Development of a tool to facilitate real life activity retraining in hand and arm therapy

2017 ◽  
Vol 80 (5) ◽  
pp. 310-318 ◽  
Author(s):  
Kanta Ohno ◽  
Kounosuke Tomori ◽  
Takashi Takebayashi ◽  
Tatsunori Sawada ◽  
Hirofumi Nagayama ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Upper Extremity ◽  
Delphi Method ◽  
Daily Living ◽  
Real Life ◽  
Field Tests ◽  
Occupational Therapists ◽  
Life Activity ◽  
Successful Recovery

Introduction Successful recovery of upper extremity function after stroke is more likely when the affected limb is used regularly in daily life. We developed an iPad (Apple) application called the ‘Aid for Decision-Making in Occupation Choice for Hand’ to facilitate daily upper extremity use. This study examined the suitability of items and pictures in the Aid for Decision-Making in Occupation Choice for Hand, and tested a paper prototype of the application (which has since been produced). Method We used a Delphi method with 10 expert occupational therapists to refine the items in the aid. Next, we prepared pictures of items in the aid and confirmed their suitability by testing them with 10 patients (seven stroke, three cervical spondylotic myelopathy). Nine occupational therapists conducted field tests with a paper prototype of the aid in clinical practice to examine its utility. Results After four Delphi rounds, we selected 130 items representing activities of daily living, organized into 16 categories. Of 130 pictures, 128 were recognizable to patients as representing the intended activities. Based on testing of the paper prototype, we found the Aid for Decision-Making in Occupation Choice for Hand process was suitable for clinical practice, and could be organized into six steps. Conclusion The Aid for Decision-Making in Occupation Choice for Hand process may promote daily upper extremity use. This application, since developed, now needs to be clinically tested in its digital form.

scholarly journals Desenvolvimento e Avaliação de uma Plataforma Colaborativa Digital para Educação e Tomada de Decisão Médica Baseada em Evidências

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based ◽  
Life Problems

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

scholarly journals Creating national guidelines for assessing functional and work capacity of recently settled persons

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Henriksson ◽  
S Rask ◽  
H Anttila ◽  
H Kuusio
Keyword(s):  
Clinical Practice ◽  
Daily Living ◽  
Occupational Therapists ◽  
Work Capacity ◽  
Cross Cultural ◽  
Capacity Assessment ◽  
National Guidelines ◽  
Cultural Assessment ◽  
Online Access ◽  
Work Capacity Assessment

Abstract Problem The measurement of functioning in clinical practice should be systematic and comprehensive. However, different versions of the same functioning measure are used e.g. by physicians, psychologists, physiotherapists and occupational therapists. The TOIMIA network of experts aims to harmonize and develop the measuring of functioning in Finland. Description of the problem With increasing immigration to Finland, a specific need for guidelines on how to assess functional and work capacity of recently settled persons was identified. Led by the National Institute for Health and Welfare (mobiTARMO-project, 2017-2020), guidelines for assessing functional and work capacity in the integration phase are in preparation. Results The guidelines on assessing functional and work capacity in the integration phase include four principles: Functional and work capacity assessment should be done with culturally and linguistically appropriate methods.Assessment should be based on shared expertise of the professional and the client.Assessment should be comprehensive, and take into consideration physical, psychological, social and cognitive functional capacity, activities of daily living, and environmental factors.Assessment should be systematic and lead to further actions and necessary services.The national guidelines will be disseminated as free online access material in the Terveysportti health portal to professionals in clinical practice and research. Lessons There are specificities to the cross-cultural assessment of functional and work capacity of recently settled persons. National guidelines can be created through broad collaboration of different organizations, as in the TOIMIA network of experts in Finland. Key messages Jointly agreed principles on how to assess functional and work capacity in the integration phase benefit professionals and clients. National guidelines can be created, disseminated and taken into practice through broad collaboration.

scholarly journals Individual Reference Intervals for Personalized Interpretation of Clinical and Metabolomics Measurements

2021 ◽  
Author(s):  
Murih Pusparum ◽  
G&oumlkhan Ertaylan ◽  
Olivier Thas
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Reference Interval ◽  
Clinical Decision ◽  
Upper And Lower Bounds ◽  
Life Data ◽  
Real Life Data ◽  
Data Points

The Population Reference Interval (PRI) refers to the range of outcomes that are expected in a healthy population for a clinical or a diagnostic measurement. This interval is widely used in daily clinical practice and is essential for assisting clinical decision making in diagnosis and treatment. In this study, we demonstrate that each individual indeed has a range for a given variable depending on personal biological traits. This Individual Reference Interval (IRI) can be calculated and be utilized in clinical practice, in combination with the PRI for improved decision making where multiple data points are present per variable. As calculating IRI requires several data points from the same individual to determine a personal range, here we introduce novel methodologies to obtain the correct estimates of IRI. We use Linear Quantile Mixed Models (LQMM) and Penalized Joint Quantile Models (PJQM) to estimate the IRI's upper and lower bounds. The estimates are obtained by considering both the within and between subjects' variations. We perform a simulation study designed to benchmark both methods' performance under different assumptions, resulted in PJQM giving a better empirical coverage than LQMM. Finally, both methods were evaluated on real-life data consisting of eleven clinical and metabolomics parameters from the VITO IAM Frontier study. The PJQM method also outperforms LQMM on its predictive accuracy in the real-life data setting. In conclusion, we introduce the concept of IRI and demonstrate two methodologies for calculating it to complement PRIs in clinical decision making.

