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PubMed1997

An audit tool for assessing the learning environment for Project 2000.

In preparation for the introduction of Project 2000 throughout Scotland, a need was identified to monitor the quality of the learning environment for student nurses in the practice setting. No mechanism existed to measure quality and standards, and a group was formed to devise, pilot and implement an educational audit tool which could address these requirements, since limited information was available in the literature. Using this tool, the group subsequently examined the learning opportunities available, concentrating on the physical environment, the learning climate/environment, and the students' perceptions of the learning environment within the practice setting, across hospital and community sectors, including residential accommodation and nurseries, in the wide geographical area covered by the health board. This paper describes the process by which the tool was formulated, tested and implemented, the problems encountered, and the improvements in communications between teaching and clinical staff, leading to improved opportunities for the provision of excellence in patient care.

Education, Nursing, Baccalaureate↗

PubMed2001

Methodologies and tools for proton beam design for lung tumors.

PURPOSE: Proton beams can potentially increase the dose delivered to lung tumors without increasing the dose to critical normal tissues because protons can be stopped before encountering the normal tissues. This potential can only be realized if tissue motion and planning uncertainties are correctly included during planning. This study evaluated several planning strategies to determine which method best provides adequate tumor coverage, minimal normal tissue irradiation, and simplicity of use. METHODS AND MATERIALS: Proton beam treatment plans were generated using one or more of three different planning strategies. These strategies included designing apertures and boluses to the PTV, apertures to the PTV and boluses to the CTV, and aperture and bolus to the CTV. RESULTS: The planning target volume as specified in ICRU Report 50 can be used only to design the lateral margins of beams, because the distal and proximal margins resulting from CT number uncertainty, beam range uncertainty, tissue motions, and setup uncertainties, are different than the lateral margins resulting from these same factors. The best strategy for target coverage with the planning tools available overirradiated some normal tissues unnecessarily. The available tools also made the planning of lung tumors difficult. CONCLUSIONS: This study demonstrated that inclusion of target motion and setup uncertainties into a plan should be performed in the beam design step instead of creating new targets. New computerized treatment planning system tools suggested by this study will ease planning, facilitate abandonment of the PTV concept, improve conformance of the dose distribution to the target, and improve conformal avoidance of critical normal tissues.

Algorithms↗

PubMed2006

[Assessing program sustainability in public health organizations: a tool-kit application in Haiti].

BACKGROUND: Public health stakeholders are concerned about program sustainability. However, they usually conceive sustainability in accordance with financial criteria for at least one reason. No simple frameworks are operationally and theoretically sound enough to globally evaluate program sustainability. The present paper aims to describe an application of one framework assessment tool used to evaluate the sustainability level and process of a Nutritional Care Unit managed by a Swiss humanitarian agency to fight against severe child malnutrition in a Haitian area. The managing agency is committed to put this Unit back into the structure of a local public hospital. METHODS: The evaluation was performed within the sustainability framework proposed in a former article. Data were collected with a combination of tools, semi-structured interviews (n=33, medical and support staff from the agency and the hospital), participatory observation and document review. Data concerned the four characteristics of organizational routines (memory, adaptation, values and rules) enabling assess to the level of sustainability. In addition, data were related to three types of events distinguishing routinization processes from implementation processes: specific events of routinization, routinization-implementation joint events, and specific events of implementation. Data analysis was thematic and results were validated by actors through a feed-back session and written comments. RESULTS: The current level of sustainability of the Nutritional Care Unit within the Hospital is weak: weak memory, high adaptation, weak sharing of values and rules. This may be explained by the sustainability process, and the absence of specific routinization events. The relevance of such processes is reasonable, while it has been strongly challenged in the troublesome Haitian context. Riots have been widespread over the last years, creating difficulties for the Hospital. CONCLUSION: This experience suggests the proposed framework and sustainability assessment tools are useful when the context permits scrutinization of program sustainability.

Child↗

PubMed2003

Validation of a tool to assess health practitioners' decision support and communication skills.

