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Intensive Care Medicine Oct 2022In critically ill patients, fluid infusion is aimed at increasing cardiac output and tissue perfusion. However, it may contribute to fluid overload which may be harmful.... (Review)
Review
In critically ill patients, fluid infusion is aimed at increasing cardiac output and tissue perfusion. However, it may contribute to fluid overload which may be harmful. Thus, volume status, risks and potential efficacy of fluid administration and/or removal should be carefully evaluated, and monitoring techniques help for this purpose. Central venous pressure is a marker of right ventricular preload. Very low values indicate hypovolemia, while extremely high values suggest fluid harmfulness. The pulmonary artery catheter enables a comprehensive assessment of the hemodynamic profile and is particularly useful for indicating the risk of pulmonary oedema through the pulmonary artery occlusion pressure. Besides cardiac output and preload, transpulmonary thermodilution measures extravascular lung water, which reflects the extent of lung flooding and assesses the risk of fluid infusion. Echocardiography estimates the volume status through intravascular volumes and pressures. Finally, lung ultrasound estimates lung edema. Guided by these variables, the decision to infuse fluid should first consider specific triggers, such as signs of tissue hypoperfusion. Second, benefits and risks of fluid infusion should be weighted. Thereafter, fluid responsiveness should be assessed. Monitoring techniques help for this purpose, especially by providing real time and precise measurements of cardiac output. When decided, fluid resuscitation should be performed through fluid challenges, the effects of which should be assessed through critical endpoints including cardiac output. This comprehensive evaluation of the risk, benefits and efficacy of fluid infusion helps to individualize fluid management, which should be preferred over a fixed restrictive or liberal strategy.
Topics: Cardiac Output; Critical Illness; Fluid Therapy; Hemodynamics; Humans; Pulmonary Edema; Thermodilution
PubMed: 35945344
DOI: 10.1007/s00134-022-06808-9 -
BMC Geriatrics Jul 2022To review the validated instruments that assess gait, balance, and functional mobility to predict falls in older adults across different settings. (Review)
Review
BACKGROUND
To review the validated instruments that assess gait, balance, and functional mobility to predict falls in older adults across different settings.
METHODS
Umbrella review of narrative- and systematic reviews with or without meta-analyses of all study types. Reviews that focused on older adults in any settings and included validated instruments assessing gait, balance, and functional mobility were included. Medical and allied health professional databases (MEDLINE, PsychINFO, Embase, and Cochrane) were searched from inception to April 2022. Two reviewers undertook title, abstract, and full text screening independently. Review quality was assessed through the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS). Data extraction was completed in duplicate using a standardised spreadsheet and a narrative synthesis presented for each assessment tool.
RESULTS
Among 2736 articles initially identified, 31 reviews were included; 11 were meta-analyses. Reviews were primarily of low quality, thus at high risk of potential bias. The most frequently reported assessments were: Timed Up and Go, Berg Balance Scale, gait speed, dual task assessments, single leg stance, functional Reach Test, tandem gait and stance and the chair stand test. Findings on the predictive ability of these tests were inconsistent across the reviews.
CONCLUSIONS
In conclusion, we found that no single gait, balance or functional mobility assessment in isolation can be used to predict fall risk in older adults with high certainty. Moderate evidence suggests gait speed can be useful in predicting falls and might be included as part of a comprehensive evaluation for older adults.
Topics: Accidental Falls; Aged; Gait; Humans; Meta-Analysis as Topic; Physical Functional Performance; Postural Balance; Risk Assessment; Systematic Reviews as Topic
PubMed: 35879666
DOI: 10.1186/s12877-022-03271-5 -
JPMA. the Journal of the Pakistan... Sep 2021Evoked Potentials are electrical potentials that occur in a group of neurons in response to stimulation of a sensory organ which can be recorded by surface electrodes.... (Review)
Review
Evoked Potentials are electrical potentials that occur in a group of neurons in response to stimulation of a sensory organ which can be recorded by surface electrodes. Testing evoked potentials is useful in assessing the integrity of neuronal pathways both at sensory and motor levels of neural control. Early auditory evoked potentials include cochlear and brainstem auditory-evoked potentials, popularly known as electrocochleogram, and auditory brainstem response. Evoked potential audiometry is a neurophysiogical test to assess auditory pathway function in response to auditory stimuli. Auditory brainstem response mainly assesses brainstem functions and integrity. These evoked potentials are widely used for assessment of the cochlear functions, auditory nerve and the brainstem. Most common indications for auditory evoked potentials include routine newborn hearing screening for auditory pathway deficits, detecting retrocochlear pathologies, intraoperative and intensive care monitoring, frequency-related measurement of auditory sensitivity and for diagnosing some demyelinating disorders in initial stages. The current narrative review was planned to highlight auditory brainstem response recording's basic principles, uses and methods of interpretation in health and disease phases.
