Clinical Evaluation Tool Research Articles

Development of a Clinical Teaching Evaluation and Feedback Tool for Faculty.

IntroductionFormative evaluations of clinical teaching for emergency medicine (EM) faculty are limited. The goal of this study was to develop a behaviorally-based tool for evaluating and providing feedback to EM faculty based on their clinical teaching skills during a shift.MethodsWe used a three-phase structured development process. Phase 1 used the nominal group technique with a group of faculty first and then with residents to generate potential evaluation items. Phase 2 included separate focus groups and used a modified Delphi technique with faculty and residents, as well as a group of experts to evaluate the items generated in Phase 1. Following this, residents classified the items into novice, intermediate, and advanced educator skills. Once items were determined for inclusion and subsequently ranked they were built into the tool by the investigators (Phase 3).ResultsThe final instrument, the “Faculty Shift Card,” is a behaviorally-anchored evaluation and feedback tool used to facilitate feedback to EM faculty about their teaching skills during a shift. The tool has four domains: teaching clinical decision-making; teaching interpersonal skills; teaching procedural skills; and general teaching strategies. Each domain contains novice, intermediate, and advanced sections with 2–5 concrete examples for each level of performance.ConclusionThis structured process resulted in a well-grounded and systematically developed evaluation tool for EM faculty that can provide real-time actionable feedback to faculty and support improved clinical teaching.

Multilevel diffusion tensor imaging classification technique for characterizing neurobehavioral disorders.

This proposed novel method consists of three levels of analyses of diffusion tensor imaging data: 1) voxel level analysis of fractional anisotropy of white matter tracks, 2) connection level analysis, based on fiber tracks between specific brain regions, and 3) network level analysis, based connections among multiple brain regions. Machine-learning techniques of (Fisher score) feature selection, (Support Vector Machine) pattern classification, and (Leave-one-out) cross-validation are performed, for recognition of the neural connectivity patterns for diagnostic purposes. For validation proposes, this multilevel approach achieved an average classification accuracy of 90% between Alzheimer's disease and healthy controls, 83% between Alzheimer's disease and mild cognitive impairment, and 83% between mild cognitive impairment and healthy controls. The results indicate that the multilevel diffusion tensor imaging approach used in this analysis is a potential diagnostic tool for clinical evaluations of brain disorders. The presented pipeline is now available as a tool for scientifically applications in a broad range of studies from both clinical and behavioral spectrum, which includes studies about autism, dyslexia, schizophrenia, dementia, motor body performance, among others.

Abstract 16921: Noninvasive Quantification of Myocardial Elasticity in Patients With Hypertrophic Cardiomyopathy

Introduction: Hypertrophic cardiomyopathy (HCM) is associated with excessive left ventricular (LV) hypertrophy (LVH), myocyte disarray and expansion of interstitial collagen. These factors alter mechanical properties of the myocardial tissue. Intrinsic velocity propagation (iVP) of myocardial stretch is a new validated measure of myocardial elasticity. Hypothesis: iVP in left ventricular (LV) myocardium of patients with HCM will be increased compared to normal subjects. Methods: We studied prospectively 100 subjects: 42 with HCM (age 57 ± 14 years; 79% with asymmetric septal LVH) and 58 normal controls without cardiovascular disease (age 48 ± 13 years). Patients had comprehensive transthoracic echocardiography and cardiac magnetic resonance imaging (MRI; n=29). iVP was measured throughout the LV myocardium during late diastole using ultra-high frame rate tissue Doppler imaging (350-460 fps) (6 LV walls, 3 standard apical views). Chamber stiffness (CS) was evaluated from end-diastolic pressure-volume relationship (EDPVR) estimated noninvasively by the single-beat method (EDP=αV β ). End-diastolic pressure (EDP) was estimated from E/e’. Results: LV ejection fraction was normal in both groups (HCM: 68 ± 7%; Controls: 65 ± 5%). Myocardial stiffness by iVP was markedly higher in HCM vs. controls (Fig.A, left panel). This was confirmed by EDPVRs, which were steeper and shifted leftward (Fig. B, left). The slope (β, load-independent) of EDPVR and CS (dP/dV) were higher and LV capacitance (V 30 , estimated volume at 30 mmHg EDP) was lower in HCM (Fig. B, right) and correlated significantly, though weakly, with iVP (β: r = 0.41; CS dP/dV: r = 0.48; EDP: r = 0.61; p<0.002 for all). Patients with apical variant had lower levels of global iVP compared to patients with predominant septal LVH and diffuse concentric LVH (Fig. A, right). Conclusions: Myocardial stiffness measured noninvasively by the intrinsic wave method is highly abnormal in HCM. This novel approach allows mapping of myocardial elasticity of the entire left ventricle and shows promise to become a clinical tool for evaluation of patients with diastolic tissue abnormalities.

