Tool Sensitivity Research Articles

Development of an electronic measuring device for height and nutritional status equipped with artificial intelligence for screening stunting toddlers

Background: Technological advancements have changed various aspects of human life, including in the world of health. One technological breakthrough that dominates attention is artificial intelligence (AI). Artificial intelligence has proven its potential to revolutionize many fields, including the health sector. One of the urgent health problems that requires innovative solutions is detecting the problem of stunting in children under five.Purpose: The study aims to develop and test a measuring device that effectively determines the body height and nutritional status in toddlers 0-5 years.Method: This study is in Research and Development (R&D); it consisted of 5 stages: stage I (literature study), stage II (product development), stage III (expert validity and phase trials), stage IV (product revision and final product), and stage V (phase II trials).Results: The electronic measuring device for height and nutritional status has been created. The result is that the tool effectively determines the height and nutritional status. The value of the ultrasonic sensor works quite well, with a maximum test error value of 0.11 and an average of 0.033, which means the calibration value of the tool's sensitivity is valid in determining body height.Conclusion: The electronic measuring device effectively determines the body's height and nutritional status.

The co-construction of a reading assessment measure with adults with Down syndrome: a meaningful literacy approach.

The need to develop appropriate measures of broad-based reading-related literacy skills for adults with Down syndrome has been highlighted in the literature. In this study we aimed to co-construct a valid and reliable assessment measure that can be used to document meaningful everyday reading, in adolescents and adults with Down syndrome. The study was carried out in two stages. Stage 1 used an inclusive participatory design in which individuals with Down syndrome were research collaborators (n = 46). Items to be included in the measure were identified and ecological, face and content validity were established through an iterative process. In stage 2 we examined the reliability of the tool and explored potential relationships between meaningful reading score and (1) age, (2) receptive vocabulary, and (3) reading ability as measured by standardized assessments. In addition, we profiled what a pilot cohort of adults with Down syndrome read (n = 33) and how they experience reading in their everyday lives. Results showed that 46 items were generated for inclusion in the Meaningful Reading Measure (MRM). Our preliminary data showed that the tool has internal and external reliability and ecological and content validity. There were no associations between meaningful reading score and any of the other variables examined. There was considerable variability in items read (range 12-44) which reflected a broad range of reading practices. Adults with Down syndrome identified the importance of reading as a pleasurable activity and as something that aids learning. The MRM developed here can be used (1) as a reading intervention outcome measure to complement existing standardized tools, (2) to profile meaningful reading in adults with Down syndrome, (3) to guide reading module content, and (4) to capture change in adults' perceptions of themselves as readers. Future work is needed to establish the tool's sensitivity to change over time.

A decision curve analysis of the clinical usefulness of a two-step frailty assessment strategy in older patients with prostate, breast, colorectal, or lung cancer.

12011 Background: Geriatric Assessment (GA) is recommended to assess the health status and select the most appropriate cancer treatment in older patients. However, GA is resource- and time-consuming. Thus, a two-step approach using frailty screening has been recommended. We aimed to evaluate the usefulness of frailty screening over GA for identifying unfit individuals who need GA and reducing unnecessary GA in fit individuals in a population of older outpatients with cancer. Methods: We analyzed patients age 70 and older with prostate, breast, colorectal, or lung cancer included in the multicenter, prospective ELCAPA cohort study (NCT02884375) between February 2007 and December 2019. All patients had a GA at inclusion. GA was the reference test. We defined unfit patients as those having at least one abnormal score in the following domains: functional status, mobility, comorbidity, cognition, mental health status, nutrition, and polypharmacy. We defined unfit patients according to the G8 and modified G8 scores using the recommended cut-offs (≤ 14 out of 17 points and ≥ 6 out of 35 points, respectively). We calculated each screening tool's sensitivity, specificity, and positive and negative predictive values. We used decision curve analysis to estimate the net benefit (the percentage of patients found to be unfit) of screening over GA. We assessed the avoided unnecessary GAs for each screening tool (reducing unnecessary GA in fit patients without decreasing the number of unfit patients undergoing [necessary] GA). We calculated these estimates across different threshold probabilities corresponding to the value of missing an unfit patient compared to exposing a fit patient to an unnecessary GA. A probability of 0.33 indicated that missing an unfit patient was two times worse than referring a fit patient to an unnecessary GA. A probability of 0.50 indicated that missing an unfit patient was the same as exposing a fit patient to an unnecessary GA. Results: We analyzed 1,648 patients with prostate (15%), breast (52%), colorectal (22%), or lung cancer (11%). The median age was 81 years, 559 patients (34%) had metastatic disease, and 1,428 patients (87%) were unfit. The sensitivity (95% CI) and specificity were 85% (84-87) and 59% (57-61) for the G8 score, and 86% (84-87) and 60% (58-63) for the modified G8 score. With a threshold probability of 0.33, the net benefit was 0.71 for the G8 score, 0.72 for the modified G8 score, and 0.80 for GA. With a threshold probability of 0.50, the net benefit was 0.68 for the G8 score, 0.69 for the modified G8 score, and 0.73 for GA. We did not observe a reduction in unnecessary GA of screening tools over GA. Conclusions: Frailty screening tools showed good diagnostic performances. However, our findings suggest that the GA-for-all strategy provides the higher clinical benefit in older patients with cancer.

