Original Tool Research Articles

Health information system assessments: Opportunities for international collaboration

Abstract Since the late 1990s, with the development of European Core Health Indicators (ECHI) and the European Health Interview Survey (EHIS), the EU aims to strengthen its continental database for evidence-informed public health policy and research. BRIDGE Health (2015-2017), InfAct (Information for Action 2018-2021) and PHIRI (Population Health Information Research Infrastructure 2020-2023) projects prepared for the establishment of a sustainable European health information infrastructure. Country health information system (HIS) assessments were core project activities, performed on the basis of the WHO Euro ‘Support Tool to strengthen health information systems’. To serve project objectives, the original top-down Support Tool was modified and implemented in a peer-to-peer approach among project countries. InfAct and PHIRI conducted 9 country peer-assessments each. InfAct assessments were carried out through country visits, targeting overall health information inequalities and good practices. PHIRI performed virtual country visits, focusing on COVID-19 health information flows. The WHO Tool was further adapted by the Joint Action TEHDAS (2021-2023) to assess the readiness of HIS in Europe for the European Health Data Space. Experience with these different iterations led to the revision of the Support Tool in 2021 to include a more expanded and modular approach which enables HIS assessments to opt to focus on specific aspects. To date, a sustainable European health information infrastructure has not been set up. Currently, the EU funds a joint Health Information Network with WHO Euro. Building regional infrastructures for public health and NCDI/MH monitoring and reporting depend on structures and on the political will of supranational organizations and their members. Meanwhile, HIS assessments to improve surveillance, population health and to reduce health information inequalities lend themselves to increased international collaboration and knowledge exchange.

Performance analysis of uncoated and coated (TiN-, TiAlN-) carbide drills in drilling graphene-reinforced GF/epoxy nanocomposites: Analytical and experimental study

The present study aims to investigate the performance of conventional uncoated and coated (TiN, TiAlN) solid carbide drill tools in drilling bi-directional graphene-reinforced (2 wt.%) glass fiber (GF)/epoxy polymer nanocomposite laminate with two distinct lamination schemes ([0/90]12S and [0/90/±45]6S). Performance measures included thrust force, torque, tool flank wear, peak acoustic emission, root mean square (RMS) of acoustic energy, and average surface roughness. Moreover, the delamination that occurs beyond the critical value of thrust force (computed analytically) has also been addressed. Optimized drilling parameters were used for experimentation to minimize thrust force and torque simultaneously. Both TiN and TiAlN-coated carbide drills outperformed uncoated carbide drills for fewer holes (around 25 for TiN and about 40 for TiAlN), but their performance deteriorated with more holes due to coating chipping or peeling from the original tool material. The (0/90 ± 45)6S graphene-reinforced layup showed less tool wear, deterioration, and acoustic emission energy compared to the (0/90)12S neat layup. TiAlN-coated drills exhibited the smallest wear on the flank face followed by TiN-coated and uncoated carbide drills. Moreover, the smoothest cut surface throughout the 300 holes drilled, averaging 1.5 µm to 1.8 µm in surface roughness, was observed with the TiAlN-coated drill. Therefore, the TiAlN-coated drill is recommended for drilling a larger number of holes due to its reduced tool wear, smoother cut surfaces, and better form accuracy with minimal delamination.

An Extended Algorithm using a Divide-and-Rule Approach for Boundary Value Analysis and Equivalence Class Partitioning

An extended algorithm using a divide-and-rule approach is proposed in this paper. Instead of generating test cases by only using Boundary Value Analysis and an experience-based technique for combination of input variables with functional dependency like the original algorithm, the extended algorithm applies both Boundary Value Analysis and Equivalence Class Partitioning techniques as well as various techniques for combination of input values. In addition, a new tool provides advantages when compared with the original tool. It provides users with more choices in generating test cases.

Comparing the performance of multiple trigger tools in identifying medication-related hospital readmissions.

