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PubMed2004

Postoperative pain assessment tools in day surgery: literature review.

BACKGROUND: Postoperative pain is an expected phenomenon. However, its passage beyond acceptable limits is a common and costly experience. This is particularly the case in day surgery, partly because of the increasing demand to reduce waiting lists for elective surgery, and partly because of lack of knowledge about patients' experiences of postoperative pain and relevant published research. The latter is mainly concerned with different interpretations of the phenomenon of pain that appear to have led to a variety of often inappropriate pain measurement tools. AIM: This paper critically reviews some of the available objective and subjective measures of pain and establishes the suitability of a Visual Analogue Scale (VAS) for measuring the intensity of pain after day surgery. METHOD: Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, day surgery, ambulatory surgery, rating scales, VAS, severity, assessment, tool, nursing, validity, sensitivity, reliability and their various combinations. The databases used were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search included only papers published in the English language. FINDINGS: A range of interpretations of pain have led to the development of various measurement tools that address different components of pain. This inconsistency has led to ineffective pain management. Based on established criteria, the VAS was found to be methodologically sound, conceptually simple, easy to administer and unobtrusive to the respondent. On these grounds, the VAS seems to be most suitable for measuring intensity of pain after day surgery. CONCLUSIONS: Common guidelines on the definition and measurement of pain are needed. In day surgery, the availability of a unified and reliable measure of pain that can address its sensory component, such as the VAS, will provide more reliable information about the pain experience and, hence, improve its overall management.

Ambulatory Surgical Procedures↗

PubMed2005

Developing and validating a tool to measure parenting self-efficacy.

AIMS: This paper reports the development of a tool to measure parenting self-efficacy as an aid to evaluating parenting programmes. BACKGROUND: Whilst there has been increasing interest in parenting programmes from parents, government and professionals, there is a lack of rigorous evaluation studies of their effectiveness, particularly their longer-term outcomes. Equally, there is little research evidence of the views and experiences of parents themselves. It is important to develop robust outcome measures which draw on well-developed theoretical constructs to measure parents' perceived abilities to manage their children based on their own views and experiences. Self-efficacy, a self-perception of one's ability to perform competently and effectively in a particular task or setting, may provide such a framework. METHODS: Data from 12 focus groups conducted with parents and parenting programme facilitators informed the development of the tool. A thematic analysis of the focus group transcripts identified key items to be included in the self-efficacy instrument, and these were developed into 82 Likert-format statements. A multi-method approach was used to test the instrument for validity and reliability. FINDINGS: Nine domain specific sub-scales of parenting were identified from the analysis of the focus group data. Internal reliability coefficients for the subscales ranged from 0.80 to 0.89, and the overall scale reliability was 0.94. External reliability coefficients ranged from rs = 0.58 (n = 19, P < 0.01) to rs = 0.88 (n = 19, P < 0.01). CONCLUSION: A valid and reliable tool to measure parenting self-efficacy has been developed, which will aid evaluation of parenting programmes.

Adult↗

PubMed2005

Developing a tool to appraise fetal monitoring guidelines for women at low obstetric risk.

AIM: The aim of this paper is to report the development and use of a tool to appraise guidelines for fetal heart rate monitoring and discuss the findings generated in the appraisal process. BACKGROUND: Expert guidance on the appropriate method of monitoring the fetal heart in labour has been available for some time. However, practices not based on evidence were continuing routinely in the United Kingdom. METHODS: We produced an 18-item tool for the appraisal of guidelines. Heads of Midwifery Services were asked to send the guideline currently in use. Twenty-four out of 28 responded, and sent 32 guidelines. Pairs of multidisciplinary reviewers appraised each guideline. RESULTS: A prevalidated generic appraisal instrument was not found to be appropriate for intrapartum fetal monitoring guidelines. When using our own specifically-developed appraisal tool for assessing the quality of fetal monitoring guidelines, only 11 reviewer pairs showed 'good' or 'moderate' agreement in their scores. CONCLUSIONS: Generically-validated guidelines may not be sufficiently discriminatory for specialized areas of practice such as intrapartum fetal monitoring.

Evidence-Based Medicine↗

PubMed2005

Overcoming the barriers to patient-centred care: time, tools and training.

