scholarly journals 89 Improving Pain Assessment and Management for Patients with Cognitive Impairment on the Care of the Older Person (COOP) Wards

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
K Ryan ◽  
J Whitehead ◽  
N Lindenberg ◽  
K Shah
Keyword(s):  
Cognitive Impairment ◽  
Staff Training ◽  
Alternative Assessment ◽  
Assessment Tool ◽  
Fold Increase ◽  
Pain Scale ◽  
Older Person ◽  
Before And After ◽  
User Friendly ◽  
Practice Development

Abstract Introduction Patients with cognitive impairment are at risk of underassessment and inadequate management of pain. Self-reporting is unlikely to be a reliable indicator of pain and numerical scales have reduced validity, hence an alternative assessment tool must be used. The Abbey Pain Scale is widely regarded to be user friendly. Regular analgesia should be used for these patients where possible instead of “as required” (PRN). Using QIP methodology, we aimed to improve the use of the Abbey Pain Scale for assessment of patients with cognitive impairment and better analgesia prescribing. Methods Audit of patient records on COOP wards (computer and physical notes, n = 48 first cycle, n = 32 second cycle) before and after staff training, assessing patients with cognitive impairment for: use of Abbey Pain Scale; use of regular paracetamol; pain assessments documented by different healthcare professionals. Results In the first cycle, 16 patients had cognitive impairment: only 1 of these patients (6%) was assessed using the Abbey Pain Scale. Group teaching for the multidisciplinary team on pain assessments was undertaken with practice development nurses. In the re-audit, 13 patients had cognitive impairment and 6 of these (46%) were assessed using the Abbey Pain Scale, showing a clear improvement following staff training. The second cycle showed a 50% increase in the prescription of regular paracetamol for patients with cognitive impairment. There was also a 2.5-fold improvement in therapy staff documenting pain assessments between the two audits. Conclusions Staff training in the use of the Abbey Pain Scale led to an almost 8-fold increase in its use for patients with cognitive impairment. Training on the use of the Abbey Pain Scale should be regularly provided to nurses, physiotherapists and doctors on the care of the older person wards.

EVALUATION OF DYSPHAGIA USING THE EATING ASSESSMENT TOOL QUESTIONNAIRE (EAT-10) BEFORE AND AFTER ENDOSCOPIC TREATMENT OF THE ZENKER DIVERTICULUM

2018 ◽  
Author(s):  
M Guerra Veloz ◽  
M Jose González-Mariscal ◽  
M Belvis Jimenez ◽  
J Loscertales ◽  
H Galera-Ruiz ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Assessment Tool ◽  
Zenker Diverticulum ◽  
Before And After

Application of a Computer Vision Tool for Automated Glottic Tracking to Vocal Fold Paralysis Patients

2021 ◽  
pp. 019459982198960
Author(s):  
Tiffany V. Wang ◽  
Nat Adamian ◽  
Phillip C. Song ◽  
Ramon A. Franco ◽  
Molly N. Huston ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Medical Center ◽  
Characteristic Curve ◽  
Academic Medical Center ◽  
Vocal Fold Paralysis ◽  
Control Group ◽  
Large Patient ◽  
Patient Reported ◽  
Before And After

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.

scholarly journals Virtual Reality Functional Capacity Assessment Tool (VRFCAT-SL) in Parkinson’s Disease

2021 ◽  
pp. 1-9
Author(s):  
Travis H. Turner ◽  
Alexandra Atkins ◽  
Richard S.E. Keefe
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Virtual Reality ◽  
Cognitive Impairment ◽  
Functional Capacity ◽  
Visual Memory ◽  
Assessment Tool ◽  
Task Force ◽  
Self Report ◽  
Capacity Assessment

Background: Cognitive impairment is common in Parkinson’s disease (PD) and highly associated with loss of independence, caregiver burden, and assisted living placement. The need for cognitive functional capacity tools validated for use in PD clinical and research applications has thus been emphasized in the literature. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT-SL) is a tablet-based instrument that assesses proficiency for performing real world tasks in a highly realistic environment. Objective: The present study explored application of the VRFCAT-SL in clinical assessments of patients with PD. Specifically, we examined associations between VRFCAT-SL performance and measures of cognition, motor severity, and self-reported cognitive functioning. Methods: The VRFCAT-SL was completed by a sample of 29 PD patients seen in clinic for a comprehensive neuropsychological evaluation. Fifteen patients met Movement Disorders Society Task Force criteria for mild cognitive impairment (PD-MCI); no patients were diagnosed with dementia. Non-parametric correlations between VRFCAT-SL performance and standardized neuropsychological tests and clinical measures were examined. Results: VRFCAT-SL performance was moderately associated with global rank on neuropsychological testing and discriminated PD-MCI. Follow-up analyses found completion time was associated with visual memory, sustained attention, and set-switching, while errors were associated with psychomotor inhibition. No clinical or motor measures were associated with VRFCAT-SL performance. Self-report was not associated with VRFCAT-SL or neuropsychological test performance. Conclusion: The VRFCAT-SL appears to provide a useful measure of cognitive functional capacity that is not confounded by PD motor symptoms. Future studies will examine utility in PD dementia.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals A hydrological modelling-based approach for vulnerable area identification under changing climate scenarios

