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Using standardised patients in an objective structured clinical examination as a patient safety tool.

Standardised patients (SPs) are a powerful form of simulation that has now become commonplace in training and assessment in medical education throughout the world. Standardised patients are individuals, with or without actual disease, who have been trained to portray a medical case in a consistent manner. They are now the gold standard for measuring the competence of physicians and other health professionals, and the quality of their practice. A common way in which SPs are used in performance assessment has been as part of an objective structured clinical examination (OSCE). The use of an SP based OSCE can be a powerful tool in measuring continued competence in human reliability and skill performance where such skills are a critical attribute to maintaining patient safety. This article will describe how an OSCE could be used as a patient safety tool based on cases derived from actual events related to postdonation information in the blood collection process. The OSCE was developed as a competency examination for health history takers. Postdonation information events in the blood collection process account for the majority of errors reported to the US Food and Drug Administration. SP based assessment is an important patient safety tool that could be applied to a variety of patient safety settings and situations, and should be considered an important weapon in the war on medical error and patient harm.

Clinical Competence↗

Improved tool for testing screen-film contact in mammography.

Good screen-film contact is essential to obtain high definition in radiographic images. We compared the conventional test tool for measuring screen-film contact, which uses #8 mesh (eight wires per inch [about three wires per centimeter]), with a prototype tool of #40 copper mesh. The conventional tool did not adequately test screen-film contact for mammography, in which significantly higher resolution is obtained. We believe #40 copper mesh should be used to test screen-film contact of mammographic cassettes. We also found that entrapped air may reduce screen-film contact and, therefore, recommend that cassettes be loaded at least 15 minutes before they are exposed.

Mammography↗

PACSPulse: a web-based DICOM network traffic monitor and analysis tool.

PACSPulse, an open-source tool, was developed to identify and analyze the performance bottlenecks of picture archiving and communication systems (PACS). PACSPulse provides a graphical Web interface for straightforward analysis of PACS performance on the basis of data acquired by tracking usage by network, server, workstation, type of traffic, and time of day. The PACS archive logs performance and usage data on image traffic being sent to it from the imaging units and study data requested by users. The performance log is sent via file transfer protocol (FTP) to a separate server for analysis. The data are parsed and sent to a database server connected to a Web server. The Web site is used to depict trends in the performance of the entire system to detect signs of degradation. The system was built entirely of open-source components for the operating system, database, charting tool, and Web server. Performance monitoring is an essential tool for analyzing, understanding, and predicting the performance characteristics of a PACS.

Humans↗

Who wants to be a physician? An educational tool for reviewing pulmonary physiology.

Traditional review sessions are typically focused on instructor-based learning. However, experts in the field of higher education have long recommended teaching modalities that incorporate student-based active-learning strategies. Given this, we developed an educational game in pulmonary physiology for first-year medical students based loosely on the popular television game show Who Wants To Be A Millionaire. The purpose of our game, Who Wants To Be A Physician, was to provide students with an educational tool by which to review material previously presented in class. Our goal in designing this game was to encourage students to be active participants in their own learning process. The Who Wants To Be A Physician game was constructed in the form of a manual consisting of a bank of questions in various areas of pulmonary physiology: basic concepts, pulmonary mechanics, ventilation, pulmonary blood flow, pulmonary gas exchange, gas transport, and control of ventilation. Detailed answers are included in the manual to assist the instructor or player in comprehension of the material. In addition, an evaluation instrument was used to assess the effectiveness of this instructional tool in an academic setting. Specifically, the evaluation instrument addressed five major components, including goals and objectives, participation, content, components and organization, and summary and recommendations. Students responded positively to our game and the concept of active learning. Moreover, we are confident that this educational tool has enhanced the students' learning process and their ability to understand and retain information.

Blood Flow Velocity↗

qPCR-DAMS: a database tool to analyze, manage, and store both relative and absolute quantitative real-time PCR data.