scholarly journals Person-Centred Care Including Deprescribing for Older People

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 101 ◽  
Author(s):  
Heather Smith ◽  
Karen Miller ◽  
Nina Barnett ◽  
Lelly Oboh ◽  
Emyr Jones ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Older People ◽  
Shared Decision Making ◽  
Real Life ◽  
Decision Making Process ◽  
Shared Decision ◽  
Good Communication ◽  
Values And Beliefs

There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person’s views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person’s priorities and the clinician’s priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies.

scholarly journals The use of virtual patient in teaching clinical practice skills to nursing students

2019 ◽  
Vol 16 (4) ◽  
pp. 907-915
Author(s):  
Gül Şahin ◽  
Tülay Başak
Keyword(s):  
Decision Making ◽  
Critical Thinking ◽  
Nursing Education ◽  
Clinical Practice ◽  
Nursing Students ◽  
Real Life ◽  
Virtual Patient ◽  
English Summary ◽  
Virtual Patients ◽  
Clinical Scenarios

Virtual patients are used as training method to gain professional competencies in nursing education. Virtual patients are real-life interactive computer-based clinical scenarios where students can learn appropriate information and practices to plan and manage patient care, and can be used for health care, training, or evaluation. Virtual patient technology that provides skill in a risk-free environment provides real-time feedback on student activity that can affect decision-making when they contact with the patient. If included in the curriculum appropriately; virtual patient technology can help the student develop numerous skills such as clinical assessment, patient interaction, critical thinking, therapeutic approach and adaptation to a changing environment. It helps students to overcome the limits of clinical practice, develop coping skills, support critical thinking, develop decision-making skills, and quickly adapt to clinical settings. ​Extended English summary is in the end of Full Text PDF (TURKISH) file.   Özet Sanal hastalar, hemşirelik eğitiminde mesleki yeterlikleri kazanmak için eğitim yöntemi olarak kullanılmaktadır. Öğrencilerin hasta bakımını planlamak ve yönetmek için uygun bilgi ve uygulamaları öğrenebilecekleri, sağlık bakımı, eğitim veya değerlendirme amacıyla kullanılabilen gerçek yaşamla etkileşimli bilgisayar tabanlı klinik senaryolardır. Risksiz bir ortamda beceri kazandıran sanal hasta teknolojisi, hasta ile temasa geçtiğinde karar vermeyi etkileyebilecek öğrenci etkinliği hakkında gerçek zamanlı geribildirim sağlar. Müfredata uygun bir şekilde dahil edilirse; sanal hasta teknolojisi öğrenciye klinik değerlendirme, hasta etkileşimi, eleştirel düşünme, terapötik yaklaşım ve değişen bir ortama uyum sağlama gibi çok sayıda becerinin geliştirilmesine yardımcı olabilir. Öğrencilerin klinik uygulamaların sınırlarını aşmalarına, baş etme becerilerini geliştirmelerine, eleştirel düşünceyi desteklemelerine, karar verme becerilerini geliştirmelerine ve klinik ortamlara hızlı bir şekilde adapte olmalarına yardımcı olmaktadır.

Expectations in the Care of Lung Cancer

2015 ◽  
pp. e420-e424
Author(s):  
Rogerio Lilenbaum ◽  
Natasha B. Leighl ◽  
Marcus Neubauer
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Decision Making ◽  
Clinical Practice ◽  
Statistical Significance ◽  
Real Life ◽  
Clinical Trial Data ◽  
Routine Clinical Practice ◽  
Trial Data ◽  
Decision Making Process

One of the main challenges oncologists face in the care of patients with lung cancer is the decision to incorporate new clinical trial data into routine clinical practice. Beyond the question of statistical significance, which is a more objective metric, are the results meaningful and applicable to a broader population? Furthermore, in an era of value care, do the results justify a potential increase in costs? This article discusses the main points that clinicians consider in their decision-making process and illustrates the arguments with real-life examples.

scholarly journals Effect of Education on Shared Decision-making using Clinical Practice Guidelines: A Randomized Controlled trial.