Clinical Evaluation of a Polish Translation and Cross-Cultural Adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale

BackgroundNasal obstruction is the most common rhinologic complaint in ear, nose, and throat (ENT) clinical practice and septal deviation is the leading cause. The Nasal Obstruction Symptom Evaluation (NOSE) scale is a brief, self-administered questionnaire that has been widely used to assess symptoms and quality of life related to nasal obstruction, and is commonly used in clinical outcome studies. The aim of this study was to undertake a clinical evaluation of a Polish translation and cross-cultural modification of the NOSE scale for nasal obstruction.Material/MethodsA controlled clinical validation study was conducted in a tertiary referral center. The Polish version of the NOSE scale was developed according to cross-cultural adaptation guidelines. The psychometric properties of the Polish version of the NOSE scale (internal consistency, reproducibility, validity, responsiveness, interpretability) were assessed in 51 patients with nasal obstruction and 51 controls matched according to gender and age.ResultsInternal consistency of the Polish version of the NOSE scale was 0.80 as assessed by Cronbach’s alpha, and an intraclass correlation of the reproducibility was 0.98. Construct inter-item and item-total correlations confirmed validity. Correlation confirmed appropriate criterion validity with a visual analog scale (VAS) and discriminant validity was confirmed between patients and controls. Responsiveness and interpretability were also confirmed.ConclusionsThe Polish version of the NOSE scale is a brief and reproducible clinical evaluation tool for use in clinical practice in Polish-speaking patients with nasal obstruction.

Intra- and Interrater Reliability and Concurrent Validity of a New Tool for Assessment of Breast Cancer–Related Lymphedema of the Upper Extremity

ObjectiveThe goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer–related lymphedema, for use in the context of outcome evaluation in clinical trials. DesignBlinded repeated measures observational study. SettingOutpatient research laboratory. ParticipantsBreast cancer survivors with and without lymphedema (N=71). InterventionsNot applicable. Main Outcome MeasureThe assessment of intraclass correlation coefficients (ICCs) for the Breast Cancer–Related Lymphedema of the Upper Extremity (CLUE) standardized clinical evaluation tool. ResultsIntrarater reliability for the CLUE tool was ICC: 0.88 (95% confidence interval [95% CI], 0.71-0.96). Interrater reliability for the CLUE tool was ICC: 0.90 (95% CI, 0.79-0.95). Concurrent validity of the CLUE score (Pearson r) was 0.79 with perometric interlimb difference and 0.53 with the Norman lymphedema overall score. ConclusionsThe CLUE tool shows excellent inter- and intrarater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy.

Cancer stem cell associated eight gene-based signature predicts clinical outcomes of colorectal cancer.

Previous studies have suggested that cancer stem cells serve crucial functions in tumorigenesis, metastasis and therapy failure. Stem cell signaling transduction pathways are frequently dysregulated in cancer and associated with tumorigenesis, metastasis and the cell cycle, which are necessary for cancer proliferation. However, cancer stem cell-associated gene signatures have not been established for predicting patient outcomes in colorectal cancer. Using a gene-mining approach, the present study performed mRNA expression profiling in large colorectal cancer cohorts from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) database, including a TCGA colorectal cancer cohort (n=383) and three independent validation series GSE39582 (n=582), GSE17536 (n=177) and GSE17537 (n=55). The present study identified that an eight-gene signature in cancer stem cell signaling was associated with the overall survival and disease/recurrence-free survival of patients with colorectal. On the basis of this signature, patients in the TCGA training sets were divided into high-risk and low-risk subgroups with a significantly different overall survival rate (hazard ratio, 2.38; P=0.0005). The prognostic value of this signature was confirmed using three independent GEO colorectal cancer sets. Identifying this prognostic stem cell signaling signature may provide an efficient classification tool for clinical prognosis evaluation, and facilitate cancer stem cell-targeted therapy.