Development of an electronic measuring device for body weight and nutritional status for children under two years old

Background: Measurement of body weight and nutritional status in children under two years are still used manuals. Besides that, there is no tool to measure nutritional status, so it is necessary to develop a tool to make it easier.Purpose: The study aims to develop and test a measuring device for weight and nutritional status in children under two years.Methods: This study is Research and Development (R&D). It consisted of 5 stages, stage I (literature study), stage II (product development), stage III (expert validity and phase I trials), stage IV (product revision and final product), and stage V (phase II trials).Result: The electronic measuring device for weight and nutritional status has been created. The result is that the tool effectively determines the weight and nutritional status. The average value of tool testing is below 5%, which means the calibration value of the tool's sensitivity is valid in determining body weight. In addition, it can also determine nutritional status with a p=0,65, which means that there is no difference between measuring nutritional status using the tool and manually.Conclusion: The electronic measuring device effectively determines the weight and nutritional status.

Validity and reliability of the Interagency Integrated Triage Tool in a regional emergency department in Papua New Guinea.

The Interagency Integrated Triage Tool (IITT) is a novel, three-tier triage system recommended by the World Health Organization. The present study sought to assess the validity and reliability of a pilot version of the tool in a resource-limited ED in regional Papua New Guinea. This pragmatic prospective observational study, conducted at Mount Hagen Provincial Hospital, commenced 1 month after IITT implementation. The facility did not have a pre-existing triage system. All ED patients presenting within a 5-month period were included. The primary outcome was sensitivity for the detection of time-critical illness, defined by 10 pre-specified diagnoses. The association between triage category and ED outcomes was examined using Cramer's V correlation coefficient. Reliability was assessed by inter-rater agreement between a local and an experienced external triage officer. There were 9437 presentations during the study period and 9175 (97.2%) had a triage category recorded. Overall, 138 (1.5%) were classified as category 1 (emergency), 1438 (15.7%) as category 2 (priority) and 7599 (82.8%) as category 3 (non-urgent). When applied by a mix of community health workers, nurses, health extension officers and doctors, the tool's sensitivity for the detection of time-critical illness was 77.8% (95% confidence interval 64.4-88.0). The admission rate was 14.5% (20/138) among emergency patients, 12.0% (173/1438) among priority patients and 0.4% (30/7599) among non-urgent patients (P=0.00). Death in the ED occurred in 13 (9.4%) of 138 emergency patients, 34 (2.4%) of 1438 priority patients and four (0.1%) of 7599 non-urgent patients (P=0.00). The negative predictive value for these outcomes was >99.5%. Among 170 observed triage assessments, weighted κ was 0.81 (excellent agreement). On average, it took clinicians 2min 43 s (standard deviation 1:10) to complete a triage assessment. There is limited published data regarding the predictive validity and inter-rater reliability of the IITT. In this pragmatic study, the pilot version of the tool demonstrated adequate performance. Evaluation in other emergency care settings is recommended.

