Assessment of Clinical Performance during Simulated Crises Using Both Technical and Behavioral Ratings 

1998 ◽  
Vol 89 (1) ◽  
pp. 8-18 ◽  
Author(s):  
David M. Gaba ◽  
Steven K. Howard ◽  
Brendan Flanagan ◽  
Brian E. Smith ◽  
Kevin J. Fish ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Crisis Management ◽  
Clinical Performance ◽  
Assessment Tools ◽  
Rating System ◽  
Ordinal Scale ◽  
Behavioral Ratings ◽  
Technical Performance ◽  
Interrater Variability ◽  
Management Behaviors

Background Techniques are needed to assess anesthesiologists' performance when responding to critical events. Patient simulators allow presentation of similar crisis situations to different clinicians. This study evaluated ratings of performance, and the interrater variability of the ratings, made by multiple independent observers viewing videotapes of simulated crises. Methods Raters scored the videotapes of 14 different teams that were managing two scenarios: malignant hyperthermia (MH) and cardiac arrest. Technical performance and crisis management behaviors were rated. Technical ratings could range from 0.0 to 1.0 based on scenario-specific checklists of appropriate actions. Ratings of 12 crisis management behaviors were made using a five-point ordinal scale. Several statistical assessments of interrater variability were applied. Results Technical ratings were high for most teams in both scenarios (0.78 +/- 0.08 for MH, 0.83 +/- 0.06 for cardiac arrest). Ratings of crisis management behavior varied, with some teams rated as minimally acceptable or poor (28% for MH, 14% for cardiac arrest). The agreement between raters was fair to excellent, depending on the item rated and the statistical test used. Conclusions Both technical and behavioral performance can be assessed from videotapes of simulations. The behavioral rating system can be improved; one particular difficulty was aggregating a single rating for a behavior that fluctuated over time. These performance assessment tools might be useful for educational research or for tracking a resident's progress. The rating system needs more refinement before it can be used to assess clinical competence for residency graduation or board certification.

Abstract 13811: Cognitive and Psychological Outcomes of Patients 6 Months After Cardiac Arrest or Intensive Care Stay

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Matthew R Potter ◽  
Marco Mion ◽  
Eleni A Nikolopoulou ◽  
Neil Magee ◽  
Kelly Farrell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cognitive Impairment ◽  
Length Of Stay ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Icu Patients ◽  
Icu Stay ◽  
Sf 36 ◽  
Significant Difference

Background: The neuropsychological and cognitive consequences of an ICU stay can cause a large burden on many patients. In this study, we assessed the outcomes of a group of patients attending a newly set up, multi-disciplinary outpatient clinic focused on assessing neuropsychological and cognitive outcomes following a significant (>72 hours) ICU stay, and compared patients whose ICU was post-OHCA (out of hospital cardiac arrest), and those non-OHCA. Methods: Between 2016 and 2019, 152 patients were assessed within the Care after REsuscitation (CARE) / ICU follow up clinic, 6 months following hospital discharge, using the SF-36, HADS, PTSS-14 and MoCA. The OHCA group were compared to other non-OHCA, ICU patients (>72 hour stay). Results: No significant differences (p<0.05) were found between the groups outcomes, however we found that 6 months post-discharge, the non-OHCA group experience significantly more pain, are older, and required a longer length of stay (p<0.05). However, we found compared to normative data of the SF-36, over half of the OHCA group (on 6 out of the 8 subscales) and the non-OHCA (on 7 out of the 8) were below population norms, especially Role-Physical (66.7% OHCA and 71.6% non-OHCA) and Energy/ fatigue (66.7% OHCA and 61.4% non-OHCA). Anxiety was observed in 33.3% of the OHCA group, and 35.2% of the non-OHCA group had an abnormal total HADS score. PTSD was seen in 12.7% of the OHCA group and 10.2% of the non-OHCA group. Cognitive impairment was observed in 61.9% of OHCA and 59.1% of non-OHCA patients. Age and hospital length of stay had no significant effect on outcomes on our OHCA population, however females had significantly worse health related quality of life (HRQoL) on 6 out of the 8 subscales (p<0.05). Conclusion: Despite the OHCA and non-OHCA groups having no significant difference between their outcomes, there is a great disease burden upon many individuals following ICU stay, with many experiencing poor HRQoL, mood disorders, PTSD and cognitive impairment. The factors contributing to poor outcome following both ICU related illness and cardiac arrest should be further studied. The creation and validation of new assessment tools is imperative to ensure we fully appreciate the extent of the morbidity in this group to improve care for all ICU patients.

