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PubMedDate not supplied

Developing an evaluation tool for instructional software programs.

The use of instructional software is predominant in many nursing programs. The need for cost-effective, quality programs requires faculty to evaluate instructional software before its purchase and use. The purpose of this work was to develop a tool for evaluating instructional software programs. The tool was based on data from the literature, as well as input and feedback from nurse educators and multimedia specialists. The evaluation tool assists faculty to ensure proper evaluation and selection of instructional software.

Choice Behavior↗

PubMed2005

Development of a combined audiovisual and extremity dose monitoring software tool for use in nuclear medicine.

OBJECTIVES: Conventional extremity dose monitoring in nuclear medicine, using thermoluminescent dosimeters, provides a convenient method of determining integral doses from a series of procedures. Although semiconductor extremity probes are able to add time information and allow doses from individual procedures to be determined, it can be difficult to relate individual operations to the dose-time curve. Solutions to this problem have been identified and developed. METHODS: A novel software tool (Extremity Dose Information Package, EDIP) has been developed that uniquely combines and synchronizes two audiovisual and extremity probe data-streams. The value of this extra information was assessed by acquiring audiovisual and extremity dose information in nuclear medicine and radiopharmacy settings. RESULTS: The ability of the software tool to synchronize audiovisual and dose data-streams was verified. Preliminary studies of handling techniques in radiopharmacy and radioiodine administrations using this tool showed areas in which techniques could be adapted to reduce extremity doses, which would have been difficult or impossible to identify using the dose-time information alone. CONCLUSIONS: This low-cost multimedia extremity dose monitoring package can be used, for example, to aid staff training and pinpoint issues with current operating procedures within a clinical nuclear medicine department. Its unique ability to combine and synchronize audiovisual and dosimetry data is also likely to be of benefit to other industries handling unsealed radioactive materials.

Diagnostic Techniques, Radioisotope↗

PubMed2000

The use of nonorganic signs and symptoms as a screening tool for return-to-work in patients with acute low back pain.

STUDY DESIGN: A longitudinal cohort study of patients with acute, work-related low back pain undergoing physical therapy treatment. OBJECTIVE: To determine cut-off values maximizing the predictive ability of the nonorganic signs and symptoms in patients with acute, work-related low back pain and to calculate the predictive validity of the signs and symptoms, alone and in combination, using an outcome of return to work within 4 weeks of initiating treatment. SUMMARY OF BACKGROUND DATA: Waddell et al have proposed nonorganic signs and symptoms as screening tools in patients with chronic low back pain for detecting the presence of abnormal illness behavior and identifying patients in need of further evaluation to improve the likelihood of a successful treatment outcome. METHODS: Consecutive patients referred to physical therapy with work-related low back pain of less than 2 weeks' duration were examined for the presence of nonorganic signs and symptoms before initiating physical therapy treatment. The outcome measure used was the ability to return to work without restrictions within 4 weeks of the initial evaluation. RESULTS: Sensitivity, specificity, and likelihood ratios were calculated for all possible cut-off values for the nonorganic signs, symptoms, and the nonorganic index (signs and symptoms). The best cut-off values were two or more signs (negative likelihood ratio = 0.75), three or more symptoms (negative likelihood ratio = 0.62), and an index score of three or more (negative likelihood ratio = 0.59). Area under a receiver operator characteristic curve for the signs, symptoms, and index were 0.60, 0.63, and 0.63, respectively. CONCLUSIONS: Because the nonorganic tests are purported to serve as screening tests, cut-off values were selected that minimized false-negative results. Even with optimal cut-off values, none of the nonorganic tests served as effective screening tools. Other screening tools may prove more effective for the early identification of patients at increased risk for delay in returning to work after an episode of acute low back pain.

Acute Disease↗

PubMed1997

Anal cytology as a screening tool for anal squamous intraepithelial lesions.

Anal squamous intraepithelial lesions (ASIL) are common in homosexual and bisexual men, and high-grade ASIL (HSIL) in particular may represent an anal cancer precursor. Cervical cytology is a useful screening tool for detection of cervical HSIL to prevent cervical cancer. To assess anal cytology as a screening tool for anal disease, we compared anal cytology with anoscopy and histopathology of anal biopsies. A total of 2958 anal examinations were performed on 407 HIV-positive and 251 HIV-negative homosexual or bisexual men participating in a prospective study of ASIL. The examination consisted of a swab for anal cytology and anoscopy with 3% acetic acid and biopsy of visible lesions. Defining abnormal cytology as including atypical squamous cells of undetermined significance and ASIL, the sensitivity of anal cytology for detection of biopsy-proven ASIL was 69% (95% confidence interval: 60 to 78) in HIV-positive and 47% (95% confidence interval; 26 to 68) in HIV-negative men at their first visit and was 81% and 50%, respectively, for all subsequent visits combined. The absence of columnar cells did not affect the sensitivity, specificity, or predictive value of anal cytology. Anal cytology may be a useful screening tool to detect ASIL, particularly in HIV-positive men. The grade of disease on anal cytology did not always correspond to the histologic grade, and anal cytology should be used in conjunction with histopathologic confirmation.