Multiple trigger tools have been developed to identify medication-related hospital (re)admissions (MRRs); however, the accuracy of these tools in real-world clinical practice is uncertain. The objective of this study was to compare the accuracy of four different trigger tools (OPERAM, STOPP/START criteria, ADR-tool, and QUADRAT) to identify MRRs compared with clinical adjudication. We conducted a secondary analysis of patients readmitted within 30 days to seven departments of a teaching hospital. In the primary study, which involved a retrospective chart review of 1111 readmissions, MRRs and their potential preventability were clinically adjudicated by physicians and pharmacists. In the current study, four trigger tools were applied by a different physician and pharmacist panel. Patients of all ages were included. Trigger tools included both explicit items specifying the event and the associated medication and implicit items requiring clinical knowledge. The accuracy of each trigger tool was assessed by calculating the proportion of clinically adjudicated MRRs each tool identified overall as well as according to explicit and implicit triggers separately. The accuracy of each tool to identify potentially preventable MRRs was also calculated. Of 1111 readmissions, 181 were adjudicated as medication-related (mean age 69 years, 56% male); 72 (40%) MRRs were potentially preventable. The original OPERAM tool identified 166 (92%) MRRs (62% through explicit triggers). The STOPP/START criteria identified 23 (13%, 7% through explicit triggers), the ADR tool identified 51 (28%, all explicit triggers), and the QUADRAT tool identified 76 (42%; all explicit triggers) MRRs. Of the 72 potentially preventable MRRs, OPERAM identified 59 (82%), STOPP/START identified 18 (25%), ADR identified 20 (28%), and QUADRAT identified 21 (29%). The original OPERAM tool identified the highest proportion of (preventable) MRRs. However, this tool includes many implicit triggers requiring expert clinical knowledge. Future studies should assess the practicality of implementing this tool in daily practice.

Characterising umbrella reviews in paediatrics: A systematic analysis.

To characterise typical practices in conducting and reporting umbrella reviews in paediatrics. PubMed database was searched for umbrella reviews focusing on children (0-18 years) published from 1 January 2020 to 15 June 2024, regardless of the speciality. The included studies were assessed for reporting practices, result summarisation and critical appraisal methods. Ninety-nine eligible umbrella reviews were included, of which 49 focused on interventions and 50 focused on epidemiology. The median number of included reviews in the umbrella reviews was 18 (range = 3-302), and statistical synthesis was performed in 32 studies. The most frequently used tool for critical appraisal of the included reviews was the updated Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool (n = 56); the original AMSTAR-1 tool was used in seven reviews, and the Risk of Bias in Systematic Reviews tool was used in 12 reviews. Evidence certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework in 14 reviews and by the Ioannidis criteria in 18 reviews. Umbrella reviews have heterogeneous characteristics in terms of reporting practices. Greater adherence to guidelines on conducting and reporting umbrella reviews is needed, particularly for improving critical appraisal methods.

Validity of facial skin analysis pore detection: A comparative analysis.

Reliable, objective measures to assess facial characteristics would aid in the assessment of many dermatological treatments. Previous work utilized an iOS application-based artificial intelligence (AI) tool compared to the "gold standard" computer-based and a physician assessment on five skin metrics (British Journal of Dermatology, 2013, 169, 474). The AI tool had superior agreement for all skin metrics except pores and subsequently underwent an algorithm update for its pore detection system. This comparative analysis assessed the performance of the updated AI tool's pore scores across all Fitzpatrick skin phototypes to determine whether the AI tool more accurately represents a dermatologist's assessment of pores. Frontal facing photographs in uniform lighting conditions were taken of each participant. Percentile scores were generated by each of the four self-learning models of the updated AI tool. The pore percentile scores generated by the original and updated AI tool were used to rate "worse" pores among participant pairs. These ratings were compared to pore assessments performed by a "gold-standard" device and a board-certified dermatologist. Compared to the original pore detection tool and the computer-based program, models A and D had the highest concordance with the physician's pore assessments for Fitzpatrick skin phototypes III-IV and V-VI, respectively. The AI tool's pores detection update was successful in its ability to accurately detect pores on all Fitzpatrick skin types, improving on the performance of the AI prior to the update. Responsibly developed AI tools that can accurately and reliably detect skin metrics across diverse Fitzpatrick skin types can facilitate dermatologic evaluation, individualize treatment, and determine treatment response.

