Assessment Tool Research Articles

MocapMe: DeepLabCut-Enhanced Neural Network for Enhanced Markerless Stability in Sit-to-Stand Motion Capture

This study examined the efficacy of an optimized DeepLabCut (DLC) model in motion capture, with a particular focus on the sit-to-stand (STS) movement, which is crucial for assessing the functional capacity in elderly and postoperative patients. This research uniquely compared the performance of this optimized DLC model, which was trained using ’filtered’ estimates from the widely used OpenPose (OP) model, thereby emphasizing computational effectiveness, motion-tracking precision, and enhanced stability in data capture. Utilizing a combination of smartphone-captured videos and specifically curated datasets, our methodological approach included data preparation, keypoint annotation, and extensive model training, with an emphasis on the flow of the optimized model. The findings demonstrate the superiority of the optimized DLC model in various aspects. It exhibited not only higher computational efficiency, with reduced processing times, but also greater precision and consistency in motion tracking thanks to the stability brought about by the meticulous selection of the OP data. This precision is vital for developing accurate biomechanical models for clinical interventions. Moreover, this study revealed that the optimized DLC maintained higher average confidence levels across datasets, indicating more reliable and accurate detection capabilities compared with standalone OP. The clinical relevance of these findings is profound. The optimized DLC model’s efficiency and enhanced point estimation stability make it an invaluable tool in rehabilitation monitoring and patient assessments, potentially streamlining clinical workflows. This study suggests future research directions, including integrating the optimized DLC model with virtual reality environments for enhanced patient engagement and leveraging its improved data quality for predictive analytics in healthcare. Overall, the optimized DLC model emerged as a transformative tool for biomechanical analysis and physical rehabilitation, promising to enhance the quality of patient care and healthcare delivery efficiency.

The Indonesian version of volunteer functions inventory: Its validity and reliability

The volunteer function inventory (VFI) is an assessment tool to measure individual volunteer motivation. VFI measures individual motivation to volunteer by examining the functional motives of each volunteer. This research aimed to adapt the VFI to the Indonesian language. VFI consists of 30 items divided into five dimensions. This study utilized a non-experimental quantitative research method. Samples were acquired by accidental random sampling with N = 176. In this study, reliability testing was carried out with items and dimensions of Cronbach's α. Validity tests were examined using construct validity and item analysis. The results of the Indonesian version of VFI showed high reliability and validity. Besides, the item analysis also shows that the quality of each item is excellent. The Indonesian version of VFI will be suitable for various education fields in Indonesia to measure the students' voluntary willingness in community development activities, for example, in measuring the impact of volunteerism in the Merdeka Belajar Kampus Merdeka (MBKM) social activities and other activities within the communities.

Remote Ischemic Conditioning With Medical Management or Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Remote ischemic conditioning (RIC) is a low-cost, accessible, and noninvasive neuroprotective treatment strategy, but its efficacy and safety in acute ischemic stroke are controversial. With the publication of several randomized controlled trials (RCTs) and the recent results of the RESIST trial, it may be possible to identify the patient population that may (or may not) benefit from RIC. This systematic review and meta-analysis aims to evaluate the effectiveness and safety of RIC in patients with ischemic stroke receiving different treatments by pooling data of all randomized controlled studies to date. We searched the PubMed, Embase, Cochrane, Elsevier, and Web of Science databases to obtain articles in all languages from inception until May 25, 2023. The primary outcome was the modified Rankin Scale (mRS) score at the specified endpoint time in the trial. The secondary outcomes were change in NIH Stroke Scale (NIHSS) and recurrence of stroke events. The safety outcomes were cardiovascular events, cerebral hemorrhage, and mortality. The quality of articles was evaluated through the Cochrane risk assessment tool. This study was registered in PROSPERO (CRD42023430073). There were 7,657 patients from 22 RCTs included. Compared with the control group, patients who received RIC did not have improved mRS functional outcomes, regardless of whether they received medical management, reperfusion therapy with intravenous thrombolysis (IVT), or mechanical thrombectomy (MT). In the medical management group, patients who received RIC had decreased incidence of stroke recurrence (risk ratio 0.63, 95% CI 0.43-0.92, p = 0.02) and lower follow-up NIHSS score by 1.72 points compared with the control group (p < 0.00001). There was no increased risk of adverse events including death or cerebral hemorrhage in the IVT or medical management group. In patients with ischemic stroke who are not eligible for reperfusion therapy, RIC did not affect mRS functional outcomes but significantly improved the NIHSS score at the follow-up endpoint and reduced stroke recurrence, without increasing the risk of cerebral hemorrhage or death. In patients who received IVT or MT, the benefit of RIC was not observed.