Quantitative real-time PCR is an important high-throughput method in the biomedical sciences. However, existing software has limitations in handling both relative and absolute quantification. We designed quantitative PCR data analysis and management system (qPCR-DAMS), a database tool based on Access 2003, to deal with such shortcomings by the addition of integrated mathematical procedures. qPCR-DAMS allows a user to choose among four methods for data processing within a single software package: 1) ratio relative quantification, 2) absolute level, 3) normalized absolute expression, and 4) ratio absolute quantification. qPCR-DAMS also provides a tool for multiple reference gene normalization. qPCR-DAMS has three quality control steps and a data display system to monitor data variation. In summary, qPCR-DAMS is a handy tool for real-time PCR users.

Database Management Systems↗

GIST: A web tool for collecting gene information.

As the human genome is sequenced and annotated, an important step in future genetic studies of complex traits and diseases will be the identification of relevant candidate genes. To enable such compilations, it would be useful to collate all necessary and available genetic information for each candidate gene. To this end, we have created a web tool (http://genome.cwru.edu/gist/gist.html+ ++) to allow the rapid cataloging of currently available genetic data. This tool, called GIST (or "Gene Information Search Tool"), allows an investigator to search the major genomic databases containing gene and marker information from a single query point. To prove the utility of GIST, a catalog of 150 hypertension candidate genes was created. This resource collates all available nucleotide and amino acid sequence data, expression data, chromosomal map location, and genetic marker interval for each gene, collected from on-line databases. These data can be used to guide genetic studies of hypertension.

Databases, Factual↗

Underdiagnosis of chronic obstructive pulmonary disease: a rationale for spirometry as a screening tool.

Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and mortality. It is the fourth leading cause of death in the United States, and its impact on quality of life can be severe. The debate on spirometry as a screening tool has been raised and dropped on various occasions over the past 30 years. This paper readdresses the debate in the light of recent evidence from population studies. Spirometry is an underused, easy to perform office-based procedure that has been further facilitated by the advent of modern technology. Despite the fact that spirometry is the gold standard for the diagnosis and assessment of COPD, mass screening using this tool remains controversial. This article provides a discussion based on a recent review of the literature regarding the current and future status of spirometry as a screening tool. A thoughtful approach to spirometry screening should include assessments of the magnitude of underdiagnosis, potential effectiveness of intervention, predictive value of spirometry and clinical profile of patients with COPD.

Humans↗

Apraxia of tool use: an autopsy case of biparietal infarction.

Although disorders in the use of single objects have been reported, there have been few detailed analyses. We describe the autopsy case of a 65-year-old, right-handed male patient with severe impairment of actual tool use which was caused by biparietal infarctions. He persistently and stably showed a severely defective use of actual objects, single or multiple, and relatively well-preserved pantomimes of object use and intransitive gestures. He did not have aphasia or dementia, and his ability for tool naming and function description was completely preserved. The author identified similar patterns of errors about a tool-action(-target) relationship both in single-object use and multiple-object use. Lesion analysis showed cortical infarcts mainly located in the bilateral inferior parietal lobules, extending into the temporal lobe on the right side.

Aged↗

Evaluation of virtual reality bronchoscopy as a learning and assessment tool.

BACKGROUND: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. OBJECTIVE: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. METHODS: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). CONCLUSIONS: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.

Bronchoscopy↗

Theoretical analysis of a carbon-carbon dimer placement tool for diamond mechanosynthesis.

Density functional theory is used with Gaussian 98 to analyze a new family of proposed mechanosynthetic tools that could be employed for the placement of two carbon atoms--a carbon-carbon (CC) dimer--on a growing diamond surface at a specific site. The analysis focuses on specific group IV-substituted biadamantane tool tip structures and evaluates their stability and the strength of the bond they make with the CC dimer. These tools should be stable in a vacuum and should be able to hold and position a CC dimer in a manner suitable for positionally controlled diamond mechanosynthesis at room temperature.

Adamantane↗

A brief screening tool for a prepubertal and early adolescent bipolar disorder phenotype.