ESCAPE‐Allergy: Evaluating screening for children and adolescents with penicillin allergy

Penicillin allergy labels are frequently encountered in children and are associated with significant harms. Most children are falsely labelled and can safely tolerate a penicillin but delabelling strategies are underutilised and paediatric-specific resources are lacking. The aim of this study was to evaluate an allergy assessment tool for children in hospital. We evaluated a paediatric-adapted penicillin allergy assessment tool, using an online survey of clinicians in a tertiary paediatric hospital, with 10 hypothetical potential penicillin allergy or adverse reaction cases (including non-allergy reactions). For each case, respondents were asked to use the tool to assign a reaction phenotype and recommend management. We determined the tool's sensitivity, specificity and acceptability to end users. We evaluated 30 complete survey responses from senior and junior medical staff, nurses and pharmacists. The tool's overall sensitivity was 80.7% (95% confidence interval (CI) 74.2-87.1%) for assigning the correct reaction phenotype and 85.3% (95% CI 79.4-91.3%) for appropriate management. The tool had high sensitivity for identifying immediate hypersensitivity reactions at 95.6% (95% CI 90.2-100%). Most respondents agreed or strongly agreed that they would use the tool in their practice (22/30, 73.3%). This survey evaluated a paediatric-adapted penicillin allergy assessment tool in a tertiary paediatric hospital among multidisciplinary clinician groups. The tool performed well overall and had high safety in identifying immediate hypersensitivity reactions. Further research to support implementation of allergy assessment and delabelling programmes among children is required.

Validation of the Interagency Integrated Triage Tool in a resource-limited, urban emergency department in Papua New Guinea: a pilot study

BackgroundThe Interagency Integrated Triage Tool (IITT) is a three-tier triage system designed for resource-limited emergency care (EC) settings. This study sought to assess the validity and reliability of a pilot version of the tool in an urban emergency department (ED) in Papua New Guinea. MethodsA pragmatic observational study was conducted at Gerehu General Hospital in Port Moresby, commencing eight weeks after IITT implementation. All ED patients presenting within the subsequent two-month period were included. Triage assessments were performed by a variety of ED clinicians, including community health workers, nurses and doctors. The primary outcome was sensitivity for the detection of time-critical illness, defined by ten pre-specified diagnoses. The association between triage category and ED outcomes was examined using Cramer's V correlation coefficient. Reliability was assessed by inter-rater agreement between a local and an experienced, external triage officer. FindingsAmong 4512 presentations during the study period, 58 (1.3%) were classified as category one (emergency), 967 (21.6%) as category two (priority) and 3478 (77.1%) as category three (non-urgent). The tool's sensitivity for detecting the pre-specified set of time-sensitive conditions was 70.8% (95%CI 58.2-81.4%), with negative predictive values of 97.3% (95%CI 96.7 - 97.8%) for admission/transfer and 99.9% (95%CI 99.7 - 100.0%) for death. The admission/transfer rate was 44.8% (26/58) among emergency patients, 22.9% (223/976) among priority patients and 2.7% (94/3478) among non-urgent patients (Cramer's V=0.351, p=0.00). Four of 58 (6.9%) emergency patients, 19/976 (2.0%) priority patients and 3/3478 (0.1%) non-urgent patients died in the ED (Cramer's V=0.14, p=0.00). The under-triage rate was 2.7% (94/3477) and the over-triage rate 48.2% (28/58), both within pre-specified limits of acceptability. On average, it took staff 3 minutes 34 seconds (SD 1:06) to determine and document a triage category. Among 70 observed assessments, weighted κ was 0.84 (excellent agreement). InterpretationThe pilot version of the IITT demonstrated acceptable performance characteristics, and validation in other EC settings is warranted. FundingThis project was funded through a Friendship Grant from the Australian Government Department of Foreign Affairs and Trade and an International Development Fund Grant from the Australasian College for Emergency Medicine Foundation.

Predicting Recurrent Instability of the Shoulder (PRIS): A Valid Tool to Predict Which Patients Will Not Have Repeat Shoulder Instability After First-Time Traumatic Anterior Dislocation.

To assess the sensitivity, specificity, and validity of the Predicting Recurrent Instability of the Shoulder (PRIS) tool in people with a first-time traumatic anterior shoulder dislocation. Prospective cohort study. People with first-time traumatic anterior shoulder dislocation (n = 85), aged 16 to 40 years, were recruited within 12 weeks of their shoulder dislocation and followed prospectively for 1 year post injury. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value of the PRIS tool. Of the 75 participants available for 1-year follow-up, 57 (76%) did not have recurrent shoulder instability. With the PRIS tool cut point set at 0.895, the tool's sensitivity was 39% (95% confidence interval [CI]: 17.3%, 64.3%) and its specificity was 95% (95% CI: 85.4%, 98.9%). The area under the curve was 0.69 (95% CI: 0.55, 0.84; P = .01). The PRIS tool correctly identified 54 of the 57 (95%) who did not have recurrent instability (accuracy, 81%; 95% CI: 70.7%, 89.4%). Negative and positive predictive values were 83% (95% CI: 77.2%, 87.7%) and 70% (95% CI: 40.2%, 89.0%), respectively. The PRIS tool can predict those who will not have further shoulder instability in the year following first-time traumatic anterior shoulder dislocation. The PRIS tool cannot accurately predict those who will have recurrent shoulder instability. J Orthop Sports Phys Ther 2020;50(8):431-437. doi:10.2519/jospt.2020.9284.

