Standardized Assessment Tools Research Articles

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Oxford Level 3.

A Comparative Study on Aggression and Performance Anxiety in Physical and Non-physical Sports in India

Understanding the interplay of aggression and anxiety in individuals who compete in physical sport against those who compete in non-physical sport is crucial to provide individuals with customized training programs, interventions, and coping strategies. Incorporating a comparative framework this study aims to investigate the correlation of aggression and performance anxiety in physical and non-physical sports. The study included a total 100 participants of which 51 were individuals competing in physical sports and 49 competing in non-physical sports, the distribution also included 64 males and 36 females. Both performance anxiety and aggression were measured through standardized assessment tools, Sports Anxiety Scale-2 (SAS-2) by Smith, Ronald E. et, al. (2006) and the Buss Perry Aggression Questionnaire (BPAQ) by Buss and Perry (1992). The scores of physical sport participants indicated a mean score of 78.3 (SD=16.5) in Aggressive behaviours and 29.7 (SD=9.9) in Anxious behaviours, mean scores for non-physical sport participants were 67.9 (SD=16.4) for aggression and 27.8 (SD=7.4) for sport anxiety. The findings of this study highlight that both groups physical sport and non-physical) sport had a moderate to good positive correlation of aggression and performance anxiety, and the need for further research dedicated to professional athletes in both domain.

Unveiling the paradoxes of implementing post graduate competency based medical education programs

Purpose Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation. Method A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards. Results Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators. Conclusions Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.

Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test (CANELT): A functional approach.

The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA). CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted. An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [χ2 (2) = 95.2, p < .001] and NI [χ2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's α of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained. Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed.

Research gaps in the neurodevelopmental assessment of children with complex congenital heart defects: a scoping review

BackgroundChildren with congenital heart defects (CHD) are at risk for a range of developmental disabilities that challenge cognition, executive functioning, self-regulation, communication, social-emotional functioning, and motor skills. Ongoing developmental surveillance is therefore key to maximizing neurodevelopmental outcome opportunities. It is crucial that the measures used cover the spectrum of neurodevelopmental domains relevant to capturing possible predictors and malleable factors of child development.ObjectivesThis work aimed to synthesize the literature on neurodevelopmental measures and the corresponding developmental domains assessed in children aged 1−8 years with complex CHD.MethodsPubMed was searched for terms relating to psycho-social, cognitive and linguistic-communicative outcomes in children with CHD. 1,380 papers with a focus on complex CHD that reported neurodevelopmental assessments were identified; ultimately, data from 78 articles that used standardized neurodevelopmental assessment tools were extracted.ResultsThirty-nine (50%) of these excluded children with syndromes, and 9 (12%) excluded children with disorders of intellectual development. 10% of the studies were longitudinal. The neurodevelopmental domains addressed by the methods used were: 53% cognition, 16% psychosocial functioning, 18% language/communication/speech production, and 13% motor development-associated constructs.ConclusionsData on social communication, expressive and receptive language, speech motor, and motor function are underrepresented. There is a lack of research into everyday use of language and into measures assessing language and communication early in life. Overall, longitudinal studies are required that include communication measures and their interrelations with other developmental domains.

Enhancing Care Standard at Public Healthcare Facilities through Patient Satisfaction Assessment – A Review

This review paper provides a comprehensive analysis of research on enhancing care standard at public healthcare facilities through patient satisfaction assessment. By synthesizing findings from peer-reviewed studies, this review aims to identify trends, gaps, and best practices in this critical area of healthcare. Through rigorous search and selection criteria, a total of 15 relevant articles were identified and analyzed. The review explores various dimensions of patient satisfaction assessment, including factors influencing satisfaction, methods of assessment, and the impact on healthcare delivery. Key findings highlight the importance of effective communication, staff attitudes, waiting times, and facility cleanliness in shaping patient satisfaction. Additionally, the review examines the role of different assessment tools, such as surveys, interviews, and online platforms, in capturing patient experiences. Furthermore, it discusses the implications of patient satisfaction assessment on healthcare outcomes, provider-patient relationships, and organizational performance. The review also identifies challenges and opportunities for future research and practice, including the need for standardized assessment tools, resource allocation, and cultural sensitivity. Overall, this review paper contributes to the understanding of how patient satisfaction assessment can be leveraged to improve the care standard at public healthcare facilities.