Discovery and Validation of Salivary Extracellular RNA Biomarkers for Noninvasive Detection of Gastric Cancer.

Biomarkers are needed for noninvasive early detection of gastric cancer (GC). We investigated salivary extracellular RNA (exRNA) biomarkers as potential clinical evaluation tools for GC. Unstimulated whole saliva samples were prospectively collected from 294 individuals (163 GC and 131 non-GC patients) who underwent endoscopic evaluation at the Samsung Medical Center in Korea. Salivary transcriptomes of 63 GC and 31 non-GC patients were profiled, and mRNA biomarker candidates were verified with reverse transcription quantitative real-time PCR (RT-qPCR). In parallel, microRNA (miRNA) biomarkers were profiled and verified with saliva samples from 10 GC and 10 non-GC patients. Candidate biomarkers were validated with RT-qPCR in an independent cohort of 100/100 saliva samples from GC and non-GC patients. Validated individual markers were configured into a best performance panel. We identified 30 mRNA and 15 miRNA candidates whose expression pattern associated with the presence of GC. Among them, 12 mRNA and 6 miRNA candidates were verified with the discovery cohort by RT-qPCR and further validated with the independent cohort (n = 200). The configured biomarker panel consisted of 3 mRNAs (SPINK7, PPL, and SEMA4B) and 2 miRNAs (MIR140-5p and MIR301a), which were all significantly down-regulated in the GC group, and yielded an area under the ROC curve (AUC) of 0.81 (95% CI, 0.72-0.89). When combined with demographic factors, the AUC of the biomarker panel reached 0.87 (95% CI, 0.80-0.93). We have discovered and validated a panel of salivary exRNA biomarkers with credible clinical performance for the detection of GC. Our study demonstrates the potential utility of salivary exRNA biomarkers in screening and risk assessment for GC.

Validity and Reliability of the Arabic Version of the Copenhagen Neck Functional Disability Scale in Neck Pain Patients.

Study DesignProspective observational study.PurposeTo test the face validity, content validity, feasibility, internal consistency, reliability, and test–retest reliability of the Arabic version of the Copenhagen Neck Functional Disability Scale (CNFDS).Overview of LiteratureCNFDS is a clinical evaluation tool that accurately reflects the patient’s perception regarding his/her functionality with existing cervical pain. This study aimed to investigate the validity and reliability of the Arabic version of the CNFDS in measuring the disability level in chronic neck pain patients.MethodSeventy-four patients with neck pain were recruited, and 135 sheets (test and retest sheets) were completed by patients; two expert panels (each comprising ten experts) participated in this study. Arabic translation (forward translation), development of the preliminary translated version, English translation (backward translation), development of the prefinal version, and testing of the prefinal version was performed by experts; thereafter, the final version was tested on patients. Index of clarity, expert proportion of clearance, index of content validity (CVI), expert proportion of relevance, descriptive statistics, missed item index, Cronbach’s alpha, and Spearman’s rank correlation coefficient were used for statistical analyses.ResultsThe study revealed that the scale index of clarity was 86.84%, scale CVI was 99.33%, scale-level content validity index (universal agreement method) was 99.33%, 99.15% of the scale items were filled in all sheets, the scale was answered in less than 3 minutes in about 75% cases, Cronbach’s alpha was 0.856 (0.796, 0.905), and all Spearman’s correlations between the test and retest results were statistically significant.ConclusionsThe Arabic version of the CNFDS has adequate validity and reliability for the measurement of the disability level in chronic neck pain patients.

Dynamic instability of the acromioclavicular joint: Anew classification for acute AC joint separation.