Developing and validating the construct maps to assess mathematical proficiencies

The study was aimed to develop and validate a measurement test to assess mathematical proficiencies in the numbers and algebra strand. A total of 125 seventh-grade learners with diverse learning abilities from secondary educational institutions under the management of the Khon Kaen Educational Service Area 25, Thailand was chosen as respondents. The researchers employed design-based research consisting of four building blocks to construct a prototype utilizing a construct modeling approach. Firstly, the researchers developed construct maps to identify the learners’ mathematical proficiency (MP) level. This was followed by the creation of the items of measurement test according to the proficiency levels. Next, the researchers allocated scoring measures and formed the conversion of learners’ MP stages. Lastly, the researchers validated the superiority of the measurement test through Wright map consuming the multi-dimensional random coefficient multinomial logit model. The construct maps of the MP level consisted of two dimensions, namely mathematical procedures and structure of learning outcome. Findings discovered that there were 20 items in the assessment tool and its quality passed the determined education and psychological assessment criteria. It can be determined that every item is capable to measure the learners’ multi-dimensional mathematical proficiencies.

Development of higher order thinking skill assessment instruments in social studies learning

&lt;span lang="EN-US"&gt;Higher order thinking skill (HOTS) in social studies learning are still often ignored by teachers despite the need for students to acquire these skills. The purpose of this study is to develop her HOTS assessment in a social studies classroom to help teachers improve their students’ thinking skills. This kind of research is research and development with 4D models. Validation was performed by two social studies learning assessment specialists and three social studies teachers. The HOTS test was administered to 112 students in class VIII (second grade) of Yogyakarta junior high school. Data analysis consisted of validity, reliability, difficulty, selectivity, and distractor index. Explanatory factor analysis (EFA) pathway analysis was used for data analysis of small trials and confirmatory factor analysis (CFA) pathway analysis was used for large trials. The multiple-choice HOTS assessment tool consisted of 30 items, and the effectiveness results of this HOTS questions on material, structure, and language aspects by two social studies learning assessment experts where it was valid and suitable for our application. Effective results for three social studies teachers indicated that the assessment tool was valid and applicable. HOTS in social studies learning helps improve quality and learning outcomes, enabling students to examine information critically, develop creativity, and improve problem-solving skills.&lt;/span&gt;

Effectiveness of Using a Self-Directed Learning Program to Teach Physical Examination and Health Assessment Skills: A Quasi-Experimental Study.

Conducting health assessments and physical examinations are essential skills for independent practice. Exploring how to teach these skills effectively is essential. This study was designed to validate the effectiveness of a self-directed learning program in improving nursing student outcomes in terms of their learning health assessment and physical examination skills. A quasi-experimental design was used, and second-year nursing students enrolled in a health assessment and physical examination course at a university of science and technology in central Taiwan were recruited using purposive sampling. Both the control and experimental groups were taught using a traditional teaching method. The experimental group additionally participated in a self-directed learning program. Structured questionnaires, including the Chinese version of the Self-Directed Learning Readiness Scale, Scales of Motivation and Learning Strategies, Interpersonal Skills Assessment Tool, the Course Satisfaction Evaluation Scale, and the Perception of Health Assessment and Physical Examination Competence Scale, were used to collect data at three time points. After controlling for the effects of pretest scores, after the intervention, the experimental group achieved significantly higher scores than the control group for self-directed learning (creative learning and love of learning), learning motivation (goal orientation, work value, expected success, and test anxiety), and cognitive strategies (total score, elaboration strategy, recitation strategy, and monitoring strategy). In addition, the health assessment exercise improved interpersonal and communication skills, and learning satisfaction was significantly higher in the experimental group than the control group. A physical examination and health assessment course designed using the self-directed learning framework can effectively improve student competence in related skills to enhance their ability to assess patient health problems in clinical settings. This study presents an alternative approach to teaching health assessment and physical examination courses and validates the positive effect of this approach on student learning outcomes.