Clinical diagnostic practices for Chinese developmental dyslexia

Objective: To explore the optimization of the standardized assessment tool for clinical diagnosis of Chinese developmental dyslexia (DD). Methods: A cross-sectional study was conducted from May to December 2023, in which 130 primary school children in grades 1 to 3 with clinical signs of literacy lag and positive screening results on the screening scales were recruited from the outpatient clinic of Child Health Care Medical Division, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine. Chinese dyslexia screening behavior checklist for primary students (CDSBC) was used as the screening scales, and supplemented by dyslexia checklist for Chinese children. Referring to the standard procedure of the"expert advice on diagnosis and intervention of chinese developmental dyslexia", the developmental dyslexia scale for standard mandarin (DDSSM) was used to evaluate the children's literacy-related cognitive abilities and conduct the diagnostic assessment, and divided the children into learning backward group and the DD group. The t-test and χ2 test were used to compare the differences in the distribution of intelligence, literacy and attention deficit hyperactivity disorder between the two groups. Spearman's correlation was used to analyze the correlation between the scores for each cognitive ability in the DDSSM and the CDSBC. Results: Of the 130 children, 90 were male, aged (8.3±1.0) years; 40 were female, aged (8.1±0.9) years. A final diagnosis of DD was made in 59 cases, of which 41 were males. There was no statistically significant difference in operational intelligence quotient (101±15 vs.100±15, t=0.53, P>0.05) and statistically significant difference in literacy of DDSSM (32±5 vs.21±4, t=11.56, P<0.001) between the learning backward group and the DD group. Eighteen cases (25.4%) of the learning backward group were children with attention deficit subtype attention deficit hyperactivity disorder (ADHD-I), and 16 cases (27.1%) in DD group, the difference in incidence between the two groups was not statistically significant (χ2=0.05, P>0.05). There were correlations between the DDSSM (for oral vocabulary, morphological awareness and orthographic awareness) and the CDSBC total score (r=-0.42, -0.32, -0.35, all P<0.01), but the correlations for visuospatial perception and rapid automatized naming with CDSBC total score were not statistically significant (r=-0.09 and -0.20,both P>0.05). Conclusions: For literacy-related cognitive abilities, screening scales CDSBC are not sufficiently useful for assessment, so the introduction of standardized assessment tools DDSSM is an optimization of the clinical diagnosis of Chinese DD, which is crucial for achieving accurate diagnosis and intervention.

Simulation-Based Cardiopulmonary Examination Skills Checklist: Assessment of Inter-rater Reliability

Purpose: Experiential learning using high-fidelity simulation is a valuable tool for teaching Doctor of Physical Therapy (DPT) students the cardiopulmonary examination. There are currently no standardized assessment tools to evaluate student performance and provide feedback on these skills. The cardiovascular and pulmonary section of the American Physical Therapy Association recently published recommended competency levels for entry-level physical therapists including examination skills. The primary aim of this study was to create and assess inter-rater reliability of a cardiopulmonary examination skills checklist that aligns with these recommendations and can be used in the simulation environment. Methods: A skills checklist with 6 sections was developed to assess student performance on the cardiopulmonary examination within a high-fidelity simulation experience. Training videos on the cardiopulmonary examination and checklist use were created and given to 3 graders. Seventy-three DPT students performed the cardiopulmonary examination within simulation while being recorded. Three graders then assessed the same 25 randomly selected videos using the checklist. Inter-rater reliability, item % agreement and student performance were analyzed. Results: The overall interclass correlation coefficient (ICC) of the checklist was calculated to be 0.858, demonstrating strong agreement between graders. The ICC for individualized checklist sections ranged from 0.659 to 0.960, demonstrating good to near perfect agreement. The average percent correct achieved by students was 80.48 (6.91%), R = 65% to 93.33%. There were &gt;80% agreement for 55/60 items and &gt;90% agreement for 44/60 items. Conclusion: The checklist provided an effective tool to assess student performance on the cardiopulmonary examination and demonstrated consistent scoring between graders.