Accurate Identification of Colonoscopy Quality and Polyp Findings Using Natural Language Processing

The aim of this study was to test the ability of a commercially available natural language processing (NLP) tool to accurately extract examination quality-related and large polyp information from colonoscopy reports with varying report formats. Colonoscopy quality reporting often requires manual data abstraction. NLP is another option for extracting information; however, limited data exist on its ability to accurately extract examination quality and polyp findings from unstructured text in colonoscopy reports with different reporting formats. NLP strategies were developed using 500 colonoscopy reports from Kaiser Permanente Northern California and then tested using 300 separate colonoscopy reports that underwent manual chart review. Using findings from manual review as the reference standard, we evaluated the NLP tool's sensitivity, specificity, positive predictive value (PPV), and accuracy for identifying colonoscopy examination indication, cecal intubation, bowel preparation adequacy, and polyps ≥10 mm. The NLP tool was highly accurate in identifying examination quality-related variables from colonoscopy reports. Compared with manual review, sensitivity for screening indication was 100% (95% confidence interval: 95.3%-100%), PPV was 90.6% (82.3%-95.8%), and accuracy was 98.2% (97.0%-99.4%). For cecal intubation, sensitivity was 99.6% (98.0%-100%), PPV was 100% (98.5%-100%), and accuracy was 99.8% (99.5%-100%). For bowel preparation adequacy, sensitivity was 100% (98.5%-100%), PPV was 100% (98.5%-100%), and accuracy was 100% (100%-100%). For polyp(s) ≥10 mm, sensitivity was 90.5% (69.6%-98.8%), PPV was 100% (82.4%-100%), and accuracy was 95.2% (88.8%-100%). NLP yielded a high degree of accuracy for identifying examination quality-related and large polyp information from diverse types of colonoscopy reports.

Psychometric Evaluation of a Pain Intensity Measure for Persons with Dementia.

The goal of this study was to conduct initial psychometric analyses of a seven-item pain intensity measure for persons with dementia (PIMD) that was developed using items from existing pain observational measures. We evaluated validity by examining associations with an expert clinician's pain intensity rating (ECPIR) and an established pain observation tool (Mobilization Observation Behaviour Intensity Dementia [MOBID]). We also examined correlations between the PIMD and known correlates of pain: depression, sleep disturbances, agitation, painful diagnoses, and caregiver pain reports. We examined the differences between PIMD scores for "at rest" and "during movement" observations. We assessed reliability by calculating Cronbach's alpha and estimating inter-rater reliability using intraclass correlations (ICCs). Finally, we examined whether six additional "recent changes in behavior" items improved the PIMD's ability to predict expert clinicians' pain ratings. Sixteen nursing homes located in Alabama, Georgia, Pennsylvania, and New Jersey. One hundred ninety residents with moderate to severe cognitive impairment, mean age of 84 years, 49.5% female, and 70% white. PIMD during movement scores were highly correlated with the ECPIR and overall MOBID scores. As expected, there were large differences between at rest and during movement PIMD scores. Associations of PIMD with known correlates of pain were generally low and statistically nonsignificant. Internal consistency was supported with a Cronbach alpha of 0.72 and an inter-rater ICC of 0.82 for during movement PIMD scores. Initial evaluation of the PIMD supports its validity and reliability. Additional testing is needed to evaluate the tool's sensitivity to changes in pain intensity.

