric properties. The agreement-based standards for the selection of health measurement tools and the Terwee criteria were used to assess the quality and the results of each included study, respectively.

RESULTS

Eighteen tools were identified. The psychometric properties of many of the tools used with children with CP have not been evaluated for this population.

CONCLUSION

The psychometric properties evaluated often have a poor methodological quality of measurement. Overall, we suggest the tools with most empirical support to evaluate children with CP.

Analyses of Landing Mechanics in Division I Athletes Using the Landing Error Scoring System

BACKGROUND

Injury to the anterior cruciate ligament (ACL) can be detrimental to any athlete, having both short- and long-term health consequences. Examining preseason screening landing mechanics can indicate the likelihood of injury during the season. Furthermore, previous injury is also commonly referred as a predisposing factor for reinjury.

HYPOTHESIS

Players with a history of lower extremity injury would have higher Landing Error Scoring System (LESS) scores than those with no previous injury, and healthy soccer athletes who sustained an injury during the 2014 season would have higher LESS scores than those who remained uninjured.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Thirty-four Division I male and female soccer athletes (19 men, 15 women; mean age, 19.6 ± 1.2 years; mean height, 172.4 ± 8.7 cm; mean weight, 70.8 ± 9.1 kg). An a priori sample size estimation for a power of 0.80 (80%) and an alpha error of 0.05 with an estimated effect size of 0.6 for a sample of 30 participants was attained. Participants performed a drop-landing task and were scored on their landing mechanics using the LESS. Lower extremity injuries were tracked during the season. LESS scores between those with and without a history of injury and those who were injured and uninjured during the season were compared using 2 separate 1-way analyses of variance.

RESULTS

No statistically significant differences (F(1,33) = 0.47, P = 0.50) existed between LESS scores in athletes who had a previous injury history compared with those with no injury history. No statistically significant differences (F(1,20) = 0.05, P = 0.83) existed between LESS scores in healthy athletes who were injured during the 2014 season compared with those healthy athletes who were uninjured.

CONCLUSION

No differences were present between athletes with and without a history of lower extremity injury. The majority of healthy participants who were injured during the season had similar LESS scores to those who remained uninjured, suggesting that the LESS may not be able to identify atypical landing mechanics in this group of athletes.

Method to classify elderly subjects as fallers and non-fallers based on gait energy image

Falls are one of the leading causes of injuries among the elderly. Therefore, distinguishing fallers and performing preventive actions is vitally important. A new variation of the gait energy image (GEI) called coloured gait energy image (CGEI) is proposed for classifying subjects as fallers and non-fallers and for visualising their gait patterns. Eight elderly fallers, eight elderly non-fallers and eight young subjects performed timed up and go (TUG) test, which is one of the well-known clinical tools for fall risk assessment and contains two gait sequences. Subjects were also asked to perform two other variations of the TUG test, namely TUG with manual load and TUG with cognitive load. Gait sequences were extracted from the TUG test based on the opinion of three human observers. Then the gait cycles were automatically extracted from the walking sequence and divided into three phases, corresponding to double support and first and second half of single support. Next, the GEI of each phase was generated and formed one of the colour components of CGEI. Histogram-based features obtained from CGEI were then used to classify the video collected from walking sequences of elderly fallers and non-fallers. Correct classification rate was improved by approximately 27% compared with the standard TUG test.