As patients become more involved in decisions affecting their health, it is important to monitor and improve the support clinicians provide to facilitate shared decision making. The Decision Support Analysis Tool (DSAT) was developed as a research tool to evaluate practitioners' use of decision support and related communication skills during a clinical encounter. The DSAT, consisting of six categories of decision support skills and four categories of communication skills, was tested with 34 actual transcripts of patient-physician dialogue. The patients were prepared for the clinical encounter with either a detailed decision aid plus worksheet (n=16) or a pamphlet (n=18). Pairs of raters, blinded to the intervention allocation, coded each transcript independently. The overall inter-rater agreement and kappa coefficients were, respectively 75% and 0.59 for the decision support skills and 76% and 0.68 for the communication skills categories. The frequency of DSAT skills coded: (a) were significantly correlated with three out of six patient and physician outcome measures (r>0.30, P<0.05); and (b) showed significant discrimination (P=0.05) or trends (P<0.15) in discrimination between the decision aid and pamphlet groups. The DSAT shows promise as a reliable and valid evaluation tool but requires further testing with larger samples.

Communication↗

PubMed2004

A participatory process for developing quality assurance tools for health education programs.

There is a constant need to find methods and tools for achieving high quality in health education and health promotion programs. The aim of this initiative was to develop standards and criteria for quality assessment of health education programs. Health educators participated in a process to develop these standards and criteria. A consensus was reached regarding the list of standards by participation of the health educators in two workshops. This list consisted of the three main stages of health education programs: planning, implementation and evaluation. Operational criteria for each standard were developed in order to be able to measure the standards. Four different subjects were chosen for the development of the criteria: menopause, smoking cessation, cardiac rehabilitation and prenatal care. A consensus regarding these criteria was reached by discussions in workshops. The tools developed were tested by interviewing health educators who were planning and running these programs. The tools built were found acceptable by the health educators as they provided information on the quality of the programs.

Attitude of Health Personnel↗

PubMed2005

Utility of The Regina Risk Indicator Tool among case managed elderly clients.

The Regina Risk Indicator Tool (RRIT) is used to identify how at risk clients are for requiring admission to long-term care. This study examined the potential use of this tool by case managers of older community dwelling clients receiving home care. The RRIT exhibited moderate to good inter-rater reliability and good predictive validity as clients of varying degrees of risk differed in amount of case management and services used. Healthcare managers may wish to consider using the tool to support decision-making related to case management and home care service.

Aged↗

PubMed1996

A clinical tool for nonorganic failure-to-thrive feeding interactions.

An interdisciplinary team of professionals developed and piloted a clinical tool, the Feeding Checklist, for assisting observations of feeding interactions with nonorganic failure-to-thrive (NOFTT) clients. The piloting process involved two phases. During the development phase, content validity and reliability were established with three NOFTT experts. The tool was compared with a standardized feeding interaction assessment instrument to determine concurrent validity. Both tools revealed similar behavior patterns significantly differentiating between NOFTT and Thriving dyads. The results also concurred with NOFTT literature findings. During the second phase of the study, pediatric nursing staff significantly improved the nursing documentation of NOFTT feeding interactions when using the Feeding Checklist.

Adult↗

PubMed2001

An analysis of the validity of the Hospital Anxiety and Depression scale as a screening tool in patients with advanced metastatic cancer.

Depression is difficult to diagnose in the terminally ill patient. As a result, it frequently is not treated. This has can have an adverse effect on quality of life and make the palliation of physical symptoms more difficult. In an effort to improve the detection of depression, many palliative care teams are using the Hospital Anxiety and Depression (HAD) scale as a screening tool. The HAD was devised for use in general medical settings and has not been validated for use in palliative care patients. One hundred patients receiving palliative care with an estimated prognosis of 6 months or less were invited to complete the HAD and a semi-structured psychiatric interview, the Present State Examination. The depression and anxiety subscales of the HAD showed poor efficacy for screening when used alone. The optimum threshold was at a combined cut-off of 19, which had a sensitivity of 68% and specificity of 67%. The major construct of the HAD is anhedonia, which may be present at the end of life due to increasing physical illness and may not be pathognomic of a depressive illness in this population. We recommend, therefore, that if the HAD is used as a screening tool in palliative care, it should be as a combined scale, but low sensitivity and specificity may lead to poor efficacy as a screening tool.

Adult↗

PubMedDate not supplied

Statistical tools to assess the reliability of self-organizing maps.