2020 ◽  
Author(s):  
Sonam S. Dash ◽  
Dipaka R. Sena ◽  
Uday Mandal ◽  
Anil Kumar ◽  
Gopal Kumar ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Fold Increase ◽  
Maximum Temperature ◽  
Climate Scenarios ◽  
Vulnerable Area ◽  
Temperature And Precipitation ◽  
Monthly Streamflow ◽  
Rcp 8.5 ◽  
Streamflow Data ◽  
Critical Zones

Abstract The hydrologic behaviour of the Brahmani River basin (BRB) (39,633.90 km2), India was assessed for the base period (1970–1999) and future climate scenarios (2050) using the Soil and Water Assessment Tool (SWAT). Monthly streamflow data of 2000–2009 and 2010–2012 was used for calibration and validation, respectively, and performed satisfactorily with Nash-Sutcliffe Efficiency (ENS) of 0.52–0.55. The projected future climatic outcomes of the HadGEM2-ES model indicated that minimum temperature, maximum temperature, and precipitation may increase by 1.11–3.72 °C, 0.27–2.89 °C, and 16–263 mm, respectively, by 2050. The mean annual streamflow over the basin may increase by 20.86, 11.29, 4.45, and 37.94% under RCP 2.6, 4.5, 6.0, and 8.5, respectively, whereas the sediment yield is likely to increase by 23.34, 10.53, 2.45, and 27.62% under RCP 2.6, 4.5, 6.0, and 8.5, respectively, signifying RCP 8.5 to be the most adverse scenario for the BRB. Moreover, a ten-fold increase in environmental flow (defined as Q90) by the mid-century period is expected under the RCP 8.5 scenario. The vulnerable area assessment revealed that the increase in moderate and high erosion-prone regions will be more prevalent in the mid-century. The methodology developed herein could be successfully implemented for identification and prioritization of critical zones in worldwide river basins.

The Keloid Intervention Benefit Inventory 21: A New Assessment Tool for the Quality of Life of Patients with Auricular Keloids

2021 ◽  
Author(s):  
Daniel Häussler ◽  
Stefanie Hüttemann ◽  
Christel Weiß ◽  
Nicole Karoline Rotter ◽  
Haneen Sadick
Keyword(s):  
Quality Of Life ◽  
Internal Consistency ◽  
Social Impact ◽  
Assessment Tool ◽  
Clinical Symptoms ◽  
Physical Symptoms ◽  
Medical Intervention ◽  
Medical Interventions ◽  
Before And After

Abstract Purpose The assessment of the quality of life (QoL) of patients with chronic diseases before and after medical interventions has gained increasing importance in recent decades. Particularly for patients with visible keloid scars in the head and neck region, standardized measurement tools are either absent or have been shown to be insufficient. The aim of the present study was to create a new standardized questionnaire that is specific to auricular keloid patients and reflects their clinical symptoms and QoL. Methods The Keloid Intervention Benefit Inventory 21 (KIBI-21) questionnaire was developed in two stages. First, a group of experts identified a pool of 26 questions and modified and supplemented the items through a comparison with existing QoL assessments so that they related to keloid-specific clinical symptoms and the QoL of patients with auricular keloids before and after a medical intervention. This questionnaire was distributed to 27 outpatients who had undergone medical interventions for visible auricular keloids. Second, a sequential statistical analysis was conducted. This included a single-item assessment and reduction, analysis for internal consistency, construct validity, and divergence validity as well as a factor analysis. The analyses were performed for the entire questionnaire and for the items in the subcategories General Health, Physical Symptoms, Self-Esteem, and Social Impact. Results The final version of this newly validated and standardized KIBI questionnaire consisted of 21 items, of which each item was assigned to only one subscale. The questionnaire showed a Cronbach's α of 0.84 with a good internal consistency. In the item correlation validity, strong associations were found in all subscales, except for the Social Impact Subscale. Conclusion The keloid-specific QoL questionnaire KIBI-21 proved to be a reliable and reproducible instrument to assess the QoL and clinical symptoms in patients suffering from auricular keloids before and after a medical treatment.

scholarly journals Implementation and Evaluation of a Communication Strategy to Control Ragweed Pollen

2016 ◽  
Vol 5 (1) ◽  
pp. 87
Author(s):  
Celine Plante ◽  
Audrey Smargiassi ◽  
Francine Hubert ◽  
Sophie Goudreau
Keyword(s):  
Fold Increase ◽  
Ambrosia Artemisiifolia ◽  
Communication Strategy ◽  
Ragweed Pollen ◽  
Communication Intervention ◽  
Effective Measure ◽  
Land Owners ◽  
Before And After ◽  
Logistic Regressions ◽  
The Common