scholarly journals Agreement between commercially available ELISA and in-house Luminex SARS-CoV-2 antibody immunoassays

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rebeca Santano ◽  
Diana Barrios ◽  
Fàtima Crispi ◽  
Francesca Crovetto ◽  
Marta Vidal ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Diagnostic Tests ◽  
Distress Syndrome ◽  
Clinical Performance ◽  
External Validation ◽  
Severe Respiratory Distress ◽  
Technical Performance ◽  
Severe Respiratory Distress Syndrome

AbstractSerological diagnostic of the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is a valuable tool for the determination of immunity and surveillance of exposure to the virus. In the context of an ongoing pandemic, it is essential to externally validate widely used tests to assure correct diagnostics and epidemiological estimations. We evaluated the performance of the COVID-19 ELISA IgG and the COVID-19 ELISA IgM/A (Vircell, S.L.) against a highly specific and sensitive in-house Luminex immunoassay in a set of samples from pregnant women and cord blood. The agreement between both assays was moderate to high for IgG but low for IgM/A. Considering seropositivity by either IgG and/or IgM/A, the technical performance of the ELISA was highly imbalanced, with 96% sensitivity at the expense of 22% specificity. As for the clinical performance, the negative predictive value reached 87% while the positive predictive value was 51%. Our results stress the need for highly specific and sensitive assays and external validation of diagnostic tests with different sets of samples to avoid the clinical, epidemiological and personal disturbances derived from serological misdiagnosis.

Abstract 10394: Long-Term Functional and Quality-of-Life Outcomes of Cardiac Arrest Survivors Stratified by Shock Provider: A 10 Year Retrospective Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Brian A Haskins ◽  
Ziad Nehme ◽  
Emily Andrew ◽  
Stephen Bernard ◽  
Peter Cameron ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Functional Recovery ◽  
Short Form ◽  
First Responders ◽  
Assessment Tools ◽  
Related Quality ◽  
Health Related

Introduction: To assess the long-term functional recovery and health related quality-of-life (HRQoL) outcomes for out-of-hospital cardiac arrest (OHCA) survivors stratified by shock provider. Methods: We included adult OHCA in initial shockable rhythms between 2010-2019. Those surviving to 12 months post arrest were invited to participate in telephone interviews to identify functional recovery and HRQoL outcomes, using the following assessment tools, Glasgow Outcome Scale-Extended (GOS-E), EuroQol-5D (EQ-5D), and 12-Item Short Form (SF-12). Results: Of the 1,581 patients surviving to 12 months, 1,325 (85.5%) responded to the interviews, of these, 227 (17.1%) and 144 (10.9%) were initially shocked by bystanders and first responders, respectively. A higher proportion of patients shocked by bystanders were located in public (p<0.001), received bystander CPR (p<0.001) and received initial defibrillation faster from time of collapse (P<0.001). Survivors receiving bystander defibrillation reported higher rates of living at home without care (p=0.004), upper good recovery (GOS-E) (p=0.008) and EQ-5D index score of 1 (perfect health) (p=0.023). After adjustment, bystander defibrillation was associated with a 64% increase in the odds of an EQ-5D current Visual Analogue Scale ≥ 80 (AOR 1.64, 95%CI: 1.17-2.31; p=0.004) and a 45% increase in the odds of a good functional recovery (GOS-E ≥ 7) (AOR 1.45, 95% CI: 1.02-2.06; p=0.037), than those initially shocked by paramedics. No improvement in adjusted outcomes were observed for survivors initially defibrillated by first responders. Conclusion: Patients receiving bystander defibrillation reported better functional recovery and HRQol outcomes at 12 months compared to those defibrillated by first responders and paramedics.

Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems

Dermatology ◽  
2019 ◽  
Vol 236 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Katarzyna Włodarek ◽  
Aleksandra Stefaniak ◽  
Łukasz Matusiak ◽  
Jacek C. Szepietowski
Keyword(s):  
Interrater Reliability ◽  
Hidradenitis Suppurativa ◽  
Intraclass Correlation ◽  
Scoring Systems ◽  
Staging System ◽  
Severity Index ◽  
Assessment Tools ◽  
Intrarater Reliability ◽  
Global Assessment Scale ◽  
Interrater Variability

A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.

