Evidence-based Assessment Tools Research Articles

Development and Validation of a Composite Skin Quality Scale

Abstract Background The increasing demand for skin quality interventions in aesthetic medicine underscores the necessity for objective, evidence-based assessment tools that may be used to evaluate novel interventions or devices. Objectives To develop and validate a 5-point photo-numeric rating scale for assessing overall skin quality, including radiance, color evenness, and smoothness. Methods The IBSA (Institut Biochimique SA) Composite Skin Quality Scale was developed and underwent live validation with 88 real-world patients, chosen to encompass a broad spectrum of skin qualities and Fitzpatrick skin types. Scale validation was performed by board-certified plastic surgeons and dermatologists over 2 rounds, 2 weeks apart. Reliability was assessed via intrarater and interrater agreements, utilizing weighted kappa statistics and intraclass correlation coefficient (ICC). The scale's ability to discern a clinically relevant 1-grade difference was evaluated with 72 photo pairs. Results Combined intrarater reliability results showed weighted kappa values of 0.812 (right side) and 0.815 (left side), and an ICC of 0.903 for both sides, indicating almost perfect agreement. Interrater reliability ranged from substantial to almost perfect, with kappa coefficients between 0.654 and 0.853, and ICCs from 0.657 to 0.855 across all rater pairs in both rounds. The ability to detect a clinically relevant 1-point difference using the scale was established. Conclusions Integrating various key aspects of skin quality, the IBSA Composite Skin Quality Scale is a clinically relevant and highly reliable tool, suitable for skin assessment in clinical studies of new aesthetic technologies and products.

Predictive value of a novel digital risk calculator to determine early patient outcomes after major surgery: a proof-of-concept pilot study

BackgroundA structured risk assessment of patients with validated and evidence-based tools can help to identify modifiable factors before major surgeries. The Protego Maxima trial investigated the value of a new digitized risk assessment tool that combines tools which can be easily used and implemented in the clinical workflow by doctors and qualified medical staff. The hypothesis was that the structured assessment and risk-grouping is predictive of short-term surgical quality reflected by complications and overall survival.MethodsThe Protego Maxima Trial was a prospective cohort analysis of patients undergoing major surgery (visceral, thoracic, urology, vascular and gynecologic surgeries) as key inclusion criterion and the absence of an acute or acute on chronically decompensated pulmo-cardiovascular decompensation. Patients were risk-scored with the software (The Prehab App) that includes a battery of evidence-based risk assessment tools that allow a structured risk assessment. The data were grouped to predefined high and low risk groups and aggregate and individual scores. The primary outcome was to validate the predictive value of the RAI score and the TUG for overall survival in the high and low risk groups. Secondary outcomes were surgical outcomes at 90-days after surgery (overall survival, Clavien-Dindo (CD) 1–5 (all complications), and CD 3–5 (major complications)). The study was carried out in accordance with the DIN ISO 14,155, and the medical device regulation (MDR) at Frankfurt University Hospital between March 2022 and January 2023.ResultsIn total 267 patients were included in the intention to treat analysis. The mean age was 62.1 ± 12.4 years. Patients with a RAI score > 25 and/or a timed up and go (TUG) > 8 s had a higher risk for mortality at 90 days after surgery. The low-risk group predicted beneficial outcome and the high-risk group predicted adverse outcome in the ROC analysis (Area Under the Curve Receiver Operator Characteristics: AUROC > 0.800; p = 0.01). Risk groups (high vs. low) showed significant differences for 90-day survival (99.4% vs. 95.5%; p = 0.04) and major complications (16.4% vs. 32.4%; p < 0.001).ConclusionThe proof-of-concept trial showed that a risk assessment with ‘The Prehab App’ may be viable to estimate the preoperative risk for mortality and major complications before major surgeries. The overall performance in this initial set of data indicated a certain reliability of the scoring and risk grouping, especially of the RAI score and the TUG. A larger data set will be required to proof the generalizability of the risk scoring to every subgroup and may be fostered by artificial intelligence approaches.Trial registrationEthics number: 2021-483-MDR/MPDG-zuständig monocentric; The Federal Institute for Pharmaceuticals and Medical Devices/BfArM, reference number: 94.1.04-5660-13655; Eudamed: CIV-21-07-0307311; German Clinical Trial Registry: DRKS 00026985.

Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension.

Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.

Navigating the digital world: development of an evidence-based digital literacy program and assessment tool for youth

The rapid expansion of digital connectivity has provided youth with wide-ranging access to digital platforms for communication, entertainment, and education. In light of this profound shift, there have been growing concerns about online safety, data privacy, and cybersecurity. A critical factor influencing the ability of youth to responsibly navigate digital platforms is digital literacy. While digital literacy programs have been implemented in various regions worldwide, significant disparities remain not only in overall digital literacy levels, but also the assessment of digital literacy initiatives. To address these challenges, an environmental scan and literature review were conducted to identify existing digital literacy programs in Canada developed specifically for youth, as well as digital literacy assessment tools, respectively. The search encompassed peer-reviewed articles, organizational curricula, and assessment measures indexed in various databases and organization websites. The environmental scan identified 15 programs targeting key components of digital literacy such as data safety, cyberbullying, and digital media. The literature review identified 12 digital literacy assessment tools. Based on the findings, data were synthesized from shortlisted programs and assessment tools to inform the development of both a new digital literacy program and assessment tool to complement the youth-focused program. The new program focuses on four key components: (1) digital fluency, (2) digital privacy and safety, (3) ethics and empathy, and (4) consumer awareness. A 15-item assessment tool was also developed consisting of 4–5 questions specific to each program component. Given the growing importance of digital competencies, a youth-focused program and assessment tool are crucial for understanding and addressing digital literacy among this vulnerable cohort. This program's adaptability allows for customization across sociodemographic target groups, including culturally diverse and geographically remote communities—an aspect that has the potential to enhance digital literacy across settings. Implementing digital literacy programs can better prepare youth for an increasingly digital world, while minimizing potential risks associated with technology use.

Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients

BackgroundCentral to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AimsThe purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DesignThe Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SettingsOn a six-bed adult inpatient Palliative Care Unit (PCU). Participants/SubjectsNonverbal palliative care patients. MethodsEvidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. ResultsNurses’ attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. ConclusionsMOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.

Development of a novel primate welfare assessment tool for research macaques.

Primates are important species for biomedical research and ensuring their good welfare is critical for research translatability and ethical responsibility. Systematic animal welfare assessments can support continuous programme improvements and build institutional awareness of areas requiring more attention. A multi-facility, collaborative project aimed to develop and implement a novel primate welfare assessment tool (PWAT) for use with research macaques. PWAT development involved: establishing an internal focus group of primate subject matter experts, identifying animal welfare categories and descriptors based on literature review, developing a preliminary tool, beta-testing the tool to ensure practicality and final consensus on descriptors, finalising the tool in a database with semi-automated data analysis, and delivering the tool to 13 sites across four countries. The tool uses input- and outcome-based measures from six categories: physical, behavioural, training, environmental, procedural, and culture of care. The final tool has 133 descriptors weighted based upon welfare impact, and is split into three forms for ease of use (room level, site level, and personnel interviews). The PWAT was trialled across facilities in March and September 2022 for benchmarking current macaque behavioural management programmes. The tool successfully distinguished strengths and challenges at the facility level and across sites. Following this benchmarking, the tool is being applied semi-annually to assess and monitor progress in behavioural management programmes. The development process of the PWAT demonstrates that evidence-based assessment tools can be developed through collaboration and consensus building, which are important for uptake and applicability, and ultimately for promoting global improvements in research macaque welfare.

Pengembangan Instrumen Deteksi Kemunduran Bio, Psiko, Sosio, Spiritual pada Pasien Lanjut Usia

This research aims to develop an instrument that detects bio, psycho, social, and spiritual decline in elderly hospital patients by using theoretical concepts in nursing care. The research method uses cross-sectional, with validity and reliability tests using the Product Moment correlation test. The research results show that the bio, psycho, social, and spiritual deterioration detection instrument consists of 26 questions with high validity and reliability. This instrument has been based on various concepts that focus on the individual's bio, psychological, social, and spiritual needs. In conclusion, this instrument is easy to use and is an evidence-based nursing assessment tool.&#x0D; Keywords: Bio-Psycho-Socio-Spiritual Decline; Elderly Patients

