scholarly journals New Device for Intrinsic Hand Muscle Strength Measurement: An Alternative to Strain Gauge Handheld Dynamometer

2017 ◽  
Vol 42 (1) ◽  
pp. 103-113 ◽  
Author(s):  
Jagannathan Madhanagopal ◽  
Om Prakash Singh ◽  
Vikram Mohan ◽  
Kathiresan V. Sathasivam ◽  
Abdul Hafidz Omar ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Clinical Decision Making ◽  
Force Measurement ◽  
Interobserver Reliability ◽  
Clinical Decision ◽  
Strength Measurement ◽  
New Device ◽  
Intrinsic Hand Muscle ◽  
Hand Muscle ◽  
Accuracy And Repeatability

An accurate measurement of intrinsic hand muscle strength (IHMS) is required by clinicians for effective clinical decision-making, diagnosis of certain diseases, and evaluation of the outcome of treatment. In practice, the clinicians use Intrins-o-meter and Rotterdam Intrinsic Hand Myometer for IHMS measurement. These are quite bulky, expensive, and possess poor interobserver reliability (37–52%) and sensitivity. The purpose of this study was to develop an alternative lightweight, accurate, cost-effective force measurement device with a simple electronic circuit and test its suitability for IHMS measurement. The device was constructed with ketjenblack/deproteinized natural rubber sensor, 1-MΩ potential divider, and Arduino Uno through the custom-written software. Then, the device was calibrated and tested for accuracy and repeatability within the force range of finger muscles (100 N). The 95% limit of agreement in accuracy from −1.95 N to 2.06 N for 10 to 100 N applied load and repeatability coefficient of ±1.91 N or 6.2% was achieved. Furthermore, the expenditure for the device construction was around US$ 53. For a practical demonstration, the device was tested among 16 participants for isometric strength measurement of the ulnar abductor and dorsal interossei. The results revealed that the performance of the device was suitable for IHMS measurement.

scholarly journals Direct current electrocorticography for clinical neuromonitoring of spreading depolarizations

2016 ◽  
Vol 37 (5) ◽  
pp. 1857-1870 ◽  
Author(s):  
Jed A Hartings ◽  
Chunyan Li ◽  
Jason M Hinzman ◽  
C William Shuttleworth ◽  
Griffin L Ernst ◽  
...  
Keyword(s):  
Direct Current ◽  
Clinical Decision Making ◽  
Tissue Injury ◽  
Interobserver Reliability ◽  
Electrical Potential ◽  
Training Session ◽  
Clinical Decision ◽  
Platinum Electrodes ◽  
Slow Potentials ◽  
The Impact

Spreading depolarizations cause cortical electrical potential changes over a wide spectral range that includes slow potentials approaching the direct current (or 0 Hz) level. The negative direct current shift (<0.05 Hz) is an important identifier of cortical depolarization and its duration is a measure of potential tissue injury associated with longer lasting depolarizations. To determine the feasibility of monitoring the full signal bandwidth of spreading depolarizations in patients, we performed subdural electrocorticography using platinum electrode strips and direct current-coupled amplifiers in 27 patients with acute brain injury at two neurosurgical centers. While large baseline direct current offsets developed, loss of data due to amplifier saturation was minimal and rates of baseline drift throughout recordings were generally low. Transient negative direct current shifts of spreading depolarizations were easily recognized and in 306/551 (56%) cases had stereotyped, measurable characteristics. Following a standardized training session, novice scorers achieved a high degree of accuracy and interobserver reliability in identifying depolarizations, suggesting that direct current-coupled recordings can facilitate bedside diagnosis for future trials or clinical decision-making. We conclude that intracranial monitoring of slow potentials can be achieved with platinum electrodes and that unfiltered, direct current-coupled recordings are advantageous for identifying and assessing the impact of spreading depolarizations.

scholarly journals A New Device to Automate the Monitoring of Critical Patients’ Urine Output

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Abraham Otero ◽  
Andrey Apalkov ◽  
Roemi Fernández ◽  
Manuel Armada
Keyword(s):  
Patient Outcomes ◽  
Urine Output ◽  
Clinical Decision Making ◽  
Capacitive Sensor ◽  
Clinical Decision ◽  
In Vitro Tests ◽  
Therapeutic Goals ◽  
New Device ◽  
Improve Patient

Urine output (UO) is usually measured manually each hour in acutely ill patients. This task consumes a substantial amount of time. Furthermore, in the literature there is evidence that more frequent (minute-by-minute) UO measurement could impact clinical decision making and improve patient outcomes. However, it is not feasible to manually take minute-by-minute UO measurements. A device capable of automatically monitoring UO could save precious time of the healthcare staff and improve patient outcomes through a more precise and continuous monitoring of this parameter. This paper presents a device capable of automatically monitoring UO. It provides minute by minute measures and it can generate alarms that warn of deviations from therapeutic goals. It uses a capacitive sensor for the measurement of the UO collected within a rigid container. When the container is full, it automatically empties without requiring any internal or external power supply or any intervention by the nursing staff. In vitro tests have been conducted to verify the proper operation and accuracy in the measures of the device. These tests confirm the viability of the device to automate the monitoring of UO.

scholarly journals Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

2020 ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Intraobserver Agreement ◽  
Intraobserver Reproducibility ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with PM. However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system was proposed, known as the ATN grading and classification system, which was based on the fundus photographs and OCT images, including three variable components: atrophy (A), traction (T), and neovascularization (N). Hence, this study aimed to perform an independent interobserver and intraobserver agreement evaluation of the recently developed ATN grading system for MM. Methods: This was a retrospective study. Fundus photographs and the optical coherence tomography (OCT) images of 125 patients (226 eyes) with various of MM were evaluated and classified using the ATN grading of the new MM classification system by four evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were repeatedly evaluated by the same evaluators after an interval of 6 weeks. The Kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.Results: The interobserver reliability was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the sub-types was good or excellent, except for stages A1, A2, and N1 which weighted κ value was less than 0.6, with a moderate agreement. The intraobserver reproducibility of types or sub-types was excellent, with κ>0.8. No significant differences were observed between attending ophthalmologists and residents in the interobserver reliability and intraobserver reproducibility.Conclusions: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented at clinical decision-making and disease progression assessment.

scholarly journals Intra- and interobserver concordance of a new classification system for myopic maculopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Pathologic Myopia ◽  
Intraobserver Agreement ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM. Methods This was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement. Results The interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility. Conclusions The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

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