AIMS AND OBJECTIVES: To investigate whether nurses experience barriers to delivering high quality care in areas that are of particular concern to patients and to describe which aspects of care are most affected when nurses lack the required resources, such as time, tools and training to do their job. BACKGROUND: Patient surveys conducted in the National Health Service of the United Kingdom tend to show there is variation in the extent to which they are satisfied with care in a number of important areas, such as physical comfort, emotional support and the coordination of care. DESIGN: A sample of nurses working in 20 acute London hospitals was asked to complete a postal questionnaire based on a prototype employee survey developed in the United States and adapted by the authors for use in the United Kingdom. METHOD: Staff in the human resources departments of participating hospitals mailed the questionnaires to nurses' home addresses. After two reminders, 2880 (out of 6160) useable responses were returned, giving a response rate of 47%. RESULTS: Nurses are aware that there are deficits in standards of care in areas that are particularly important to patients. The majority feel overworked (64%) and report that they do not have enough time to perform essential nursing tasks, such as addressing patients' anxieties, fears and concerns and giving patients and relatives information. Their work is often made more difficult by the lack of staff, space, equipment and cleanliness. They are often unable to control noise and temperature in clinical areas. Nurses in acute London hospitals are subject to high levels of aggressive behaviour, mainly from patients and their relatives, but also from other members of staff. More positively, high proportions of the nurses in our survey expressed the desire for further training, particularly in social and interpersonal aspects of care. RELEVANCE TO CLINICAL PRACTICE: This paper goes beyond reporting problems with the quality and safety of care to try to understand why patients do not always receive optimum care in areas that are important to them. In many cases nurses lack the time, tools and training to deliver high quality care in acute London hospitals. We suggest a number of low-cost interventions that might remove some of the barriers to patient-centred care. The questionnaire we have developed could be a useful tool for improving quality locally.

Acute Disease↗

PubMed2006

Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +/- 6.1 years) and all patients had both Beers' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers' criteria (ID) was 148 affecting 121 patients. The Beers' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. CONCLUSIONS: This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.

Aged↗

PubMed1996

Genogram: a useful tool for nurse practitioners.

This paper presents the genogram, originated by family therapists and utilized in the psychosocial field, as a valuable tool to be used by the nurse practitioner. The nurse practitioner from any area of practice, primary care, women's health, paediatrics, geriatrics, psychiatry, in any setting (hospital, clinic, school, industry, community and home), requires a tool that provides a comprehensive assessment of the client and the factors that affect their health. The theoretical background of Bowen's family system theory and of systems theory is reviewed as the genogram evolved from the theories. Two hypothetical case illustrations utilizing the genogram are presented, one presenting only medical problems, the other presenting medical, psychiatric and family relationships. The usefulness of the genogram is not new, but it is reviewed here for its value to the nurse practitioner. Evidence leads to the conclusion that the genogram is an assessment tool that enhances intervention strategy and communication in the client's record. It augments treatment planning, care provision, health promotion and prevention, as well as cost management.

Adolescent↗

PubMed1994

Internet tools in the medical classroom.

The Internet contains a vast amount of medically relevant information. In order to access this information, however, many networks require one to master applications written in UNIX, an operating system considered by many not to be user friendly. Although these tools may be available on campus, it is difficult to teach their use unless there is some immediate benefit to the already busy user. From that standpoint, it is important for instructors to realize that common UNIX applications can be utilized as classroom tools to significantly enhance the learning experience by facilitating teacher/student communication. Also, whilst the student enjoys greater communication with the instructor (and with other students) he/she is also becoming adept at using information management tools.

Computer Communication Networks↗

PubMed2004

Solanum nigrum: a model ecological expression system and its tools.

