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PubMed2004

Development and preliminary examination of the predictive validity of the Falls Risk Assessment Tool (FRAT) for use in primary care.

BACKGROUND: There is no validated assessment of an older person's risk of falling that is easily applied in primary care. We aimed to develop a two-part tool for use in primary care or the community. Part 1 includes a rapid assessment of the individual's risk of falling for administration by clinical or non-clinical staff. Part 2 (for clinical staff) includes guidance on further assessment, referral and interventions. We assessed the predictive validity of part 1. METHODS: The tool was developed by an expert panel following the updating of an existing systematic review of community-based prospective studies identifying risk factors for falling and modified in accordance with the feedback from extensive piloting. We assessed predictive validity by a questionnaire survey sent at baseline and 6 months to a random sample of 1000 people aged over 65 in one Primary Care Group area. RESULTS: Five items were included in part 1: history of any fall in the previous year, four or more prescribed medications, diagnosis of stroke or Parkinson's disease, reported problems with balance, inability to rise from a chair without using arms. The presence of three or more risk factors had a positive predictive value for a fall in the next 6 months of 0.57 (95 per cent confidence interval 0.43-0.69). Less than three risk factors had a negative predictive value of 0.86 (0.82-0.89), and a specificity of 0.92 (0.88-0.94). CONCLUSION: The tool may be useful for identifying people who would benefit from further assessment of their risk of falling and appropriate intervention.

Accident Prevention↗

PubMed2003

A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over.

OBJECTIVE: To use a brief screening tool to identify knee pain (all knee pain, non-chronic and chronic knee pain) and associated health-care use in the general population aged 50 yr and over. METHODS: A cross-sectional survey was mailed to 8995 individuals registered with three general practices in North Staffordshire, UK. The questionnaire included a Knee Pain Screening Tool (KNEST), the Short Form 36 (SF36), demographic questions and, for those who reported knee pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: The survey achieved a 77% response. The 12-month period prevalence of all knee pain was 46.8% [95% confidence interval (CI) 45.6%, 48.0%]. Figures for non-chronic knee pain (pain of less than 3 months duration) and chronic knee pain (pain of more than 3 months duration) were 21.5% (95% CI 20.5%, 22.5%) and 25.3% (95% CI 24.3%, 26.4%) respectively. An estimated 6% of the older population had non-chronic but severe knee pain or disability. Thirty-three per cent of all knee pain sufferers had consulted their general practitioner (GP) about their symptom in the last year. This included 34% of those with non-chronic but severe knee pain or disability and 56% of those with chronic and severe knee pain or disability. The use of private treatments or services for knee pain was minimal. A third of those with chronic and severe knee pain or disability had not used any services (including GP) in the last year. CONCLUSIONS: The KNEST is a simple tool for the identification of individuals with knee pain and their health-care use. Focusing only on chronic knee pain will underestimate the total need and demand for health-care in knee pain sufferers in the general older population, as non-chronic as well as chronic knee pain has a significant impact on people's lives and on their use of primary health-care. The KNEST, when combined with the WOMAC, identifies population groups who have potentially diverse health-care needs and who might benefit from effective health-care. These data can be used alongside evidence on effective treatments by service planners when considering needs for the care of older adults in primary care.

Aged↗

PubMed2005

Current developments at IRSN on computational tools dedicated to assessing doses for both internal and external exposure.

The paper presents the OEDIPE (French acronym that stands for tool for personalised internal dose assessment) and SESAME (for simulation of external source accident with medical images) computational tools, dedicated to internal and external dose assessment, respectively, and currently being developed at the Institute for Radiological Protection and Nuclear Safety. The originality of OEDIPE and SESAME, by using voxel phantoms in association with Monte Carlo codes, lies in their ability to construct personalised voxel phantoms from medical images and automatically generate the Monte Carlo input file and visualise the expected results. OEDIPE simulates in vivo measurements to improve their calibration, and calculates the dose distribution taking both internal contamination and internal radiotherapy cases into account. SESAME enables radiological overexposure doses to be reconstructed, as also victim, source and accident environment modelling. The paper presents the principles on which these tools function and an overview of specificities and results linked to their fields of application.

Academies and Institutes↗

PubMed1990

Endoscopy assessment tool--a new approach.