The validity of the original and Saudi-modified screening tools for the assessment of malnutrition in pediatrics (STAMP): A cross-sectional study

The validity of the original and Saudi-modified screening tools for the assessment of malnutrition in pediatrics (STAMP): A cross-sectional study

Validation of the Dutch Infant Crying and Parent Well-Being Screening Tool in Parents of Infants Less than 12 Months of Age

To evaluate reliability and validity of the Dutch version of the Infant Crying and Parent Well-Being (ICPW) tool in identifying parents struggling with infant crying in the first year of life. The original ICPW tool was translated into Dutch following established guidelines. The internal consistency and criterion validity of the Dutch ICPW tool were evaluated using a cross-sectional design. The translated ICPW tool and validated questionnaires on parental depression, stress, anxiety, and parenting balance were presented to parents of infants under 12months during child health care visits and online. The survey was completed by 488 parents, 400 mothers and 88 fathers. Of these, 172 participated after a child health care visit and 316 via online platforms. The Dutch ICPW showed satisfactory internal consistency (α=0.69) and excellent criterion validity with parental mental health measures (r=0.53-0.85). ICPW scores demonstrated positive correlations with parental depression, stress, and anxiety levels, and a negative correlation with parenting balance. Both mothers and fathers with a positive ICPW screen (≥3) reported significantly higher levels of parental mental health issues compared with those with a negative screen (P<.001). The ICPW was positive in 32% of the parents (n=155), with consistent total scores regardless of the infant's increasing age (r=-0.024, P=.59). The ICPW tool exhibited a strong negative predictive value (93%) for diagnosing postpartum depression. The Dutch ICPW tool is a reliable and valid screening instrument for identifying parents struggling with infant crying.

Assessment Tools for Patient Notes in Medical Education: A Scoping Review.

Physician proficiency in clinical encounter documentation is a universal expectation of medical education. However, deficiencies in note writing are frequently identified, which have implications for patient safety, health care quality, and cost. This study aimed to create a compendium of tools for educators' practical implementation or future research. A scoping review was conducted using the Arksey and O'Malley framework. PubMed, Embase, Ovid All EBM Reviews, Web of Science, and MedEdPortal were searched for articles published from database inception to November 16, 2023, using the following search terms: documentation, note-writing, patient note, electronic health record note, entrustable professional activity 5, and other terms. For each note-writing assessment tool, information on setting, section(s) of note that was assessed, tool properties, numbers and roles of note writers and graders, weight given, if used in grading, learner performance, and stakeholder satisfaction and feasibility was extracted and summarized. A total of 5,257 articles were identified; 32 studies were included. Eleven studies (34.4%) were published since 2018. Twenty-two studies (68.8%) outlined creating an original assessment tool, whereas 10 (31.2%) assessed a curriculum intervention using a tool. Tools varied in length and complexity. None provided data on equity or fairness to student or resident note writers or about readability for patients. Note writers often had missing or incomplete documentation (mean [SD] total tool score of 60.3% [19.4%] averaged over 25 studies), often improving after intervention. Selected patient note assessment tool studies have been cited a mean (SD) of 6.3 (9.2) times. Approximately half of the tools (53.1%) or their accompanying articles were open access. Diverse tools have been published to assess patient notes, often identifying deficiencies. This compendium may assist educators and researchers in improving patient care documentation.

CAP, comprendre, agir et partager : une boite à outils made in Nouvelle Aquitaine pour accompagner les établissements dans leur transformation écologique

In the face of climate change, Health is mobilizing to find solutions and reduce its environmental impact. The CAP (Understand, Act and Share) sustainable hospital toolbox cited in the roadmap for the Ecological Planning of the French Health System offers 3 original, operational and complementary tools to (1) acculturate professionals in the sector (Plan Health Faire®), (2) build the establishment strategy (2030 Agenda), and (3) take action with healthcare professionals (The Sustainable Units program).

Analysis and optimization of microchannel array precision grinding processes with micro-structured micro-grinding tool

Micro-grinding has been widely used in aerospace and other industry. However, the small diameter of the micro-grinding tool has limited its machining performance and efficiency. In order to solve the above problems, micro-structure has been applied on the micro-grinding tool. A morphology modeling has been established in this study to characterize the surface of micro-structured micro-grinding tool, and the grinding performance of micro-structured micro-grinding tool has been analyzed through undeformed chip thickness, abrasive edge width, and effective distance between abrasives. Then deviation analysis, path optimization and parameter optimization of microchannel array precision grinding have been finished to improve processing quality and efficiency, and the deflection angle has the most obvious effects on the rectangular slot depth, micro-structured micro-grinding tool could reduce 10% surface roughness and 20% grinding force compared to original micro-grinding tool. Finally, the microchannel array has been machined with a size deviation of 2 μm and surface roughness of 0.2 μm.

