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PubMed2006

Self-control and tool use in tufted capuchin monkeys (Cebus apella).

Self-control is defined as forgoing immediate gratification to obtain a greater reward. Tool use may relate to self-control because both behaviors may require foresight and deliberate control over one's actions. The authors assessed 20 capuchin monkeys (Cebus apella) for the ability to delay gratification in a tool task. Subjects were given rod-shaped food items that could either be consumed immediately or be carried to an apparatus and used to extract a more preferred food. The authors found that some monkeys were able to exhibit self-control. Monkeys with relatively more tool use experience demonstrated the greatest levels of self-control. These results indicate that capuchins are capable of delaying gratification when a higher quality reinforcer is present and that tool experience can influence levels of self-control in this task.

Age Factors↗

PubMed1996

Initial experience of the ORATEL computerised information tools in general practice.

ORATEL (a telematic system for quality assurance indicators in oral health care) is a three-year project with the ultimate objective of improving the quality of oral health care through the use of appropriate computerised information systems. These tools are designed to promote quality assurance and quality of care development in oral health care by using common quality indicators/standards. ORATEL has developed three prototypes of computerised information systems: an interactive multimedia teach software on quality assurance in oral health care, ORATEL-TEACH; a proactive quality assurance support tool for real time use at the dental unit, ORATEL-PROACT; and an integrated set of modules for monitoring and self assessment at the clinical level and for the computerised reporting of aggregated data for evaluation at higher levels, ORATEL-REVAL. The initial experiences of using these tools was assessed during 1993 in general dental practice locations in Liverpool and clinics in for other European countries. Overall, the dentists were positive about the potential usefulness of the ORATEL tools but further improvements were considered necessary. Finding has been approved by the European Commission for further development under a new project called ORQUEST.

Computer Communication Networks↗

PubMed1998

Reliability of a tool for assessing mobility in wheelchair-dependent paraplegics.

The aim of this study was to design and test the reliability of an assessment tool that could be used by physiotherapists to quantify the mobility of wheelchair-dependent paraplegics. The assessment tool examined six key tasks fundamental to the mobility of wheelchair-dependent paraplegics, comprising moving from lying to sitting, completing a horizontal transfer, completing a vertical transfer, pushing on flat ground, pushing on ramps and negotiating kerbs. A six-point scoring system was used to assess the level of mobility attained by subjects on each task. The scoring system was different for each task and took into account the level of assistance and time required to complete the task or the complexity of the task. Twenty wheelchair-dependent paraplegics were assessed independently by two therapists using the assessment tool. The Cohen's Weighted Kappas describing inter-rater reliability of each task ranged between 0.82-0.96, indicating a high reliability between therapists. It was concluded that the assessment tool is a reliable way of assessing the mobility of wheelchair-dependent paraplegics.

Diagnostic Tests, Routine↗

PubMed1997

The Buckinghamshire nursing record audit tool: a unique approach to documentation.

A project to examine the quality of manual nursing documentation using an action research approach, prior to the introduction of a computerized system is described. The findings showed that there was a general lack of understanding about care planning. There was therefore a need to find an audit tool which could identify and develop nurses' knowledge of documentation as well as identifying the strengths and weaknesses of existing documentation. A literature review revealed Phaneuf's audit tool, but this proved difficult to use. Two nurse teachers agreed to develop their own documentation audit tool, based on the UKCC document on record keeping, which identifies criteria for effective documentation. A tool was developed which adopts a facilitative educational approach enabling the practitioner to audit and learn simultaneously. Much interest is being shown by other areas, and the questions are worded so that it could be used in a variety of settings.

Education, Nursing, Continuing↗

PubMed2002

The digital portfolio: a tool for human resource management in health care?

This article discusses the current situation of human resource management (HRM) in Finnish health care and charts the views of nurse directors (ward sisters and clinical nurse managers, n = 47) on the digital portfolio as a tool of HRM. The study is part of an evaluation research project; this article reports on the findings from nurse directors' perspective. The data were collected from three organizations in eastern Finland: a University Hospital, a Central Hospital and a Social and Health Centre. The nurse directors indicated a need for information on their staff's skills and competencies, but the area on which they had most information was on staff's formal education. They did not have access to systematic tools and methods for monitoring the continuous education of staff members. The digital portfolio can be used as a tool for HRM in health care, although the nurse directors did not realize it could provide a tool for sharing expertise through the units or wards.

Adult↗

PubMed2004

Introduction of a pain and symptom assessment tool in the clinical setting--lessons learned.