Argentine version of the PediEAT, a pediatric eating assessment tool.

Introduction. During childhood, children may experience some degree of difficulty eating. A tool (PediEAT) has been developed in the United States and is available to assess pediatric eating and to identify problematic symptoms. Objective. To obtain an Argentine version that is transculturally adapted, culturally adequate, and semantically equivalent to the original version. Population and methods. A self-administered version of the PediEAT was used and completed by families and/or caregivers of children aged 6 months to 7 years. In the first phase, content validity was assessed by a group of experts. This was followed by a pre-test phase with families using cognitive interviews to test word and phrase comprehension. The necessary changes were made to obtain a version adapted to the context. Results. The tool's content validity was assessed by a group of 8 experts; as a result, 36 of the 80 items were changed. During the pre-test phase, cognitive interviews were conducted with 18 caregivers; 11 items were changed to improve comprehension by the Argentine population. The Argentine version was approved by the original authors. Conclusions. The Argentine version of the PediEAT tool is linguistically equivalent to the original version, and this allows its use to screen for feeding problems in children.

The 30,000 Foot View: Using Big Data to Address Complex Clinical Questions in the Most Vulnerable Older Adults

Older people of color, those who are socially isolated, veterans, and incarcerated older adults experience disparities in mental healthcare and high levels of psychiatric and physical comorbidity, including increased risk of suicide. The identification of risk factors and understanding the culture and context that impact risk are major public health challenges. Effective approaches to address these challenges are likely to involve using national databases and applying advanced methodologies to address complex clinical questions in older adults. By leveraging extensive epidemiological datasets, we can effectively pinpoint risk factors and consequences associated with mental health disorders in later stages of life. Moreover, these datasets allow us to disaggregate heterogeneous groups which are often treated as homogeneous (e.g. people of color, veterans, etc.). This disaggregation may reveal significant within group differences and provide important contextual information regarding these groups which can be used to deliver precision mental healthcare in an efficient manner and reduce the burden of mental illness in late life. In this session, we will explore innovative methodologies of utilizing national datasets to discern the cultural and contextual elements that impact the mental health and well-being of four high-risk, older adult populations. Emphasis will be placed on identifying patterns in mental healthcare disparities and comprehending how factors such as race, ethnicity, sex, gender, and incarceration contribute to feelings of loneliness, suicide rates, and dementia. Furthermore, we will also discuss the potential application of this data in developing precise risk assessment tools and targeted prevention and treatment strategies. interventions for late-life mental health issues.

Effectiveness, reach, uptake and feasibility of digital health interventions for adults with venous thromboembolism: protocol of a systematic review and meta-analysis

IntroductionPrevention of recurrence after an episode of venous thromboembolism (VTE), and also the post-thrombotic syndrome (PTS), is still a recognised challenge. In this meta-analysis, we will summarise existing evidence to...

The use of a project management tool in distance education to enhance students’ engagement in group work

Group work is a widely embraced learning and assessment method that holds considerable importance in both in-person and online settings in higher education. However, group assignments introduce distinctive challenges, including unequal contributions, team conflict and divergent work ethics, leading to a pervasive reluctance among students to engage in university-level group work. Despite these concerns, group work continues to be a vital assessment approach for students, equipping them with essential skills for professional environments that prioritise teamwork and collaboration. In this opinion piece, I explore students' reluctance to engage in group work and introduce strategies and tools to transform unproductive group work into a collaborative learning experience. The discussion outlines implications for academics and learning developers, contributing to the ongoing discourse on collaborative tools in higher education assessments. With a primary focus on the challenges faced by distance-learning students, the opinion piece delves into the potential of Trello, a collaborative project management tool, to address these challenges and enhance collaborative learning in distance education. Its purpose is threefold: (1) enhance academics’ understanding of students’ reluctance to engage in group work, (2) enrich the experience of distance-learning students by highlighting the multifaceted benefits of collaborative learning in their educational journey that extend beyond traditional classroom boundaries and (3) propose innovative solutions to educators for fostering a culture of collaboration for more effective group work.