Towards evidence-based human resource development for South African local government

Background: The effective management of human resources is crucial for the sustainability of municipalities. However, as evidenced by poor service delivery, municipalities are not measuring human resource development. There is no known assessment tool or system to measure the performance of human resource development in South African municipalities.Aim: This study investigated the human resource development challenges experienced in municipalities and recommends, among other things, an evidence-based assessment tool that will improve human resource development implementation.Setting: Participants included line managers, human resource development professionals, employees, and councillors from randomly sampled local, district and metropolitan municipalities in South Africa.Method: An exploratory sequential mixed-methods design was used. Quantitative data were collected using questionnaires from 111 respondents. Qualitative data were collected from respondents given an opportunity to elaborate on their responses to statements in the questionnaire.Results: The results of the study show that municipalities are not effectively implementing human resource development, which compromises service delivery and municipal performance. They also suggest that municipalities are not effectively implementing the adopted Integrated Municipal Framework for Human Resource Development.Conclusion: The study concludes that there is an urgent need for local government to prioritise the management of human resource development. An evidence-based assessment tool will ensure that human resource development governance gaps are addressed in municipalities.Contribution: This study adds to the debate on the management of human resource development in South African local government by providing a context-specific analysis of implementing and managing human resource development and by recommending improvement strategies.

An evidence-based quality assessment tool for ovarian cancer care delivery.

384 Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States (US). Optimizing care for patients with ovarian cancer using a systematic, guideline-concordant approach improves outcomes. However, notable gaps persist for most patients with ovarian cancer in the US. Beginning in 2018, the Association of Community Cancer Centers (ACCC) implemented a quality improvement (QI) initiative in community and academic cancer centers to address care gaps. From this work, our expert steering committee published a quality document to inform evidence based ovarian cancer care delivery. Methods: In Phase II of this project we used the quality document to inform a qualitative baseline self-assessment and development of four six-month QI initiatives at cancer centers in the US. Based on this work, we developed a quality assessment tool to aid cancer centers in performing QI needs-assessments using the ovarian cancer quality document. The assessment tool applies evidence-based care recommendations in key areas identified by our multidisciplinary steering committee comprised of experts in ovarian cancer care. Results: The assessment tool includes a series of program-level questions and addresses seven key domains: 1. Care coordination and patient education, 2. Prevention and screening, 3. Diagnosis and initial management, 4. Treatment planning, 5. Disease surveillance, 6. Equity in care, and 7. Quality of life. Each domain has between two and seven key recommendations identified. Sites rate themselves on a four-point scale (1-unsatisfactory, 2-needs improvement, 3-acceptable, 4-good) for each key recommendation. Each key recommendation is given equal weight, and a combined score from 0-100 is calculated for each of the seven domains. The tool includes a macro-enabled spreadsheet that makes necessary calculations and provides an overall score, domain-specific sub-scores, and a list of key recommendations that received low ratings. The tool is to be used by clinical sites to self-assess the quality of ovarian cancer care currently provided at their cancer program and serves as a needs assessment. It is recommended that the site team performs the self-assessment in the context of a facilitated half-day multidisciplinary team meeting. After the self-assessment, sites are encouraged to develop QI initiatives to address the gaps identified using the format and structure we have previously described. Conclusions: The QI Assessment tool provides an important resource for cancer centers to conduct needs assessments in key areas of ovarian cancer care. The needs assessment can be used to inform the implementation of program-specific QI initiatives to elevate quality care delivery.

