Standardized Assessment Protocol Research Articles

Reliability of forward head posture evaluation while sitting, standing, walking and running

Forward head posture has been evaluated mostly by visual observation or simple non-invasive measurements without a standardized evaluation method or protocol. In this experimental study, the reliability of existing forward head-posture measurement methods was evaluated by computing the intra-class correlation coefficients of three different head-position variables (two horizontal gap variables and one head-orientation variable) in seven different posture conditions from 20 asymptomatic participants. The position variables of the head were measured three times using a three-dimensional motion capture system while sitting comfortably, sitting with the back straight, standing comfortably, standing with the back straight, walking at 4 and 6km/h on a treadmill, and running at 8km/h on a treadmill. Intra-class correlation coefficients between repetitive measures ranged from 0.81 to 0.96, and high correlation coefficient values (>0.9) were produced when the head-position variables were measured during straight sitting, straight standing, and walking at 6km/h. Among the three head-position variables, a horizontal gap between the tragus and the 7th cervical vertebra was recorded more consistently than other variables. Results of this study highlight the importance of a standardized evaluation protocol for more reliable assessment of the forward head posture.

An ontology-based approach to patient follow-up assessment for continuous and personalized chronic disease management

ObjectiveChronic diseases are complex and persistent clinical conditions that require close collaboration among patients and health care providers in the implementation of long-term and integrated care programs. However, current solutions focus partially on intensive interventions at hospitals rather than on continuous and personalized chronic disease management. This study aims to fill this gap by providing computerized clinical decision support during follow-up assessments of chronically ill patients at home. MethodsWe proposed an ontology-based framework to integrate patient data, medical domain knowledge, and patient assessment criteria for chronic disease patient follow-up assessments. A clinical decision support system was developed to implement this framework for automatic selection and adaptation of standard assessment protocols to suit patient personal conditions. We evaluated our method in the case study of type 2 diabetic patient follow-up assessments. ResultsThe proposed framework was instantiated using real data from 115,477 follow-up assessment records of 36,162 type 2 diabetic patients. Standard evaluation criteria were automatically selected and adapted to the particularities of each patient. Assessment results were generated as a general typing of patient overall condition and detailed scoring for each criterion, providing important indicators to the case manager about possible inappropriate judgments, in addition to raising patient awareness of their disease control outcomes. Using historical data as the gold standard, our system achieved a rate of accuracy of 99.93% and completeness of 95.00%. ConclusionsThis study contributes to improving the accessibility, efficiency and quality of current patient follow-up services. It also provides a generic approach to knowledge sharing and reuse for patient-centered chronic disease management.

Oleander toxicity – the clinical spectrum and mortality predictors: an observational study

A major cause of mortality in Government Villupuram Medical College & Hospital is due to toxin exposure. Oleander poisoning ranks second in the list being superseded only by organophosphate poisoning. Data on the incidence, clinical features and the determinants of mortality are scanty. Standardized treatment or monitoring protocols are lacking. The study aimed to identify key mortality predictors in oleander poisoning, document the clinical spectrum of patients presenting with oleander poisoning and to devise a standard assessment protocol in oleander-poisoned patients. This is a prospective, observational study conducted at Villupuram Medical College. Consecutive hospitalized patients who had consumed oleander seeds, fruits or leaves were included in the study after obtaining informed, written consent. Upon registration, detailed history, clinical examination, baseline investigations and targeted investigations were performed. The data were documented in the standardized case proforma and subsequently computed. Patients were followed up 12 hourly by clinical examination and ECG recordings for a duration of 3 days. The data were analyzed using standard statistical methods. A total of 101 patients (46 male and 55 female) were enrolled into the study. There were 18 deaths, most of them (82.55%) occurring within 24 hours of intake. Among the parameters assessed, females, low BMI (Body Mass Index), consumption of > 3 seeds, delayed presentation (after 120 minutes), altered mental status, clinical shock, presence of heart block and absent p waves in ECG were significantly associated with mortality. Males, high BMI, low dosage of poison (<=3 seeds) and hemodynamic stability on day 1 were associated with favorable outcomes. ST-T segment changes, sinus tachycardia, ventricular premature contractions and administration of orciprenaline had no significant effect on the outcome. Oleander poisoning claims lives in the rural tropics. Institutional assessment and treatment protocols based on the infrastructure and expertise available are the need of the hour. Prompt first aid, critical assessment and timely referral for cardiac pacing can cut down mortality to a large extent. Keywords: Oleander poisoning; Cardiac glycoside toxicity; Mortality predictors