Association of cesarean section delivery with childhood behavior: a systematic review protocol.

This review will evaluate the association between cesarean section delivery and child behavior problems. Cesarean section (C-section) deliveries account for over 30% of deliveries in Canada and 21% of all births globally. Mode of delivery via C-section has been associated with altered maternal mental health in the postpartum period, and postpartum depression is linked to an increased risk of internalizing and externalizing behaviors in children. Given the high rates of C-section deliveries worldwide, it is important to determine how mode of delivery impacts child behavior. The review will examine child behavior outcomes among preschool and school-aged children as determined by medical diagnosis or a standardized assessment tool. Multiple gestation pregnancies and pre-term delivery will be excluded. A search will be conducted using APA PsycINFO (Ovid), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and Scopus. This review will evaluate peer-reviewed primary observational research studies specifically looking at examining C-section delivery. Two reviewers will independently screen titles, abstracts, and full-text studies to determine alignment with the inclusion and exclusion criteria. Data will be recorded using the standardized JBI data extraction tool and be presented using figures, tables, and a summary. Where feasible, we will conduct a meta-analysis and subgroup analysis of suitable populations. Critical appraisal of studies will be performed for included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. PROSPERO CRD42022371294.

The prevalence of presbyphagia in older adults: asystematic review and meta-analysis.

Presbyphagia is defined as structural, physiological and innervational alterations in the swallowing process as aresult of aging and is considered to be involved in the etiology of dysphagia. This systematic review and meta-analysis aimed to estimate the prevalence of presbyphagia in older adults without disease-related dysphagia. In this study five databases were searched in October 2023 with no time limitation. Combined effect sizes of presbyphagia prevalence were calculated using random effect models. Meta-regression and subgroup analyses were conducted to identify sources of heterogeneity. Egger's test and afunnel plot were employed to examine publication bias. Atotal of 19studies were selected for analysis. Overall, the prevalence of presbyphagia in older adults was 30.8% (95% confidence interval [CI] 24.8-36.7%). Publication bias was adjusted for using the fill-and-trim method and the corrected pooled prevalence of presbyphagia was 17.3% (95% CI 11.0-23.6%). In addition, the meta-regression findings revealed that the assessment tool had significant effects upon heterogeneity. Although the pooled prevalence of presbyphagia in older adults was 17.3%, the lack of large representative studies limited the interpretation of these findings. In the future, further large studies that diagnose presbyphagia using standardized assessment tools would facilitate new avenues to reduce the risk of dysphagia in older adults.

Accuracy of Gonial Angle Measurements Using Panoramic Imaging versus Lateral Cephalograms in Adults with Different Mandibular Divergence Patterns.

Gonial angle is an important craniofacial parameter providing information about symmetry and vertical dimensions of the facial skeleton. It can be measured on panoramic radiographs and lateral cephalograms. Reliable assessment of the gonial angle is challenged by the superimpositions associated with lateral cephalograms. The aim of the current study was to assess the precision of panoramic imaging in measuring the gonial angles compared to lateral cephalograms in adult patients with different mandibular divergence patterns. Panoramic radiographs and lateral cephalograms of 448 adults (18-30 years old) were utilized in the study. The gonial angle was determined on the lateral cephalograms using an online AI-driven assessment tool (WebCephTM) and compared to the panoramic measurements among the different gender, malocclusion, and mandibular divergence groups. Statistically significant differences were recorded between measurements taken on lateral cephalograms or panoramic radiographs (p=0.022). In addition, statistically significant differences were reported in gonial angle measurements on panoramic radiographs among the different mandibular divergence groups (p=0.004) for FMA (p=0.002) for Sn-GoMe. While cephalometry is considered the gold standard tool for reliable gonial angle assessment, panoramic radiographs were more accurate in detecting the differences between the divergence groups in the current study.