Plants respond to environmental stresses through a series of complicated phenotypic responses, which can be understood only with field studies because other organisms must be recruited for their function. If ecologists are to fully participate in the genomics revolution and if molecular biologists are to understand adaptive phenotypic responses, native plant ecological expression systems that offer both molecular tools and interesting natural histories are needed. Here, we present Solanum nigrum L., a Solanaceous relative of potato and tomato for which many genomic tools are being developed, as a model plant ecological expression system. To facilitate manipulative ecological studies with S. nigrum, we describe: (i) an Agrobacterium-based transformation system and illustrate its utility with an example of the antisense expression of RuBPCase, as verified by Southern gel blot analysis and real-time quantitative PCR; (ii) a 789-oligonucleotide microarray and illustrate its utility with hybridizations of herbivore-elicited plants, and verify responses with RNA gel blot analysis and real-time quantitative PCR; (iii) analyses of secondary metabolites that function as direct (proteinase inhibitor activity) and indirect (herbivore-induced volatile organic compounds) defences; and (iv) growth and fitness-estimates for plants grown under field conditions. Using these tools, we demonstrate that attack from flea beetles elicits: (i) a large transcriptional change consistent with elicitation of both jasmonate and salicylate signalling; and (ii) increases in proteinase inhibitor transcripts and activity, and volatile organic compound release. Both flea beetle attack and jasmonate elicitation increased proteinase inhibitors and jasmonate elicitation decreased fitness in field-grown plants. Hence, proteinase inhibitors and jasmonate-signalling are targets for manipulative studies.

Animals↗

PubMed2005

Genomic tools and cDNA derived markers for butterflies.

The Lepidoptera have long been used as examples in the study of evolution, but some questions remain difficult to resolve due to a lack of molecular genetic data. However, as technology improves, genomic tools are becoming increasingly available to tackle unanswered evolutionary questions. Here we have used expressed sequence tags (ESTs) to develop genetic markers for two Müllerian mimic species, Heliconius melpomene and Heliconius erato. In total 1363 ESTs were generated, representing 330 gene objects in H. melpomene and 431 in H. erato. User-friendly bioinformatic tools were used to construct a nonredundant database of these putative genes (available at http://www.heliconius.org), and annotate them with blast similarity searches, InterPro matches and Gene Ontology terms. This database will be continually updated with EST sequences for the Papilionideae as they become publicly available, providing a tool for gene finding in the butterflies. Alignments of the Heliconius sequences with putative homologues derived from Bombyx mori or other public data sets were used to identify conserved PCR priming sites, and develop 55 markers that can be amplified from genomic DNA in both H. erato and H. melpomene. These markers will be used for comparative linkage mapping in Heliconius and will have applications in other phylogenetic and genomic studies in the Lepidoptera.

Adaptation, Biological↗

PubMed2006

Action planning in young children's tool use.

Tool use consists of at least two coupled phases of activities, involving multi-step problem solving. It therefore provides an interesting window on the development of planning in goal-directed behavior. This study investigated 2-year-olds' and 3-year-olds' hand use in picking up and subsequently using a tool for displacing a target-object towards a specified goal location. The children had to use a stick (Experiment 1; N = 41 in total) or a cane (hooked stick) that was lying in varying starting orientations (Experiment 2; N = 32 in total). Age differences were found in the way goal-related information in combination with tool-related information influenced the choice of which hand to use in different phases of the task. A view on action planning is developed as a dynamic action-selection process for which actions to take. This process integrates factors that are internal to the child's action system (e.g. motor preferences and dexterity) with external (i.e. sensory) sources of information.

Child↗

PubMed1984

The use of tools by children with haemophilia.

Eight mothers with their 3.1- to 5.7-year-old children with haemophilia and eight control mothers with their children were videotaped while playing three games using a knife, a pair of scissors and a wooden hammer, and two games without tools. Although the children with haemophilia were less proficient, took less care, and were more excited when handling sharp tools than the control children, their mothers did not correct their children when they used a knife incompetently and carelessly. It is recommended that counselling should emphasize the deliberate preparation and training of the haemophilic child in the use of tools which are potentially dangerous.

Adaptation, Psychological↗

PubMed1995

A fetal alcohol syndrome screening tool.