Neonatal early-onset sepsis calculator: Impact on antibiotic use in a level II neonatal unit in Western Australia

BackgroundOveruse of empirical intravenous antibiotics in neonates in high-income countries (HICs) is well documented. The Kaiser Permanente neonatal early-onset sepsis (EOS) calculator is an evidence-based sepsis risk assessment tool that has demonstrated potential to reduce antibiotic usage in this population. The incidence of early-onset sepsis in most HICs is 0.4–0.8 per 1000 live births. The objective was to evaluate the calculator's impact on antibiotic rates and length of stay in a regional level II Special Care Nursery. MethodsA single-centre retrospective cohort study compared antibiotic administration rates in the first 72 h in neonates ≥35 weeks gestation born during two 6-month periods in 2019 (pre-EOS calculator) and 2021 (post-EOS calculator). Electronic and paper case records were accessed to capture data. Continuous data were summarised using mean and standard deviation, and categorical data were summarized using frequency distributions. There were 951 (2019) and 1129 (2021) infants born during the study periods. ResultsFollowing implementation of the calculator, antibiotic exposure decreased from 13.7% to 4.7% of all neonates without reported negative outcomes. Mean length of stay for neonates born across the two periods decreased from 2.38 to 2.13 days. Indications for antibiotic use shifted more towards clinical condition and away from obstetric risk factors. There were no culture-proven cases of sepsis or readmissions with EOS in either period. ConclusionImplementation of the EOS calculator significantly reduced exposure to antibiotics, without adverse outcomes.

Developing a questionnaire to evaluate the health information literacy in China.

Health information literacy is critical for individuals to obtain, understand, screen, and apply health information. However, there is currently no specific tool available to evaluate all four dimensions of health information literacy in China. Public health emergencies can present an opportunity to evaluate and monitor the health information literacy level of residents. Therefore, this study aimed to develop a questionnaire to evaluate the level of health information literacy and to measure the reliability and validity. The development process of the questionnaire consisted of the determination of questionnaire items, expert consultation, and validation. Based on the National Residents Health Literacy Monitoring Questionnaire (2020) and the 2019 Informed Health Choices key concepts, the researchers drafted the questionnaire, including all four dimensions of health information literacy. Experts in relevant fields were invited to evaluate the draft questionnaire, and revisions were made accordingly. Finally, the reliability and validity of the finalized version were examined in Gansu Province, China. The research team preliminarily formulated 14 items encompassing the four dimensions of health information literacy. After consulting with 28 experts, modifications were made. A convenience sample of 185 Chinese residents was invited to participate. Cronbach's alpha coefficient was 0.715 and McDonald's omega was 0.739 for internal consistency, and the test-retest intra-class correlation coefficient after 4 weeks was 0.906, indicating that the questionnaire content and measurement structure was relatively stable. This questionnaire is the first evidence-based assessment tool developed for monitoring health information literacy in China, and it has shown good reliability and validity. It can help to monitor the health information literacy levels of Chinese residents, promote evidence-based decision-making, and guide interventions to improve health information literacy.

Management of Prostate Cancer in Older Adults.

The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.

Assessing the speech production of multilingual children: A survey of speech-language therapists in French-speaking Belgium.

Assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs) around the world. Scientific recommendations to improve clinical practice are available, but their implementation has mostly been described in studies from English-speaking countries. This survey aimed to describe the perspectives and practices of SLTs in assessing the speech production of multilingual children in French-speaking Belgium. An online survey was completed by 134 SLTs in French-speaking Belgium. SLTs predominantly used norm-referenced assessment approaches, which are not recommended for use with multilingual children, and lacked necessary training and resources to implement recommended practices in the assessment of speech production of multilingual children. The shift towards more appropriate practices with multilingual children seems to be in its infancy among SLTs in French-speaking Belgium. Some challenges identified by the SLTs were common to those in other countries and languages, such as the difficulty to distinguish between speech differences and speech disorders. Other challenges were specific to the French language and/or the Belgian context, such as the lack of appropriate tools in French. Action is required to improve clinical practice in assessing the speech production of multilingual children in French-speaking contexts: better training for SLTs regarding linguistic diversity, more implementation research in the field of SLT, and advocacy for linguistic diversity with decision makers. What is already known on this subject Existing research indicates that assessing the speech production of multilingual children is challenging for speech-language therapists (SLTs). Scientific recommendations for best practices have been published, and the shift to more appropriate assessment practices may be progressing differently across countries. SLTs' practices have been described in surveys, mostly conducted in English-speaking countries. Although French is the fifth most spoken language in the world, data about SLTs' perspectives and practices in French-speaking regions are scarce. What this study adds The implementation of recommended practices in assessing multilingual children's speech production was limited among SLTs in French-speaking Belgium. The norm-referenced approach to assessment was predominant and few SLTs used recommended practices (e.g., criterion-referenced measures, dynamic assessment, assessment of the child's speech production in the home language). Some challenges were identified that related specifically to practices in French-speaking contexts (e.g., lack of French tools) and Belgian context (e.g., health policies unfavourable to multilingualism). These findings confirm that specific understanding of a situation is needed to develop context- and/or language-specific solutions-and ultimately improve clinical practice. What are the clinical implications of this work? SLTs in French-speaking Belgium require specific training and support to provide appropriate assessment of speech production in multilingual children. Efforts to improve practices in French-speaking contexts should focus on increasing understanding and consideration of cultural and linguistic diversity at all levels of the child's environment. Evidence-based knowledge, assessment tools and multilingual resources are available to SLTs on websites in French and in English.

Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection.

Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.

Suicide Risk Assessment, Management, and Mitigation in the Emergency Setting.

Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and mitigation is paramount to successful encounters with individuals presenting to emergency settings in psychiatric crises. Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk. Mitigation aims to reduce the risk of suicide or of a serious attempt for a person at risk. These aims cannot be achieved with perfect reliability, but some approaches are more effective than others. Suicide screening specifics are important, even to individual practitioners, because a positive screen triggers assessment. Most practitioners understand assessment well: beginning with early psychiatric training, they are taught signs and symptoms suggesting that a patient might be at risk of suicide. Mitigating suicide risk is increasingly important to reduce the misery of ED boarding for patients awaiting psychiatric admission. For many patients, hospital admission is unnecessary if support, monitoring, and contingency plans are workable. For any individual patient, there may be a complicated mix of findings, risks, and interventions. Evidence-based screening and assessment tools are inadequate for the possible complexities, making care of individual patients dependent on good clinical assessment. The authors review the available evidence and offer experienced recommendations for challenges not yet thoroughly researched.

Self-Management of Medication on a Cardiology Ward: Feasibility and Safety of the SelfMED Intervention

An intervention, SelfMED, was introduced to facilitate patient self-management of medication during hospitalization. This study aimed to evaluate the feasibility and safety of the SelfMED intervention. All patients in a cardiology ward in a Belgian regional hospital were assessed for suitability for inclusion, applying an evidence-based stepped assessment tool. Patients eligible for medication self-management and willing to participate were included in the study (i.e., consecutive sampling). Patients who self-managed their medication were closely monitored by nurses. The feasibility of medication self-management was evaluated by implementation and completion rates and the opinions of cardiologists. Safety was evaluated by medication administration errors and errors in patients' registration of intake. Of 159 patients assessed for eligibility to self-manage medication in-hospital, 61 were included. A total of 367 medicines were self-managed. Pill counts showed 3 administration errors (0.8%), and on 6 occasions (1.7%) the patient's registration of the intake was incorrect. SelfMED was deemed feasible within the hospital ward. In cardiologists' opinions, SelfMED requires substantial time investment. In summary, SelfMED facilitated patient medication self-management in-hospital. As an essential step in the preparation for a full trial, this study showed it is feasible and safe to implement the intervention and identified some possibilities for refinement.

Standardising the elusive diagnosis of NEC in the premature infant - A practical score

ObjectiveThe perceived risk of necrotising enterocolitis (NEC) can result in overtreatment of the otherwise adapting preterm neonate. We aim to develop an assessment tool to aid the decision making in the management of preterm neonates at risk of NEC. MethodAn evidence-based assessment tool was designed bringing together clinical, laboratory and radiological signs commonly associated with NEC. A numerical score was awarded for each sign, with those more specific to NEC being graded higher. A multi-centre validation was conducted of the proposed assessment tool over three tertiary neonatal units. ResultsA total of 125 patients were included, 53 (42.4 %) with a final diagnosis of NEC and 72 (57.6 %) with an alternative diagnosis. The NEC group had a significantly higher total score compared to the non-NEC group; 15(2–28) vs. 4(1–9) (p ≤ 0.0001). In ROC analysis, using a cut-off of eight, the assessment tool gave a sensitivity of 92.3 % and a specificity of 90.4 % for identifying NEC compared to an alternative diagnosis. ConclusionThis comprehensive scoring system encourages a full assessment of the infant before deciding on withholding feeds, starting antibiotics, and transferring to a surgical centre. It is a safe objective measure to support a diagnosis of NEC in the presence of certain clinical signs.

