Client Tools Research Articles

Responsiveness and Minimal Clinically Important Difference of the Canadian Occupational Performance Measure Among Patients With Frozen Shoulder.

Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time. To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders. Prospective, single-blind, randomized controlled trial. Two physical medicine and rehabilitation clinics. Ninety-four patients with frozen shoulders enrolled in a previous study. Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method. The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively. The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.

Pathways to sustainable antimicrobial use in cats.

Antimicrobial stewardship encompasses all the individual and collective actions that medical professionals take to preserve the efficacy of antimicrobials. It is a one-health problem, affecting animals and humans. The current state of antimicrobial use in cats, particularly (1) the overuse and improper use of cefovecin, which belongs to the third-generation cephalosporin class that is critically important to human health, and (2) use of antimicrobials when they are not needed, poses unsustainable risks of antimicrobial resistance. This paper describes the principles of antimicrobial stewardship and stewardship challenges faced by feline veterinarians, including (1) poor adherence to or awareness of antimicrobial use guidelines, (2) lack of access to affordable diagnostic tests and antibiograms, (3) lack of access to materials and tools for clients that may facilitate more sustainable antimicrobial use and help cat owners understand resistance risks, (4) underestimating the ability of cat owners to administer oral antimicrobials, and (5) limited time and resources to support stewardship efforts. Based on research described in this paper; an original research article by Cazer et al, JAVMA, December 2023; and a Currents in One Health article by Cobo-Angel et al, AJVR, December 2023, several solutions are proposed to advance antimicrobial stewardship in feline medicine. Many of these proposals were expressly requested by veterinarians interviewed in Cazer et al, JAVMA, December 2023. Education and training of veterinarians and cat owners is an essential step toward sustainable antimicrobial use, but it must be complemented with innovations in diagnostic testing, antimicrobial drug development, structural changes, and technological supports.

Development of occupational therapy screening tool for clients with stroke

Background: The number of new stroke cases in the Thai population increases every year. Occupational therapy has a crucial role in stroke rehabilitation. In Thailand, there is currently no standardized occupational therapy screening tool for gathering clients’ impairments to facilitate further evaluation and intervention. Objectives: To develop an occupational therapy screening tool for clients with stroke and investigate its psychometric properties. Materials and methods: The development of the screening tool was based on a literature review and opinions of registered occupational therapists (OTs) who have had at least five years of experience working with stroke clients. Five experts examined content validity. The Index of Congruence (IOC) was calculated, and the items that showed IOC scores of over 0.5 were incorporated into the target screening tool. Afterward, two types of reliability were measured, including test-retest and inter-rater reliability. Using purposive sampling, 44 participants with chronic stroke were selected to test each type of reliability. Intraclass correlation coefficient (ICC) models 3, 1, and 2, k were used to determine test-retest and inter-rater reliability, respectively. Results: Based on the literature review and 128 OTs’ opinions, the screening tool covers four domains: sensation, voluntary movement control of upper extremity and hand function, perception, and cognition. Content validity IOC scores were between 0.8 and 1.0 for all items. The screening tool had excellent test-retest reliability on all items, except memory. And the ICC between the two raters ranged from 0.91 to 1.00, which showed excellent inter-rater reliability. Conclusion: The occupational therapy screening tool for clients with stroke has proven valid and reliable as a screening tool in clinical settings. Further research is recommended for concurrent, sensitivity, and specificity studies.

DeepPhe-CR: Natural Language Processing Software Services for Cancer Registrar Case Abstraction.