SWAT‐GL: A new glacier routine for the hydrological model SWAT

AbstractThe hydrological model Soil Water Assessment Tool (SWAT) is widely used in water resources management worldwide. It is also used to simulate catchment hydrology in high‐mountainous regions where glaciers play an important role. However, SWAT considers glaciers in a simplistic way. Although some efforts were done to overcome this limitation, there is no official version available that considers glaciers adequately. This strongly impairs its applicability in glacierized catchments. In this technical note, we propose a novel version of the traditional SWAT, called SWAT‐GL, which introduces (1) a mass balance module and (2) a glacier evolution routine to represent dynamic glacier changes. Mass balance calculations are based on a conceptual degree‐day approach, similar to the snow routine implemented in SWAT. Glacier evolution is realized using the delta‐h (∆h) parameterization, which requires a minimum of data and is thus suitable in data‐scarce regions. The approach allows users to simulate spatially distributed glacier changes. Annual mass balance changes are translated to distributed ice thickness changes depending on the glacier elevation. We demonstrate how SWAT‐GL is technically integrated into SWAT and how glaciers are merged with the existing spatial units. Model code and test data are freely accessible to promote further model development efforts and a wide application. Ultimately, SWAT‐GL aims to make SWAT easily applicable in glacierized catchments without the need of additional tools.

Comparative Analysis of Water Sustainability Indices: A Systematic Review

The achievement of water sustainability necessitates the development and application of comprehensive assessment tools to monitor and evaluate the impact of water resource management. This article presents a comprehensive comparative analysis of various water sustainability indices, emphasizing their underlying principles, methodologies, and potential applications. Our study reveals the diverse landscape of existing indices, illustrating that even indices with similar names can vary significantly in scope and methodology. Via a systematic review of 124 publications, this study provides insights into existing composite indices related to water sustainability, highlighting their specific applications and potential contributions to water resource management and sustainability. The information gathered from the selected papers was synthesized and analyzed thematically to identify common patterns through keyword co-occurrence mapping, SDG mapping, standard review protocols, and cluster analyses. Through a cluster analysis, we identified six distinct clusters of indices, highlighting the need for careful consideration in selecting appropriate ones. Moreover, our analysis of co-occurring keywords underscores the close relationship between sustainable development, water resources, water supply, and water conservation within the context of water-related indices. Notably, these indices address not only sustainable development goal six but also a number of other interconnected goals. It was also found that “sustainability index” is a common name for different nature water indices. This review also identifies research gaps in the existing literature. However, significant limitations exist, including a lack of historical application and future projections for many current water sustainability indicators. Without the ability to track changes over time and project the future, identifying areas of improvement and measuring progress toward long-term water sustainability goals becomes challenging. Furthermore, many indices are complex and designed for watershed or regional levels, limiting their adaptability to different contexts. Despite these challenges, indices remain valuable tools for assessing and managing water resources sustainably, addressing various dimensions of sustainability, and supporting decision-making processes across different sectors and contexts.

Tools to measure the burden on informal caregivers of cancer patients: A literature review.

(1) To describe existing tools to assess the burden of informal caregivers of people with cancer, (2) to describe how these tools have been validated and (3) to describe the areas of interest of existing assessment tool entries. The caregiver burden of informal caregivers of people with cancer greatly affects their lives. There is a wide variety of relevant assessment tools available, but there are no studies to help researchers to select tools. A search was conducted using the keywords 'cancer', 'caregiver', 'burden' and 'scale' in Medline (PubMed), CINAHL and EMBASE to include articles that developed or applied tools to assess the burden on informal caregivers of cancer patients. Once eligible tools were identified, we searched their 'primary reference' studies. If the original scale was assessed in a population other than informal caregivers of cancer patients, we again searched for psychometric measures in the population of caregivers of cancer patients. This study retrieved 938 articles on developing or applying the informal caregiver burden instrument for cancer patients, including 42 scales. Internal consistency of the original scales ranged from 0.53 to 0.96. Nineteen scales initially developed to assess caregiver burden for patients with dementia, stroke and other disorders were later used for caregivers of cancer patients, eight of which have not yet been validated. Reclassifying all scale domains of concern revealed that scale assessments focused more on caregivers' physical health, emotional state and caregiving tasks. This review identifies many scales for assessing informal caregiver burden in cancer patients and gives scales recommended. However, a portion still needs to be validated. The development of a new scale proposes to be based on a theoretical framework and to consider dimensions for assessing support resources. What problem did the study address?: This paper collates assessment tools on the burden of informal carers of people with cancer. It also provides information on the applicable population, reliability and validity. What were the main findings?: 41 scales could be considered for use, eight of which have not been validated. The scales focus more on assessing caregivers' physical health, emotional state and caregiving tasks, and less on the dimension of support resources. Where and on whom will the research have an impact?: There are implications for informal carers of cancer patients in hospitals or in the community, as well as for relevant researchers. Retrieved with reference to systematic evaluation. No patient or public contribution.