Choosing Wisely: A Quality Improvement Initiative to Decrease Unnecessary Preoperative Testing

Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations...

How to Measure 24-hour Central Blood Pressure and Its Potential Clinical Implications

The evaluation of 24-hour central blood pressure (24h cBP) combines the cBP non-invasive assessment with the 24-h ambulatory BP measurement. The major strength of the 24-h cBP evaluation is the ability to assess the degree of circadian changes between central and peripheral BP, namely 24-h BP amplification. This allows an accurate quantification of the degree of spatial and temporal BP variability in each single individual. BP amplification depends from a number of factors, such as the interaction between pressure and flow pulsatile motions, vasomotor tone, arterial tapering and other physiological and anthropometrical determinants. The assessment of 24-h BP amplification, a relatively pressure-independent parameter, may be helpful in better refining the risk of organ damage and future CV events over traditional measures of office and 24-h brachial BP. Currently, only few devices enable the assessment of 24-h cBP. These devices are based on peripheral (brachial or radial) BP waveform detection, and reconstruction of central BP waveform through mathematical models. The estimation of 24-h cBP imputed from multivariate regression equations was also proposed. Clinical data are still scarce and, although suggesting a possible superiority of 24-h cBP over brachial BP in the association with markers of organ damage, they are limited by methodological and technical aspects. There is urgent need of a standardized methodology and rigorous validation protocols for the 24-h cBP assessment. The field of 24-h cBP measurement still requires significant advancements of scientific knowledge before its introduction into clinical practice.

Perioperative Delirium Protocol for the Older Patient

Delirium is an acute change in cognition and attention. It may affect any age group. It is most common in older patients and is associated with a significant increase in mortality. The purpose of this project was to implement an assessment protocol to identify patients at risk for postoperative delirium. A case study approach was used. The Confusion Assessment Method (CAM) tool for screening and diagnostic purposes was used to train surgeons, anesthesia providers, and nurses. A standardized delirium assessment and management protocol was developed and implemented. The CAM and geriatric preoperative assessment was used with the patient discussed in the case study. The patient did not experience postoperative delirium and was discharged from perioperative services on the same day. Evidence informs us that early recognition and multifaceted interventions can prevent postoperative delirium in the elderly.

Concept renovation and technical progress in surgical treatment of pancreatic cancer

Pancreatic carcinoma has the poorest prognosis in all the digestive cancers, and the management is still challenging. In recent years, the rapid development of surgical technique has led to the increase in the resection rate and the significant decrease in perioperative mortality and morbidity. However, the prognosis of pancreatic carcinoma has not been improved. Nowadays, the treatment strategy of pancreatic carcinoma has been changed from first into the mode of multidisciplinary team. If 1 mm rule was used as the standard protocol for assessment of resection margins, most of the pancreatic resection were therefore R1 resections. Neoadjuvant therapy is advocated for patients who meet specific characteristics. Under the guidance of the concept of precision medicine, surgical treatment of pancreatic carcinoma should be changed from the modes of morphology and surgery to the modes biology and oncology. Key words: Pancreatic neoplasms; Surgical procedures, operative; Multidisciplinary team

Systematic Left Ventricular Assist Device Implant Eligibility with Non-Invasive Assessment: The SIENA Protocol.