The purpose of this study was to derive a multivariate, quantitative case definition of the fetal alcohol syndrome (FAS) facial phenotype from a dysmorphologist-derived gold standard and use it to develop an effective screening tool for identification of children at risk for FAS. The facial and physical features of a racially mixed group of children (0.2-10.0 years of age), evaluated by a single dysmorphologist in the University of Washington FAS Clinic, were used to determine which feature or set of features best differentiated between children with and without a diagnosis of FAS. The study population was divided into two groups balanced on gender, age at examination, race, diagnosis, and date of examination. Group 1 was used to identify the most differentiating feature(s), and group 2 was used to validate the differentiating capability of the feature(s). Group 1 included 97 children (20 with FAS and 77 without FAS). Group 2 included 97 children (19 with FAS and 78 without FAS). Discriminant analysis identified smooth philtrum, thin upper lip, and short palpebral fissures as the cluster of features that best differentiated children with and without FAS based on the discriminant function [D = 1.7953086 + 0.8116083 (thin upper lip) + 2.6411562 (smooth philtrum)-3.4073780 (% predicted right palpebral fissure length)]. Patients with a D-score > or = 1.5 were classified as at-risk for FAS (screen positive). Using this cut-off value for the D-score, children in group 1 were classified with 100% sensitivity (20 of 20 true positives) and 90.0% specificity (70 of 77 true negatives). The children in group 2 were classified with 100% sensitivity (19 of 19 true positives) and 87.3% specificity (68 of 78 true negatives). Across all 194 patients, sensitivity was 100% [95% confidence interval (97-100)] and specificity was 89% [95% confidence interval (85 to 93)]. Seventy-one percent (n = 12) of the 17 false-positives had a true classification of possible fetal alcohol effects. Sensitivity and specificity were unaffected by race, gender, and age through 10 years. The screening tool is effective at differentiating children with and without FAS as diagnosed by a single dysmorphologist (S.K.C) at the University of Washington FAS Clinic. Assessment of diagnostic interrater agreement between trained dysmorphologists and testing in other clinic populations will be needed to assess the tool's external validity.

Anthropometry↗

PubMed1999

Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool.

OBJECTIVES: To develop a self-report screening tool to identify older people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long-term hospitalization, or a clinically significant decrease in functional status. DESIGN: Prospective (6-month) follow-up study of a cohort of ED patients aged 65 and older. SETTING: The EDs of four acute-care hospitals in Montreal, Quebec, Canada. PARTICIPANTS: Community-dwelling patients aged 65 and older who came to the EDs during the weekday shift over a 3-month recruitment period. Patients were excluded if they could not be interviewed either because of their medical condition or because of cognitive impairment and no other informant was available. MEASUREMENTS: Measures ascertained at the ED visit included: 27 self-report screening questions on social, physical, and mental risk factors; medical history; use of hospital services, medications, and alcohol; and the Older American Resources and Services (OARS) activities of daily living (ADL) scale. At follow-up, the OARS scale was readministered by telephone, and other adverse health outcomes were ascertained. RESULTS: Among 1673 patients who completed the follow-up measures, 488 (29.2%) had an adverse health outcome. Scale development and selection methods included logistic regression, receiver operating characteristic curves, and expert judgment. The proposed screening tool (ISAR) comprises six self-report questions on functional dependence (premorbid and acute change), recent hospitalization, impaired memory and vision, and polymedication. The tool performed well in the total cohort aged 65 and older, and in sub-groups defined by disposition (admitted or released from ED), language of questionnaire administration (French or English), information source (patient or other), and other characteristics. CONCLUSIONS: The ISAR is a short self-report questionnaire that can quickly identify older patients in the ED at increased risk of several adverse health outcomes and those with current disability.

Aged↗

PubMed2006

Development and validation of Transfusion Risk Understanding Scoring Tool (TRUST) to stratify cardiac surgery patients according to their blood transfusion needs.

BACKGROUND: Allogeneic blood transfusion is associated with transfusion reactions, infection transmission, and postoperative morbidity and mortality. The objective of this study was to develop and validate an accurate and simple clinical index to stratify cardiac surgery patients according to their blood transfusion needs. METHODS AND RESULTS: Data on consecutive adult patients who underwent cardiac surgery at Toronto General Hospital (n = 11,113) and Sunnybrook and Women's College Health Sciences Center (n = 5316) between May 1999 and June 2004 were collected for the development, validation, and external validation of the index. Primary outcome was the exposure to blood transfusion in the operative and first postoperative days. Multivariable logistic regression modeling techniques were used to determine the relationship between each independent variable and the exposure to allogeneic blood transfusion. Score assignment for each predictor variable was based on its regression coefficient. The predicted probabilities at each total score were compared to the observed proportions of patients exposed to blood transfusion. The clinical tool consists of eight preoperative variables: preoperative hemoglobin, weight, female sex, age, nonelective procedure, preoperative creatinine, previous cardiac surgical procedure, and nonisolated procedure. CONCLUSIONS: Based on the standards of measurement in clinical research, a valid clinical tool was developed for predicting the need for blood transfusion in patients undergoing cardiac surgery. The clinical tool was internally and externally validated, and the results suggest that it should perform well at other institutions.