BackgroundAcute acromioclavicular (AC) dislocation is classified according to Rockwood (RW). Although of clinical relevance, dynamic horizontal translation (DHT) is not listed in this classification or in frequently used clinical evaluation tools. The aim of this study was (a) to evaluate vertical and horizontal AC joint instabilities and assess their combined occurrence and clinical appearance in a consecutive group of patients, as well as (b) to develop a new classification of acute AC joint dislocation.MethodA consecutive group of 61 patients (seven female, 54 male) with a mean age of 34.5 years (18.9–60.1) were included in the study. All patients underwent posttraumatic clinical—Taft Score (TF), Acromioclavicular Joint Instability Score (ACJI), Constant Score (CS), Subjective Shoulder Value (SSV)—and radiological (bilateral anteroposterior stress and bilateral Alexander views) evaluation.ResultsAccording to the RW classification, the following AC dislocations were present: eight (13.1%) type I, nine (14.8%) type II, 22 (36.1%) type III, and 22 (36.1%) type V. Based on the clinical and radiographic results, a new classification is proposed: Type I instabilities show only a partial vertical displacement (≤30% coracoclavicular distance [CCD]) and type II a complete vertical displacement (>30% CCD). Both type I and II are further graded into none or partial (A) and complete DHT (B) as seen on bilateral Alexander views.ConclusionDHT can be found in low-grade instabilities and lead to inferior clinical results in the posttraumatic situation.

Quantitative Evaluation of Post-stroke Spasticity Using Neurophysiological and Radiological Tools: A Pilot Study.

ObjectiveTo determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients.MethodsEight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides. ResultsMAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2–R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis.ConclusionThe BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.

Optimal Estimation of Anthropometric Parameters for Quantifying Multisegment Trunk Kinetics.

Kinetics assessment of the human head-arms-trunk (HAT) complex via a multisegment model is a useful tool for objective clinical evaluation of several pathological conditions. Inaccuracies in body segment parameters (BSPs) are a major source of uncertainty in the estimation of the joint moments associated with the multisegment HAT. Given the large intersubject variability, there is currently no comprehensive database for the estimation of BSPs for the HAT. We propose a nonlinear, multistep, optimization-based, noninvasive method for estimating individual-specific BSPs and calculating joint moments in a multisegment HAT model. Eleven nondisabled individuals participated in a trunk-bending experiment and their body motion was recorded using cameras and a force plate. A seven-segment model of the HAT was reconstructed for each participant. An initial guess of the BSPs was obtained by individual-specific scaling of the BSPs calculated from the male visible human (MVH) images. The intersegmental moments were calculated using both bottom-up and top-down inverse dynamics approaches. Our proposed method adjusted the scaled BSPs and center of pressure (COP) offsets to estimate optimal individual-specific BSPs that minimize the difference between the moments obtained by top-down and bottom-up inverse dynamics approaches. Our results indicate that the proposed method reduced the error in the net joint moment estimation (defined as the difference between the net joint moment calculated via bottom-up and top-down approaches) by 79.3% (median among participants). Our proposed method enables an optimized estimation of individual-specific BSPs and, consequently, a less erroneous assessment of the three-dimensional (3D) kinetics of a multisegment HAT model.

S103. Description of short and middle latency somatosensory evoked potentials in adult patients with ischemic cerebrovascular accident

Introduction In the United States, cerebrovascular accidents (CVAs) are the fourth most common cause of death with a general prevalence of 2.6%. Approximately 85% of all CVAs are of the ischemic type. Somatosensory evoked potentials (SSEPs) evoked through transcutaneous bipolar electrical stimulation applied to the selected nerve, this is one of the most informative neurophysiological techniques available, since it provides an evaluation of brain function. In turn, the middle latency somatosensory evoked potentials (MLSEP) between 35 and 100 ms after stimulation of the median nerve. SSEPs are abnormal in patients with lesions in the brainstem, diencephalon or cerebral hemispheres, when lemniscal pathways are involved, with similar patterns for brainstem, thalamic and thalamic-capsular lesions. The SSEPs have been studied in an attempt to prove their usefulness as a tool for clinical evaluation and prognosis in ischemic CVA. Methods Observational, cross-sectional, exploratory study enrolled 7 adult patients with corroborated ischemic stroke by imaging study (computed tomography CT or magnetic resonance imaging MRI) within the first 24 h of evolution. Short and middle latency somatosensory evoked potentials were performed at the American British Cowdray Medical Center, with Sierra Wave 4 channels electromyograph, recording and quantifying its latencies of N35, P45 and N60 ipsi and contralateral responses to the site of injury taking into account clinical and paraclinical variables. Results In this study 7 patients were recorded; the group had a median age of 61 years, with a minimum age of 25 years and maximum of 84 years. With their respective controls, the study showed the MLSEP in patients with CVA being of cardioembolic, atherothrombotic, prothrombotic and indeterminate etiology; in the short latency potentials peripheral response was found in all cases (N9), N60 was absent in patients with CVAs of different etiologies, the proportion of waves absent in lesion-ipsilateral MLSEP was greater than in contralateral MLSEP. Conclusion The clinical use of the middle latency responses has been limited by the incomplete knowledge of their generators, since the specific utility of this neurophysiological study is based on the evaluation of neurological pathways which can be interrupted in their journey by other pathologies such as ischemic stroke. The use of MLSEP shows that in patients with CVA they are present unilaterally, contralaterally and bilaterally, so the usefulness of performing them has future implications to determine the frequency of each of them related to the type of etiology, treatment and prognostic outcome.