OBJECTIVE: Although there has recently been increased interest in child mania, there is as yet no brief screening tool that separates a prepubertal and early adolescent bipolar disorder phenotype from attention deficit hyperactivity disorder (ADHD), the most relevant differential diagnosis. METHOD: Parents of 268 consecutively ascertained subjects (93 with a prepubertal and early adolescent bipolar disorder phenotype, 81 with ADHD, 94 in a healthy comparison group) completed the 10-item Conners' Abbreviated Parent Questionnaire, before separate Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia interviews of parents and children. Data from the Conners' Abbreviated Parent Questionnaire were analyzed by using receiver operating characteristic methods. RESULTS: A screening algorithm that yielded a sensitivity of 0.73 and a specificity of 0.86 was developed from the Conners' Abbreviated Parent Questionnaire. CONCLUSIONS: The Conners' Abbreviated Parent Questionnaire is a promising tool as a screen for a prepubertal and early adolescent bipolar disorder phenotype and has similar sensitivity and specificity to screening tools for adult bipolar disorder.

Adolescent↗

Development of the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) tool.

Increasing numbers of seniors are choosing to remain in the community; however statistics for in-home accidents indicate that the over-65 age group is at the greatest risk. The purpose of this article is to describe the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) Tool, which was developed by occupational therapists to address the need for a comprehensive functional and environmental assessment tool to be used with the elderly in the community. It consists of 15 areas of concern arranged in a logical and sensitive manner, subdivided into 128 items or functions. All items must be addressed and if appropriate, checked off as a problem. The tool fulfills the requirements of being quick and easy to use and on completion, it provides clear directions for intervention and treatment.

Accidents, Home↗

Pistol grip power tool handle and trigger size effects on grip exertions and operator preference.

Finger and palmar forces were measured during actual pneumatic nutrunner operation using a strain gauge dynamometer. Eighteen student subjects were assigned to one of three categories based on hand length. Two triggers and four handle spans were presented randomly. Handle span affected maximal and submaximal grip force. As span increased from 4 cm to 7 cm, average peak finger force increased 24%, peak palmar force increased 22%, and average finger and palmar tool-holding forces increased 20%. When an extended trigger was used, average peak finger force decreased 9%, peak palmar force decreased 8%, finger tool-holding force decreased 65%, and palmar tool-holding force decreased 48%. Hand size affected grip strength (MVC), grip force, and exertion level (force/MVC). Holding exertion level was maximum for large-handed subjects using a 4-cm handle and for small-handed subjects using a 7-cm handle. Subjective handle span preference increased as hand size increased. A similar experiment was performed using 11 factory workers.

Adult↗

The Mini Nutritional Assessment as an assessment tool in elders in long-term care.

The prevalence of malnutrition increases with age and is most common in the institutionalized individual. Malnutrition is a condition associated with greater susceptibility to infection, longer hospital stay, and increased mortality. Detection of risk of malnutrition in elders and early intervention may lessen these negative consequences. A tool that has been used for assessing nutritional status of elders is the Mini Nutritional Assessment, or MNA. The MNA tool was originally validated in relatively healthy elders in France and New Mexico, but assessment scores seem to correlate with immune function, morbidity, and mortality of elders in long-term care. One of the advantages of using the MNA for assessing nutritional status of elders in long-term care is that it does not need any biochemical tests, such as serum albumin or prealbumin. A weakness of the MNA is that a number of questions target independent-living elders but not elders in long-term care or elders receiving nutrition support. The benefits, limitations, and interpretations in the use of this tool in a long-term care setting are discussed.

Journal Article↗

Assessing psychosocial variables: a tool for diabetes educators.

