Clinical decision support systems for outcome measurement and management

Clinical decision support systems are the foundation for outcome management programs through the measurement of specific outcomes, data storage, data analysis, predictive modeling, and risk-adjusted comparison of actual outcomes with predicted outcomes. Many clinical decision support tools or databases are available to clinicians. This article reviews two widely available tools that provide clinical decision support for critical care clinicians, the Project IMPACT and APACHE III Critical Care Series clinical decision support systems. These tools are discussed with regard to risk adjustment methodology, validity, reliability, database size and representation, retrospective and prospective data and analysis, and quality control. Clinical application of clinical decision support systems for benchmarking and use in process improvement and outcome management is reviewed.     

Multi-database mining

Biomedical data useful for data mining are often distributed across multiple databases. These databases may be aggregated using several techniques to create single data sets that may be mined using standard approaches; however, separate databases may, in their design or data representation, capture information that is analytically useful and that is lost on integration. Recent techniques for mining multiple databases simultaneously but separately may preserve and leverage the unique perspectives within each database. This article presents an example, "dual mining," in which concurrent analysis of a target database with a related knowledge base can improve the identification of association patterns in the target most likely to be of interest for further analysis.     

Systematic Review of Instrumented Measures of Skeletal Muscle Mechanical Properties: Evidence for the Application of Shear Wave Elastography with Children

The aim of this review was to identify instrumented devices that quantify skeletal muscle mechanical properties and to evaluate their potential clinical utility and clinimetric evidence with respect to children. Four databases were searched to identify articles reporting original clinimetric data for devices measuring muscle stiffness or elastic modulus, along a muscle's main fibre direction. Clinimetric evidence was rated using the Consensus-Based Standard for the Selection of Measurement Instruments (COSMIN) checklist. Sixty-five articles provided clinimetric data for two devices meeting our criteria: the Aixplorer and the Acuson. Both are shear wave elastography devices that determine the shear modulus of muscle tissue. The Aixplorer had strong construct validity and reliability, and the Acuson, moderate construct validity and reliability. Both devices have sound clinical utility with non-invasive application at various joint positions and data acquisition in real time, minimizing fatigue. Further research is warranted to evaluate utility for children with specific disorders of abnormal muscle structure or function.     

Reliability and Validity of Panoramic Ultrasound Imaging for Evaluating Muscular Quality and Morphology: A Systematic Review

Panoramic ultrasound (US) is a novel method used to assess linear dimensions, cross-sectional area, fatty infiltrate and echo-intensity features of muscles that cannot be measured with B-mode US. However, a structured overview of its validity and reliability is lacking. MEDLINE, PubMed, SCOPUS and Web of Science databases were systematically searched for studies evaluating reliability or validity data on panoramic US imaging to determine the muscular morphology and/or quality of skeletal muscles. Most studies had acceptable methodological quality. Seventeen studies analyzing reliability (n = 16) or validity (n = 5) were included. Twelve studies assessed cross-sectional area, seven studies assessed echo-intensity, five assessed linear dimensions (fascicle/tendon length, muscle/subcutaneous adipose thickness or between-structure distance) and one assessed intramuscular fat. Panoramic US seems to be a reliable and valid tool for the assessment of muscle morphology and quality in healthy populations at specific locations, particularly the lower extremities. Studies including scanning procedures are needed to confirm these findings in locations not included in this revision and in both clinical and healthy populations.     

A review of instruments to measure interprofessional collaboration for chronic disease management for community-living older adults

It is acknowledged internationally that chronic disease management (CDM) for community-living older adults (CLOA) is an increasingly complex process. CDM for older adults, who are often living with multiple chronic conditions, requires coordination of various health and social services. Coordination is enabled through interprofessional collaboration (IPC) among individual providers, community organizations, and health sectors. Measuring IPC is complicated given there are multiple conceptualisations and measures of IPC. A literature review of several healthcare, psychological, and social science electronic databases was conducted to locate instruments that measure IPC at the team level and have published evidence of their reliability and validity. Five instruments met the criteria and were critically reviewed to determine their strengths and limitations as they relate to CDM for CLOA. A comparison of the characteristics, psychometric properties, and overall concordance of each instrument with salient attributes of IPC found the Collaborative Practice Assessment Tool to be the most appropriate instrument for measuring IPC for CDM in CLOA.     