Manual extraction of case details from patient records for cancer surveillance is a resource-intensive task. Natural Language Processing (NLP) techniques have been proposed for automating the identification of key details in clinical notes. Our goal was to develop NLP application programming interfaces (APIs) for integration into cancer registry data abstraction tools in a computer-assisted abstraction setting. We used cancer registry manual abstraction processes to guide the design of DeepPhe-CR, a web-based NLP service API. The coding of key variables was performed through NLP methods validated using established workflows. A container-based implementation of the NLP methods and the supporting infrastructure was developed. Existing registry data abstraction software was modified to include results from DeepPhe-CR. An initial usability study with data registrars provided early validation of the feasibility of the DeepPhe-CR tools. API calls support submission of single documents and summarization of cases across one or more documents. The container-based implementation uses a REST router to handle requests and support a graph database for storing results. NLP modules extract topography, histology, behavior, laterality, and grade at 0.79-1.00 F1 across multiple cancer types (breast, prostate, lung, colorectal, ovary, and pediatric brain) from data of two population-based cancer registries. Usability study participants were able to use the tool effectively and expressed interest in the tool. The DeepPhe-CR system provides an architecture for building cancer-specific NLP tools directly into registrar workflows in a computer-assisted abstraction setting. Improved user interactions in client tools may be needed to realize the potential of these approaches.

Promoting financial capability within the field of social work practice among families with children: a systematic review

ABSTRACT Financial difficulties have a severe impact on families and children who grow up in poor families. Social workers can help families address their financial problems through a variety of practice settings, hence simultaneously promoting financial well-being. We investigate how financial capability among families with children has been promoted in social work practice. We generated a systematic review by following the PRISMA standards and applying the concepts of the CAIMeR theory. Two hundred seventy-seven references were identified, of which a total of 14 articles were analysed. We found there was a large understanding about the phenomenon, but the knowledge of contexts was limited, with a lack of evidence-based knowledge. Formal interventions in social work practice emphasise financial education as a key contributor to financial capability. Likewise, the improvement of financial inclusion is underlined. The literature indicates that interventions provide tools for clients to help strengthen economic self-sufficiency and increase financial confidence. However, social work practices often concentrate on money management, ignoring the ways in which clients can increase income and other resources or avoid future risks. Implementation of interventions requires attention. Unique situations in the family should be considered closely, and the implementation should rely more consciously on the psychosocial elements of support.

Development of Service Experience Evaluation Tool for Visiting Nurses of Public Health Center in Korea

Objectives: The objective of this study is to develop an evaluation tool for clients’ experience of visiting nursing service provided by visiting nurses of public health center in Korea.Methods: This study is built upon Clark’s theory (2008) of community nurse role model and the 8-stage tool development methodology suggested by DeVellis (2012).Results: Major findings are as follows. First, a tentative list of questionnaires with forty two measurable items were derived through several rounds of focus group interviews with nursing professors, health policy experts and visiting nursing staff, and later twenty five items were determined as a preliminary test set after a series of revision and removal from the aforementioned tentative set. Second, the 25-item preliminary survey tool comprised five dimensions of service quality, which include 4 items for Tangibles, 9 items for Reliability, 3 items for Responsiveness, 7 items for Assurance, and 2 items for Empathy. Third, after factor analysis and reliability analysis, only 14 items survived, being categorized into five dimensions of the SERVPERF model: The final version of evaluation tool to measure service experience for visiting nurse of public health center is comprised of 18 items.Conclusions: This study tried to develop a valid and reliable tool for evaluating the clients’ experience of visiting nursing service provided by visiting nurses of public health center in Korea for the first time.

Experiences and support needs of lifestyle professionals in the use of digital coaching tools for clients with overweight

