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Validated Tool (validated + tool)
Selected AbstractsPre-operative screening for excessive alcohol consumption among patients scheduled for elective surgeryDRUG AND ALCOHOL REVIEW, Issue 2 2007SWATI SHOURIE Abstract Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation. [source] Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable EldersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007Vineet M. Arora MD OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3,83.7% vs 75.8%, 95% CI=70.5,81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3,83.7 vs 31.4% 95% CI=27.5,35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care. [source] Development of a test to evaluate residents' knowledge of medical procedures,,JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009Shilpa Grover MD Abstract BACKGROUND AND AIM: Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications. METHODS: Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals. RESULTS: Reliability of the instrument as measured by Cronbach's , was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures. CONCLUSIONS: We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare. Journal of Hospital Medicine 2009;4:430,432. © 2009 Society of Hospital Medicine. [source] Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's diseaseMOVEMENT DISORDERS, Issue 13 2007Yael Manor MA Abstract Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 ± 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients. © 2007 Movement Disorder Society [source] Systematic Review of Emergency Physician,performed Ultrasonography for Lower-Extremity Deep Vein ThrombosisACADEMIC EMERGENCY MEDICINE, Issue 6 2008Patrick R. Burnside MD Abstract Objectives:, The authors performed a systematic review to evaluate published literature on diagnostic performance of emergency physician,performed ultrasonography (EPPU) for the diagnosis and exclusion of deep venous thrombosis (DVT). Methods:, Structured search criteria were used to query MEDLINE and EMBASE, followed by a hand search of published bibliographies. Relevance and inclusion criteria required prospective investigation of emergency department (ED) outpatients with suspected DVT; diagnostic evaluations had to consist of EPPU followed by criterion standard (radiology-performed) imaging. Two authors independently extracted data from included studies; study quality was assessed utilizing a validated tool for quality assessment of diagnostic accuracy studies (QUADAS). Pooled data were analyzed using an unweighted summary receiver-operating-characteristic (SROC) curve; sensitivity and specificity were estimated using a random effects model. Results:, The initial search yielded 1,162 publications. Relevance screening and selection yielded six articles including 936 patients. Four of the six studies reported adequate blinding but a number of other methodologic flaws were identified. A random effects model yielded an overall sensitivity of 0.95 (95% confidence interval [CI] = 0.87 to 0.99) and specificity of 0.96 (95% CI = 0.87 to 0.99). Conclusions:, Systematic review of six studies suggests that EPPU may be accurate for the diagnosis of DVT compared with radiology-performed ultrasound (US). However, given the methodologic limitations identified among the primary studies, the estimates of diagnostic test performance may be overly optimistic. Further research into EPPU for suspected DVT is needed before it can be adopted into routine clinical practice. [source] Fishing new proteins in the twilight zone of genomes: The test case of outer membrane proteins in Escherichia coli K12, Escherichia coli O157:H7, and other Gram-negative bacteriaPROTEIN SCIENCE, Issue 6 2003Rita Casadio Abstract We address the problem of clustering the whole protein content of genomes into three different categories,globular, all-,, and all-, membrane proteins,with the aim of fishing new membrane proteins in the pool of nonannotated proteins (twilight zone). The focus is then mainly on outer membrane proteins. This is performed by using an integrated suite of programs (Hunter) specifically developed for predicting the occurrence of signal peptides in proteins of Gram-negative bacteria and the topography of all-, and all-, membrane proteins. Hunter is tested on the well and partially annotated proteins (2160 and 760, respectively) of Escherichia coli K 12 scoring as high as 95.6% in the correct assignment of each chain to the category. Of the remaining 1253 nonannotated sequences, 1099 are predicted globular, 136 are all-,, and 18 are all-, membrane proteins. In Escherichia coli 0157:H7 we filtered 1901 nonannotated proteins. Our analysis classifies 1564 globular chains, 327 inner membrane proteins, and 10 outer membrane proteins. With Hunter, new membrane proteins are added to the list of putative membrane proteins of Gram-negative bacteria. The content of outer membrane proteins per genome (nine are analyzed) ranges from 1.5% to 2.4%, and it is one order of magnitude lower than that of inner membrane proteins. The finding is particularly relevant when it is considered that this is the first large-scale analysis based on validated tools that can predict the content of outer membrane proteins in a genome and can allow cross-comparison of the same protein type between different species. [source] | ||||||||||