Endoscopy outpatient assessment should be simple, yet comprehensive. Assessment is done to identify nursing care problems in order to deliver appropriate care. Four weaknesses are commonly found with outpatient assessment tools: assessment criteria are not based on Standards of Care, abnormal findings are not easily identifiable, nursing care problems are not stated, and there is no stated plan of care. The purpose of this paper is to introduce a new concept for the GI outpatient assessment. In the proposed concept, the "traditional" assessment is merged with a nursing care plan to produce a comprehensive assessment tool. Assessment criteria are based on predetermined Standards of Care. The assessment analysis is stated via the same assessment tool as a nursing problem, and the care plan interventions are noted and based on nursing care problems.

Ambulatory Care↗

PubMedDate not supplied

Developing an outcome-based multidisciplinary care planning tool: process and outcomes.

Multidisciplinary care planning is required for patients in acute care settings. A task force was charged by the Vice President of Patient Care to develop and implement a multidisciplinary care planning tool. This article outlines the process used and includes examples of the tool and outcomes to date. This major change project resulted in the development of a successful tool, a successful Joint Commission on Accreditation of Healthcare Organization survey, and new opportunities for outcome-based care planning.

Critical Pathways↗

PubMed2001

Simulation tool for schedule-dependent etoposide exposure based on pharmacokinetic findings published in the literature.

It is the aim of this study to establish a simulation tool for etoposide (Eto) which can be used to interpret drug monitoring data in clinical practice and to design new schedules for future protocols. As schedule dependency was observed for Eto, knowledge of concentration-time profiles is important. Pharmacokinetic data from children after low-dose i.v. administration of Eto together with data reported in the literature were used to construct the simulation tool. Validation was performed by independently reproducing various published data. Dose linearity of AUC was shown over the whole dose range of 20-2000 mg/m2 reported in the literature and fits the predictions by the simulation tool. There was no difference in clearance between children and adults. Close agreement was found between predicted and reported concentration-time profiles after various administration schedules. However, subgroups with significantly altered pharmacokinetics of Eto, such as patients with renal impairment or concurrent cisplatin chemotherapy, were excluded from the comparisons. In these patients values predicted for a 'regular' patient might be used as a base for possible dose modifications. In summary, a pharmacokinetic model of high predictive value is presented which allows simulations of Eto concentration-time profiles for low- as well as high-dose conditions and various infusion times.

Adolescent↗

PubMed2002

An interactive, web-based tool for learning anatomic landmarks.

PURPOSE: To evaluate the effectiveness of a Web-based interactive teaching tool that uses self-assessment exercises with real-time feedback to aid students' learning in a gross anatomy class. METHOD: A total of 107 of 124 first-year medical students at one school were enrolled in the study. Students were divided into three groups: Group 1 (n = 63) received introductory material and activated their Web-based accounts; Group 2 (n = 44) received introductory material but did not activate their Web-based accounts; and Group 3 (n = 17) were not enrolled in the study and received no introductory material. Students in Group 1 had access to a graphic showing the locations of anatomic landmarks, a drill exercise, and a self-evaluation exercise. Students' ability to identify the anatomic landmarks on a 30-question midterm and a 30-question final exam were compared among the groups. RESULTS: The mean scores of students in Group 1 (midterm = 28.5, final = 28.1) were significantly higher than were the mean scores of students in Group 2 (midterm = 26.8, p <.001; final = 26.9, p <.017) and Group 3 (midterm = 24.8, p <.001; final = 26.4, p <.007). CONCLUSIONS: The Web-based tool was effective in improving students' scores on anatomic landmark exams. Future studies will determine whether the tool aids students in identifying structures located in three-dimensional space within regions such as the cranium and the abdominal cavity.

Adult↗

PubMed1993

Capturing the multiple contributions of the CNS role: a criterion-based evaluation tool.

The CNSs at a community hospital found that tools used to evaluate their performance did not reflect the wide variety of activities native to the CNS role within the institution. A six-member working group came to consensus on practice behaviors, and ordered them into a hierarchy of performance levels. The resulting role description and evaluation tool provides flexibility in application to unit-based, centralized, and specialty-based positions. The benefits of the new role description and evaluation tool to the organization and individual are multiple and serve to highlight the unique talents the role can bring to nursing.