Measuring Positive Health using the My Positive Health (MPH) and Individual Recovery Outcomes Counter (I.ROC) Dialogue Tools: A Panel Study on Measurement Properties in a Representative General Dutch Population

AbstractWe aimed to investigate whether the dialogue tools My Positive Health (MPH) and Individual Recovery Outcomes Counter (I.ROC) tools were useful for quantitively measuring the positive health construct for monitoring and scientific purposes as well. An observational cross-sectional study was conducted in a representative general Dutch population (the LISS panel) to investigate factor structures and internal consistency from the 42-items MPH and 12-items I.ROC. After randomly splitting the dataset, principal component analysis (PCA) and confirmatory factor analysis (CFA) were applied. Pearson and Spearman correlation coefficient between both tools’ total scores were calculated. 2,457 participants completed the questionnaires. A six-factor structure was extracted for MPH (PH42) and a two-factor structure for I.ROC (I.ROC12). Explained variances were 68.1% and 56.1%, respectively. CFA resulted in good fit indices. Cronbach’s alphas were between 0.74 to 0.97 (PH42) and 0.73 to 0.87 (I.ROC12). Pearson correlation between the total scores was 0.8 and Spearman correlation was 0.77. Both PH42 and I.ROC12 are useful to quantitatively measure positive health aspects which can be summarised in sum scores. The dimensions found in this study and the corresponding item division differed from the dimensions of the original dialogue tools. Further research is recommended focussing on item reduction for PH42, factor structure of I.ROC, assessment of construct validity (in a general population) and response scales in more depth.

Validated Tools Used to Assess Musculoskeletal Injuries in Dancers: A Systematic Review.

Introduction: Dance is a physically demanding art form that often results in musculoskeletal injuries. To effectively treat these injuries, standardized and reliable assessment tools designed to the dancer's needs are required. Thus, the aim of this review is to identify studies that have employed validated tools to assess musculoskeletal injuries in ballet, modern, and contemporary dancers, focusing on describing the content and psychometric quality of the tools used. Methods: This systematic review is registered at PROSPERO (CRD42022306755). PubMed, Cochrane, LILACS, Web of Science and SPORTDiscus databases were searched by two independent reviewers. Articles assessing musculoskeletal injuries with validated tools in ballet, modern and/or contemporary dancers and written in English, Portuguese, or Spanish were included. Non-peer reviewed articles, books, conference abstracts, thesis/review articles, or case design studies were excluded. The original validation studies were compiled when necessary. Two independent reviewers conducted a standardized data extraction and evaluated the methodological quality using an adapted Downs and Black checklist. Results: From the 3933 studies screened, 172 were read to verify if they met the inclusion criteria, resulting in 37 studies included accounting for 16 unique validated tools. Two were imaging exams, one was an injury classification system, and 13 were self-reported injury questionnaires. Only four injury assessment tools were validated for dancers, emphasizing the need for further validation studies for the dance population. Most of the articles (57%) achieved high-quality methodological scores and the remaining (43%) reported medium-quality scores. Conclusions: Valid, reliable, and specific tools to assess dance injuries are lacking in general. For enhanced methodological rigor in future studies, the incorporation of validated tools is recommended to improve methodological quality and facilitate cross-study comparisons. Researchers may consider conducting validation studies, involving processes such as translation into another language, validation of modifications to the original tool, or reporting reliability within the article itself.

Psychometric properties of the French Infant-Toddler Working Alliance Inventory Short version (IT-WAI-S)

Objective Therapeutic alliance has been little investigated in infant and toddler therapy, with no tools specifically adapted to this population. However, we have developed the Infant-Toddler Working Alliance Inventory-Short form (IT-WAI-S) which is based on the Working Alliance Inventory. The aim of this study was to assess the psychometric properties of this original French tool, in its two versions: for parent (IT-WAI-SP) and for therapist (IT-WAI-STh). Method This study included 227 families consulting with their 18–48-month-old child for emotional or behavioral disorders. The scales were filled in at the first three therapy sessions. The IT-WAI-S acceptability, internal validity, reliability and predictive validity (association with child and mother’s outcomes) were evaluated. Results Confirmatory then exploratory factor analyses revealed a three-factor structure for the both scales: Negative Experience of Care Relationship, Positive Alliance and Alliance with the Child. Acceptability, reproducibility and construct validity were satisfactory for both versions. The two versions predicted the child's outcome. The IT-WAI-SP predicted also the mother’s outcome. The IT-WAI-STh gave more reproducible results, whereas the IT-WAI-SP was a better predictor of the child's progress. Conclusion The two IT-WAI-S versions showed good psychometric properties and could be used to study the therapeutic alliance in young children.