The common ragweed (<em>Ambrosia artemisiifolia</em>) is widespread in southwestern areas of Quebec, Canada. It is known to release large quantities of pollen from July through September, triggering allergic reactions such as rhinitis and generating significant costs for public health. The objective of this study was to implement and evaluate a communication intervention aimed at decreasing ragweed pollen. Selected lands with potential ragweed presence were visited twice, before and after the intervention, on three seasons in the East of the Montreal Island, Quebec. At the first visit done in 2010, 2011, and 2012, ragweed plots were located and measured; at the second visit in 2012, the measures were redone. Various numbers of communications were sent to owners of ragweed-infested lands that included explanations of health impacts of ragweed pollen and the importance of mowing. Mixed logistic regressions were used to test the effect of the number of communications on the mow. In the group that received four notices, a statistically significant three-fold increase in the proportion of land owners that had cut ragweed plots (OR = 3.20; 95 %CI: 1.16-8.84) was noted, compared to the group that received only one notice. For owners of vacant lands, the effect was somewhat more pronounced (OR = 3.82; 95%CI: 1.23-11.67). Nonetheless, the change from one to three communications showed no increase of mowing. In conclusion, the results of the present study suggest that communications and reminders of the importance of ragweed cut to landowners could be an effective measure to limit ragweed pollen.

Enhancing students' HOTS in laboratory educational activity by using concept map as an alternative assessment tool

2017 ◽  
Vol 18 (4) ◽  
pp. 849-874 ◽  
Author(s):  
I. B. A. Ghani ◽  
N. H. Ibrahim ◽  
N. A. Yahaya ◽  
J. Surif
Keyword(s):  
Alternative Assessment ◽  
Concept Maps ◽  
Assessment Tool ◽  
Concept Map ◽  
Thinking Skills ◽  
Learning Activities ◽  
Educational Activity ◽  
Chemistry Laboratory ◽  
Mapping Technique ◽  
Laboratory Learning

Educational transformation in the 21st century demands in-depth knowledge and understanding in order to promote the development of higher-order thinking skills (HOTS). However, the most commonly reported problem with respect to developing a knowledge of chemistry is poor mastery of basic concepts. Chemistry laboratory educational activities are shown to be less effective in developing an optimum conceptual understanding and HOTS among students. One factor is a lack of effective assessment and evaluation tools. Therefore, the primary focus of this study is to explore concept maps as an assessment tool in order to move students' thinking skills to a higher level during laboratory learning activities. An embedded mixed method design is used in this study, which has also employed a pre-experimental research design. This design triangulates quantitative and qualitative data, which are combined to strengthen the findings. A low-directed concept mapping technique, convergence scoring method, and pre-post laboratory concept map were used in this study. An electrolysis HOTS test was used as the research instrument in order to measure the level of student achievement with respect to high-level questions. In addition, the thought process that is involved when students construct concept maps has been explored and studied in detail by utilising a think-aloud protocol. Results showed a positive development towards understanding and higher level thinking skills in students with respect to electrolysis concepts learned through chemistry laboratory activities. An investigation of the students' thinking processes showed that high-achieving students were more capable of giving a content-based explanation of electrolysis and engaged in monitoring activities more often while building a concept map. Nonetheless, all categories of students managed to show a positive increase in the activities of explanation and monitoring during the construction of concept maps after they were exposed to the assessment tool in the laboratory learning activities. In conclusion, the assessment activity using concept maps in laboratory learning activities has a positive impact on students' understanding and stimulates students to increase their HOTS.

LUU CHECKER: A Web-based Tool to Incorporate Emerging LUs in the SWAT Model

2019 ◽  
Vol 35 (5) ◽  
pp. 723-731 ◽  
Author(s):  
Gurdeep Singh ◽  
Dharmendra Saraswat ◽  
Naresh Pai ◽  
Benjamin Hancock
Keyword(s):  
Land Use ◽  
Management Practices ◽  
Assessment Tool ◽  
Urban Forest ◽  
Swat Model ◽  
Land Use Changes ◽  
Web Based ◽  
Large Size ◽  
Hydrologic Response Unit ◽  
User Friendly

Abstract. Standard practice of setting up Soil and Water Assessment Tool (SWAT) involves use of a single land use (LU) layer under the assumption that no change takes place in LU condition irrespective of the length of simulation period. This assumption leads to erroneous conclusions about efficacy of management practices in those watersheds where land use changes (LUCs) (e.g. agriculture to urban, forest to agriculture etc.) occur during the simulation period. To overcome this limitation, we have developed a user-friendly, web-based tool named LUU Checker that helps create a composite LU layer by integrating multiple years of LU layers available in watersheds of interest. The results show that the use of composite LU layer for hydrologic response unit (HRU) delineation in 2474-km2 L’Anguile River Watershed in Arkansas was able to capture changed LU at subbasin level by using LU data available in the year 1999 and 2006, respectively. The web-based tool is applicable for large size watersheds and is accessible to multiple users from anywhere in the world. Keywords: Land use, Web-based tool, SWAT, LUU Checker.

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