Development of a Thai Parkinson's Disease Screening Tool and the Prevalence of Parkinsonism and Parkinson's Disease, Based on a Community Survey in Bangkok

Introduction: Few epidemiological data of parkinsonism and Parkinson's disease (PD) exist in Southeast Asia. We aimed to develop and validate a screening tool, and investigate the prevalence of parkinsonism and PD via a community survey. Methods: A PD-screening tool comprising 11 “yes/no” items was developed in a clinical setting and validated in the community. The prevalence of PD and parkinsonism was investigated in a survey that included PD screening tools, face-to-face interviews, and physical examinations. Receiver operating characteristic curves were constructed for a range of cutoff points to explore the screening tool's sensitivity and specificity. Results: Of 1,846 participants surveyed, the mean age was 64.4 ± 8.0 years. The age-standardized prevalence of parkinsonism was 1,954 per 100,000 people, and that of PD was 706. Of 36 parkinsonism cases, 13 were PD, 13 were vascular parkinsonism, 8 were drug-induced parkinsonism, and 2 were head-injury related. Three cases were previously diagnosed with PD. A cutoff score of 5 on the screening tool showed a sensitivity of 98%, a specificity of 94%, and positive and negative likelihood ratios of 16.33 and 0.02, respectively. The area under the curve was 0.985. Conclusions: The prevalence of parkinsonism and PD in Thailand is similar to that in Western countries but slightly higher than that for other Asian countries. Differing methodologies, diagnostic criteria, and case identification strategies may contribute to variations in the reported prevalence of PD. Widespread use of the Thai PD-screening tool should be implemented to facilitate early detection of new cases and, in turn, better healthcare.

The use of natural language processing on pediatric diagnostic radiology reports in the electronic health record to identify deep venous thrombosis in children.

Venous thromboembolism (VTE) is a potentially life-threatening condition that includes both deep vein thrombosis (DVT) and pulmonary embolism. We sought to improve detection and reporting of children with a new diagnosis of VTE by applying natural language processing (NLP) tools to radiologists' reports. We validated an NLP tool, Reveal NLP (Health Fidelity Inc, San Mateo, CA) and inference rules engine's performance in identifying reports with deep venous thrombosis using a curated set of ultrasound reports. We then configured the NLP tool to scan all available radiology reports on a daily basis for studies that met criteria for VTE between July 1, 2015, and March 31, 2016. The NLP tool and inference rules engine correctly identified 140 out of 144 reports with positive DVT findings and 98 out of 106 negative reports in the validation set. The tool's sensitivity was 97.2% (95% CI 93-99.2%), specificity was 92.5% (95% CI 85.7-96.7%). Subsequently, the NLP tool and inference rules engine processed 6373 radiology reports from 3371 hospital encounters. The NLP tool and inference rules engine identified 178 positive reports and 3193 negative reports with a sensitivity of 82.9% (95% CI 74.8-89.2) and specificity of 97.5% (95% CI 96.9-98). The system functions well as a safety net to screen patients for HA-VTE on a daily basis and offers value as an automated, redundant system. To our knowledge, this is the first pediatric study to apply NLP technology in a prospective manner for HA-VTE identification.

Performance of the Angle Labor Pain Questionnaire During Initiation of Epidural Analgesia in Early Active Labor.

The Angle Labor Pain Questionnaire (A-LPQ) is a new, 22-item multidimensional psychometric questionnaire that measures the 5 most important dimensions of women's childbirth pain experiences using 5 subscales: The Enormity of the Pain, Fear/Anxiety, Uterine Contraction Pain, Birthing Pain, and Back Pain/Long Haul. Previous work showed that the A-LPQ has overall good psychometric properties and performance during early active labor in women without pain relief. The current study assessed the tool's sensitivity to change during initiation of labor epidural analgesia with the standardized response mean (SRM, primary outcome). Two versions of the A-LPQ were administered once, in each of 2 test sessions, by the same trained interviewer during early active labor. The sequence of administration was randomized (ie, standard question order version [Test 1] followed by mixed version [Test 2] or vice versa). Test 1 was completed before epidural insertion; Test 2 commenced 20 to 30 minutes after the test dose. Providers assessed/treated pain independently of the study. Sensitivity to change was assessed using SRMs, Cohen's d, and paired t tests. Overall pain intensity was concurrently examined using Numeric Rating Scale and the Verbal Rating Scale (VRS); coping was assessed with the Pain Mastery Scale. Changes in pain were measured with the Patient Global Impression of Change Scale. Internal consistency was assessed with Cronbach's α. Concurrent validity with other tools was assessed using Spearman's rank correlation coefficient. A total of 51 complete datasets were analyzed. Most women reported moderate (63%, 32/51) or severe (18%, 9/51) baseline pain on VRS scores during Test 1; 29% (15/51) reported mild pain, and 6% (3/51) reported moderate pain during Test 2. Approximately 90% (46/51) of women reported much or very much improved pain at the end of testing. Cronbach's α for A-LPQ summary scores was excellent (0.94) and ranged from 0.78 (acceptable) to 0.92 (excellent) for subscales (Test 1). Large SRMs were found for A-LPQ summary scores (1.6, 95% CI: 1.2, 2.1) and all subscales except the Birthing Pain subscale (moderate, 0.60, 95% CI: 0.23, 0.97). Significant (P < .001) differences were found between A-LPQ summary scores and between all subscales on paired t tests. Correlations between A-LPQ summary and Numeric Rating Scale scores (overall pain intensity) were strong (ρ > 0.73), correlations were moderate (ρ > 0.5) with VRS scores and coping scores (ρ > 0.67). Findings support A-LPQ use for measurement of women's childbirth pain experiences during initiation of labor epidural analgesia during early active labor. Combined with our previous work, they also support the use of the A-LPQ in late labor and at delivery.