Quantifying Motor Impairment in Movement Disorders.

Until recently the assessment of many movement disorders has relied on clinical rating scales that despite careful design are inherently subjective and non-linear. This makes accurate and truly observer-independent quantification difficult and limits the use of sensitive parametric statistical methods. At last, devices capable of measuring neurological problems quantitatively are becoming readily available. Examples include the use of oculometers to measure eye movements and accelerometers to measure tremor. Many applications are being developed for use on smartphones. The benefits include not just more accurate disease quantification, but also consistency of data for longitudinal studies, accurate stratification of patients for entry into trials, and the possibility of automated data capture for remote follow-up. In this mini review, we will look at movement disorders with a particular focus on Parkinson's disease, describe some of the limitations of existing clinical evaluation tools, and illustrate the ways in which objective metrics have already been successful.

Development and implementation of a competency-based clinical evaluation tool for midwifery education

BackgroundThe learning goals and evaluation strategies of competency-based midwifery programs must be explicit and well-defined. In the US, didactic learning is evaluated through a standardized certification examination, but standardized clinical competence evaluation is lacking. Description of the toolThe Midwifery Competency Assessment Tool (MCAT) has been adapted from the International Confederation of Midwives’ (ICM) “Essential Competencies” and from the American College of Nurse-Midwives’ (ACNM) “Core Competencies”, with student self-evaluation based on Benner's Novice-to-Expert theory. The MCAT allows for the measurement and monitoring of competence development in all domains of full-scope practice over the course of the midwifery program. Application and evaluation of the toolStrengths of the MCAT are that it provides clear learning goals and performance evaluations for students, ensures and communicates content mapping across a curriculum, and highlights strengths and gaps in clinical opportunities at individual clinical sites and for entire programs. Challenges of the MCAT lie in balancing the number of competency items to be measured with the tedium of form completion, in ensuring the accuracy of student self-evaluation, and in determining “adequate” competence achievement when particular clinical opportunities are limited. ConclusionsUse of the MCAT with competency-based clinical education may facilitate a more standardized approach to clinical evaluation, as well as a more strategic approach to clinical site development and use.

Student’s Preparedness and Their Clinical Performance in Psychiatric and Mental Health Nursing

This study determined the level of preparedness of student nurses of Manila Tytana Colleges Philippines, school year 2014-2015 in terms of knowledge, skills and attitude and its relationship with their clinical performance during their psychiatric rotation. Survey questionnaire and clinical evaluation tool appraisal were utilized to gather data from the 181 respondents selected through purposive sampling. Ethical clearance was secured from the institutional review board. The statistical tools used were mean, frequency and percentage distribution, and Pearson r. The results revealed that preparations in knowledge, skills and attitude in psychiatric clinical rotation doesn’t guarantee learning success in their psychiatric clinical duty. There was no significant relationship between the level of students’ preparedness and their clinical performance in psychiatric and mental health nursing (r value: 0.20; sig: 0.863). Thus, it was recommended that a similar study in the future would be conducted in other schools for validation of the findings. Also a qualitative study was recommended to assess further the best practice of the student in the psychiatric rotations including quality health care delivery in the said undertakings.

Bridging the Gap: One Nursing School's Response to Clinical Evaluation Challenges

This article describes the experience of an associate degree nursing program as they developed a clinical evaluation tool based on entry-level registered nurse competencies, Quality and Safety Education for Nurses concepts, Massachusetts Department of Higher Education Nurse of the Future Competencies, and their end-of-program learning outcomes. The result is an effective tool, which facilitates the students' and faculty abilities to evaluate clinical performance objectively based on observed behaviors versus a checklist methodology.