Paracetamol Combination Therapy for Back Pain and Osteoarthritis: A Systematic Review and Meta-Analyses.

Although paracetamol (acetaminophen) combined with other analgesics can reduce pain intensity in some pain conditions, its effectiveness in managing low back pain and osteoarthritis is unclear. This systematic review investigated whether paracetamol combination therapy is more effective and safer than monotherapy or placebo in low back pain and osteoarthritis. Online database searches were conducted for randomised trials that evaluated paracetamol combined with another analgesic compared to a placebo or the non-paracetamol ingredient in the combination (monotherapy) in low back pain and osteoarthritis. The primary outcome was a change in pain. Secondary outcomes were (serious) adverse events, changes in disability and quality of life. Follow-up was immediate (≤ 2 weeks), short (> 2 weeks but ≤ 3 months), intermediate (> 3 months but < 12 months) or long term (≥ 12 months). A random-effects meta-analysis was conducted. Risk of bias was assessed using the original Cochrane tool, and quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Twenty-two studies were included. Pain was reduced with oral paracetamol plus a non-steroidal anti-inflammatory drug (NSAID) at immediate term in low back pain (paracetamol plus ibuprofen vs ibuprofen [mean difference (MD) - 6.2, 95% confidence interval (CI) -10.4 to -2.0, moderate evidence]) and in osteoarthritis (paracetamol plus aceclofenac vs aceclofenac [MD - 4.7, 95% CI - 8.3 to - 1.2, moderate certainty evidence] and paracetamol plus etodolac vs etodolac [MD - 15.1, 95% CI - 18.5 to - 11.8; moderate certainty evidence]). Paracetamol plus oral tramadol reduced pain compared with placebo at intermediate term for low back pain (MD - 11.7, 95% CI - 19.2 to - 4.3; very low certainty evidence) and osteoarthritis (MD - 6.8, 95% CI - 12.7 to -0.9; moderate certainty evidence). Disability scores improved in half the comparisons. Quality of life was infrequently measured. All paracetamol plus NSAID combinations did not increase the risk of adverse events compared to NSAID monotherapy. Low-to-moderate quality evidence supports the oral use of some paracetamol plus NSAID combinations for short-term pain relief with no increased risk of harm for low back pain and osteoarthritis compared to its non-paracetamol monotherapy comparator.

The evolution of Cow’s Milk-related Symptom Score (CoMiSS™) in presumed healthy infants

The Cow’s Milk-related Symptom Score (CoMiSS™) is a scoring system that reflects the appearance and intensity of symptoms possibly related to consumption of cow’s milk. The original tool was recently updated by changing the cut-off, and the stool scale and by adding angioedema. There is no data available regarding the natural evolution of CoMiSS in infants with no cow’s milk allergy (no-CMA) or a comparison between original and updated CoMiSS values. We determined the original and the updated CoMiSS in infants not diagnosed with cow’s milk allergy. The evolution of CoMiSS during the first year of life was assessed repetitively during predefined check-ups at 1.5, 3, 4, 6, 8, 10, and 12 months. The original and updated scores were compared with the Wilcoxon Signed-Rank Test. We also tested the impact of feeding type, age, gender, and order in the family on the CoMiSS. One hundred and twenty-two infants were included. CoMiSS values during the first year of life showed an inverse relation to age. The difference in CoMiSS between the original and updated versions was significant at 6,8,10, and 12 months (p < 0.001), related to the switch from the Bristol Stool Form Scale to the Brussels Infants and Toddlers Stool Scale (BITSS). The difference between both versions of CoMiSS was not significantly different in infants < 6 months (p = 0.999 at 1.5 and 4 months, and p = 0.586 at 3 months, respectively).Conclusion: CoMiSS decreases with age during the first year of life. While there is no difference between the two CoMiSS versions in healthy infants under 6 months of age, the CoMiSS value in the updated version is lower than the original 1 in infants aged 6 to 12 months.What is known?• The Cow’s Milk-related Symptom Score (CoMiSS) is a validated awareness tool for cow’s milk allergy (CMA).• A CoMiSS of ≥ 10 indicates a risk for cow’s milk allergy.What is new?• The natural evolution of CoMiSS in infants not diagnosed with CMA (no-CMA) shows an inverse relation to age.• There is no difference between the original and the updated CoMiSS versions in no-CMA-infants under six months of age, but the updated CoMiSS is lower in infants 6–12 months than the original one.