In patients with end-stage left ventricular (LV) heart failure who receive LV assist device (LVAD) implantation, right ventricular (RV) failure represents a possible critical complication that heavily affects morbidity and mortality. Several clinical, laboratory, hemodynamic, and echocardiographic variables have been found to be associated with RV failure occurrence after surgery. Different models and risk scores have been proposed, with poor results. No accordance has ever been reached about RV pre-operative evaluation, and time has come to introduce a standardized systematic protocol for LVAD suitability assessment according to RV function. We analyzed imaging parameters associated with LVAD implantation-related RV failure, in order to identify the minimum number for pre-operative reliable prediction of post-operative RV failure. A few echocardiographic parameters have been identified as the most reliable, or promising, and reproducible tools in this field: free-wall RV longitudinal strain, RV fractional area change, RV sphericity index, and RV ejection fraction with 3D-echocardiography. We propose the Systematic LVAD Implant Eligibility with Non-invasive Assessment protocol–the SIENA protocol–as a new and simple way of pre-operative evaluation of patients candidates to LVAD implantation.

MicroRNAs as biomarkers for early breast cancer diagnosis, prognosis and therapy prediction.

Breast cancer is a major health problem that affects one in eight women worldwide. As such, detecting breast cancer at an early stage anticipates better disease outcome and prolonged patient survival. Extensive research has shown that microRNA (miRNA) are dysregulated at all stages of breast cancer. miRNA are a class of small noncoding RNA molecules that can modulate gene expression and are easily accessible and quantifiable. This review highlights miRNA as diagnostic, prognostic and therapy predictive biomarkers for early breast cancer with an emphasis on the latter. It also examines the challenges that lie ahead in their use as biomarkers. Noteworthy, this review addresses miRNAs reported in patients with early breast cancer prior to chemotherapy, radiotherapy, surgical procedures or distant metastasis (unless indicated otherwise). In this context, miRNA that are mentioned in this review were significantly modulated using more than one statistical test and/or validated by at least two studies. A standardized protocol for miRNA assessment is proposed starting from sample collection to data analysis that ensures comparative analysis of data and reproducibility of results.

The effect of standard pain assessment on pain and analgesic consumption amount in patients undergoing arthroscopic shoulder surgery

Pain assessment has a key role in relief of the postoperative pain. In this study, we aimed to examine the effect of the Standard Pain Assessment Protocol (SPAP), which we developed based on acute pain guidelines, on pain level, and analgesic consumption. The study population consisted of a total of 101 patients who had arthroscopic shoulder surgery. The routine pain assessment was administered to the control group, while the SPAP was administered to the study group. The routine pain therapy of the clinic was administered to the subjects from both groups based on the pain assessment. Throughout the study, pain was assessed nearly two times more in the study group (p<0.001) and the mean pain levels were lower at 8th–11th hours in the study group (p<0.001). Pain assessment was not performed after 12th hour despite the severe pain in the control group, and, therefore, analgesia was administered at irregular intervals or was not administered at all. However, the hours of analgesic administration were found to be more regular according to the pain levels of the patients in the study group. In conclusion, the SPAP reduced the pain level by providing regular analgesia when used in combination with regular pain assessment. PerspectiveThis article highlights the appropriate assessment for patients with surgical pain. In majority of literature on the subject, the authors emphasize the importance of Standard Pain Assessment Protocol to provide adequate pain relief.

A Data Entry System for Dietary Surveys Based on Visual Basic for Applications Programming