Approaches to Consciousness Assessment in Neurocritically Ill Patients

The majority of neurocritically ill patients have disorders of consciousness. Both level and content of consciousness should be assessed repeatedly throughout the course of patient care. In this review, we describe the definition and diagnostic criteria for disorders of consciousness, and the neurological examination and standardized neurobehavioral assessment tools as methods of assessing consciousness. Next, we will discuss neurophysiological and neuroimaging tests as tools for assessing consciousness: automated quantitative pupillometry, electroencephalogram, evoked potentials, brain imaging, functional near-infrared spectroscopy, and biomarkers. We discuss the clinical utility of each assessment tool and the importance of a multimodal approach in the diagnosis, treatment, and prognostication of disorders of consciousness.

Virtual Reality-Based Interventions to Improve Balance in Patients with Traumatic Brain Injury: A Scoping Review.

Virtual reality (VR)-based interventions to improve balance and mobility are gaining increasing traction across patient populations. VR-based interventions are believed to be more enjoyable and engaging for patients with traumatic brain injury. This scoping review aims to summarize existing studies from the literature that used VR to improve balance and mobility and determine the gap in VR-based balance literature specific to individuals with traumatic brain injury. Two authors independently searched the literature using the search terms "Virtual Reality Traumatic Brain Injury Lower Limb", "Virtual Reality Traumatic Brain Injury Balance", and "Virtual Reality Traumatic Brain Injury Gait". A total of seventeen studies, specifically, three randomized controlled trials, one one-arm experimental study, two retrospective studies, two case studies, one feasibility/usability study, one cohort study, and seven diagnostic (validation) studies, met the inclusion criteria for this review. The methodological quality of the studies evaluated using the PEDro scale was fair. Future studies should focus on large-scale clinical trials using validated technology to determine its effectiveness and dose-response characteristics. Additionally, standard assessment tools need to be selected and utilized across interventional studies aimed at improving balance and mobility to help compare results between studies.

Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment.

Pancreatico-duodenectomy (PD) carries significant morbidity and mortality, with very few modifiable risk factors. Radiological evidence of sarcopenia is associated with poor outcomes. This retrospective study aimed to analyse the relationship between easy-to-use bedside nutritional assessment techniques and radiological markers of muscle loss to identify those patients most likely to benefit from prehabilitation. Data were available in 184 consecutive patients undergoing PD. Malnutrition was present in 33-71%, and 48% had a high visceral fat-to-skeletal muscle ratio, suggestive of sarcopenic obesity (SO). Surgical risk was higher in patients with obesity (OR 1.07, 95%CI 1.01-1.14, p = 0.031), and length of stay was 5 days longer in those with SO (p = 0.006). There was no correlation between skeletal muscle and malnutrition using percentage weight loss or the malnutrition universal screening tool (MUST), but a weak correlation between the highest hand grip strength (HGS; 0.468, p < 0.001) and the Global Leadership in Malnutrition (GLIM) criteria (-0.379, p < 0.001). Nutritional assessment tools give widely variable results. Further research is needed to identify patients at significant nutritional risk prior to PD. In the meantime, those with malnutrition (according to the GLIM criteria), obesity or low HGS should be referred to prehabilitation.

Patient-Perceived Quality Assessment in Orthopedics and Traumatology Departments during COVID-19 Pandemic.