The purpose of this article is to share an educational strategy or tool that is relevant for use in patient and professional diabetes education. The tool offers an opportunity for diabetes educators to screen for psychosocial variables such as depression or emotional distress. A systematic review of the literature was conducted to identify psychological variables that have an impact on individuals living with diabetes and their ability to self-manage their disease. The literature revealed that both depression and emotional distress related to diabetes was experienced by individuals with diabetes along with those individuals who were unable to self-management their disease. The Accu-Check Interview is a computer software program that may assist diabetes educators to provide diabetes education. Use of the Accu-Check Interview software program has been implemented at various sites including the Joslin Clinic (Boston, Mass), Baystate Medical Center (Springfield, Mass), and Emerson Hospital (Concord, Mass). The Diabetes Self Care Profile is a Web-based version of the Accu-Check Interview and can be accessed as a demonstration in English and Spanish. These tools allow diabetes educators to screen for psychosocial variables and address issues with individuals while using a motivational interviewing approach.

Computers↗

In search of tools to aid logical thinking and communicating about medical decision making.

To have real-time impact on medical decision making, decision analysts need a wide variety of tools to aid logical thinking and communication. Decision models provide a formal framework to integrate evidence and values, but they are commonly perceived as complex and difficult to understand by those unfamiliar with the methods, especially in the context of clinical decision making. The theory of constraints, introduced by Eliyahu Goldratt in the business world, provides a set of tools for logical thinking and communication that could potentially be useful in medical decision making. The author used the concept of a conflict resolution diagram to analyze the decision to perform carotid endarterectomy prior to coronary artery bypass grafting in a patient with both symptomatic coronary and asymptomatic carotid artery disease. The method enabled clinicians to visualize and analyze the issues, identify and discuss the underlying assumptions, search for the best available evidence, and use the evidence to make a well-founded decision. The method also facilitated communication among those involved in the care of the patient. Techniques from fields other than decision analysis can potentially expand the repertoire of tools available to support medical decision making and to facilitate communication in decision consults.

Carotid Stenosis↗

The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI).

The purpose of this study was to develop a valid, reliable, and responsive disease-specific quality of life measurement tool for patients with shoulder instability. Development included 1) identification of a specific patient population; 2) generation of issues specific to the "disease" ("items") from reviewing the literature, interviewing health caregivers, and interviewing patients representing all demographics, disease type and severity, and treatments; 3) item reduction using patient-generated frequency-importance products and correlation matrices; and 4) pretesting the prototype instrument on 2 groups of 10 patients. The final instrument, the Western Ontario Shoulder Instability Index, has 21 items representing 4 domains. The instrument attributes (validity, reliability, and responsiveness) were evaluated. Construct validation demonstrated that this index correlated predictably with other measures. Reliability was very high at 2 weeks and 3 months, and the index was more responsive (sensitive to change) than five other shoulder measurement tools (the Disabilities of the Arm, Shoulder and Hand scale; The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form; the UCLA Shoulder Rating Scale; the Constant Score; and the Rowe Rating Scale), a global health instrument (the SF12), and range of motion. Since the patient's perception of changes in health status is the most important indicator of the success of a treatment, we suggest that this measurement tool be used as the primary outcome measure to evaluate treatments in this patient population, although it can also be used for monitoring patients' progress in clinical practice.

Demography↗

A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit.

OBJECTIVE: The aim of this study was to validate a clinician-friendly pain assessment tool for all groups of critically ill infants cared for in the specific neonatal intensive care units (NICUs) studied. DESIGN: A prospective study was undertaken to test the Pain Assessment Tool (PAT). Interrater reliability of the PAT score was assessed by two nurses who simultaneously determined an infant's PAT score. The PAT was validated against the CRIES score--crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness--and the mother's assessment of her infant's discomfort using the Visual Analogue Scale (VAS). SETTING: The NICUs at two children's hospitals. PATIENTS: Participants were 144 preterm and term infants. Infants on a ventilator and those who had undergone surgery were included. RESULTS: The interrater reliability of the PAT was .85 with a mean difference of 0.17 (standard deviation: 1.73). There was a strong correlation between the PAT and CRIES scores (r = 0.76) and a moderate correlation (.38) between the PAT score and the VAS scores of the infant's mother. The correlation coefficient between the PAT score and CRIES score was significant for all groups (p < .01). CONCLUSIONS: The PAT score was shown in this study to be a valid, reliable, and clinician-friendly pain assessment measurement tool for all infants nursed in the NICU.

Female↗