Computer-based intake collection and nutrient analysis systems have been used to manage dietary intake information obtained from large groups of individuals. 1 Baranowski T. 24-Hour recall and diet record methods. in: Willett W.C. Nutritional Epidemiology. 3rd ed. Oxford University Press, 2013: 50 Google Scholar , 2 Blanton C.A. Moshfegh A.J. Baer D.J. The USDA multi-pass method accurately estimates group total energy and nutrient intake. J Nutr. 2006; 136: 2594-2599 Crossref PubMed Scopus (474) Google Scholar , 3 Slimani N. Deharveng G. Charrondiere R.U. et al. Structure of the standardized computerized 24-h diet recall interview used as reference method in the 22 centers participating in the EPIC project. European Prospective Investigation into Cancer and Nutrition. Comput Methods Prog Biomed. 1999; 58: 251-266 Crossref PubMed Scopus (270) Google Scholar , 4 Feskanich D. Sielaff B. Chong K. Bartsch G. Computerized collection and analysis of dietary intake information. Comput Methods Prog Biomed. 1989; 30: 47-57 Crossref PubMed Scopus (239) Google Scholar Some can automatically classify foods into food groups. 3 Slimani N. Deharveng G. Charrondiere R.U. et al. Structure of the standardized computerized 24-h diet recall interview used as reference method in the 22 centers participating in the EPIC project. European Prospective Investigation into Cancer and Nutrition. Comput Methods Prog Biomed. 1999; 58: 251-266 Crossref PubMed Scopus (270) Google Scholar , 4 Feskanich D. Sielaff B. Chong K. Bartsch G. Computerized collection and analysis of dietary intake information. Comput Methods Prog Biomed. 1989; 30: 47-57 Crossref PubMed Scopus (239) Google Scholar However, these diet analysis systems were largely designed to collect short-term intake data by food record and 24-hour dietary recall. When used with a standardized diet assessment protocol, bias and incomplete information can be minimized. 1 Baranowski T. 24-Hour recall and diet record methods. in: Willett W.C. Nutritional Epidemiology. 3rd ed. Oxford University Press, 2013: 50 Google Scholar , 5 NDSR—Nutrition Data System for Research. http://www.ncc.umn.edu. Accessed June 15, 2014. Google Scholar

Secretin-Stimulated Magnetic Resonance Imaging Assessment of the Benign Pancreatic Disorders

This systemic review summarizes the current literature and general consensus on secretin-stimulated magnetic resonance imaging (s-MRI) of the benign pancreatic disorders and discusses important aspects on how s-MRI is optimally performed. The aim is to provide an overview, for clinicians and radiologist, of the s-MRI protocols and the range of clinical applications. Furthermore, the review will summarize the criteria for evaluation of pancreatic morphology and function based on s-MRI.The literature search indentified 69 original articles and 15 reviews. Chronic pancreatitis was the disease that was most frequently assessed by s-MRI (33%), followed by acute pancreatitis (9%). Dynamic thick-slab 2-dimensional magnetic resonance cholangiopancreatography was the most used imaging sequence (86%). The diameter of the main pancreatic duct (75%) and pancreatic exocrine function based on visual grading of duodenal filling (67%) were the most evaluated pancreatic features. Sufficient similarities between studies were identified to propose the most agreeable standardized s-MRI protocol for morphological and functional assessment of the pancreas. In the future, more research and increased collaboration between centers is necessary to achieve more consensus and optimization of s-MRI protocols.

Eyes Behind the Camera: Development and Validation of a Protocol to Conduct Home-Safety Assessments

Abstract Date Presented 4/8/2016 A standardized remote home-safety assessment protocol was developed and validated on the basis of experts’ opinions and caregivers’ feedback and demonstrations. This protocol can be used by a caregiver to assist an occupational therapist in conducting a remote assessment of a client’s home. Primary Author and Speaker: Mijung Lee Contributing Authors: Ivana Simic, Jon A. Sanford, Sergio Romero

Clinical Study on the Management of Cerebral Palsy with Yoga Basti (Medicated Enema)