Creation of complexity assessment tool for patients receiving home care.

To create and validate a complexity assessment tool for patients receiving home care from a public health service. A diagnostic accuracy study, with estimates for the tool's validity and reliability. Measurements of sensitivity and specificity were considered when producing validity estimates. The resulting tool was used for testing. Assessment by a specialized team of home care professionals was used as the gold standard. In the tool's reliability study, the authors used the Kappa statistic. The tool's sensitivity and specificity were analyzed using various cut-off points. On the best cut-off point-21-with the gold standard, a sensitivity of 75.5% was obtained, with the limits of confidence interval (95%) at 68.3% and 82.8% and specificity of 53.2%, with the limits of confidence interval (95%) at 43.8% and 62.7%. The tool presented evidence of validity and reliability, possibly helping in service organization at patient admission, care type change, or support during the creation of care plans. Elaborar e validar instrumento de classificação de complexidade assistencial de pacientes em atenção domiciliar de um serviço público de saúde. Estudo de acurácia de diagnóstico, com estimativas de validade e de reprodutibilidade do instrumento. Para a estimativa da validade foram consideradas as medidas de sensibilidade e especificidade; como teste, o instrumento elaborado e como padrão ouro, a classificação atribuída por equipe especializada de profissionais de saúde em atenção domiciliar. No estudo de reprodutibilidade do instrumento foi utilizada a estatística Kappa. A sensibilidade e especificidade do instrumento foram analisadas considerando-se diferentes pontos de corte. Para o melhor ponto de corte - 21 - com o padrão ouro obteve-se Sensibilidade de 75,5% com os limites do IC (95%) iguais a 68,3% e 82,8% e Especificidade igual a 53,2% com os limites do IC (95%) iguais a 43,8% e 62,7%. O instrumento apresentou evidências de validade e reprodutibilidade, podendo vir a auxiliar na organização do serviço, quer na admissão do paciente, quer na migração de modalidade assistencial e no suporte para elaboração do plano terapêutico.

Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome.

The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds 40%. Most AUD patients experience uncomplicated alcohol withdrawal syndrome (AWS), requiring only supportive medical intervention, while complicated AWS occurs in up to 20% of cases (i.e. seizures, delirium tremens). We aimed to prospectively test and validate the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), a new tool to identify patients at risk for developing complicated AWS, in medically ill hospitalized patients. We prospectively considered all subjects hospitalized to selected general medicine and surgery units over a 12-month period. Participants were assessed independently and blindly on a daily basis with PAWSS, Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) and clinical monitoring throughout their admission to determine the presence and severity of AWS. Four hundred and three patients were enrolled in the study. Patients were grouped by PAWSS score: Group A (PAWSS < 4; considered at low risk for complicated AWS); Group B (PAWSS ≥ 4; considered at high risk for complicated AWS). The results of this study suggest that, using a PAWSS cutoff of 4, the tool's sensitivity for identifying complicated AWS is 93.1% (95%CI[77.2, 99.2%]), specificity is 99.5% (95%CI[98.1, 99.9%]), positive predictive value is 93.1% and negative predictive value is 99.5%; and has excellent inter-rater reliability with Lin's concordance coefficient of 0.963 (95% CI [0.936, 0.979]). PAWSS has excellent psychometric characteristics and predictive value among medically ill hospitalized patients, helping clinicians identify those at risk for complicated AWS and allowing for prevention and timely treatment of complicated AWS.