The COVID-19 pandemic has led to significant disruptions in various healthcare systems. In Romania, the elective procedures in the orthopedic and traumatology specialty were one of the most affected. The study aims to investigate the influence of the COVID-19 pandemic on patient perceptions of quality in these departments. Standardized assessment tools were used, which consist of satisfaction questionnaires addressed to patients in order to assess the quality of health services in orthopedics and traumatology departments. Thus, a retrospective study was conducted using satisfaction questionnaires addressed to patients admitted to the orthopedics and traumatology departments of the County Clinical Emergency Hospital Bihor between January 2019 and December 2022. Eight reports, based on 746 questionnaires conducted during the studied period, were evaluated. To gauge patient satisfaction, Likert scales featuring five response options were used. A total of 627 questionnaires were valid, the exclusion criteria being incomplete questionnaires (the patients did not respond on all questions, n = 119). Four domains were analyzed: demographic data, hotel conditions, quality of medical care, and overall satisfaction. Demographic data highlight that patients exhibited an equitable distribution across residences, with 50.2% hailing from urban locales, while 53.5% (n = 333) were female. Regarding the overall impression, in 2020, there was a decline in the top rating of 5 compared to 2019, dropping to just 45.10% from 53.45%. Scores of 4 increased to 41.83%, while scores of 3 stayed under 8.5%. Scores of 2 and 1 were negligible. In 2021 and 2022, we can observe a sustained increase in the number of patients who awarded 5 points for overall impression and a decrease in the number of patients who awarded 4 points compared to previous years. The maximum difference between 2020 and 2021 and the period before and after this period was 27.24% (p-value < 0.001). The results indicate that while overall impressions of the hospital remained positive throughout the studied period, there were notable fluctuations in satisfaction levels during the pandemic. Patient satisfaction with attending physicians dipped in 2020 from 86.70% to 77.78% but recovered by 2022. The same trend can be observed with nurses and caregivers, as well as hotel services, during this period. These findings underscore the importance of addressing patient concerns and improving the quality of care delivery, particularly during times of crisis.

Interventions for anxiety and depression in patients with atopic dermatitis: a systematic review and meta-analysis

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with anxiety and depression. Few studies have addressed interventions for symptoms of anxiety and depression in this population. To determine the efficacy of interventions for anxiety and depression in patients with AD. PubMed, MEDLINE, EMBASE, and PsycINFO were searched from inception to November 2023. English-language studies published in peer-reviewed journals evaluating the effect of interventions on anxiety and/or depression using validated assessment tools on patients with AD were included. Titles, abstracts, and articles were screened by at least two independent reviewers. Of 1410 references that resulted in the initial search, 17 studies were included. Fourteen of these studies are randomized controlled trials, while the other 3 studies are prospective controlled trials with pre and post-test designs. Data were extracted using a standardized extraction form, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. To accommodate trials with multiple interventions (each compared to a control group), we conducted a mixed-effects meta-analysis with the trial as a random effect. Prespecified outcomes were changes in symptoms of anxiety and depression in patients with AD as evaluated using standardized assessment tools. Of the 17 studies included in this systematic review, 7 pharmacological intervention studies with 4723 participants examining 5 different medications were included in a meta-analysis. Of these studies, only 1 study evaluated medications prescribed to treat anxiety and/or depression; the rest evaluated medications prescribed to treat AD. Meta-analysis of all the pharmacological interventions resulted in significant improvement in anxiety, depression, and combined anxiety-depression scale scores (standardized mean difference [95% CI]: − 0.29 [− 0.49 to − 0.09], − 0.27 [− 0.45 to − 0.08], − 0.27 [− 0.45 to − 0.08]) respectively. The 10 non-pharmacological studies with 2058 participants showed general improvement in anxiety but not depression. A meta-analysis of the non-pharmacological interventions was not conducted due to variable approaches and limited data. Pharmacological interventions designed to improve AD were found to improve anxiety and depression in patients with moderate-severe disease. More comprehensive studies on non-pharmacological and pharmacological interventions that primarily target anxiety and depression are needed.

The effects of a resiliency intervention program on indicators of resiliency and burnout in psychiatry residents

Studies have documented the stress and burnout related to medical residency and the need to design programs to reduce burnout. This study evaluates the effectiveness of an intervention for psychiatric residents to improve resiliency and reduce burnout. A six-session program was offered that included mindfulness, self-regulation, and coping strategies. The program was approved by the Institutional Review Board. Standardized assessment tools measuring perceived stress, mindfulness, professional quality of life, burnout and resiliency were used pre and post program. Burnout was defined based on any one of the three criteria for burnout: high emotional exhaustion, high depersonalization or low personal accomplishment. Six one-hour sessions were offered to residents during protected time during the academic year. Analysis compared residents who met and did not meet criteria for burnout pre and post program. Twenty-seven residents provided informed consent, and 23 had complete data on the indicators of burnout. Seven of 23 met criteria for burnout and those significantly reduced their perceived stress, emotional exhaustion, burnout and increased their mindfulness scores post program (p < 0.05). The residents who improved their mindfulness scores post program significantly improved resiliency, reduced secondary traumatic stress and perceived stress (p < 0.05). There were no significant differences in the scores of residents who did not meet criteria for burnout. Residents experiencing burnout significantly improved indicators of burnout, while those not reporting burnout did not worsen. Mindfulness was an important component of this program since residents gaining in mindfulness skills also reduced scores on indicators of burnout post program.