In the Netherlands, half of the adult population is overweight. Combined Lifestyle Interventions guide overweight clients towards ahealthy lifestyle. In addition to the face-to face sessions with clients, lifestyle professionals can use digital coaching tools to guide their clients remotely. In practice it appears that the digital applications are not fully used. To stimulate the use of digital technology, insight is needed into the experiences and support needs of lifestyle professionals. Data about the use, wishes and support needs regarding the use of digital coaching tools among lifestyle professionals were collected by aquestionnaire and two focus groups. The results of the questionnaires were analyzed descriptively and the focus groups were analyzed thematically. Seventy-nine lifestyle professionals completed the questionnaire. Ten lifestyle professionals participated in afocus group. Both methods showed that professionals have gained experience with video communication, apps and online information. Lifestyle professionals mention that these digital coaching tools support the self-reliance of clients. Online group sessions are perceived as less effective than face-to-face group sessions, because of the lack of interaction between clients. Lifestyle professionals also experience practical barriers in using digital coaching tools. To stimulate the use of digital coaching tools, they need an exchange of experience with colleagues, training and instruction on how to use these tools. Lifestyle professionals consider digital coaching tools to be an added value to individual coaching. They see opportunities for wider use in the future when practical barriers are overcome, and exchange of experience and training are facilitated.

Selecting the Best Health Care Systems: An Approach Based on Opinion Mining and Simplified Neutrosophic Sets

Measuring what hospital offers the best services is very difficult, for that reason, the opinions from previous patients have become an essential tool for the new possible clients to decide which services they must select. Many online platforms deal with opinions to analyze their services/products, primarily, by means of aspect-based sentiment analysis techniques. These techniques are mainly based on the detection of features from services/products to model the feelings toward them. Most models primarily cope with positiveness, negativeness and neutrality; nevertheless, these do not reflect other situations in which there are positive and negative aspects, but the overall sentiment is not neutral, but indeterminate. To face this issue, simplified neutrosophic sets can be a useful tool. Therefore, this study presents a novel application of the simplified neutrosophic sets to hospital ranking. The application, first, detects the hospital features, second, models the feelings toward them using simplified neutrosophic sets, and finally, ranks the hospitals according to the patients’ preferences. It has been tested using opinions from a real website and compared against other fuzzy logic-based approaches. The achieved results outperform the ones obtained by other proposals, revealing that simplified neutrosophic sets can be an interesting solution to model feelings.

Case study of using a web-based project management tool for numerous clients and processes

Case study of using a web-based project management tool for numerous clients and processes

Development and validation of a risk prediction model for lost to follow-up among adults on active antiretroviral therapy in Ethiopia: a retrospective follow-up study

BackgroundOver 420,000 people have initiated life-saving antiretroviral therapy (ART) in Ethiopia; however, lost-to-follow-up (LTFU) rates continues to be high. A clinical decision tool is needed to identify patients at higher risk for LTFU to provide individualized risk prediction to intervention. Therefore, this study aimed to develop and validate a statistical risk prediction tool that predicts the probability of LTFU among adult clients on ART.MethodsA retrospective follow-up study was conducted among 432 clients on ART in Gondar Town, northwest, Ethiopia. Prognostic determinates included in the analysis were determined by multivariable logistic regression. The area under the receiver operating characteristic (AUROC) and calibration plot were used to assess the model discriminative ability and predictive accuracy, respectively. Individual risk prediction for LTFU was determined using both regression formula and score chart rule. Youden index value was used to determine the cut-point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA).ResultsThe incidence of LTFU was 11.19 (95% CI 8.95–13.99) per 100-persons years of observation. Potential prognostic determinants for LTFU were rural residence, not using prophylaxis (either cotrimoxazole or Isoniazid or both), patient on appointment spacing model (ASM), poor drug adherence level, normal Body mass index (BMI), and high viral load (viral copies > 1000 copies/ml). The AUROC was 85.9% (95% CI 82.0–89.6) for the prediction model and the risk score was 81.0% (95% CI 76.7–85.3) which was a good discrimination probability. The maximum sensitivity and specificity of the probability of LTFU using the prediction model were 72.07% and 83.49%, respectively. The calibration plot of the model was good (p-value = 0.350). The DCA indicated that the model provides a higher net benefit following patients based on the risk prediction tool.ConclusionThe incidence of LTFU among clients on ART in Gondar town was high (> 3%). The risk prediction model presents an accurate and easily applicable prognostic prediction tool for clients on ART. A prospective follow-up study and external validation of the model is warranted before using the model.