The impact of baseline and persistent symptoms of depression and anxiety on long-term physical health outcomes and response to treatment in rheumatoid arthritis

Method: A systematic literature review (using PRISMA guidelines) identified factors associated with the development and severity of AWS used to develop a 10-item scale to predict alcohol dependent patients at risk for developing complicated AWS (i.e., seizures and DT). We prospectively recruited all consecutively hospitalized subjects to the general medicine units over a 3-mo period to test PAWSS' validity and reliability. Subjects were independently and blindly assessed daily with PAWSS, CIWA-Ar, and clinical monitoring throughout their admission to determine the presence and severity of AWS. Results: 409 patients were tested and grouped by PAWSS score: Group A included those with a PAWSS b 4 and were considered to be at low risk for AWS; while subjects in Group B obtained a PAWSS N 4 andwereconsideredat highriskforcomplicatedAWS.Twopatientsin Group A experienced elevated CIWA scores or were treated for AWS. As predicted, all but two subjects in Group B required pharmacological treatment for AWS. The results of this study suggest that, using a PAWSS cut-off of 4, the tool's sensitivity is 93.5%, specificity is 99.5%, positive predictive value is 93.5%, and negative predictive value is 99.5%. Conclusion: PAWSS appears to have excellent psychometric characteristics and predictive value among medically-ill inpatients, helping clinicians identify those at risk for complicated AWS and allowing for timely prophylactic treatment. The use of PAWSS will minimize the excessive use of medications in those at low risk for complicated AWS, thus minimizing undesirable side effects.

Development and Pilot Evaluation of an Electronic Surveillance Tool for Identifying Patients With Severe Sepsis

SESSION TITLE: Patient Safety SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM 04:15 PM PURPOSE: To develop a severe sepsis early warning system using data from the electronic medical record (EMR) to notify clinical surveillance personnel of the presence of severe sepsis in all hospital inpatients, especially those not in ICUs. We hypothesized that screening of alerts by surveillance personnel would provide more actionable information to bedside clinicians. METHODS: This is a descriptive study of CareVeillance, an electronic surveillance tool developed jointly by CSC Consulting and University of Kansas Hospital. Software for collecting sepsis-specific information from the EMR (Epic) was developed using standard criteria for diagnosis of severe sepsis and an iterative process involving clinical and quality improvement personnel with software engineers. A pilot was performed in 2/2012. Clinical personnel (one critical care surveillance nurse, backed up by one intensivist) evaluated all patients detected by CareVeillance to determine the tool's sensitivity and specificity by reviewing each patient's EMR and, when necessary, by conversation with the patient's physician and/or bedside nurse. RESULTS: The pilot study ran 11 days. CareVeillance identified 655 potential sepsis episodes involving 477 patients. Of these, numerous episodes were removed on evaluation by clinical personnel for the following reasons: No infection 297, organ dysfunction non-acute 177, patients on palliative care 4, no SIRS on review 15, patient already in ICU at detection 66, flagged for reassessment 58, beyond window for early goal-directed therapy (EGDT) 19. In all, 19 patients were deemed by clinical personnel to have severe sepsis and eligible for EGDT. Bedside clinical personnel were notified only for these 19 patients. On average, the review process required 1.9 +/1.6 minutes per episode (mean +/SD). CONCLUSIONS: CareVeillance appears to be highly sensitive for the identification of severe sepsis, but lacks specificity. Assessment of the alerts by clinical surveillance personnel can allow for transmission of specific, actionable alerts to bedside clinicians. CLINICAL IMPLICATIONS: Previous work with best practice alerts in the EMR had demonstrated that they were often ignored, and the lack of specificity in the current data may indicate why a bedside nurse would find such alerts untrustworthy. Use of a clinical surveillance nurse and/or physician along with the software may allow for improved specificity at the bedside. DISCLOSURE: The following authors have nothing to disclose: Bristol Brandt, Amanda Gartner, Michael Moncure, Chad Cannon, Liz Carlton, Steven Simpson No Product/Research Disclosure Information Copyright © 2014 American College of Chest Physicians

The Evaluation of a New Supportive Care Screening Tool for Radiation Therapy Patients