心房颤动患者疾病知识评价工具的系统综述

目的 对国内外心房颤动患者的疾病知识评价工具进行系统整理,为临床护理人员选择合适的评价工具提供借鉴。方法 采用系统综述的方法,对6个中英文数据库进行检索,检索日期截止2021年4月30日。由2位研究人员进行数据提取,对结果进行系统整理与评价。结果从数据库中鉴定出10份心房颤动患者的疾病知识问卷。所有问卷均已经过信效度评价,问卷条目从4到42个不等,各问卷所适用的细分人群不同。结论：临床护理人员可借鉴本研究结果,根据评价目标,针对性地选择合适的评价工具。     

Reliability of Cervicocephalic Proprioception Assessment: A Systematic Review

ObjectiveThe purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations.MethodsA systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies.ResultsOf 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other.ConclusionThe reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.     

Assessing data adequacy for clinical research: reliability and validity of a surgical database

As clinical databases are utilized more frequently for clinical research, it is essential that researchers assess the quality of databased information. While researchers have begun to report strategies to measure accuracy of databased information, knowledge remains limited. The purpose of this study was to assess the reliability and validity of databased information among selected study variables contained within a computerized coronary artery surgery clinical database using the written patient medical record as an external standard. Both reliability (N = 400) and validity (N = 100) samples were randomly selected from a databased sampling frame of 548 Medicare subjects who underwent coronary artery bypass grafting surgery in 1998. Reliability assessed by consistency rates were age (95%), race (94%), gender (99%), congestive heart failure (CHF) (60.5%), angina (91.5%), renal insufficiency (82%), hypertension (91.7%), diabetes mellitus (93.7%), chronic obstructive pulmonary disease (COPD) (75.5%), clinical status (97%), American Society of Anesthesiologists classification (99%), prior peripheral vascular surgery (15.5%), prior CABGS (99%), and duration of mechanical ventilation (87.5%). These percentages reflected a large portion of missing data for CHF, COPD, and prior peripheral vascular surgery. Validity assessed by sensitivity and specificity analyses were all greater than 80%. The majority of computerized databased information among selected study variables was the same information recorded in the written patient medical record. Using the same external standard to assess both reliability and validity was a significant limitation of this study, which resulted in the same measure of data adequacy by utilizing differing statistical methods.     

Project IMPACT: results from a pilot validity study of a new observational database

OBJECTIVE: The objective of this study was to evaluate the accuracy of the information contained in the Project IMPACT database. Project IMPACT is a comprehensive database system developed to measure and describe the care of intensive care patients. This database is being used by a large group of hospitals to help clinicians improve the care of these patients. Data on patient demographics, diagnoses, treatment, and outcomes are entered into the Project IMPACT database by staff at participating hospitals. This pilot study was a first step in assessing the accuracy of these data to determine the usefulness of the Project IMPACT database for measuring intensive care unit (ICU) performance and patient outcomes. DESIGN: The design of the pilot study was the independent abstraction of selected data items from a random sample of ICU patient records from two hospitals participating in Project IMPACT. The abstracted data were compared with the data existing in the Project IMPACT database for agreement. SETTING: Abstraction was performed onsite at the two pilot hospitals by a trained abstractor who was not affiliated with either hospital. PATIENTS: Patients whose records were abstracted included 45 randomly selected ICU patients at each of the two pilot hospitals. MEASUREMENTS AND MAIN RESULTS: Comparison of the Project IMPACT data with the independently abstracted data indicated good agreement (80% or above) on discrete items, such as type of ICU patient. Poorer agreement (under 80%) was seen for continuous items (e.g., 24-hr urine output) and coded items requiring judgment (e.g., reason for ICU admission). CONCLUSIONS: The pilot study showed good internal validity for most of the abstracted variables. High agreement rates were observed, regardless of method of original data capture (electronic download or manual entry), although agreement was higher for some data items that had been electronically downloaded into the Project IMPACT database. The results suggest that Project IMPACT is a valuable resource for ICUs to collect and evaluate information about treatment and patient outcomes.     

Computer assisted data analysis in intensive care: the ICDEV project-development of a scientific database system for intensive care

Introduction: Patient Data Management Systems (PDMS) for ICUs collect, present and store clinical data. Various intentions make analysis of those digitally stored data desirable, such as quality control or scientific purposes. The aim of the Intensive Care Data Evaluation project (ICDEV), was to provide a database tool for the analysis of data recorded at various ICUs at the University Clinics of Vienna.Settings: General Hospital of Vienna, with two different PDMSs used: Care Vue 9000 (Hewlett Packard, Andover, USA) at two ICUs (one medical ICU and one neonatal ICU) and PICIS Chart+ (PICIS, Paris, France) at one Cardiothoracic ICU.Concept and methods: Clinically oriented analysis of the data collected in a PDMS at an ICU was the beginning of the development. After defining the database structure we established a client-server based database system under Microsoft Windows NI^TM and developed a user friendly data quering application using Microsoft Visual C++^TM and Visual Basic^TM;Results: ICDEV was successfully installed at three different ICUs, adjustment to the different PDMS configurations were done within a few days. The database structure developed by us enables a powerful query concept representing an ‘EXPERT QUESTION COMPILER’ which may help to answer almost any clinical questions. Several program modules facilitate queries at the patient, group and unit level. Results from ICDEV-queries are automatically transferred to Microsoft Excel^TM, for display (in form of configurable tables and graphs) and further processing.Conclusions: The ICDEV concept is configurable for adjustment to different intensive care information systems and can be use to support computerized quality control. However, as long as there exists no sufficient artifact recognition or data validation software for automatically recorded patient data, the reliability of these data and their usage for computer assisted quality control remain unclear and should be further studied. Supported by the Scientific Fund of the Mayor of Vienna     