Establishing a plan to improve pediatric patient comfort during PIV insertions and blood specimen collection: a quality improvement effort.

Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

Comparison Study Between Weight Training and Fartlek To Improve The Running Speed Of Trainee Teachers In The 100-Meter Event

The purpose of this study is to compare the effectiveness of weight training and Fartlek in improving the running speed of trainee teachers in the 100-meter event. The study aims to determine which training method is more effective in enhancing running speed. The study participants were randomly assigned to either weight training or fartlek groups and underwent their respective training programs for four weeks. The running speed of both groups was evaluated and compared using a standardized assessment tool. The results of this study will contribute to the existing knowledge on the benefits and limitations of weight training and Fartlek in improving running speed. The t-test showed that there is no significant difference between the two means among both training groups and its proven that both weight training and Fartlek training is suitable is improving the running speed of trainee teachers in 100-meter event. This study is expected to provide valuable information for coaches, trainers, and physical educators in developing effective training programs for athletes and physical education students. and reduce labor costs and water wastage and increase productivity and efficiency.

Comparative diagnostic accuracy of transcranial Doppler and contrast-enhanced transthoracic echocardiography for the diagnosis of patent foramen ovale and atrial septal defect.

Recognition of right-to-left shunt is crucial in the work-up of patients with suspected patent foramen ovale (PFO) or atrial septal defect (ASD). While transesophageal echocardiography (TEE) remains the gold standard diagnostic tool for the anatomic assessment of PFO/ASD, transcranial Doppler (TCD) and contrast-enhanced transthoracic echocardiogram (CE-TTE) hold the promise of providing minimally invasive yet accurate clinical details. Their comparative accuracy remains however debated. We conducted a retrospective observational study leveraging our extensive institutional experience with systematic TCD and CE-TTE in patients with suspected PFO/ASD. Several measures of diagnostic test accuracy were computed, with point estimates and 95% confidence intervals, when applicable. A total of 1358 patients were included, with age 48±14 years and 772 (58%) women. Tests were performed for diagnostic purposes in 797 (58.6%) and during follow-up in 740 (54.5%). A PFO was eventually diagnosed in 1038 (77.9%) patients, and an ASD in 60 (4.5%). Agreement between TCD and CE-TTE occurred in 1309 (85.2%) cases, with TCD yielding worse findings than CE-TTE in 91 (5.9%) patients, and vice versa in 137 (8.9%), yielding a Cohen kappa of 78.6% (95% CI: 76.3-81.1%) and a highly significant P value at McNemar test (P<0.001). After dichotomization, and using TCD as benchmark, CE-TTE yielded sensitivity 96.9%, specificity 95.1%, area under the curve 92.1%, and P=0.249. Similar findings were obtained when focusing only on diagnostic tests or follow-up ones (Cohen kappa respectively 74.0% [70.2-77.1%], P<0.001 and 80.3% [76.4-84.3%], P<0.001). Notably, Valsalva was necessary to disclose the presence of shunt during TCD in 487 (31.7%) patients and during CE-TTE in 482 (31.4%) cases. Finally, performance of TCD and CE-TTE in a subset of patients eventually undergoing TTE was quite similar. The diagnostic accuracy of CE-TTE appears favorable, and this imaging test may identify patients who may be missed if only TCD is used to screen patients with suspected PFO/ASD. Accordingly, CE-TTE is recommended as an adjunct diagnostic modality for all patients with a high pre-test probability of PFO/ASD and right-to-left shunt.