Topics: Brain Stem; Cochlea; Cochlear Nerve; Evoked Potentials, Auditory, Brain Stem
PubMed: 34580520
DOI: 10.47391/JPMA.03-432 -
Journal of Preventive Medicine and... Jun 2022Accurate nutritional assessment based on dietary intake, physical activity, genetic makeup, and metabolites is required to prevent from developing and/or to treat people... (Review)
Review
Accurate nutritional assessment based on dietary intake, physical activity, genetic makeup, and metabolites is required to prevent from developing and/or to treat people suffering from malnutrition as well as other nutrition related health issues. Nutritional screening ought to be considered as an essential part of clinical assessment for every patient on admission to healthcare setups, as well as on change in clinical conditions. Therefore, a detailed nutritional assessment must be performed every time nutritional imbalances are observed or suspected. In this review we have explored different techniques used for nutritional and physical activity assessment. Dietary Intake (DI) assessment is a multidimensional and complex process. Traditionally, dietary intake is assessed through self-report techniques, but due to limitations like biases, random errors, misestimations, and nutrient databases-linked errors, questions arise about the adequacy of self-reporting dietary intake procedures. Despite the limitations in assessing dietary intake (DI) and physical activity (PA), new methods and improved technologies such as biomarkers analysis, blood tests, genetic assessments, metabolomic analysis, DEXA (Dual-energy X-ray absorptiometry), MRI (Magnetic resonance imaging), and CT (computed tomography) scanning procedures have made much progress in the improvement of these measures. Genes also plays a crucial role in dietary intake and physical activity. Similarly, metabolites are also involved in different nutritional pathways. This is why integrating knowledge about the genetic and metabolic markers along with the latest technologies for dietary intake (DI) and physical activity (PA) assessment holds the key for accurately assessing one's nutritional status and prevent malnutrition and its related complications.
Topics: Humans; Nutrition Assessment; Nutritional Status; Exercise; Diet; Prescriptions
PubMed: 36479490
DOI: 10.15167/2421-4248/jpmh2022.63.2S3.2753 -
Bundesgesundheitsblatt,... Oct 2022Emergency personnel assess their patients as an essential part of their daily work in emergency settings. The clinical assessment can help differentiate between... (Review)
Review
Emergency personnel assess their patients as an essential part of their daily work in emergency settings. The clinical assessment can help differentiate between immediately life-threatening conditions and milder diseases in patients. This assessment is the basis for an adequate preclinical treatment and for a rational referral to the hospital providing further care. Carried out in a thoughtful manner it allows reasonable allocation of resources for inpatient care.Well-founded training, clinical experience, scores, and tools in the form of acronyms for assessing the patient lead to successful assessments according to quality standards.The preclinical initial assessment is crucial for ensuring appropriate care for patients on site with life-threatening conditions as well as those with minor problems. Prioritization of a treatment depends on the severity of the condition or injury.
Topics: Germany; Hospitalization; Hospitals; Humans; Referral and Consultation; Triage
PubMed: 36125539
DOI: 10.1007/s00103-022-03582-3 -
Journal of Pain and Symptom Management Apr 2021The will to live (WTL) is an important factor to consider in the context of providing resource-oriented palliative care. Until now, there has been no major review of the... (Review)
Review
CONTEXT
The will to live (WTL) is an important factor to consider in the context of providing resource-oriented palliative care. Until now, there has been no major review of the existing research on this subject.
OBJECTIVES
The primary objective of this study is to summarize the state of research concerning instruments that assess the WTL. The secondary objective is to explore the theoretical models and psychometric properties of these instruments, in studies where these instruments were initially presented. The tertiary objective is to identify, among all studies where these instruments have been used, the intensity of the WTL, and factors associated with it.
METHODS
We conducted a scoping review, including studies that were designed to assess the WTL among participants in all settings. Records were systematically searched from seven bibliographic databases with no date limitations up to August 2020.
RESULTS
Of the 3078 records screened, 281 were examined in detail and 111 were included in the synthesis. A total of 25 different instruments quantitatively assessing the WTL are presented. Most are single-question tools and rate intensity. The underlying concepts and psychometric properties are incompletely explained. Lack of crossreferencing is apparent. The intensity of the WTL is high, even among people with significant health impairment, and is frequently associated with different factors, such as resilience and quality of life.
CONCLUSION
A considerable yet unconnected body of studies assesses the WTL. Its assessment in clinical routine could promote resource-oriented and patient-centered care.
Topics: Delivery of Health Care; Humans; Palliative Care; Patient-Centered Care; Psychometrics; Quality of Life
PubMed: 32931906
DOI: 10.1016/j.jpainsymman.2020.09.012 -
International Journal of Nursing Studies Sep 2020Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care... (Review)
Review
BACKGROUND
Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists.