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review

Abstract

Background: This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. Methods: A systematic review study design was used and searched six databases, including one website. The research question guiding the search was developed a priori and registered with the PROSPERO database of systematic reviews: “Are there reliable and valid instruments for measuring fatigue among EMS personnel?” (2016:CRD42016040097). The primary outcome of interest was criterion-related validity. Important outcomes of interest included reliability (e.g., internal consistency), and indicators of sensitivity and specificity. Members of the research team independently screened records from the databases. Full-text articles were evaluated by adapting the Bolster and Rourke system for categorizing findings of systematic reviews, and the rated data abstracted from the body of literature as favorable, unfavorable, mixed/inconclusive, or no impact. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the quality of evidence. Results: The search strategy yielded 1,257 unique records. Thirty-four unique experimental and non-experimental studies were determined relevant following full-text review. Nineteen studies reported on the reliability and/or validity of ten different fatigue survey instruments. Eighteen different studies evaluated the reliability and/or validity of four different sleepiness survey instruments. None of the retained studies reported sensitivity or specificity. Evidence quality was rated as very low across all outcomes. Conclusions: In this systematic review, limited evidence of the reliability and validity of 14 different survey instruments to assess the fatigue and/or sleepiness status of EMS personnel and related shift worker groups was identified.     

Reliability and Validity of the Functional Gait Assessment: A Systematic Review

Aims: The purpose of this systematic review is to assemble the available literature related to the psychometric properties (reliability and validity) of the Functional Gait Assessment (FGA) for patient populations that have been studied using the FGA. Methods: Studies of a cohort design were examined for reliability or criterion validity of the FGA from four electronic databases using a systematic review process. Results: Eight studies met the inclusion criteria. The FGA has a high inter-rater reliability across the patient populations studied and has high concurrent validity in patients with Parkinson disease, stroke, and community dwelling older adults. Conclusions: Findings suggest that the FGA is a useful clinical tool for the reported patient populations. Consideration should be given to the quality and limited number of studies included in this systematic review. Further research to enhance the accuracy of these findings is needed, including clearly defining a cut-off score for fall risk.     

Health Systems and Maternal and Child Survival in Central Asian Republics

Purpose: To describe the status of health care systems in five Central Asian Republics (CAR): Kyrgzstan, Kazakhstan, Uzbekistan, Turkmenistan, and Tajikistan, with particular attention to women's and children's health.
Organizing construct: Changing mortality profiles are investigated using the "protractedpolarized" model of epidemiologic transition.
Sources: Empirical evidence was drawn from the World Health Organization (WHO) database for the region, along with additional evidence presented at a maternal-child health conference held in Bishkek, Kyrgyzstan, on November 11–14, 1998. The conference was sponsored by the Albert Schweitzer Institute and the Soros Foundation. This evidence is evaluated for completeness, validity, and reliability. Trends are identified using the 1998 and 1999 World Health Reports and 1999/2000 World Bank Development Report.
Findings: Incomplete data prohibited comprehensive analysis. Available data indicated high but variable rates of maternal and child mortality and overall declines in health status and the health care infrastructure in the 1990s.
Conclusions: Data collection and analysis from this part of the world are often incomplete and unreliable. Future research should focus on improving maternal and child health indicators by enhancing resource sharing and opportunities for international collaboration.     

Statistical Methodology: II. Reliability and Validity Assessment in Study Design, Part B

SUMMARY
Validity measures the correspondence between a test and other purported measures of the same or similar qualities. When a reference standard exists, a criterion-based validity coefficient can be calculated. If no such standard is available, the concepts of content and construct validity may be used, but quantitative analysis may not be possible. The Pearson and Spearman tests of correlation are often used to assess the correspondence between tests, but do not account for measurement biases and may yield misleading results. Techniques that measure intertest differences may be more meaningful in validity assessment, and the κ statistic is useful for analyzing categorical variables.
Questionnaires often can be designed to allow quantitative assessment of reliability and validity, although this may be difficult. Inclusion of homogeneous questions is necessary to assess reliability. Analysis is enhanced by using Likert scales or similar techniques that yield ordinal data. Validity assessment of questionnaires requires careful definition of the scope of the test and comparison with previously validated tools.     