Aged↗

PubMed2005

Consortium for Atlantic Regional Assessment: information tools for community adaptation to changes in climate or land use.

To inform local and regional decisions about protecting short-term and long-term quality of life, the Consortium for Atlantic Regional Assessment (CARA) provides data and tools (for the northeastern United States) that can help decision makers understand how outcomes of their decisions could be affected by potential changes in both climate and land use. On an interactive, user-friendly website, CARA has amassed data on climate (historical records and future projections for seven global climate models), land cover, and socioeconomic and environmental variables, along with tools to help decision makers tailor the data for their own decision types and locations. CARA Advisory Council stakeholders help identify what information and tools stakeholders would find most useful and how to present these; they also provide in-depth feedback for subregion case studies. General lessons include: (1) decision makers want detailed local projections for periods short enough to account for extreme events, in contrast to the broader spatial and temporal observations and projections that are available or consistent at a regional level; (2) stakeholders will not use such a website unless it is visually appealing and easy to find the information they want; (3) some stakeholders need background while others want to go immediately to data, and some want maps while others want text or tables. This article also compares what has been learned across case studies of Cape May County, New Jersey, Cape Cod, Massachusetts, and Hampton Roads, Virginia, relating specifically to sea-level rise. Lessons include: (1) groups can be affected differently by physical dangers compared with economic dangers; (2) decisions will differ according to decision makers' preferences about waiting and risk tolerance; (3) future scenarios and maps can help assess the impacts of dangers to emergency evacuation routes, homes, and infrastructure, and the natural environment; (4) residents' and decision makers' perceptions are affected by information about potential local impacts from global climate change.

Journal Article↗

PubMed2004

Selective site pacing: tools and training.

Current tools and techniques for pacemaker and ICD lead insertion have been optimized for implantation of leads at traditional sites but may be ill-suited for achieving alternate or selective site placement. If clinical studies confirm that optimal pacing is achieved from locations other than the right atrial appendage and right ventricular apex, new tools for reliably, easily and safely implanting leads at these sites will need to be created and methods for identifying these optimal pacing site(s) in each patient will be needed. Implant centers will need to understand the benefits of selective site pacing and make the transition to using these new tools. The various factors affecting the change from traditional to selective site pacing lead placement are discussed.

Cardiac Pacing, Artificial↗

PubMedDate not supplied

A discharge planning tool for use with families of high-risk infants.

The transition from hospital care to home care for high risk infants can be facilitated by the process of discharge planning. A tool designed specifically to coordinate discharge counseling and instruction for parents of high-risk infants has been developed and implemented in a perinatal center. Preliminary results indicate that the tool enables the health team to make an objective, rather than subjective, decision in respect to discharge of infants. Use of the tool also standardizes and documents the nurse's role in discharge planning.

Chicago↗

PubMed2007

Type III secretion system-associated pilus of Pseudomonas syringae as an epitope display tool.

Type III secretion system-associated pili found in several plant pathogenic bacteria are required for injection of virulence proteins from bacteria into the plant cells. The possibility to use the type III secretion pilus of Pseudomonas syringae as an epitope display tool was studied. The advantage of the type III secretion pilus, compared with conventional fimbrial epitope display tools, is that the pilin subunits of the type III secretion pilus can auto-assemble into intact pili in vitro. Various peptides were inserted into the type III secretion pilin subunit, and secretion, assembly and surface properties of the modified pili were monitored. It was concluded that the outwards-projecting N-terminal region of the pilin can bear even 43 amino acids insertion. The three-dimensional structure of the epitope, however, can restrict the use of the pilus as an epitope display tool: a beta-hairpin structure was poorly tolerated.

Amino Acid Sequence↗