It has long been acknowledged that pain is a subjective, multifaceted phenomenon which is influenced by many factors such as past experience and culture. However there are other symptoms that can be distressing such as dyspnea and nausea. In Ottawa, Canada there was recognition that inconsistencies existed in pain and symptom assessment methods and documentation in the different institutions and agencies when patients with cancer moved from one setting to another as their illness progressed. Therefore, a working group with clinical representatives was formed with a mandate to develop a standardized tool so that there would be a common language for pain and symptom assessment. Although various tools have been developed for pain assessment such as visual analogue or numeric rating scales, there has been limited attention focused on the sustainability of these tools in the practice setting. This paper will focus on the importance of the use of tools for pain and symptom management, issues around implementing them, and sustaining their use in the clinical setting. The Ottawa Pain and Symptom Assessment Record will be used as an exemplar.

Bias↗

PubMed2002

The use of discharge risk assessment tools in general psychiatric services in the UK.

Closure of asylums dismantled a system of risk control based on containment, resulting in a rise in homicides and suicides by discharged patients. Remedial action centred on a structured approach to managing multidisciplinary care (the Care Programme Approach) and a system of independent inquiries into homicides. A need for better discharge risk assessment was identified by government and health professions. The literature points to inherent limitations in the predictive power of actuarially based tools, restricting them to augmenting clinical judgement. This paper addresses the development and effective use of tools to predict risk to patients and public following discharge into the community. Methods used were: (i) a questionnaire to NHS Trusts in the UK; (ii) an analysis of documentation on tools in use; and (iii) interviews of hospital and community mental health teams at eight NHS Trusts. Findings point to: (i) a sporadic development of risk assessment tools at Trust level; (ii) that this has been stimulated by clinical governance but is unguided by any coherent national strategy; and (iii) that information technology for risk data collection is not well used in the UK, where there is reliance on use of paper records and informal communication. The implications for management and health professions are discussed.

Community Mental Health Services↗

PubMed2003

Hospital fall risk assessment tools: a critique of the literature.

There are numerous fall risk assessment tools developed for use by nurses in hospitals; however, few of them have established validity and reliability. This article will examine the current state of knowledge in regard to fall risk assessment tools through review and critique of the literature on the topic. Recommendations for future research on fall risk assessment tools will be made and a conceptual framework detailing the relationship between the variables involved in assessing the accuracy of fall risk assessment tools will be presented.

Accidental Falls↗

PubMed2001

The development of a disease-specific quality of life measurement tool for osteoarthritis of the shoulder: The Western Ontario Osteoarthritis of the Shoulder (WOOS) index.

OBJECTIVE: The purpose of this study was to develop and validate a disease-specific quality of life measurement tool for osteoarthritis (OA) of the shoulder. METHODS: An instrument which could be used as the primary outcome measure in clinical trials involving patients with OA of the shoulder was developed using a specific methodological protocol: (1) identification of a specific patient population; (2) item generation; (3) item reduction; (4) pre-testing of the prototype questionnaire and (5) determining the validity, reliability and responsiveness of the final questionnaire. RESULTS: The final instrument contains 19 items, each with a visual analog response option for the four domains (six questions for pain and physical symptoms, five questions for sport, recreation and work, five questions for lifestyle function and three questions for emotional function). Ten of the 19 questions had not been identified previously on other shoulder measurement tools. The instrument proved to be valid by demonstrating predicted correlations with previously published shoulder measures, global health status measure and range of motion. The new instrument was also more responsive than other shoulder measurement tools, a global health status measure and range of motion. CONCLUSIONS: Since the patient's own perception of changes in health status is the most important indicator of the success of treatment we suggest that this measurement tool be used as the primary outcome in clinical evaluation of various treatments for OA of the shoulder and monitoring patients over time.

Adult↗

PubMed2001

Nursing in Colorectal Cancer Initiative--the audit phase. Part 1. Development of the audit tool.