Background: Disabled children are of great concern for families as well as the society. Cerebral Palsy (CP) is the leading cause of chronic disability in children, making them physically and mentally handicapped and socially apart. Considering the signs and symptoms of CP, the disease entity seems to be very close to the presentation of Vata Vyadhi (disease caused due to predominance of Vata bio-humor). Treatment of Vata Dosha consists of a variety of modalities among which Basti (enema) is said to be the prime one. Aim: The present study was designed to evaluate the role of Yoga Basti in the management of cerebral Palsy. Materials & Methods: Six patients were enrolled in the study who were administered with three courses of procedures. Initially Udvartana (a type of massage usually with dry powder) was done for rst 5 days, followed by Abhyanga (a type of massage usually with oil) for next 5 days with Bala Taila & Nadi Sweda (type of fomentation) and Yoga Basti (medicated enema) for next 8 days. Medhya Churna (powder of drugs) was given as internal medication for 86 days. The International standard assessment protocol was adopted to evaluate the efcacy of the therapy. Results: The efficacy of treatment assessed on CDC grade revealed that head holding, sitting, standing, fine motor improved significantly (p

B-Mode Sonographic Assessment of the Posterior Circumflex Humeral Artery: The SPI-US Protocol-A Technical Procedure in 4 Steps.

Elite overhead athletes are at risk of vascular injury due to repetitive abduction and external rotation of the dominant arm. The posterior circumflex humeral artery (PCHA) is prone to degeneration, aneurysm formation, and thrombosis in elite volleyball players and baseball pitchers. The prevalence of PCHA-related thromboembolic complications is unknown in this population. However, the prevalence of symptoms associated with digital ischemia is 31% in elite volleyball players. A standardized noninvasive imaging tool will aid in early detection of PCHA injury, prevention of thromboembolic complications, and measurement reproducibility. A standardized vascular sonographic protocol for assessment of the proximal PCHA (SPI-US protocol [Shoulder PCHA Pathology and Digital Ischemia-Ultrasound protocol]) is presented.

Genetic variation in SLC17A7 promoter associated with response to sport-related concussions

Objective: To determine the association of the single nucleotide polymorphism (SNP) rs74174284 within SLC17A7 promoter with concussion severity or duration.Design: A between-subjects design was utilized.Methods: Saliva samples and concussion severity and duration data were collected from 40 athletes diagnosed with a sport-related concussion by a physician, utilizing a standardized concussion assessment protocol. DNA was extracted, estimated and genotyped.Results: An association was found between the dominant genetic model (CC vs GG + GC; p = 0.0179) and recovery, where those carrying the minor allele were 6.33-times more likely to experience prolonged recovery rates. Within the ImPACT assessment, those carrying the CC genotype (33.38 ± 10.15, p = 0.01) had worse motor speed scores upon initial assessment compared to both heterozygous (CG) and homozygous (GG) genotypes (41.59 ± 7.39).Conclusions: This study was the first to demonstrate an association between genetic polymorphism at rs7417284 SNP in the promoter region of the SLC17A7 gene and concussion severity and duration. Based upon these findings, rs74174284 is a potential predictive genetic marker for identifying athletes who are more susceptible for altered recovery times and worse motor speed ImPACT scores after sport-related concussion.

Can clinical foot and ankle assessments improve the prediction of patient reported outcomes in knee arthroplasty?

Knee arthroplasty (KA) has been considered to be a successful and cost-effective intervention for individuals with severe end stage Osteoarthritis (OA). A number of clinically important predictors of outcomes following KA have been established, however there are still other factors to be identified to improve our ability to recognise patients at risk of poor KA outcomes. Although the relationship between foot, ankle and knee kinematics has become widely accepted, it is not known whether foot and ankle status affect KA outcomes. This thesis therefore aims to determine whether clinical foot and ankle measures are useful in predicting patient reported outcomes following KA. A formal literature review was firstly undertaken to identify current methods of assessing musculoskeletal foot and ankle status. Findings of the review revealed an absence of a standardised assessment protocol and a lack of agreement and validity for many current clinical measures. In response to this an international expert consensus study was undertaken to produce an agreed set of objective clinical musculoskeletal foot and ankle assessment measures to form a new protocol. Two measures identified from the review, and agreed via expert consensus, as the most robust assessment methods- the Foot Posture Index (FPI) and ankle dorsiflexion, were introduced to a large prospective cohort of patients awaiting knee arthroplasty, in addition to foot pain questions. Results show that ankle dorsiflexion and foot posture were not associated with one year knee outcomes, however pre-operative foot pain was associated to outcome; the presence of foot pain increased the risk of a poor post-operative clinical outcome. Findings suggest that it would be beneficial to address foot pain prior to surgery to reduce the risks associated with a poor outcome. Further work would be beneficial to establish the sequential link between foot pain and knee OA in order to inform the most appropriate method of the conservative management.

Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research.

Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1) use standardized assessment protocols; (2) confirm diagnosis through established clinical interview when possible; (3) provide a clear operationalized definition for breastfeeding variables; (4) clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5) be prospective or longitudinal in nature; and (6) take into consideration other potential risk factors identified in the empirical literature.

Rates of presurgical underestimation of breast cancer after standardized assessment of breast calcifications

Purpose: To determine the frequency of histopathological underestimation of breast cancer after vacuum-assisted biopsy (VAB) in standardized assessment of breast calcifications compared to postsurgical diagnosis. Materials and methods: The retrospective study included acquired data of 506 consecutively examined women, who underwent VAB for the assessment of pure calcifications after standardized digital mammographic and sonographic imaging. 119/506 (24.5 %) women underwent further surgical procedures: 37 women had a surgical diagnostic excision biopsy, 82 women a surgical procedure based on a therapeutic concept. Presurgical results of VAB were compared with the postsurgical histopathological reports. Results: In 91/119 women (76.5 %) the final histology was malignant. The rate of ductal carcinoma in situ (DCIS) was 79.1 % (72/91) and the rate of invasive carcinoma was 20.9 % (19/91). In 9/37 women with diagnostic excision biopsy, the presurgical status of benign or uncertain changed to a postsurgical diagnosis of malignant (24.3 %). In eight cases underestimation included DCIS (21.6 %) and in one case invasive cancer (2.7 %). Seven of the nine underestimated cases (77.8 %) resulted from excision biopsy of atypical epithelial proliferation of ductal type (AEPDT, positive predictive value 30.4 % (7/23)). After surgery due to DCIS in 7/71 women invasive breast cancer was diagnosed (9.9 %). In 11/82 women with oncological surgery, invasive cancer was already diagnosed by VAB. Conclusion: Underestimation of invasive cancer in terms of presurgical DCIS diagnosis can be minimized by the standardized assessment protocol to about 10 %. Underestimation of DCIS is mainly related to presurgical diagnosis of AEPDT. Key points:

Effective management of attention-deficit/hyperactivity disorder (ADHD) through structured re-assessment: the Dundee ADHD Clinical Care Pathway

Attention-deficit/hyperactivity disorder (ADHD) has become a major aspect of the work of child and adolescent psychiatrists and paediatricians in the UK. In Scotland, Child and Adolescent Mental Health Services were required to address an increase in referral rates and changes in evidence-based medicine and guidelines without additional funding. In response to this, clinicians in Dundee have, over the past 15 years, pioneered the use of integrated psychiatric, paediatric, nursing, occupational therapy, dietetic and psychological care with the development of a clearly structured, evidence-based assessment and treatment pathway to provide effective therapy for children and adolescents with ADHD. The Dundee ADHD Clinical Care Pathway (DACCP) uses standard protocols for assessment, titration and routine monitoring of clinical care and treatment outcomes, with much of the clinical work being nurse led. The DACCP has received international attention and has been used as a template for service development in many countries. This review describes the four key stages of the clinical care pathway (referral and pre-assessment; assessment, diagnosis and treatment planning; initiating treatment; and continuing care) and discusses translation of the DACCP into other healthcare systems. Tools for healthcare professionals to use or adapt according to their own clinical settings are also provided.Electronic supplementary materialThe online version of this article (doi:10.1186/s13034-015-0083-2) contains supplementary material, which is available to authorized users.