Payment options: An analysis of 6 years of payment plan data and potential implications for for-profit clinics, non-profit veterinary providers, and funders to access to care initiatives.

Analyzing a dataset of payment plans disassociated with traditional credit scoring, this research, for the first time, offers insights into the mitigation of cash flow and credit ineligibility challenges in access to veterinary care. Specifically, this paper explores financial fragility among pet families and whether payment options offer substantial bridges in access to care challenges for veterinarians and clients. Researchers introduce a veterinary care multiplier to estimate the potential increase in veterinary care that may be provided by for-profit and non-profit clinics from additional payment options. The implications for non-profits working to address access to care is that by directing donor dollars to cover the 6.9% that is potentially left unpaid in meeting pet families simply facing cash flow challenges, a non-profit clinic could provide 14.5 times the veterinary care vs. full subsidies. In for-profit clinics, allocating some of a clinic's discount budget may similarly yield 14.5 times the care for clients likely to be declined by the traditional credit options. Further research is recommended to explore how deeply these options penetrate all financially fragile pet owners and outcomes in the absence of these tools for credit-declined clients. Additional research to determine the levels at which payment options reduce economic euthanasia decisions, reduce the client and staff stress, increase the value perception and compliance with suggested care, enable better outcomes for patients, and increase clinic revenue is also recommended. The researchers conclude that payment options that are independent of traditional credit scoring mitigate financial barriers to obtaining veterinary care.

A formal foundation for symbolic evaluation with merging

Reusable symbolic evaluators are a key building block of solver-aided verification and synthesis tools. A reusable evaluator reduces the semantics of all paths in a program to logical constraints, and a client tool uses these constraints to formulate a satisfiability query that is discharged with SAT or SMT solvers. The correctness of the evaluator is critical to the soundness of the tool and the domain properties it aims to guarantee. Yet so far, the trust in these evaluators has been based on an ad-hoc foundation of testing and manual reasoning. This paper presents the first formal framework for reasoning about the behavior of reusable symbolic evaluators. We develop a new symbolic semantics for these evaluators that incorporates state merging. Symbolic evaluators use state merging to avoid path explosion and generate compact encodings. To accommodate a wide range of implementations, our semantics is parameterized by a symbolic factory, which abstracts away the details of merging and creation of symbolic values. The semantics targets a rich language that extends Core Scheme with assumptions and assertions, and thus supports branching, loops, and (first-class) procedures. The semantics is designed to support reusability, by guaranteeing two key properties: legality of the generated symbolic states, and the reducibility of symbolic evaluation to concrete evaluation. Legality makes it simpler for client tools to formulate queries, and reducibility enables testing of client tools on concrete inputs. We use the Lean theorem prover to mechanize our symbolic semantics, prove that it is sound and complete with respect to the concrete semantics, and prove that it guarantees legality and reducibility. To demonstrate the generality of our semantics, we develop Leanette, a reference evaluator written in Lean, and Rosette 4, an optimized evaluator written in Racket. We prove Leanette correct with respect to the semantics, and validate Rosette 4 against Leanette via solver-aided differential testing. To demonstrate the practicality of our approach, we port 16 published verification and synthesis tools from Rosette 3 to Rosette 4. Rosette 3 is an existing reusable evaluator that implements the classic merging semantics, adopted from bounded model checking. Rosette 4 replaces the semantic core of Rosette 3 but keeps its optimized symbolic factory. Our results show that Rosette 4 matches the performance of Rosette 3 across a wide range of benchmarks, while providing a cleaner interface that simplifies the implementation of client tools.