ObjectivesIndividuals undergoing radiation therapy for cancer may experience a wide range of supportive care needs that are frequently not addressed. A screening tool was designed and tested for psychometric properties (technical characteristics) to assist radiation therapists to quickly identify those patients who require additional intervention during the course of their radiation treatment, allowing early and timely referral and facilitating the provision of quality, in-depth, and patient-centred supportive care. MethodologyA comprehensive and itemized screening tool was designed to identify the patient concerns and distress level, capture the patient desire to be helped with specific concerns, and inform the centre of alternative help provided. The tool was administered simultaneously with the standardized instrument quality-of-life questionnaire. One hundred and fifteen radiation therapy patients completed both instruments on three occasions; the first two were 2 days apart, and the third, 2 weeks later. To test the new tool for reliability and sensitivity, the agreement between the responses on the first two occasions and those between the first and third occasions were analysed for both instruments. Correlations between the responses on the two instruments were also examined for concurrent validity. ResultsMcNemar's test and the simple kappa coefficient both showed high agreement between item scores on the new screening tool when the first and the second occasions were compared. When the first and the third occasions were compared, the former test showed a shift from high agreement to lesser agreement across the item scores. The latter showed a shift in more than 97.7% of the items from a higher agreement to a lesser agreement. The new tool's sensitivity to change was further reinforced by the data from the validated quality-of-life questionnaire, which showed a similar change over time; the Pearson product moment correlation coefficient fell on average from 0.75 to 0.58 for the first and the second comparisons respectively, with all P values less than .0001. Concurrent validity was found to be acceptable. ConclusionsThe new screening tool was found to be reliable and sensitive, with acceptable validity. It is anticipated that the screening intervention will allow radiation therapists to standardize and formalize their approach to supportive care in radiation therapy outpatient clinics and enhance their capacity to identify and address patient concerns in a timely manner.

Development and evaluation of a questionnaire for assessment of health-related quality of life in cats with cardiac disease

To develop, validate, and evaluate a questionnaire (Cats' Assessment Tool for Cardiac Health [CATCH] questionnaire) for assessing health-related quality of life in cats with cardiac disease. Prospective study. 275 cats with cardiac disease. The questionnaire was developed on the basis of clinical signs of cardiac disease in cats. A CATCH score was calculated by summing responses to questionnaire items; possible scores ranged from 0 to 80. For questionnaire validation, owners of 75 cats were asked to complete the questionnaire (10 owners completed the questionnaire twice). Disease severity was assessed with the International Small Animal Cardiac Health Council (ISACHC) classification for cardiac disease. Following validation, the final questionnaire was administered to owners of the remaining 200 cats. Internal consistency of the questionnaire was good, and the CATCH score was significantly correlated with ISACHC classification. For owners that completed the questionnaire twice, scores were significantly correlated. During the second phase of the study, the CATCH score ranged from 0 to 74 (median, 7) and was significantly correlated with ISACHC classification. Results suggested that the CATCH questionnaire is a valid and reliable method for assessing health-related quality of life in cats with cardiac disease. Further research is warranted to test the tool's sensitivity to changes in medical treatment and its potential role as a clinical and research tool.

Development of a functional assessment measure for manual wheelchair users.

This investigation developed the Wheelchair Users Functional Assessment (WUFA). Because no functional outcome tools exist that include many of the daily activities that are needed to be independent by individuals using manual wheelchairs, development of an appropriate tool was deemed important. Although the Functional Independence Measure (FIM) can be used to assess disability in those using a wheelchair, it only measures some aspects of basic activities of daily living (ADLs) and does not measure community independence. Therefore, both basic activities and community activities were included in the new tool. A panel of six rehabilitation experts, with input from manual wheelchair users, determined content of the instrument. The resulting WUFA scale includes 13 items. Interrater reliability and stability were established with the calculation of an intraclass correlation coefficient (ICC). ICC for interrater reliability was 0.96 and ICC for stability was 0.78. Further analysis was performed on the internal consistency of the 13-item tool using a sample of 101 tested subjects. This analysis was done using a Cronbach's Alpha. Results indicated excellent internal consistency of the 13 items. The standardized coefficient alpha was 0.96. The WUFA was shown to have content validity, promising interrater reliability and stability, and good internal consistency. Further research is warranted to determine the tool's sensitivity and capability to discriminate between levels of functional independence.