OBJECTIVE
To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC.
DESIGN
State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017.
REVIEW METHODS
Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles.
RESULT
16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed.
CONCLUSION
Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.
Topics: Health Personnel; Humans; Patient-Centered Care; Psychometrics; Reproducibility of Results
PubMed: 32531569
DOI: 10.1016/j.ijnurstu.2020.103634 -
American Journal of Pharmaceutical... Mar 2021To explore how teamwork is taught (ie, skills and format), measured, and assessed within pharmacy education. A mapping review was conducted to provide a selection of... (Review)
Review
To explore how teamwork is taught (ie, skills and format), measured, and assessed within pharmacy education. A mapping review was conducted to provide a selection of articles to specifically capture how teamwork is taught, measured, and assessed within pharmacy education. Of the 114 references retrieved, 18 studies from 17 schools or colleges of pharmacy met the inclusion criteria for review and data abstraction. Ten of the studies (56%) described how teamwork training was integrated into courses while the other eight studies described workshops, clinical rotations, modules, interprofessional simulations, long-term projects, and retreats on teamwork. Learning activities involving patient cases were the most common teaching method described (n=12, 67%). For the teamwork principles taught, all articles included leadership training or evaluating leadership skills in their program. To assess teamwork, 17 (94%) of the programs used students' self-reported measures of skills and behaviors, attitudes, and/or knowledge. Fourteen studies (78%) demonstrated improvements in students' attitude-related outcomes, 13 (72%) studies demonstrated improvements in skills-related outcomes, and six studies (33%) described improvements in knowledge related outcomes. Teamwork is regarded as an integral component of being an effective health care professional. While teamwork is common in pharmacy curricula, few studies describe strategies for teaching effective teamwork strategies to pharmacy students. The articles reviewed revealed a wide range of approaches to teaching, measuring, and assessing teamwork skills within pharmacy education. This review highlights an opportunity to further explore and identify the teamwork skills that are requisite for success in pharmacy practice, which could then be supported by standardized teamwork training programs and assessments.
Topics: Curriculum; Education, Pharmacy; Health Personnel; Humans; Learning; Students, Pharmacy
PubMed: 34283772
DOI: 10.5688/ajpe8356 -
JMIR Rehabilitation and Assistive... Mar 2022Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be... (Review)
Review
BACKGROUND
Loss of fine motor skills is observed in many neurological diseases, and remote monitoring assessments can aid in early diagnosis and intervention. Hand function can be regularly assessed to monitor loss of fine motor skills in people with central nervous system disorders; however, there are challenges to in-clinic assessments. Remotely assessing hand function could facilitate monitoring and supporting of early diagnosis and intervention when warranted.
OBJECTIVE
Remote assessments can facilitate the tracking of limitations, aiding in early diagnosis and intervention. This study aims to systematically review existing evidence regarding the remote assessment of hand function in populations with chronic neurological dysfunction.
METHODS
PubMed and MEDLINE, CINAHL, Web of Science, and Embase were searched for studies that reported remote assessment of hand function (ie, outside of traditional in-person clinical settings) in adults with chronic central nervous system disorders. We excluded studies that included participants with orthopedic upper limb dysfunction or used tools for intervention and treatment. We extracted data on the evaluated hand function domains, validity and reliability, feasibility, and stage of development.
RESULTS
In total, 74 studies met the inclusion criteria for Parkinson disease (n=57, 77% studies), stroke (n=9, 12%), multiple sclerosis (n=6, 8%), spinal cord injury (n=1, 1%), and amyotrophic lateral sclerosis (n=1, 1%). Three assessment modalities were identified: external device (eg, wrist-worn accelerometer), smartphone or tablet, and telerehabilitation. The feasibility and overall participant acceptability were high. The most common hand function domains assessed included finger tapping speed (fine motor control and rigidity), hand tremor (pharmacological and rehabilitation efficacy), and finger dexterity (manipulation of small objects required for daily tasks) and handwriting (coordination). Although validity and reliability data were heterogeneous across studies, statistically significant correlations with traditional in-clinic metrics were most commonly reported for telerehabilitation and smartphone or tablet apps. The most readily implementable assessments were smartphone or tablet-based.
CONCLUSIONS
The findings show that remote assessment of hand function is feasible in neurological disorders. Although varied, the assessments allow clinicians to objectively record performance in multiple hand function domains, improving the reliability of traditional in-clinic assessments. Remote assessments, particularly via telerehabilitation and smartphone- or tablet-based apps that align with in-clinic metrics, facilitate clinic to home transitions, have few barriers to implementation, and prompt remote identification and treatment of hand function impairments.
PubMed: 35262502
DOI: 10.2196/33157