Evaluation of alternate form reliability for the 9-item versions of the interprofessional socialization and valuing scale (ISVS-9A/9B)

BackgroundThe Interprofessional Socialization and Valuing Scale (ISVS) was developed to measure interprofessional socialization as one adopts and integrates learning into practice. While items for the ISVS-9A and 9B were drawn from three subscales of the original 24-item tool, these parallel forms were validated as a unidimensional measure using Canadian health professional and student populations. ObjectivesThe aim was to investigate if the ISVS-9A and ISVS-9B forms are interchangeable and examine their internal structure. DesignStudents completed an 18-question survey that included the nine items from the ISVS-9A followed by the nine items for ISVS-9B. SettingsTwo U.S. academic health science centers provided longitudinal interprofessional education (IPE) in a classroom setting. Participants625 students representing 13 programs from one institution and 512 students representing 7 health professions programs from the second institution were included in the study. MethodsParticipants completed the ISVS-9A and 9B as a single form. Intraclass correlation coefficients (ICC) and corresponding 95 % confidence intervals were calculated to measure the absolute agreement between the scores from the ISVS-9A and 9B forms. A factor analysis considering the original tool's three subscales was conducted. Results592 responses from one institution and 500 responses from the second institution were analyzed. ICC for the ISVS total scores demonstrated good reliability (0.75–0.90). However, the internal structure of the three factors demonstrated moderate reliability (0.5–0.75) and may need further investigation. ConclusionsThis study confirms the use of the ISVS-9A and 9B total score to measure interprofessional socialization in health professional students attending U.S. institutions. Additional research is needed to determine potential reasons for mixed outcomes from studies using ISVS-9A and 9B parallel forms.

Modeling of mechanical behavior of Agave sisalana fiber's yarn using the design of experiments method

The aim of this study is to propose a model for predicting the mechanical properties of natural sisal yarn based on mechanical strength of used fibers, unit twist of yarn and its density. To achieve this, a complete factorial design modelling method was used, based on a design of experiments approach, which is recommended today because of the ease it offers in taking into account the most complex phenomena. It was developed on the basis of laboratory tests. The model obtained predicts mechanical strength and elasticity modulus of sisal yarn, based on control parameters such as fiber strength, unit twist and yarn mass. This model is currently one of the most accurate tools for predicting and optimising the mechanical properties of sisal yarns. The iso-surface curves represented by this model, can be used to obtain the strength and elasticity modulus of sisal yarn during manufacture, by varying the optimum control parameters. This model is an original tool that can be recommended to the spinning and sisal fiber composite manufacturing industries and others, as it saves time and materials and ensures precision in the manufacture of yarns according to the field of application, thereby contributing to safety in use.

Variability in the prevalence of inappropriate medication use among older adults: A review highlighting the importance of screening methods and database types.

The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools. This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods. This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria. This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules' impact on public health implications.

Application of the updated International IgA Nephropathy Prediction Tool in children one or two years post-biopsy

The pediatric International IgA Nephropathy (IgAN) Prediction Tool comprises two models with and without ethnicity and is the first method to predict the risk of a 30% decline in estimated glomerular filtration rate (eGFR) or kidney failure in children at the time of biopsy using clinical risk factors and Oxford MEST histology scores. However, it is unknown if the Prediction Tool can be applied after a period of observation post-biopsy. Using an international multi-ethnic cohort of 947 children with IgAN, 38% of whom were followed into adulthood, the Prediction Tool was updated for use one-year after biopsy. Compared to the original pediatric Prediction Tool, the updated post-biopsy Prediction Tool had a better model fit with higher R2D (51%/50% vs 20%), significant increase in 4-year C-statistics (0.83 vs 0.73/0.69, ΔC 0.09 [95% confidence interval 0.07-0.10] and ΔC 0.14 [0.12-0.15]) and better 4-year calibration with lower integrated calibration indices (0.74/0.54 vs 2.45/1.01). Results were similar after internal validation and when the models were applied two-years after biopsy. Trajectories of eGFR after a baseline one-year post-biopsy were non-linear and those at higher predicted risk started with a lower eGFR and experienced a more rapid decline over time. In children, eGFR had a variable rate of increase until 15-18 years old then decreased linearly with a more rapid decline in higher risk groups that was similar to young adults of comparable risk. Thus, the original pediatric Prediction Tool should be used in children at the time of biopsy, and the updated pediatric Prediction Tool should be used to revaluate risk one- or two-years after biopsy.