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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 -
Advances in Medical Education and... 2018We describe programmatic assessment and the problems it might solve in relation to assessment and learning, identify some models implemented internationally, and then...
We describe programmatic assessment and the problems it might solve in relation to assessment and learning, identify some models implemented internationally, and then outline what we believe are programmatic assessment's key components and what these components might achieve. We then outline some issues around implementation, which include blueprinting, data collection, decision making, staff support, and evaluation. Rather than adopting an all-or-nothing approach, we suggest that elements of programmatic assessment can be gradually introduced into traditional assessment systems.
PubMed: 29606896
DOI: 10.2147/AMEP.S144449 -
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 -
BMJ Global Health 2017Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed... (Review)
Review
Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both 'economy' and 'efficiency' can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case-control studies or randomised controlled trials can be used to assess 'effectiveness'. To assess 'cost-effectiveness', cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such 'economy' and 'efficiency' are relatively easy to assess. However, 'effectiveness' and 'cost-effectiveness' which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help.
PubMed: 29081998
DOI: 10.1136/bmjgh-2017-000310 -
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 -
The National Medical Journal of India 2018The assessment of the suitability of an individual for the profession of medical science is carried out worldwide on the basis of several yardsticks. While a few methods... (Review)
Review
The assessment of the suitability of an individual for the profession of medical science is carried out worldwide on the basis of several yardsticks. While a few methods assess domain knowledge of sciences, others focus on evaluating the cognitive aptitude skills of the candidate, while few others assess communicative skills. Though it has been considered that the possession of an aptitude for the profession is a prerequisite, considering its strenuous demands from the candidate, a comprehensive assessment of these areas under the construct of medical aptitude has not been analysed so far, though medical aptitude has been socially defined. This article attempts to develop a comprehensive construct to 'Medical aptitude', meant for the pre-medical student, which has been encapsulated with respect to the areas of its assessment. We did an extensive survey of the literature pertaining to the mode of selection of students towards medical profession and analysed their areas of assessments for admittance. This enabled to identify similarities in the areas of assessment which were then classified under several domains of assessment. Special reference to the keywords involving 'Aptitude' and 'Medical Aptitude' was made. We analysed the definitions to the construct of aptitude from the literature with respect to its relevance in the profession of medical science to be possessed by the pre-medical aspirant-in context. From this, a new construct of medical aptitude was formulated incorporating the existing construct of medical aptitude. Medical aptitude is a comprehensive construct that encompasses the dimensions of a consistent core, a peripheral content and the support of a scaffold. Each of these dimensions have their importance and distinct objective in being assessed in the pre-medical student. A perfect intertwining of these 3 dimensions can prove beneficial in assessing individuals to be fit for the profession of medical science.
Topics: Aptitude; Aptitude Tests; Communication; Education, Medical, Undergraduate; Humans; School Admission Criteria; Schools, Medical; Students, Medical
PubMed: 31397372
DOI: 10.4103/0970-258X.262905 -
Harvard Review of Psychiatry 2017After participating in this activity, learners should be better able to:• Assess the neuropsychological literature on decision making and the medical and legal... (Review)
Review
After participating in this activity, learners should be better able to:• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia ABSTRACT: Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.
Topics: Aged; Decision Making; Dementia; Executive Function; Humans; Mental Competency; Metacognition; Punishment; Reward
PubMed: 29117022
DOI: 10.1097/HRP.0000000000000163 -
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 -
European Journal of Ophthalmology Jul 2018Rising healthcare costs and increasing demands for health care require techniques to choose between competing uses and even rationing of health care. Economic... (Review)
Review
Rising healthcare costs and increasing demands for health care require techniques to choose between competing uses and even rationing of health care. Economic evaluations and health technology assessments are increasingly a means to assess the cost effectiveness of healthcare interventions so as to inform such resource allocation decisions. To date, the adoption of health technology assessments, as a way of assessing cost effectiveness, in ophthalmology has been slower, relative to their implementation in other specialities. Nevertheless, demands for eye services are increasing due to an ageing population. The prevalence of conditions such as glaucoma, cataract, diabetic eye disease and age-related macular degeneration increases with age, and it is predicted that global blindness will triple by 2050. So there is a challenge for ophthalmologists to ensure that they can contribute to, interpret, critically evaluate, and use findings from economic evaluations in their clinical practice. To aid this, this article serves as a primer on the use of health technology assessments to assess cost effectiveness using economic evaluation techniques for ophthalmologists. Healthcare systems face many challenges worldwide - changing demographics and evolution of new technologies are only going to intensify. With this in mind, ophthalmology needs to be ready and able to engage with health economists to prepare, interpret, critically evaluate and use findings of economic evaluations and health technology assessments.
Topics: Delivery of Health Care; Eye Diseases; Humans; Ophthalmology; Technology Assessment, Biomedical
PubMed: 29973070
DOI: 10.1177/1120672117747040