This paper describes the structure of an audit study together with the two-phase development of an audit tool and methodology. The purpose of the study was to develop a tool that defines and measures best practice in colorectal cancer nursing, and identifies areas for development. The European Oncology Nursing Society (EONS) and AstraZeneca collaborated to develop the Nursing in Colorectal Cancer Initiative (NICCI). The initiative was funded through educational grants from AstraZeneca and led by EONS. It is a project with two components, education and audit. The purpose of the project is to provide a sound educational basis for nurses in the elements of colorectal cancer care, together with the tools to evaluate and develop practice. The education phase culminated in an educational manual that provides a core set of materials concerning the fundamental aspects of colorectal cancer, to foster a common understanding amongst nurses nationally and internationally. The education manual provided the referenced rationale for the definition of a set of hallmarks and standards of clinical practice. The audit tool was developed from the hallmarks and standards and is focused on the care of patients receiving cytotoxic chemotherapy for colorectal cancer. The audit methodology is based on the structure, process outcome triad, together with the TELER system of audit.

Journal Article↗

PubMed2000

Developing an audit tool for health promotion learning opportunities in clinical placements.

Education audit has proved to be an effective way of reviewing current activities and learning opportunities available to health-care students during clinical placements. Despite the importance attributed to education audit in highlighting good practice, identifying where there is a need for change as well as providing information for future planning, there is no evidence in the literature to support its specific application to health-promotion learning opportunities. This paper describes a two-part study in which an education audit tool for use in evaluating health-promotion learning opportunities for students in clinical placements was successfully developed. This tool can be utilized by multiple stakeholders in a variety of clinical settings. Following a discussion of the background literature, the methodology (which involved the development of a series of dynamic relationships between researchers, commissioners and participants) is described. The aim of this article is to discuss the lessons learned from the process of developing the tool, including the problems that were encountered and how they were addressed. The authors conclude that their experiences in developing this tool can be usefully transferred to other educational and clinical settings.

Attitude of Health Personnel↗

PubMed2003

Modular organization of internal models of tools in the human cerebellum.

Human capabilities in manipulating many different tools with dexterity suggest modular neural organization at functional levels, but anatomical modularity underlying the capabilities has yet to be demonstrated. Although modularity in phylogenetically older parts of the cerebellum is well known, comparable modularity in the lateral cerebellum for cognitive functions remains unknown. We investigated these issues by functional MRI (fMRI) based on our previous findings of a cerebellar internal model of a tool. After subjects intensively learned to manipulate two novel tools (the rotated mouse whose cursor appeared at a rotated position, and the velocity mouse whose cursor velocity was proportional to the mouse position), they could easily switch between the two. The lateral and posterior cerebellar activities for the two different tools were spatially segregated, and their overlaps were <10%, even at low statistical thresholds. Activities of the rotated mouse were more anterior and lateral than the velocity mouse activities. These results were consistent with predictions by the MOdular Selection And Identification Controller (MOSAIC) model that multiple internal models compete to partition sensory-motor experiences and their outputs are linearly combined for a particular context.

Adult↗

PubMed1991

The effects of method of use, tool design, and roof height on trunk muscle activities during underground scaling bar use.

Epidemiologic studies have shown that the scaling bar, a hand tool used in underground mining, is frequently associated with the risk of back injury. An experiment was performed to investigate the effects of method of tool use, mine roof height, and tool design upon the activity of six trunk muscles and the ability to exert force with the bar. Roof height and scaling bar design had the largest effects on levels of muscle activation. Striking force did not differ significantly between tool designs. A biomechanical model was used to evaluate the collective effects of the trunk musculature activities upon spine loading. It was found that a significant reduction in predicted spine compression and shear forces can be achieved through the use of a counterbalanced scaling bar. The implications of these results are discussed.

Back Pain↗

PubMed2005

Using a 360 degrees diagnostic screening tool to provide an evidence trail of junior doctor performance throughout their first postgraduate year.

New medical graduates in the UK are known as Preregistration House Officers (PRHOs). At the end of this first postgraduate year, the Postgraduate Dean is responsible for allowing the PRHO to be fully registered with the General Medical Council. During the period 1999-2002 Professor Miriam Friedman Ben-David designed a more robust approach to appraisal and assessment of PRHOs, which provided educational feedback to all trainees, allowed any poor performers to be detected at an early stage, and provided 'hard' observable evidence for certification decisions. This paper describes the more recent development of her work resulting from further piloting of her system. The key tool, a 360 degrees diagnostic questionnaire, is designed to identify strengths and weaknesses in individual performance. It is presently being used as a screening tool to identify any trainees needing additional support and further assessment. The tool also forms part of an evidence trail for all PRHOs and helps inform formative assessment as well as contributing, along with other evidence, to full registration decisions. The evaluation of this tool, also described in this paper, shows the feasibility of implementing such a system on a wider scale and illustrates the successful balance made between robustness and feasibility.