Adult↗

PubMed2001

Medical insurance claims and surveillance for occupational disease: analysis of respiratory, cardiac, and cancer outcomes in auto industry tool grinding operations.

To evaluate medical insurance claims for chronic disease investigation, claims from eight automotive machining plants (1984 to 1993) were linked with work histories (1967 to 1993), and associations with respiratory, cardiac, and cancer conditions were investigated, in a case-control design analyzed with logistic regression. The primary focus was tool grinding, but other important processes examined were metal-working, welding, forging, heat treat, engine testing, and diverse-skilled trades work. Considerable variability in claim-derived incidence rates across plants was not explained by age or known exposure differences. Asthma incidence increased in tool grinding (at mean cumulative duration: odds ratio [OR], 3.0; 95% confidence interval [CI], 0.90 to 10.0), as did non-ischemic heart disease (cardiomyopathy, cor pulmonale, rheumatic heart disease, or hypertension; OR, 3.1; 95% CI, 1.26 to 7.6). These trends appeared in models with deficits (OR < 1.0) for those ever exposed to tool grinding because of exposure-response miss-specification, demographic confounding, or removal of high-risk workers from the exposed group. The apparent cancer rates identified from claims greatly exceeded the expected rates from a cancer registry, suggesting that diagnostic, "rule-out," and surveillance functions were contributing. This study supports the epidemiologic use of medical insurance records in surveillance and, possibly, etiologic investigation and identifies issues requiring special attention or resolution.

Adolescent↗

PubMed2003

Cardiovascular monitoring tools: use and misuse.

PURPOSE OF REVIEW: To review important areas of current and novel hemodynamic monitoring practice in the intensive care unit and to highlight potential areas of physiologic and clinical use or misuse, as well as areas of uncertainty and ongoing controversy. RECENT FINDINGS: To truly determine when hemodynamic monitoring tools are misused would require randomized controlled evidence of a measurable improvement in relevant clinical (as opposed to physiologic) outcomes. Unfortunately, little evidence of this kind exists, and that which does exist is highly controversial in nature. Because of the limited evidence of an effect of hemodynamic monitoring on clinical outcomes, the use and misuse of hemodynamic monitoring tools is typically judged on physiologic grounds (Does it improve physiology? Does it predict physiology? Is it physiologically rational?). The relation between physiologic gain and final clinical outcome, however, is tenuous. Recent investigations confirm this lack of a clear link. They also suggest that new technology that is now emerging to less invasively measure cardiac output and intrathoracic fluid compartments is ready for formal evaluations of efficacy and effectiveness. SUMMARY: The effectiveness of hemodynamic monitoring in the intensive care unit remains inadequately tested and unproven. New tools are now rapidly emerging to challenge established technologies. Formal assessment of their efficacy and effectiveness is needed to avoid a repeat of the pulmonary artery catheter experience.

Blood Pressure Determination↗

PubMed2003

Respiratory monitoring tools in the intensive care unit.

PURPOSE OF REVIEW: Respiratory monitoring tools remain important in the overall assessment of a patient in the ICU. A working knowledge of the various tools is helpful in applying their use to patient care. RECENT FINDINGS: The past year has seen tremendous research in this domain of patient care, fueled by rapid advances in modern technology. Still, the ICU clinician continues to rely on tried and true established tools while awaiting proof of clinical efficacy of newer modalities. SUMMARY: This review discusses traditional methods of respiratory system evaluation and their current controversies. Attention is also given to newer modalities, including those that are investigational or currently limited to bench application, that show promise of future application in ICU clinical practice.

Adult↗

PubMedDate not supplied

Narrowing the possibilities: using quality improvement tools to decrease competence assessment overload.

In many institutions, competence assessment tools are seen as the way to address all clinical practice issues. In the absence of a systematic approach to development, these tools are produced en masse with little sharing of information among educators, managers, and clinical leaders. In an effort to harness "competence assessment overload," the authors propose a system that will assist staff in prioritizing the use and development of outcome-driven competence assessment tools.

Clinical Competence↗

PubMedDate not supplied

Developing the MAPP community health improvement tool.