Evaluation of PLC4X based Middleware as Integrator of Brownfield systems into Industrial Cyber-Physical Systems

The emergence of the Internet of Things (IoT) and Cyber-Physical Systems (CPS), supported by the rapid growth in computing and communication technologies in the past decade, has started the fourth industrial revolution (Industry 4.0). Industry 4.0 reinvents the industrial communication paradigm by proposing a mesh of intertwined physical and digital entities, namely the digital twin network. Integration of brownfield legacy systems into an Industry 4.0 compliant CPS, due to their relatively high vendor dependency and technological heterogeneity, remains one of the biggest challenges. To tackle this issue, Open Platform Communication Unified Architecture (OPC UA) was developed. OPC UA acts as a vendor and protocol-agnostic communication middleware for data acquisition. Modern Programmable Logic Controllers (PLC) allow running an OPC UA server inside them and data access can be performed through any OPC UA client tool. While this does solve the brownfield integration problem to a certain extent, the majority of the tools on the shop floor still use vendor-specific technologies. PLC4X is a set of libraries for communicating with PLCs and fetching data from them. It supports a wide range of communication protocols and could be a promising candidate for addressing the integration challenges. Therefore, in this paper, we evaluate the viability of PLC4X as an enabler for a communication middleware that tackles the integration challenges concerning the brownfield systems in Industry 4.0.

Expansion of a Web-Based Platform to Support Caregivers in California Using CareNav

About one in five Americans is engaged in providing care to a family member. Caregivers (unpaid family members or friends) support older adults and persons with disability with a variety of conditions, including challenges in physical, cognitive, and mental health. In California, 4.5 million family caregivers are assisting individuals over the age of 18. The CA Department of Health Care Services funds 11 Caregiver Resource Centers (CRC) to support caregivers and, in 2019, provided support to expand information technology services through adoption of a statewide online assessment platform and client portal, CareNav™, to serve as a client record and referral tool. CareNav™ facilitates collection of consistent state-wide data that can inform program improvement and policy. This study evaluated the implementation process from the perspective of 35 CRC team members in guided focus group discussions. CRC staff identified several potential benefits to adopting CareNav™, including ease of client access and convenience, the ability to aggregate data to inform planning and policy, and a streamlined process for resource sharing. Challenges included customizing site-specific data needs, as well as concerns about equitable access to internet services. Ongoing evaluation will focus on validation and visualization of data, and translation of data into actionable information to improve quality and reach.

Use of Virtual Reality Technology to Support the Home Modification Process: A Scoping Review.

Healthcare is a field in which the benefits of virtual reality (VR), such as risk-taking without consequences, direct experience, and service outcome prediction, can be utilized. VR technology has been used to help clients face environmental barriers by implementing a home environment in virtual reality without a home visit by an expert. This scoping review was conducted to identify the areas and implementation methods of the home modification process supported by VR technology. Twelve studies met the research criteria. The following three types of tools supported by VR technology for the home modification process were identified: educational tools for clients or specialists, home environment measurement tools, and intermediaries for decision making and collaboration between clients and specialists. Most of the studies reported positive results regarding the usability and acceptability of the technology, but barriers have also been reported, such as technical problems, inappropriate population groups for technical use, cost-related issues, the need for training, and fear that the technology could replace home visits. Thus, VR technology has potential value in the home modification process. However, for future clinical applications, additional studies to maximize the benefits of these VR technologies and address the identified problems are required.

The Implementation of Visual Art in Counseling to Help Client Revealing the Internal Condition

The counseling process needs to involve the disclosure of information from the client as an individual who needs help. Some clients find it very difficult to disclose information regarding their experiences, thoughts, and feelings about the issues. A counselor needs to have a creative way of supporting clients to achieve good self-disclosure. The use of visual arts in counseling is very useful as a tool for clients to express their thoughts, feelings, and experiences which are then reflected on both personally by the client or with the help from the counselor. The purpose of this article is to examine the basic knowledge of visual arts in the counseling process. The literature review used several databases such as Google Scholar and Google Books as well as well as other supporting sources. The results of the study show that visual arts are useful in helping clients reveal the information that is needed for the counseling process.