Employee Performance Appraisal↗

PubMed2000

A multi-level performance appraisal tool: transition from the traditional to a CQI approach.

The commitment of many health care organizations to CQI calls for the introduction of tools, principles, and procedures to ensure that the performance improvement in all parts of the organization is initiated. In order to determine whether the desired performance standards are indeed being achieved on all organizational levels, it is necessary to apply a holistic performance appraisal tool that would allow for an assessment of the company's progress from multiple dimensions. This article details the design of the multilevel appraisal model, explicates where the evaluation errors may occur, and presents managerial implications for successful implementation of this evaluation tool.

Efficiency, Organizational↗

PubMed2004

Development of a consumer-driven Wheelchair Seating Discomfort Assessment Tool (WcS-DAT).

This study examined the concept of seating discomfort in a population of full-time wheelchair users with intact sensation. The goal was to construct a tool that would quantify seating discomfort experienced by wheelchair users. Ten participants were interviewed using ethnographic interview techniques. Data were analyzed using a cross-classifying matrix to examine commonalities among the 10 participants' responses. There were 16 discomfort and 13 comfort descriptors used by the participants. Of these, eight discomfort and five comfort descriptors were selected to include in the Wheelchair Seating Discomfort Assessment Tool (WcS-DAT). The discomfort descriptors selected were: aches and pains, need to move, pressure points, feeling poorly positioned, unable to concentrate, instability, not comfortable, and feeling too hot, cold or damp. The comfort descriptors selected were: absence of discomfort, feeling good, having no pain, able to concentrate, and feeling stable. The WcS-DAT also includes general information, such as the amount of time spent sitting and whether the individual was transferred into the chair properly--factors thought to affect discomfort--and ratings of discomfort intensity--in general and differentiated by body area. The WcS-DAT is a comprehensive tool for quantification of wheelchair seat discomfort for this population.

Adult↗

PubMedDate not supplied

Management tools for Medicaid and State Children's Health Insurance Program (SCHIP).

Medicaid and the State Children's Health Insurance Program need analytic tools to manage their programs. Drawing upon extensive discussions with experts in states, this article describes the state of the art in tool use, making several observations: (1) Several states have linked Medicaid/State Children's Health Insurance Program administrative data to other data (eg, birth and death records) to measure access to care. (2) Several states use managed care encounter data to set payment rates. (3) The analysis of pharmacy claims data appears widespread. The article also describes "lessons learned" regarding building capacity and improving data to support the implementation of management tools.

Child Health Services↗

PubMedDate not supplied

Integration of data and management tools into the new york state medicaid managed care encounter data system.

The New York State Department of Health has created a data warehouse to analyze and evaluate the Medicaid managed care program. Online query tools and reports, grouping tools such as Diagnostic Related Groups, and measurement tools such as Health Plan Data and Information Set (HEDIS) measures have been incorporated into the data warehouse. Other public health data sets including birth certificate data have also been integrated. The result is a powerful data set that can analyze information quickly and efficiently, with built-in data intelligence. Developed over time, this system can provide states, health insurance companies, and health data consortiums a roadmap on how to implement an integrated data warehouse solution.

Databases, Factual↗

PubMed2002

Lining up for children's mental health services: a tool for prioritizing waiting lists.

OBJECTIVE: The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 health-related organizations that was created to develop tools to manage waiting lists for five types of health services. METHOD: The children's mental health (CMH) panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting CMH services. The criteria were applied to 817 patients by 92 mental health professionals in three western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' global urgency ratings. To assess reliability, raters used the criteria to score six standardized "paper cases." RESULTS: The criteria accounted for about 40% of the observed variance in overall urgency ratings (R2 = 41.7%). The panel modified the criteria on the basis of the initial empirical work. Reliability assessment of the revised tool indicated that half of the items had excellent or fair/good interrater agreement; test-retest reliability was good. CONCLUSIONS: Priority criteria were able to capture clinicians' judgments of relative urgency in the CMH setting. A number of operational challenges remain with the use of priority criteria for scheduling CMH services. Further development and testing of the tool appear warranted.

Adolescent↗

PubMedDate not supplied

What tools help make "whole-of-patient" practices happen?: a Tasmanian falls prevention project.