Demographic, Clinical and Language Characteristics of Malaysian Patients with Aphasia: A Retrospective Study

Limited research has been conducted in Malaysia on the characteristics of patients with aphasia. To address this gap, a retrospective study was conducted at Hospital Rehabilitasi Cheras (HRC). The study aimed to profile the demographic, clinical, and language characteristics of patients who underwent speech therapy for aphasia. Medical records from 2014 to 2017 were reviewed, focusing on 1,259 adult patients who were referred to the Speech Therapy Unit. Analysis included demographics, clinical aspects, and linguistic features. The Western Battery of Aphasia-Revised (WAB-R), a comprehensive assessment tool, was used to evaluate the language abilities. Among the patients' files analysed, a total of 211 contained WAB-R test results. The demographic profile revealed a higher proportion of male patients compared to females, with Malay patients comprising the majority, followed by Chinese and Indians. Age distribution included 41.7% older adults (aged 55 and above), 37.9% middle-aged (aged 36-55), and 20.4% younger adults (aged 18- 35). Notably, 44.5% had completed high school education. Clinically, right- sided hemiparesis was prevalent as noted with 67.8% of patients, while 14.7% had left-sided hemiparesis. The primary cause of aphasia was stroke, accounting for 71.1% of cases, with ischemic stroke being the dominant subtype (56.9%). Fluent aphasia was presented in 50.2% of the cases, compared to 49.3% of non-fluent aphasia. Anomic aphasia was the most common subtype (35.5%), followed by global aphasia (27.5%) and Broca’s aphasia (17.5%). The language profile provided a detailed description, encompassing linguistic aspects relevant to different aphasia types. These preliminary findings yielded valuable insights and hold significant implications for the clinical management of aphasia patients in Malaysia.

Prospective comparative study on enhancing geometrical mental representation and anatomical learning in medical students through modeling clay as an assessment tool.

While traditional anatomy education often emphasizes passive learning and rote memorization, it seldom employs constructivist theories that focus on active, hands-on experiences for effective learning. This study tests the hypothesis that tactile experiences with modeling clay enhance geometric mental representation more effectively than verbal descriptions. We examine the potential of clay modeling to reflect and evaluate students' mental representation of anatomical structures. Utilizing a prospective randomized, open, blind endpoint (PROBE) design, we engaged 36 participants divided into three groups: blind, visually impaired, and a control group. The primary outcome measure was the difference between post-touch score and pre-touch score, which gauged the efficacy of tactile intervention in enhancing the participants' capacity to mentally reconstruct a well-designed anatomical fiction structure. Scoring was executed using a double-blind double-evaluation methodology, positioning clay model reconstruction as both an objective reliable assessment and a pedagogical tool. The analysis demonstrated a pronounced improvement in mental representation of anatomical structures, particularly in spatial comprehension and detailed textural discernment, with the mean score soaring from 47.81 pre-touch to 85.09 post-touch. Distinct cognitive processing adaptations were evident across groups, with the blind group excelling in tactile acuity and the visually impaired group showing the most significant gains in spatial understanding post-intervention (Cohen's d = 2.74). The application of modeling clay as a tactile intervention tool can significantly improve the learning of anatomy among medical students. The study underscores the value of active, multisensory engagement and customized teaching strategies for effective anatomy education among this demographic.