From 1997 to 2001, the National Association of County and City Health Officials, in collaboration with the Centers for Disease Control and Prevention's Public Health Practice Program Office, developed a new community strategic planning tool, titled Mobilizing for Action through Planning and Partnerships (MAPP). This article provides a chronological description of the development of MAPP, devoting significant attention to pivotal decisions, development milestones, and distinguishing features of this new public health planning tool. All phases of the development ensured a practice-driven process, ongoing substantive input from the field, careful attention to research and literature, and intentional linkage with related efforts. This deliberate process laid the foundation for a tool that is not only well grounded in research and concepts but also relevant for practical use in communities. The process also demonstrates how practice-based research can be conducted in a way that effectively balances the need for applied relevance with intellectual integrity.

Community Health Planning↗

PubMed2002

Human papillomavirus testing and conventional pap smear cytology as optional screening tools of women at different risks for cervical cancer in the countries of the former soviet union.

OBJECTIVES: Human papillomavirus (HPV) infection is a sexually transmitted disease (STD) and the single most important etiological agent of cervical cancer. In parallel with the increase of STDs and because of the lack of any organized cancer screening in the new independent states of the former Soviet Union, the incidence and mortality rates of cervical cancer are rapidly rising. This is the first report from an ongoing European Commission-funded (INCO-Copernicus Program) cross-sectional and cohort study (focused on the key issues of this major health problem in the new independent states) analyzing the performance of the HPV DNA (Hybrid Capture II) test as a potential screening tool for cervical cancer in these countries. MATERIALS AND METHODS: A series of 3,175 women (screening, gynecological, or STD patients) from six clinics in Russia, Belarus, and Latvia received routine cytology and HPV testing with Hybrid Capture II (HCII). All women with HPV-positive results or abnormalities in cytology were subjected to colposcopy and biopsy. The sensitivity, specificity, receiver operating characteristics, as well as positive (PPV) and negative predicting values (NPV), were determined for HCII and quality-controlled cytology in detecting significant pathology (cervical intraepithelial neoplasia [CIN] 3 and cancer). RESULTS: Significant pathology was strongly associated with high-grade cytology (odds ratio [OR] = 8.5; 95% confidence interval [CI] = 4.1-17.8; chi-square, p < .0001). Pap smear cytology detected high-grade lesions with a sensitivity of 64.0% (44.8-83.2), specificity of 89.1% (84.5-93.7), PPV of 44.4% (28.8-61.0), and NPV of 94.8% (91.2-98.4). Of the 3,086 samples analyzed by HCII, 33.0% were positive for oncogenic HPV types, with a wide variation (from 23% to 45%) between the three patient groups (p < .0001). The presence of high-grade cytology was significantly associated with HCII positivity at all cutoff levels (OR = 14.4; 95% CI = 8.4-24.5; chi-square, p < .0001; 1 pg/mL threshold). In the receiver operating characteristics curve, the HCII cutoff point most closely balancing sensitivity (83.1%) and specificity (75.6%) was 2 pg/mL. The presence of high-grade histology was associated with HCII positivity (cutoff 1 pg/mL; OR = 4.8; 95% CI = 0.7-34.2;p = .047). At the cutoff (1 pg/mL), sensitivity of the HCII test was 96.6% (90.0-100), specificity was 15.9% (10.6-21.2), PPV was 15.1% (9.9-20.3), and NPV was 96.8% (90.3-100). Changing the cutoff significantly affected sensitivity at 20 pg/mL and NPV at 500 pg/mL. CONCLUSIONS: HCII assay is a sensitive tool in detecting significant pathology, but less specific than the Pap test. A negative HCII test practically precludes high-grade CIN (NPV, >95%). Because the performance characteristics of the HCII test depend on the prevalence of HPV and CIN in the study population, the cost-benefit issues in different settings will be the limiting factor for the application of this test as a screening tool.

Journal Article↗

PubMed2004

Development, validity, reliability, and responsiveness of a new leg ulcer measurement tool.

OBJECTIVE: To develop and validate an assessment tool--the Leg Ulcer Measurement Tool (LUMT)--that would be able to detect changes in the appearance of lower extremity ulcers. SUBJECTS: Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) participated in the validation study. DESIGN: An interdisciplinary panel consisting of 9 local wound care specialists confirmed content validity. Concurrent criterion validity was determined by correlation of the size domain (1 of 14 clinician-rated domains in the LUMT) with acetate tracing measurement of wound surface area. Reliability was determined using repeated assessments by 4 wound care specialist and 2 inexperienced evaluators; responsiveness was determined using monthly reassessments by a single rater for 4 months. RESULTS: Concurrent criterion validity was r = 0.82. Excellent values of intrarater and interrater reliability (ICC > 0.75) were obtained for total LUMT scores and for many of the 14 individual domains; however, several domains were found to be less reproducible. The LUMT detected change in wound status over time (responsiveness coefficient = 0.84). CONCLUSION: The LUMT can be used by 1 or more assessors, with relatively little previous training, to make reproducible evaluations of lower extremity ulcer appearance and to document change in appearance over time. The LUMT represents a novel assessment tool specifically designed and validated for clinical or research use on chronic leg ulcers.