Social Isolation: Levels of Response for Nurse Practitioners

Although social isolation occurs across the lifespan, this article focuses on the unique challenges faced by the older adult population. Older adults are particularly sensitive to the health risks of social isolation. High-risk groups within the older adult population are minorities, immigrants, LGBTQ+, and victims of elder abuse. Nurse practitioners have the education and are poised to assess and intervene appropriately on social isolation at the primary, secondary, and tertiary levels of care. This article provides evidence-based assessment tools and resources for the nurse practitioner to use in clinical practice.

PHYSIOTHERAPISTS’ CURRENT KNOWLEDGE AND CLINICAL USE OF TOOLS TO PREDICT, MONITOR, EVALUATE THE TREATMENT OUTCOME AND CLASSIFY PATIENTS WITH SCIATICA IN GREECE: AN ONLINE SURVEY

Purpose: The use of evidence-based assessment tools is important to differentiate, give prognosis and guide the therapeutic approaches in sciatica. We aimed to evaluate whether physiotherapists’ knowledge and clinical practice in Greece are aligned with up-to-date research recommendations in the assessment of sciatica. Methods: An online-survey was developed, validated and disseminated in registered physiotherapists in Greece. The survey designed to capture physiotherapists’ demographic characteristics, knowledge and use of patient-reported outcome measures (PROMs), classification systems and neurological tests in sciatica. Descriptive statistics were used to analyze the data. Results: 381 physiotherapists participated in the survey. Most of the participants reported that at least one or more of the proposed PROMs (85.5%), classification system (87%) or neurological tests (95%). 75.6% of responders use one or more PROMs during the management of patients with sciatica. Pain intensity evaluation tools are the most commonly used (35.9%) followed by disability or psychosocial evaluation scales (25.9% and 22.5%, respectively). 38.8% of participants use the McKenzie classification while almost 90% use common neurological examination tests (myotomes, sensory tests, reflexes, straight-leg-raise, slump and femoral slump test). No association was found between participants’ characteristics and number of assessment tools known or used. Conclusions: Our findings suggest that physiotherapy practice in Greece is aligned to research recommendations only in terms of delivering common neurological physical examination tests. The knowledge and clinical use of evidence-based tools to assess the treatment outcome and classify patients with sciatica is limited. Further training and organizational or peer support are required to improve the management of the condition.

The CURB65 score predicted 180-day mortality of non-small cell lung carcinoma patients with immune checkpoint inhibitor-associated pneumonitis: A pilot retrospective analysis.

IntroductionThe immune checkpoint inhibitor-associated pneumonitis (CIP) is a particularly worrisome and potentially lethal form of immune-related adverse events. An objective and evidence-based assessment tool for evaluating the severity of CIP is in urgent need. CURB65 (consciousness, urea nitrogen, respiratory rate, blood pressure, and age) is a potential candidate to meet the need.MethodsA retrospective study was conducted to explore preliminarily if CURB65 could predict the mortality in non-small cell lung carcinoma (NSCLC) patients with CIP.ResultsA total number of 28 NSCLC patients with CIP were included in the current study and classified into low-CURB65 group (n = 21) and high-CURB65 group (n = 7). Mortality after onset of CIP was consistently higher in the high-CURB65 group than in the low-CURB65 group (30-day: 57.1% vs. 0; 90-day: 71.4% vs. 4.76%; 180-day:71.4% vs. 14.29%). Two patients (9.5%) in the low-CURB65 group had severe CIP, and more than half of patients in the high-CURB65 group had severe CIP (p = 0.0008). The patients in the high-CURB65 group received more aggressive treatment. Both groups showed a predominant organizing pneumonia-like pattern on CT scan. CURB65 was moderately correlated with the American Society of Clinical Oncology (ASCO) grade of CIP, with a Pearson correlation coefficient R of 0.524.ConclusionCURB65 accurately stratified the risk of mortality in NSCLC patients with CIP. CURB65 might complement the ASCO grade in the assessment and prediction of mortality in these populations.