The cross‐cultural adaptation of the Belgium Nursing Minimum Data Set to Finnish nursing

Background Nursing has been invisible in most of the international and national healthcare information systems and databases; also in Finland. The use of nursing minimum data set could be one solution to this problem. It is an information system that collects, stores, processes, retrieves, displays and communicates timely information about nursing practice needed for a variety of users and purposes. Objectives To test the cultural applicability of the Belgian Nursing Minimum Data Set (BeNMDS) to Finnish nursing. Methods The study design was methodological. It included testing of the validity, reliability and sensitivity of the BeNMDS. Content validity was tested using content analysis of the Finnish nursing doctorate dissertations, Katie Eriksson's publications of her Nursing Process Model and focus‐group interviews of the healthcare administrators. Reliability, construct validity and sensitivity were tested using the data collected with the BeNMDS‐tool from patients' nursing notes in Finnish Hospitals. Findings The validity, reliability and sensitivity of the BeNMDS in Finland were mainly good. The study showed, however, that the interventions to describe the patient's spiritual well‐being, were missing and the psycho‐social care interventions were insufficient in the data set. Conclusion The Finnish version of the BeNMDS has been shown to be valid, reliable and sensitive and applicable to describe nursing practice in Finland. Should the interventions to describe patient's spiritual and psycho‐social well‐being be included in the data set, Finnish nursing will have a valuable tool available to make nursing visible for the healthcare information systems and databases.     

Nutritional screening and assessment tools for use by nurses: literature review

AIM: This paper reports a literature review describing the range of published tools available for use by nurses to screen or assess nutritional status of patients/clients, and to examine whether the validity, reliability, sensitivity, specificity and acceptability of the tool have been investigated. Tools developed specifically for use with older adults are not considered in this review. A screening/assessment tool is described as a tool that uses a questionnaire-type format, contains more than one risk factor for malnutrition and gives an assessment of risk. BACKGROUND: The incidence of malnutrition in people cared for by nurses is high and screening or assessment tools are often used to identify those with, or at risk of, malnutrition. METHODS: A comprehensive literature review methodology was employed. A range of electronic databases was searched from 1982 to 2002. Search terms incorporating "nutrition", "screening", assessment, feeding, instrument, tool, validity, reliability, sensitivity and specificity were combined. Manual searches were also conducted. RESULTS: Seventy-one nutritional screening/assessment tools were identified of which 35 were reviewed. Tools not reviewed included those which incorporated significant use of biochemical measures (8), included complex anthropometric measures (3), were concerned specifically with ingestion (4) or were designated for use with an older population (21). The tools reviewed use a wide variety of risk factors for malnutrition, varying from anthropometric measurements to socio-cultural aspects of eating behaviour. Some identify an action plan based on the score obtained. Many have not been subjected to validity and/or reliability testing and yet appear to be in use in clinical practice. The sensitivity, specificity and acceptability of the tools are often not investigated. CONCLUSION: There are many published nutritional screening/assessment tools available for use by nurses to screen or assess the nutritional status of patients/clients. Many have not been subject to rigorous testing. Future work should consider a more standardized approach to the use of these tools.     

What do we really know about the transition to adult-centered health care? A focus on cerebral palsy and spina bifida

OBJECTIVES: To address the lack of synthesis regarding the factors, processes, and outcomes specific to the transition from child-centered to adult-centered health care for people with cerebral palsy (CP) and spina bifida (SB); more specifically, to identify barriers, to outline key elements, to review empirical studies, and to make clinical and research recommendations. DATA SOURCES: We searched Medline and CINAHL databases from 1990 to 2006 using the key words: transition, health care transition, pediatric health care, adult health care, health care access, health care use, chronic illness, special health care needs, and physical disability. The resulting studies were reviewed with a specific focus on clinical transition for persons with CP and SB, and were supplemented with key information from other diagnostic groups. STUDY SELECTION: All studies meeting the inclusion criteria were included. DATA EXTRACTION: Each article classified according to 5 criteria: methodology, diagnostic group, country of study, age group, and sample size. DATA SYNTHESIS: We identified 149 articles: 54 discussion, 21 case series, 28 database or register, 25 qualitative, and 34 survey articles (some included multiple methods). We identified 5 key elements that support a positive transition to adult-centered health care: preparation, flexible timing, care coordination, transition clinic visits, and interested adult-centered health care providers. There was, however, limited empirical evidence to support the impact of these elements. CONCLUSIONS: This review summarizes key factors that must be considered to support this critical clinical transition and sets the foundation for future research. It is time to apply prospective study designs to evaluate transition interventions and determine long-term health outcomes.