Aged↗

PubMedDate not supplied

Development of a risk assessment tool for intraoperative pressure ulcers.

This article discusses the current literature related to intraoperative and preoperative risk factors for pressure ulcer development. Although surgical patients have a high risk of pressure ulcer development, the intraoperative period of patient care has often been missed as a time of increased risk. Pressure ulcers, which may originate in the operating room, may be incorrectly blamed on postoperative areas of care resulting from delay of pressure ulcer demarcation. In the literature review, current risk assessment tools do not adequately address intraoperative risk factors. A risk assessment tool that incorporates the specific variables relevant to the preoperative and intraoperative environment is proposed based on existing literature. A pilot study of the tool was done testing for intrarater reliability.

Age Factors↗

PubMed2003

A software tool for analyzing multichannel cochlear implant signals.

A useful and convenient means to analyze the radio frequency (RF) signals being sent by a speech processor to a cochlear implant would be to actually capture and display them with appropriate software. This is particularly useful for development or diagnostic purposes. sCILab (Swiss Cochlear Implant Laboratory) is such a PC-based software tool intended for the Nucleus family of Multichannel Cochlear Implants. Its graphical user interface provides a convenient and intuitive means for visualizing and analyzing the signals encoding speech information. Both numerical and graphic displays are available for detailed examination of the captured CI signals, as well as an acoustic simulation of these CI signals. sCILab has been used in the design and verification of new speech coding strategies, and has also been applied as an analytical tool in studies of how different parameter settings of existing speech coding strategies affect speech perception. As a diagnostic tool, it is also useful for troubleshooting problems with the external equipment of the cochlear implant systems.

Cochlear Implants↗

PubMed2006

A quantitative composite scoring tool for orthopaedic residency screening and selection.

The ability to accurately screen and select orthopaedic resident applicants with eventual successful outcomes has been historically difficult. Many preresidency selection variables are subjective in nature and a more standardized objective scoring method seems desirable. A quantitative composite scoring tool (QCST) to be used in a standardized manner to help predict orthopaedic residency performance from application materials was developed. In 64 orthopaedic residents, four predictors (United States Medical Licensing Examination [USMLE] Part I scores, Alpha Omega Alpha status, junior year clinical clerkship honors grades, and the QCST score) were analyzed with respect to four residency outcomes assessments. The outcomes included three standardized assessments, the orthopaedic in-training examination scores (OITE), the American Board of Orthopaedic Surgery (ABOS) written and oral examinations, and an internal outcomes assessment, attainment of satisfactory chief resident associate (CRA) status. Collectively, the QCST score had the strongest association as a predictor for all three standardized outcomes assessments (p < 0.001). Honors grades during junior years clinical clerkships was most strongly associated with satisfactory CRA status (p < 0.001). A composite scoring tool that is an effective predictor of orthopaedic resident outcomes can be developed. Additional work is still required to refine this scoring tool for orthopaedic residency screening and selection.

Clinical Competence↗

PubMed2006

Family history of type 2 diabetes: a population-based screening tool for prevention?

PURPOSE: To evaluate the use of self-reported family medical history as a potential screening tool to identify people at-risk for diabetes. METHODS: The HealthStyles 2004 mail survey comprises 4345 US adults who completed a questionnaire to ascertain personal and family history of diabetes, perceived risk of diabetes, and practice of risk-reducing behaviors. Using number and type of affected relatives, respondents were ranked into three familial risk levels. Adjusted odds ratios (AORs) were obtained to evaluate associations between familial risk and prevalent diabetes, perceived risk of disease, and risk-reducing behaviors. Validity of family history as a screening tool was examined by calculating sensitivity, specificity, and positive and negative predictive values. RESULTS: Compared to those of average risk, people with moderate and high familial risk of diabetes were more likely to report a diagnosis of diabetes (AOR: 3.6, 95% CI: 2.8, 4.7; OR: 7.6, 95% CI: 5.9, 9.8, respectively), a higher perceived risk of diabetes (AOR: 4.6, 95% CI: 3.7, 5.7; OR: 8.5, 95% CI: 6.6, 17.7, respectively), and making lifestyle changes to prevent diabetes (AOR: 2.2, 95% CI: 1.8, 2.7; OR: 4.5, 95% CI: 3.6, 5.6, respectively). A positive familial risk of diabetes identified 73% of all respondents with diabetes and correctly predicted prevalent diabetes in 21.5% of respondents. CONCLUSION: Family history of diabetes is not only a risk factor for the disease but is also positively associated with risk awareness and risk-reducing behaviors. It may provide a useful screening tool for detection and prevention of diabetes.