The development of "whole-of-patient" approaches is explored using transcripts of 10 interviews with registered nurses implementing the Quickscreen Clinical Falls Risk Assessment Tool in general practices in northern Tasmania. These data suggest that while the tool helped develop holistic nursing practices, the development of multidisciplinary practices requires different tools and strategies.

Accident Prevention↗

PubMed2002

Advanced tools for digital EEG review: virtual source montages, whole-head mapping, correlation, and phase analysis.

Digital EEG allows one to combine recorded EEG channels into new montages without the need to record new data. Using spherical splines, voltages can be estimated at any point on the head. This allows one to generate various montages with the recorded or virtual electrodes at standardized locations, to interpolate bad electrodes, and to generate topographic maps over the whole head. Simulations of EEG activity originating in various brain regions are used to illustrate the effects of known generators on various montages and on whole-head maps. Some properties of spatial filters are introduced, and it is shown how they can be used to develop source montages with signals that estimate the activity in specific brain regions. The usefulness and validity of a source montage designed to focus on temporal lobe activity is illustrated with simulations and examples of temporal lobe spikes and seizures. Additional tools such as cross-correlation among channels, fast Fourier transform, and phase maps are described. These tools are useful in estimating time lags between source channels and in interpreting propagating spike and seizure activity. In combination, these tools help to analyze and to enhance activities that may be hard to detect from the background scalp EEG in traditional montages.

Adult↗

PubMedDate not supplied

Development and evaluation of essentials of magnetism tool.

Staff nurses in 14 magnet hospitals identified 8 attributes associated with the original concept of magnetism as essential to their ability to give quality care. The 8 Essentials of Magnetism (EOM) tool was generated from participant observation and interviews with 289 magnet hospital staff nurses. The psychometric properties of the EOM tool were established in a study involving 3602 staff nurses in 16 magnet and 10 nonmagnet hospitals. The authors discuss the EOM tool and its use in diagnosing elements needed in the environment to produce what staff nurses say is essential for productivity of quality patient care.

Analysis of Variance↗

PubMedDate not supplied

Patient rating of wrist pain and disability: a reliable and valid measurement tool.

OBJECTIVE: The goal of this study was to develop a reliable and valid tool for quantifying patient-rated wrist pain and disability. DESIGN: Survey, tool development, reliability, and validity study. SETTING: Upper extremity unit. PARTICIPANTS: One hundred members of the International Wrist Investigators were surveyed by mail to assist in development of the scale. Patients with distal radius (n = 64) or scaphoid (n = 35) fractures were enrolled in a reliability study, and 101 patients with distal radius fractures were enrolled in a validity study. INTERVENTION: Information from the expert survey, biomechanical literature, and patient interviews was used as a basis for item generation and definition of structural limitations for a scale that would be practical in the clinic. Patients with distal radius or scaphoid fractures completed the Patient-Rated Wrist Evaluation (PRWE) on two occasions to determine test-retest reliability. Patients with distal radius fractures (n = 101) completed the PRWE and the SF-36 and were tested with traditional impairment measures at baseline and at two, three, and six months after fracture to determine construct and criterion validity. MAIN OUTCOME MEASURES: Reliability coefficients (ICCs) and validity correlations (Pearson product moment correlations). RESULTS: Patient opinions on pain and on ability to do activities of daily living and work were thought to be the most important dimensions to include in subjective outcome tools. Brevity and simplicity were seen as essential in the clinic environment. A fifteen-item questionnaire (the PRWE) was designed to measure wrist pain and disability. Test-retest reliability was excellent (ICCs > 0.90). Validity assessment demonstrated that the instrument detected significant differences over time (p < 0.01) and was appropriately correlated with alternate forms of assessing parameters of pain and disability. CONCLUSIONS: The PRWE provides a brief, reliable, and valid measure of patient-rated pain and disability.

Activities of Daily Living↗

PubMedDate not supplied

Development of a consumer satisfaction survey tool for a nurse-managed community health center.

The authors describe a group project in a graduate nursing course in which the students developed a consumer satisfaction survey tool for use in an academic nursing center. Included in this article are a description of the project inception, course objectives, group collaboration, review of the literature, and tool development. The completed tool and recommendations are included.

Community Health Centers↗