Results of neural network learning are always subject to some variability, due to the sensitivity to initial conditions, to convergence to local minima, and, sometimes more dramatically, to sampling variability. This paper presents a set of tools designed to assess the reliability of the results of self-organizing maps (SOM), i.e. to test on a statistical basis the confidence we can have on the result of a specific SOM. The tools concern the quantization error in a SOM, and the neighborhood relations (both at the level of a specific pair of observations and globally on the map). As a by-product, these measures also allow to assess the adequacy of the number of units chosen in a map. The tools may also be used to measure objectively how the SOM are less sensitive to non-linear optimization problems (local minima, convergence, etc.) than other neural network models.

Databases as Topic↗

PubMed1999

Multi-sensor integration for on-line tool wear estimation through radial basis function networks and fuzzy neural network.

On-line tool wear estimation plays a very critical role in industry automation for higher productivity and product quality. In addition, appropriate and timely decision for tool change is significantly required in the machining systems. Thus, this paper is dedicated to develop an estimation system through integration of two promising technologies, artificial neural networks (ANN) and fuzzy logic. An on-line estimation system consisting of five components: (1) data collection; (2) feature extraction; (3) pattern recognition; (4) multi-sensor integration; and (5) tool/work distance compensation for tool flank wear, is proposed herein. For each sensor, a radial basis function (RBF) network is employed to recognize the extracted features. Thereafter, the decisions from multiple sensors are integrated through a proposed fuzzy neural network (FNN) model. Such a model is self-organizing and self-adjusting, and is able to learn from the experience. Physical experiments for the metal cutting process are implemented to evaluate the proposed system. The results show that the proposed system can significantly increase the accuracy of the product profile.

Journal Article↗

PubMed2003

What's so special about human tool use?

Evidence suggests homologies in parietofrontal circuits involved in object prehension among humans and monkeys. Likewise, tool use is known to induce functional reorganization of their visuotactile limb representations. Yet, humans are the only species for whom tool use is a defining and universal characteristic. Why? Comparative studies of chimpanzee tool use indicate that critical differences are likely to be found in mechanisms involved in causal reasoning rather than those implementing sensorimotor transformations. Available evidence implicates higher-level perceptual areas in these processes.

Animals↗

PubMed2001

[Quality of life in children: what is a good evaluation tool?].

The tools most often used to measure subjective data in health, especially quality of life, are based on psychometry. The object of this article is to provide as simply as possible an explanation to the specific methodological aspects of this field. As an example, the child version of the Children Health Questionnaire (CHQ-CF87) is used to study how to demonstrate the qualities required for a good assessment tool: acceptability in practice, responsiveness, reliability and validity. These qualities must be reassessed when a given tool is translated into another language.

Adolescent↗

PubMed2003

Bioinformatics tools for identifying class I-restricted epitopes.

The lack of simple methods to identify relevant T-cell epitopes, the high mutation rate of many pathogens, and restriction of T-cell response to epitopes due to human lymphocyte antigen (HLA) polymorphism have significantly hindered the development of cytotoxic T-lymphocyte (CTL) epitope-based or "epitope-driven" vaccines. Previously, CTL epitopes were mapped using large arrays of overlapping synthetic peptides. The large number of protein sequences available for mapping is now making this method prohibitively expensive and time-consuming. Bioinformatics tools such as EpiMatrix and Conservatrix, which search for unique or multi-HLA-restricted (promiscuous) T-cell epitopes and identify epitopes that are conserved across variant strains of the same pathogen, accelerate epitope mapping. These tools offer a significant advantage over other methods of epitope selection because high-throughput screening can be performed in silico, followed by confirmatory studies in vitro. CTL epitopes discovered using these tools might be used to develop novel vaccines and therapeutics for the prevention and treatment of infectious diseases such as human immunodeficiency virus, hepatitis C, tuberculosis, and some cancers.

Algorithms↗

PubMed2000

Applying workflow analysis tools to assess immunization delivery in outpatient primary care settings.