Cultural Adaptation and Psychometric Properties of the A-PASS

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The need for diverse and culturally relevant assessment tools is the responsibility of all OTs when delivering client-centered care. Assessment tools for Arabic-speaking clients in the United States are close to none. The use of culturally less-relevant assessment tools sabotages the client-centered care approach (e.g., addressing self-care activities that are culturally or religiously mandated). This study reviews the adaptation and the psychometric properties of the A-PASS. Primary Author and Speaker: Razan Hamed Additional Authors and Speakers: Margo Holm

The institutional drivers of social procurement implementation in Australian construction projects

Social procurement policies are becoming an increasingly popular tool for construction project clients to meet their corporate social responsibility objectives. This research employs New Institutional Theory to investigate the coercive, mimetic and normative drivers behind the adoption of social procurement policies in Australian construction projects. It presents a thematic analysis of semi-structured interviews with sixteen social procurement actors in the Australian construction industry who are responsible for implementing these policies at a project level. Results contribute new theoretical and practical insights into the nascent and under-theorized body of social procurement research in the field of project management. They indicate that coercive isomorphism is the most powerful driver of social procurement adoption in Australian construction projects, followed by mimetic isomorphism and normative isomorphism. It is concluded that the effective implementation of social procurement policies in construction projects requires project supply chains to shift from a compliance and mimicking mindset to one which normalizes social procurement. This will require institutional change based on the legitimisation of new social procurement professionals, roles and practices and the development of new project-based intermediaries to mitigate the risks and maximize the opportunities that social procurement presents.

Implementing a Novel Facility-Community Intervention for Strengthening Integration of Infant Nutrition and Family Planning in Mara and Kagera, Tanzania.

Tanzania has high fertility, low contraceptive prevalence and low exclusive breastfeeding (EBF). The Lake Zone, including Mara and Kagera regions, leads the country in total fertility; use of the lactational amenorrhea method (LAM) is negligible. This pre-/post-study explored the effects of a multi-level facility and community intervention (service delivery support, community engagement, media and LAM tracking) to integrate maternal and infant nutrition and postpartum family planning (FP) within existing health contacts. Mixed methods were used, including service statistics, exit interviews, patient-tracking tools for community health workers, client self-tracking tools, supervision data, focus group discussions and in-depth interviews. Results are presented using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) implementation science framework. The intervention reached primarily the second and fourth wealth quintiles, increased FP and EBF at six weeks postpartum. LAM was very acceptable, provided an entry point for FP conversations and for addressing misconceptions, and reinforced EBF practices. Partners felt encouraged to support spousal nutrition, breastfeeding and FP. Higher adoption in Kagera may be influenced by performance-based financing. The intervention was implemented with generally high fidelity. Maintenance data reflected stakeholder interest in continuing the intervention. A multi-level facility and community intervention was feasible to implement and likely contributed to improved EBF practices and FP uptake, including LAM use.

Rasch Analysis of the Assessment of Quality of Activities (A-QOA), an Observational Tool for Clients With Dementia.

The Assessment of Quality of Activities (A-QOA) is an observation-based tool for assessing the strength of engagement in an activity by the person performing it in a natural context. By quantifying the quality of engagement, the A-QOA can help occupational therapy practitioners be better able to select meaningful activities and more clearly understand the effectiveness of various choices. To examine use of the A-QOA as a valid unidimensional scale and to clarify preliminary results on its internal scale validity and item reliability using the Rasch model. One hundred thirty-one participants with dementia performing 262 activities. We used the Rasch model to clarify the psychometric properties of A-QOA's measurement quality. Rasch analysis revealed that 21 of the 25 items reached an acceptable level of fit, and 4 did not. After eliminating the 4 misfitting items, the resulting A-QOA was determined to have both acceptable internal scale validity and item separation reliability, which are fundamental psychometric properties of a clinical observational instrument. The A-QOA can be used to quantitatively assess the strength of engagement in an activity by the person performing it by using the observational method. In clinical settings, the A-QOA can be used both to select activities for clients with dementia and to quantitatively show the effects of occupational therapy interventions.