2020 ◽  
Author(s):  
Shuhei Fujimoto ◽  
Tatsuya Ogawa ◽  
Kanako Komukai ◽  
Takeo Nakayama
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based Practice ◽  
Occupational Therapists ◽  
Evidence Based ◽  
Shared Decision ◽  
Randomized Controlled

Abstract Background: To investigate the influence of the evidence–practice gap on physiotherapists and occupational therapists through shared decision making (SDM) using clinical practice guidelines (CPGs).Methods: The study was designed as a blocked, randomized controlled multicenter trial. Participants included 126 therapists with 42 continuous samplings from three institutions. Being a permanent employee from any of these institutions was a necessary inclusion criterion. However, participants with disorders (visual, auditory, attentional disorder) were excluded. An allocator was assigned to mask the participation’s attribution until the allocation was completed. The evaluator and analyzer were also masked. For the intervention group, a workshop was conducted on SDM using CPGs. Lecture on the knowledge of CPGs (CPG group) and lecture on the knowledge of SDM (SDM group) were the control groups. The primary outcomes were “education, attitudes and beliefs, and interest and perceived role in evidence-based practice (EPIC scale).” The secondary outcome included evidence-based practice (EBP) knowledge. To review the intervention effect of education on SDM using CPGs, two-factor variance analysis (mixed model) was adopted to conduct Holm’s method.Results: In each group, 42 participants were randomized and analyzed. The EPIC scale showed significant difference between the CPG with SDM and CPG groups (CPG with SDM group [mean ± standard deviation, pre/post]：2.4±0.9/4.4±1.7; CPG group： 3.0±1.5/3.5±2.0; SDM group： 2.6±1.2/ 3.3±1.8）. The question on EBP “I learned the foundations for EBP as a part of my academic preparation” showed significant differences between the CPG with SDM and CPG groups （CPG with SDM group： 1.8±0.8/2.2±1.0; CPG group： 2.3±1.1/ 2.0±1.0）.Conclusion: SDM education using CPGs for physical and occupational therapists improves EBP self-efficacy.

scholarly journals Development and Evaluation of a Crowdsourcing Platform for Education and Evidence-Based Medical Decision-Making

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

scholarly journals The Effect of Education on Clinical Practice Guidelines with Shared Decision Making: A Randomized Controlled trial

2020 ◽  
Author(s):  
Shuhei Fujimoto ◽  
Tatsuya Ogawa ◽  
Kanako Komukai ◽  
Takeo Nakayama
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Evidence Based Practice ◽  
Occupational Therapists ◽  
Secondary Outcome ◽  
Evidence Based ◽  
Shared Decision

Abstract Background: To investigate the influence of the evidence-practice gap on physiotherapists and occupational therapists through shared decision making (SDM) education using clinical practice guidelines (CPGs).Methods: The study design was a multicenter, blocked, randomized control trial. Participants included 126 therapists with 42 continuous samplings from the three institutions. Inclusion criteria were being a permanent employee from the institutions. Exclusion criteria were participants with disorders that may cause intervention (visual, auditory, attentional disorder). An allocator assigned masked the participation’s attribution until the allocation was completed. The evaluator and analyzer were masked. For the intervention group, workshop on SDM using the CPGs were conducted. The control group was lecture on the knowledge of CPGs (CPG group) and lecture on the knowledge of SDM (SDM group). The primary outcomes were education, attitudes and beliefs, and interest and perceived role in evidence-based practice (EPIC scale). The secondary outcome was the Evidence based practice (EBP) knowledge. To review the intervention effect of the education on SDM using CPGs, two-factor variance analysis (mixed model) was adopted to conduct Holm’s method in comparison to a post-hoc test.Results: Participants randomized and analysed in each group were 42. The EPIC scale showed significant difference between CPGs with SDM group and the CPG group (CPG with SDM group (mean ± standard deviation, pre/post）：2.4±0.9/4.4±1.7; CPG group：3.0±1.5/3.5±2.0; SDM group ：2.6±1.2/ 3.3±1.8）. The question item on EBP “I learned the foundations for EBP as part of my academic preparation” had significant differences between CPGs with SDM group and CPGs group（CPG with SDM group：1.8±0.8/2.2±1.0; CPG group：2.3±1.1/ 2.0±1.0）.Conclusions: EBP education on the SDM using CPGs increased confidence in using EBP for physiotherapists and occupational therapists.

Assistive Technology for Cognition: Perspectives on Funding

2013 ◽  
Vol 23 (2) ◽  
pp. 84-89
Author(s):  
Kathy de Domingo
Keyword(s):  
Assistive Technology ◽  
Daily Living ◽  
Occupational Therapists ◽  
Personal Digital Assistants ◽  
Speech Language Pathology ◽  
Prosthetic Devices ◽  
Funding Sources ◽  
Ankle Foot Orthoses ◽  
Language Pathology ◽  
Communication Challenges

Physical and occupational therapists commonly provide services that incorporate prosthetic and orthotic devices such as crutches, canes, reachers, and ankle–foot orthoses to support mobility and activities of daily living (ADLs). Likewise, speech-language pathologists provide services incorporating prosthetic devices to support communication such as an electrolarynx, microcomputers, and mobile devices and apps with voice output capability. Assistive technology for cognition (ATC) includes the use of personal digital assistants (PDAs), tablets, and smart phones — cognitive prostheses — to compensate for cognitive challenges following acquired brain injury (ABI). Whereas funding sources for devices and services that support/compensate for mobility, ADLs, and communication challenges are generally well established, funding for ATC devices and services is relatively new to the field of speech-language pathology. This article explores the funding aspect of ATC devices and services.

Sign in / Sign up

Export Citation Format

Share Document