BACKGROUND: As health care organizations face increasing pressure to institute quality assurance activities, the already-underfunded community clinics that treat the poor and underserved are challenged to perform these activities within tight constraints of human and financial resources. With pediatric immunizations as a marker, a workflow observation tool was used to identify causal processes affecting immunization delivery. METHODS: Ten clinics and five private practices, located in areas designated as health professional shortage areas, participated in the study, gaining access to a tool that would have been unaffordable to them from the private sector. Trained observers followed families through the clinic, using a 127-item workflow observation form--the Observational Checklist of Patient Encounters (OCPE)--assessing discrete activities that families encountered during the checkin/pre-exam, exam, discharge, and billing processes. A convenience sampling of the targeted population--children younger than three years of age--included observations of scheduled acute, scheduled well-child, follow-up, and walk-in visits. In the feedback session, a summary of each clinic's immunization delivery patterns was presented, with an emphasis on the individual health center's operational issues. RESULTS: The workflow observation tool was used to identify operational errors affecting both clinical and fiscal processes in each of the clinics that had not been previously apparent to either clinic management or the quality improvement (QI) teams. DISCUSSION: Feedback addressed and encouraged process-oriented improvements in response to the workflow observations, which were incorporated into the clinics' QI procedures. Twelve of the 15 clinics have formed process action teams to address QI issues on an ongoing basis.

Age Factors↗

PubMed1998

Selection and use of pressure ulcer risk-assessment tools and treatment protocols in extended-care facilities in the southwest.

PURPOSE: The purpose of this study was to investigate pressure ulcer treatment protocol selection and use by care providers in extended health care facilities. DESIGN: Descriptive survey. SETTING AND SUBJECTS: The target population was directors of extended health care facilities in the southwestern border region of Arizona, New Mexico, and west Texas. METHODS: Questionnaires were mailed to 427 directors of extended-care facilities, who were asked to self-report treatment selection methods. The results from 96 returned and usable questionnaires were analyzed. MAIN OUTCOME MEASURES: Descriptive statistics were used to analyze the returned data. RESULTS: Most (56.25%) of the respondents reported using a facility-developed assessment tool, 15.63% used no assessment tool at all, and less than 50% of the responding institutions reported using established protocols for pressure ulcer treatment. Although selection methods differed, most (61.46%) pressure ulcer treatments were reported to be determined by collaboration among nurses, physicians, and other health care providers. CONCLUSION: Selection and use of pressure ulcer risk-assessment tools and treatment protocols showed a wide range of variation by extended-care facilities. A high percentage of institutions did not report the use of established, research-based protocols for pressure ulcer treatment, although interdisciplinary collaboration for treatment selection was reported.

Guideline Adherence↗

PubMed2003

[Self assessment tools].

Self assessment tools are an integral part of quality process and are involved in developing a quality assurance program. Improvements is becoming a necessity for the new international standards Iso 9001. After the evaluation of the situation and the measure of the results, the improvement developing program results from self assessment. This article intends to provide a better understanding of self assessment processing. The first part presents the technique used for the elaboration of the questionnaire in relation with 'good transfusion practices' and the tools used to identify opportunities for quality improvement. The involvement of the whole staff is the key for the efficiency of appropriate action. The second part presents how these tools can be applied in blood transfusion organisation and in some specific applications.

Blood Banks↗

PubMed2000

The reliability of measuring nursing clinical performance using a competency based assessment tool: a pilot study.

The clinical performance of the novice nurse has been identified as problematic in the areas of medication administration, time management, and comfort and safety. In order to assess new graduate nurses' clinical competence in these areas, a forty four (44) item assessment tool was developed which was drawn from the Australian Nursing Council Inc. (ANCI) (1991) competency statements. A correlation descriptive design was used to determine the inter-rater reliability between assessors using this competency based tool. A pilot study utilising a convenience sample of 30 new graduate nurses were each assessed by two observers for a mean period of 127.5 minutes. Kappa coefficients were calculated to determine the level of agreement between the two observers. Very little rating agreement was found for individual items, however, there was no significant difference in the total competency scores between the two observers. The competency assessment tool has face validity and is internally consistent. However, inter-rater reliability for individual competency items was found to be poor.

Attitude of Health Personnel↗

PubMed2002

Distribution and licensing of drug discovery tools--NIH perspectives.

Now, more than ever, drug discovery conducted at industrial or academic facilities requires rapid access to state-of-the-art research tools. Unreasonable restrictions or delays in the distribution or use of such tools can stifle new discoveries, thus limiting the development of future biomedical products. In grants and its own research programs the National Institutes of Health (NIH) is implementing its new policy to facilitate the exchanges of these tools for research discoveries and product development.

Animals↗