The Effect of Ozone Therapy Stimulation on Diabetes Wound Healing Process

&lt;p&gt;Health problems that are currently developing include diabetes mellitus (DM) with various complications including diabetic ulcers. Diabetic ulcers are the main cause of prolonged pain and even amputation in DM patients. Diabetic wounds are a complication of diabetes that often occurs in the extremities, increasing morbidity and lessens the patient's personal satisfaction. Ozone therapy is one method used to speed up the healing process for diabetic ulcers. This study plans to examine the impact of ozone treatment feeling on diabetic injury mending. The exploration strategy utilizes a semi exploratory technique with a pretest and posttest non-identical benchmark group plan. The testing strategy is a non-likelihood inspecting method.The population in this study were all patients suffering from diabetic wounds who received wound care at the Edwcare clinic in Langsa city.  The respondents of this study were patients suffering from diabetic wounds who received wound care at the Edwacare wound care center in Langsa City, Indonesia  consisting of 28 respondents who received modern wound care dressings and 28 respondents received wound care combined with modern dressings and ozone therapy. The research instrument for assessing wound severity used the Bates-Jensen Wound Assessment Tool. Data analysis used the Friedman and Kruskal Wallis tests. Based on the research results, it was found that there was a more significant effect between wound care using a combination of modern dressings and ozone therapy with a Mean Rank value of 39.75 compared to wound care that only received modern dressing wound care with a Mean Rank value of 17.25 with a value of p -value &amp;lt;0.05. The conclusion is that the effect of ozone stimulation significantly influences the healing process of diabetic wounds and is recommended as a nursing intervention that can be applied in treating diabetic wounds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords:  Diabetes mellitus, diabetic wounds, ozone therapy, stimulation&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

Psychometric properties of the Braden scale to assess pressure injury risk in intensive care: A systematic review

ObjectiveTo analyse the psychometric properties of the Braden scale to assess pressure injury risk in adults in intensive care. DesignA systematic review was conducted, with literature searches undertaken in five electronic databases. No date limits were applied. Selection, data extraction and risk of bias assessment were completed by two reviewers independently. A customised data extraction template was used, with risk of bias conducted using the COSMIN Risk of Bias checklist. Data were analysed using narrative synthesis. ResultsThirty-four studies met inclusion criteria. Two studies reported internal consistency with Cronbach’s alpha ranging from poor (0.43) to good (0.85). For interrater reliability, only four studies reported intraclass correlation, ranging from 0.66 to 0.96 for Braden sum score. Three studies reported convergent validity, with strong associations found between the COMHON Index (r = 0.70), Cubbin-Jackson scale (r = 0.80), and Norton scale (r = 0.77), but contrasting associations with the Waterlow score (r = 0.22 to 0.72). A large majority of studies reported predictive validity (n = 29), with wide variability. Several studies investigated optimal cut-off scores, with the majority indicating this was in the range of 12–14. ConclusionsThis review demonstrates inconsistency in the psychometric properties of the Braden scale in ICU settings. Further research is needed to determine suitability of the Braden scale for ICU before it can be recommended as standard for clinical practice, including comparison with other ICU-specific risk assessment tools. Implications for clinical practiceWhen used in ICU, the reliability, validity and reported cut-off scores of the Braden scale are variable. As a predictive tool, the scale should be used cautiously. In ICU, the value of the Braden scale resides in its ability to identify patients that are most at risk of developing a pressure injury and to implement preventative measures to mitigate identified risk factors.

Pressure ulcer risk assessment in the ICU. Is it time for a more objective measure?

BackgroundThe Braden scale, one of the most widely used risk assessment tools is often criticized when used in the Intensive Care Unit. Most patients in the Intensive Care Unit are at risk of pressure ulcer development meaning that the Braden score will usually indicate high risk for these patients. This study set out to determine the correlation between Sub-Epidermal Moisture measurements and Braden scores among Intensive Care Unit patients. MethodsThis study employed an observational research design. Braden score was assessed on all study days (1–5), in addition to visual skin assessment and Sub-Epidermal Moisture measurements at the sacrum and heels. Sub-Epidermal Moisture measurements were categorised as low (<0.5), borderline abnormal (≥0.5), and high (≥0.8). Correlation was assessed between Sub-Epidermal Moisture levels and Braden scores. ResultsA total of 53 participants were recruited. The median (interquartile range) baseline Braden score was 9 (9–10) and 81 % (n = 43) of participants were at very high/high risk of pressure ulcer development. Braden scores remained relatively constant over time with little fluctuation in scores. 19 % (n = 10) of patients had normal (<0.5) Sub-Epidermal Moisture delta measurements on enrolment, and all developed abnormal measurements by day 2. There were no significant correlations between Braden scores and Sub-Epidermal Moisture measurements. ConclusionAlthough this was not its original intention, a missing link with the Braden scale is that it does not provide information on how patients are responding to the adverse effects of pressure and shear forces. Furthermore, in patients who are critically unwell, most patients are classified as being “at risk” of pressure ulcer development. Therefore, an objective measure of how patients are responding to pressure and shear forces at different anatomical areas is needed. Implications to clinical practiceSub-Epidermal Moisture measurements can offer more information, not only on identifying those who are at risk, but also how those patients are tolerating this risk at different anatomical sites.