Adolescent↗

PubMed2005

Calcaneal ultrasound bone densitometry is not a useful tool to screen patients with inflammatory bowel disease at high risk for metabolic bone disease.

BACKGROUND: Up to 42% of patients with inflammatory bowel disease (IBD) have significant metabolic bone disease. The current method of screening for osteopenia or osteoporosis involves dual-energy x-ray absorptiometry (DXA). This is relatively costly and involves radiation exposure. What is needed is a safe, inexpensive, and quick screening tool to identify patients who would benefit from DXA testing. This would reduce the number of patients undergoing DXA testing unnecessarily. We tried to determine if calcaneal ultrasound bone densitometry is a useful tool in screening high-risk patients with IBD for metabolic bone disease. METHODS: Patients with IBD who presented to the clinic between August 29, 2003 and December 22, 2003 were enrolled in this prospective study. All patients underwent calcaneal ultrasound bone densitometry screening using a GE Lunar Achilles Insight quantitative ultrasound densitometry machine (QUS). Patients who were at high risk for significant metabolic bone disease (i.e., significant previous prednisone use or a long history of severe IBD) or who had a T-score on QUS less than or equal to -0.7 had DXA testing performed. The DXA results and QUS results were compared. The radiologist was blinded to the results of QUS. RESULTS: One hundred twenty-four patients with IBD were enrolled. Fifty (40%) were considered high risk for metabolic bone disease. This cohort was comprised of 29 men (58%), of which 21 (73%) had Crohn's disease (CD). Eighty percent of this high-risk group had CD, and in both groups, the majority had used corticosteroids. The overall risk of significant metabolic bone disease in this high-risk group was 62% (DXA < or = -1.0). Heel density (T-score) correlated poorly with DXA (T-score) at either hip or spine at 0.40 even when 2 outlier patients (QUS = -2.9, DXA spine = 0.7, DXA hip = 0.8 and QUS = -3.6, DXA spine = -3, DXA hip = -4) were excluded. Likewise, no association in osteopenia or osteoporosis was seen between multiple variables. These included sex, disease type (ulcerative colitis or CD), smoking, and prior intestinal resection. The sensitivity of QUS to identify patients with significant metabolic bone disease was 74%, and specificity was 63%. A positive predictive value of 81% and negative predictive value of 53% were also less than ideal. The Altman-Bland analysis showed that the agreement between QUS and DXA was poor (-2.0, 2.1). Based on this analysis, QUS cannot replace DXA in the individual patient with IBD. CONCLUSIONS: Calcaneal ultrasound bone densitometry is not a useful tool to screen high-risk patients with IBD for metabolic bone disease.

Adult↗

PubMed2004

Tools for post LEEP surveillance.

UNLABELLED: Recurrences of cervical intraepithelial neoplasia (CIN) as well as invasive cervical carcinoma have been reported to arise following ablative or excisional treatment for cervical intraepithelial neoplasia. This review utilizes MEDLINE and National Library of Medicine's PubMed review of the various screening tools used in follow-up protocols for women treated by loop excision for CIN. Cervical cytology, colposcopy, endocervical curettage and HPV typing have been advocated for use as tools for follow up. Involvement of the surgical margins and the presence of HPV-DNA are associated with higher risks of recurrence and should be taken into consideration. The psychological impact of undergoing colposcopy may affect compliance with follow-up visits and should be dealt with appropriately. LEARNING OBJECTIVES: After completion of this article, the reader should be able to list the various tools that can be used for the surveillance of patients after treatment for CIN, to compare the advantages and disadvantages of each surveillance method, and summarize methods to improve compliance with follow-up.

Clinical Protocols↗

PubMed1988

Spinal cord testing: development of a screening tool.

The Acute Spinal Cord Injury Program at Sunnybrook Medical Centre has treated more than 950 patients in the 13 years since development of the program. Ongoing assessment is essential in the care and rehabilitation of these patients. Nurses at Sunnybrook developed a screening tool which specifies muscle groups and dermatomes to be tested, and a means to quantify muscle power. The tool also addresses evaluation of vital capacity, bowel and bladder function. This article describes tool development and illustrates its use.

Adult↗