Neurological and Clinical Outcomes After In-Hospital Cardiac Arrest Following a New Legislation on Life-Sustaining Treatments

2020 ◽  
Author(s):  
Sang-beom Jeon ◽  
Hyunjo Lee ◽  
Bobin Park ◽  
Soh Hyun Choi ◽  
Yoon-Hee Hong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Clinical Performance ◽  
Early Time ◽  
Rapid Response Team ◽  
Neurological Status ◽  
Neurological Recovery ◽  
The Awakening ◽  
Before And After ◽  
Response Team ◽  
Hospital Cardiac Arrest

Abstract Background: The precise neurological profiles after in-hospital cardiac arrest (IHCA) are yet to be elucidated. We aimed to evaluate the neurological profiles of patients with IHCA from early time to long-term follow-up and the changes in their neurological outcomes after implementing legislation on the cessation of life-sustaining treatments.Methods: A national legislation allowing the withdrawal of life-sustaining treatments was implemented in South Korea on February 4, 2018. For this prospective cohort study, we established a neurological rapid response team on March 21, 2017, and serially evaluated the neurological status of patients with IHCA from the initial resuscitation to 12 months after the onset of IHCA. The primary outcome was good neurological status defined as a Clinical Performance Category score (range from 1 to 5, with higher scores indicating greater disability) of 1−2 at 12 months after IHCA. The secondary outcomes were the awakening and neurological recovery during the first week and the survival at 12 months. The outcomes were also compared between before and after the implementation of the legislation.Results: Of 291 adult patients with IHCA, 144 were included in the Before Period, and 147 were included in the After Period. Physician Orders for Life-Sustaining Treatments were made in 63 (42.9%) patients in the After Period. On the first day and during the first week after IHCA, the awakening was achieved in 21.0% and 40.9%, respectively, and neurological recovery in 4.1% and 15.8%, respectively. The proportion of patients with good neurological status at 12 months was not significantly different between the Before Period (19.0%) and the After Period (15.1%; p = 0.37). Awakening (40.0% vs. 42.2%; p = 0.65) and neurological recovery (16.7% vs. 15.0%; p = 0 .69) during the first week as well as survival at 12 months (25.0% vs. 18.4%; p = 0.17) also did not show significant differences between the two periods. Conclusion: Awakening and neurological recovery were remarkable throughout the first week. In the current study, implementating the legislation allowing the cessation of life-sustaining treatments did not significantly affect the neurological and survival outcomes after IHCA. Trial registration: This study was registered in clinical-trial.gov (NCT03006484) in December 2016.

Interrater variability of EEG interpretation in comatose cardiac arrest patients

2015 ◽  
Vol 126 (12) ◽  
pp. 2397-2404 ◽  
Author(s):  
Erik Westhall ◽  
Ingmar Rosén ◽  
Andrea O. Rossetti ◽  
Anne-Fleur van Rootselaar ◽  
Troels Wesenberg Kjaer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Interrater Variability

scholarly journals Original Approach for Automated Quantification of Antinuclear Autoantibodies by Indirect Immunofluorescence

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Daniel Bertin ◽  
Noémie Jourde-Chiche ◽  
Pierre Bongrand ◽  
Nathalie Bardin
Keyword(s):  
Indirect Immunofluorescence ◽  
Clinical Performance ◽  
Attractive Alternative ◽  
Major Step ◽  
Gold Standard Method ◽  
Technical Performance ◽  
Antinuclear Autoantibodies ◽  
Automated Quantification ◽  
Laboratory Standardization ◽  
Original Approach

Introduction. Indirect immunofluorescence (IIF) is the gold standard method for the detection of antinuclear antibodies (ANA) which are essential markers for the diagnosis of systemic autoimmune rheumatic diseases. For the discrimination of positive and negative samples, we propose here an original approach named Immunofluorescence for Computed Antinuclear antibody Rational Evaluation (ICARE) based on the calculation of a fluorescence index (FI).Methods. We made comparison between FI and visual evaluations on 237 consecutive samples and on a cohort of 25 patients with SLE.Results. We obtained very good technical performance of FI (95% sensitivity, 98% specificity, and a kappa of 0.92), even in a subgroup of weakly positive samples. A significant correlation between quantification of FI and IIF ANA titers was found (Spearman'sρ=0.80,P<0.0001). Clinical performance of ICARE was validated on a cohort of patients with SLE corroborating the fact that FI could represent an attractive alternative for the evaluation of antibody titer.Conclusion. Our results represent a major step for automated quantification of IIF ANA, opening attractive perspectives such as rapid sample screening and laboratory standardization.

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