A cluster-randomized study to evaluate the effectiveness and cost-effectiveness of the Assessment of Burden of Chronic Conditions (ABCC) tool in South Tyrolean primary care for patients with COPD, asthma, type 2 diabetes, and heart failure: the ABCC South Tyrol study

BackgroundChronic diseases, such as chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, and heart failure, often coexist and contribute to a significant burden on individuals and health systems. The Assessment of Burden of Chronic Conditions (ABCC) tool, already in routine clinical use in the Netherlands, aims to comprehensively assess and visualize disease burden, stimulate self-management, and encourage shared decision-making. This study aims to validate the German and Italian versions of the ABCC tool and evaluate its effectiveness and cost-effectiveness in the South Tyrolean Primary Care setting.MethodsThis is a cluster-randomized study involving approximately 400 patients with COPD, asthma, type 2 diabetes, and heart failure who received care from the South Tyrolean General Practices. Initially, the ABCC tool will be translated into German and Italian and validated. Subsequently, half of the participants will use the validated ABCC tool for patient-reported outcome measurement assessments, while the other half will receive usual care. The primary outcome measure is the change in the patients’ perception of the quality of care after 18 months. The secondary outcomes included changes in quality of life, self-management behavior, and healthcare utilization. The missing data will be managed using multiple imputations. Additionally, a cost-effectiveness analysis that considers the direct medical costs reimbursed by the National Health Service will be conducted.DiscussionThis study provides insights into the application, validation, and efficacy of the ABCC tool in the South Tyrolean healthcare context. The tool’s potential to enhance person-centered care, improve the quality of life, and possibly reduce healthcare costs could greatly contribute to sustainable healthcare. The challenges of implementation, such as software integration and the use of an EU data platform, will provide lessons for future international patient care data management.Trial registrationISRCTN registry, ISRCTN13531607. Registered on August 23, 2023.

Testing the validity of three acute care assessment tools for assessing residents' performance during in situ simulation: the ACAT-SimSit study.

The assessment of technical and nontechnical skills in emergency medicine requires reliable and usable tools. Three Acute Care Assessment Tools (ACATs) have been developed to assess medical learners in their management of cardiac arrest (ACAT-CA), coma (ACAT-coma) and acute respiratory failure (ACAT-ARF). This study aims to analyze the reliability and usability of the three ACATs when used for in situ (bedside) simulation. This prospective multicenter validation study tested ACATs using interprofessional in situ simulations in seven emergency departments and invited training residents to participate in them. Each session was rated by two independent raters using ACAT. Intraclass correlation coefficients (ICC) were used to assess interrater reliability, and Cronbach's alpha coefficient was used to assess internal consistency for each ACAT. The correlation between ACATs' scores and the learners' level of performance was also assessed. Finally, a questionnaire and two focus groups were used to assess the usability of the ACATs. A total of 104 in situ simulation sessions, including 85 residents, were evaluated by 37 raters. The ICC for ACAT-CA, ACAT-coma and ACAT-ARF were 0.95 [95% confidence interval (CI), 0.93-0.98], 0.89 (95% CI, 0.77-0.95) and 0.92 (95%CI 0.83-0.96), respectively. The Cronbach's alphas were 0.79, 0.80 and 0.73, respectively. The ACAT-CA and ARF showed good construct validity, as third-year residents obtained significantly higher scores than first-year residents (P < 0.001; P < 0.019). The raters supported the usability of the tools, even though they expressed concerns regarding the use of simulations in a summative way. This study reported that the three ACATs showed good external validity and usability.