2D AND 3D KINEMATICS DURING LATERAL STEP-DOWN TESTING IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

The lateral step-down test is an established clinical evaluation tool to assess quality of movement in patients with knee disorders. However, this test has not been investigated in individuals after anterior cruciate ligament reconstruction (ACLR) in association with quantitative 3D motion analysis. The purpose of this study was to determine the strength of association between visually-assessed quality of movement during the lateral step-down test and 3D lower limb kinematics in patients with history of ACLR. A second purpose was to compare kinematics between subgroups based on the presence or absence of faulty alignments during the task. The final purpose was to compare visually-assessed quality of movement scores between box heights during lateral step-down testing. Twenty subjects at least one year status post-ACLR (18 females, age of 24.5 ± 4.6 years and body mass index of 23.4 ± 2.3 kg/m2) performed the lateral step-down test unilaterally on the surgical limb atop four and six inch boxes. A board-certified orthopedic physical therapist scored overall quality of movement during the lateral step-down test using established criteria during 2D video playback. Lower limb kinematics were simultaneously collected using 3D motion capture. An alpha level of 0.05 was used for all statistical treatments. Overall 2D quality of movement score significantly correlated (r =0.47-0.57) with 3D hip adduction and hip internal rotation across box heights. Across box heights, the presence of faulty pelvic alignment differentiated a subgroup exhibiting less peak knee flexion, and the presence of faulty knee alignment differentiated a subgroup exhibiting greater peak hip adduction. The six inch box elicited worse quality of movement compared to the four inch box. These results suggest that visually-assessed quality of movement is associated with several kinematic variables after ACLR. 2D movement deviations at the pelvis appear to consistently relate to less knee flexion, and 2D deviations at the knee appear to suggest greater hip adduction. Generally, poorer quality of movement was observed for the six inch box height. Clinically, these data suggest that interventions targeting hip abductor and knee extensor strength and neuromuscular control may be useful in the presence of poor quality of movement during lateral step-down testing. 2b.

Assessment tools for screening and clinical evaluation of psychosocial aspects in addictive disorders.

This article provides an overview of the tools for psychosocial assessment of substance use disorders. Various psychosocial factors need to be assessed for effective management of individuals and to carry out research in the field. These factors include socio-demographic characteristics, neuropsychological functions, psychiatric co-morbidities, psychological vulnerabilities such as personality traits, motivation, and cognitions related to drug use, and the psychosocial functioning of the individual and his family. The various tools used to assess these aspects have been outlined below and the brief descriptions provided can help in choosing the right tool based on the characteristics that need to be measured and logistics.

Reproducibility of EEG-MEG fusion source analysis of interictal spikes: Relevance in presurgical evaluation of epilepsy.

Fusion of electroencephalography (EEG) and magnetoencephalography (MEG) data using maximum entropy on the mean method (MEM-fusion) takes advantage of the complementarities between EEG and MEG to improve localization accuracy. Simulation studies demonstrated MEM-fusion to be robust especially in noisy conditions such as single spike source localizations (SSSL). Our objective was to assess the reliability of SSSL using MEM-fusion on clinical data. We proposed to cluster SSSL results to find the most reliable and consistent source map from the reconstructed sources, the so-called consensus map. Thirty-four types of interictal epileptic discharges (IEDs) were analyzed from 26 patients with well-defined epileptogenic focus. SSSLs were performed on EEG, MEG, and fusion data and consensus maps were estimated using hierarchical clustering. Qualitative (spike-to-spike reproducibility rate, SSR) and quantitative (localization error and spatial dispersion) assessments were performed using the epileptogenic focus as clinical reference. Fusion SSSL provided significantly better results than EEG or MEG alone. Fusion found at least one cluster concordant with the clinical reference in all cases. This concordant cluster was always the one involving the highest number of spikes. Fusion yielded highest reproducibility (SSR EEG = 55%, MEG = 71%, fusion = 90%) and lowest localization error. Also, using only few channels from either modality (21EEG+272MEG or 54EEG+25MEG) was sufficient to reach accurate fusion. MEM-fusion with consensus map approach provides an objective way of finding the most reliable and concordant generators of IEDs. We, therefore, suggest the pertinence of SSSL using MEM-fusion as a valuable clinical tool for presurgical evaluation of epilepsy.

The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients.

The objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer. A total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp's mediating role between psychological distress and mental adjustment. A clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance. The Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.