Attitude of Health Personnel↗

PubMedDate not supplied

A flexible optimization tool for hyperthermia treatments with RF phased array systems.

In hyperthermia treatments performed with a radio-frequency phased array, the main issue to apply the excitation amplitudes and phases of the applicators for which tumour heating is optimal, i.e. the maximal therapeutic gain without unwanted side effects. Due to the complex interaction of the radiated EM-field and the patient's tissues, it is very difficult to find these optimal excitation (amplitude and phase) parameters by intuition. Calculation of the EM-field distribution within the patient can aid in finding the optimal excitation setting. However, this remains a difficult task because of the degrees of freedom available (2n - 1, with n the number of applicators in the array) and because a large temperature elevation may occur at healthy tissue sites resulting in unwanted side effects, e.g. pain or healthy tissue damage. Therefore, determining the excitation amplitudes and phases yielding optimal tumour heating can be done effectively only by application of a computerized optimization procedure. Optimization of the temperature distribution in the patient requires detailed knowledge of the thermal tissue parameters. Techniques for determining these properties are not commonly available and the use of averaged values for parameters like the tissue perfusion is expected to introduce large errors for individual patient treatment planning. As a consequence, the SAR distribution, being proportional to the temperature increase at treatment start, is more often selected for optimization. The 'optimized' excitation amplitudes and phases are found by maximization of a certain SAR ratio. Several propositions for this SAR ratio have been reported in the literature, e.g. the ratio of the SAR at the tumour site and the SAR at sites where unwanted side effects may occur. However, the definition of these ratios does not constrain the SAR value at these tissue locations to a safe value. In this paper, a tool for the optimization of the SAR distribution including the specification of constraints is presented. The tool focuses on the definition of the average SAR as a function of the excitation amplitudes and phases in a volume of arbitrary size (e.g. the tumour volume or the whole patient volume). These functions can be applied in either customized or commercially available optimization routines and they enable the definition of constraints for the average SAR in a certain volume. The described tool is illustrated for a patient case, showing the flexibility and easy application of the tool.

Hyperthermia, Induced↗

PubMed1993

Confidence intervals and controlled clinical trials: incompatible tools for medical research.

The probabilistic rationale for statistical design and analysis of clinical trials is random assignment. While arithmetic and mathematical formulations may be identical to those used with random samples, we should not indiscriminately borrow tools from survey sample methods. Specifically, the confidence interval should be used sparingly, if at all. Observations have an internal validity, within the clinical trial, with no basis for claims of quantitative external generalizability. Confidence intervals encourage an unnecessary dependence on statistical analysis when the careful design should allow the data to speak for itself. Confidence intervals encourage a statistical focus and statistical conclusions that ignore scientific context and misrepresent relationships among results from related research. The clinician is presented with information about population parameters when facing confidence intervals. These do not address questions about treatment and prognosis of an individual patient. Confidence intervals are particularly distracting when a clinical trial has failed to produce anticipated results. The clinical trial is the model research tool for clinical medical research, founded on randomization. The confidence interval is a statistical tool for parameter estimation based on population sampling concepts. These tools are incompatible.

Clinical Trials as Topic↗

PubMed2002

Integration of ergonomics into hand tool design: principle and presentation of an example.

The development of ergonomic tools responds to health protection needs on the part of workers, especially the work related musculoskeletal disorders of the upper limbs and to the development of ergonomic tools to take into account the needs of the factories. Only an ergonomic design process can enable tool manufacturers to meet these requirements. Three factors are involved: integration of ergonomics into the design process, definition of the different ergonomic stages involved, and finally knowledge of the different factors involved in hand tool design. This document examines these 3 elements in more detail and presents briefly a project of research whose main purpose is to integrate ergonomic criteria into a design process.

Cumulative Trauma Disorders↗

PubMed2004

Design and ergonomics. Methods for integrating ergonomics at hand tool design stage.

As a marked increase in the number of musculoskeletal disorders was noted in many industrialized countries and more specifically in companies that require the use of hand tools, the French National Research and Safety Institute (INRS) launched in 1999 a research project on the topic of integrating ergonomics into hand tool design, and more particularly to a design of a boning knife. After a brief recall of the difficulties of integrating ergonomics at the design stage, the present paper shows how 3 design methodological tools--Functional Analysis, Quality Function Deployment and TRIZ--have been applied to the design of a boning knife. Implementation of these tools enabled us to demonstrate the extent to which they are capable of responding to the difficulties of integrating ergonomics into product design.

Computer-Aided Design↗