Examining College Student Athlete Attitudes Towards Concussion Testing and Reporting Concussions

Examining College Student Athlete Attitudes and Behaviors Toward Baseline Neurocognitive Concussion Testing FryK, Anderson, M, Anderson, M, Schatz, P, Elbin, RJ: University of Arkansas, Fayetteville, Arkansas Context: Examining athletes’ attitudes toward concussion diagnosis, management, and treatment can lead to improved multi-faceted management of a concussion injury. Although attitudes towards concussion injuries have been studied, the examination of athletes’ attitudes towards baseline computerized neurocognitive testing is understudied and is warranted. Objective: To examine the relationship between sex, concussion history, and previous exposure to baseline testing on athletes’ perceptions of effort provided during baseline testing and the utility of neurocognitive testing. Methods: College athletes (18-23 years) completing a baseline neurocognitive test (Immediate Post-Concussion Assessment and Cognitive Test: ImPACT) were asked to complete an anonymous 33-item online survey. Survey questions included demographics and inquired about athletes’ effort and utility of baseline and post-concussion neurocognitive testing. A series of chi-square analyses measured the association between sex, concussion history, and previous exposure to baseline testing on effort provided during testing and utility of the test. Level of statistical significance was p \u3c .05. Results: One hundred eighty-two (88 males, 95 females) athletes (M =19.05, SD = 1.15 years) completed the survey. Thirty-eight percent (70/183) reported prior concussion history and 27% (50/182) were first time test takers. Ninety-four percent (172/183) reported providing above average to maximal effort on the baseline test they completed prior to completing the survey. Ninety percent (158/176) and 87% (156/179) of the sample reported that the baseline and post-concussion test results were useful in mitigating premature return to play, respectively. There was no association between sex, concussion history, or previous exposure to baseline testing on reported effort or perceptions of utility for baseline neurocognitive testing (p \u3e .05). Conclusion: The majority of athletes report high effort on baseline neurocognitive testing and recognize the utility of this measure for safe return to play

Technology in Practice (Section 2.31 of the Comprehensive Clinical Psychology: Vol. 2. Professional Issues)

The contemporary practice of psychology requires a prudent balance of traditional and emerging communication methods. Interpersonal interactions in the context of human relationship (e.g., speech, emotional expressions, and nonverbal gestures) have been a vital part of emotional healing throughout many centuries, and research findings in the 1990s underscore the importance of relational factors in effective psychological interventions (Whiston & Sexton, 1993). In addition to the time honored interpersonal communication methods of professional psychology, rapid technological advances have propelled psychologists into another sphere of communication. Today\u27s professional psychologist is increasingly expected to attain mastery in both of these communication methods-the very old and the very new

Computerized adaptive testing and short form development for child and adolescent oral health patient-reported outcomes measurement.

ObjectivesTo develop computerized adaptive testing (CAT) and short forms of self-report oral health measures that are predictive of both the children's oral health status index (COHSI) and the children's oral health referral recommendation (COHRR) scales, for children and adolescents, ages 8-17.Material and methodsUsing final item calibration parameters (discrimination and difficulty parameters) from the item response theory analysis, we performed post hoc CAT simulation. Items most frequently administered in the simulation were incorporated for possible inclusion in final oral health assessment toolkits, to select the best performing eight items for COHSI and COHRR.ResultsTwo previously identified unidimensional sets of self-report items consisting of 19 items for the COHSI and 22 items for the COHRR were administered through CAT resulting in eight-item short forms for both the COHSI and COHRR. Correlations between the simulated CAT scores and the full item bank representing the latent trait are r = .94 for COHSI and r = .96 for COHRR, respectively, which demonstrated high reliability of the CAT and short form.ConclusionsUsing established rigorous measurement development standards, the CAT and corresponding eight-item short form items for COHSI and COHRR were developed to assess the oral health status of children and adolescents, ages 8-17. These measures demonstrated good psychometric properties and can have clinical utility in oral health screening and evaluation and clinical referral recommendations

Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study

BACKGROUND: Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect. METHODS: A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. CONCLUSIONS: This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure

Detection of Relative Afferent Pupillary Defects Using Eye Tracking and a VR Headset.

PURPOSE The purpose of this study was to assess the feasibility of detecting relative afferent pupillary defects (RAPDs) using a commercial virtual reality headset equipped with an eye tracker. METHODS This is a cross-sectional study in which we compare the new computerized RAPD test with the traditional clinical standard using the swinging flashlight test. Eighty-two participants including 20 healthy volunteers aged 10 to 88 years were enrolled in this study. We present a bright/dark stimulus alternating between the eyes every 3 seconds using a virtual reality headset, and we simultaneously record changes in pupil size. To determine the presence of an RAPD, we developed an algorithm analyzing the pupil size differences. For the assessment of the performance of the automated and the manual measurement a post hoc impression based on all available data is created. The accuracy of the manual clinical evaluation and the computerized method is compared using confusion matrices and the gold standard of the post hoc impression. The latter is based on all available clinical information. RESULTS We found that the computerized method detected RAPD with a sensitivity of 90.2% and an accuracy of 84.4%, as compared to the post hoc impression. This was not significantly different from the clinical evaluation with a sensitivity of 89.1% and an accuracy of 88.3%. CONCLUSIONS The presented method offers an accurate, easy to use, and fast method to measure an RAPD. In contrast to today's clinical practice, the measures are quantitative and objective. TRANSLATIONAL RELEVANCE Computerized testing of Relative Afferent Pupillary Defects (RAPD) using a VR-headset and eye-tracking reaches non-inferior performance compared with senior neuro-ophthalmologists

The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

A novel computerized test for detecting and monitoring visual attentional deficits and delirium in the ICU

Objectives: Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box–ICU). Design: A pilot study was conducted, followed by a prospective case-control study. Setting: Royal Infirmary of Edinburgh General ICU. Patients: A pilot study was conducted in an opportunistic sample of 20 patients. This was followed by a validation study in 30 selected patients with and without delirium (median age, 63 yr; range, 23–84) who were assessed with the Edinburgh Delirium Test Box–ICU on up to 5 separate days. Presence of delirium was assessed using the Confusion Assessment Method for the ICU. Measurements and Main Results: The Edinburgh Delirium Test Box–ICU involves a behavioral assessment and a computerized test of attention, requiring patients to count slowly presented lights. Thirty patients were assessed a total of 79 times (n = 31, 23, 15, 8, and 2 for subsequent assessments; 38% delirious). Edinburgh Delirium Test Box–ICU scores (range, 0–11) were lower for patients with delirium than those without at the first (median, 0 vs 9.5), second (median, 3.5 vs 9), and third (median, 0 vs 10.5) assessments (all p < 0.001). An Edinburgh Delirium Test Box–ICU score less than or equal to 5 was 100% sensitive and 92% specific to delirium across assessments. Longitudinally, participants’ Edinburgh Delirium Test Box–ICU performance was associated with delirium status. Conclusions: These findings suggest that the Edinburgh Delirium Test Box–ICU has diagnostic utility in detecting ICU delirium in patients with Richmond Agitation and Sedation Scale Score greater than –3. The Edinburgh Delirium Test Box–ICU has potential additional value in longitudinally tracking attentional deficits because it provides a range of scores and is sensitive to change

Display Enhanced Testing For Concussions And Mild Traumatic Brain Injury

Cognitive assessment systems and methods that provide an integrated solution for evaluating the presence or absence of cognitive impairment. The present invention is used to test cognitive functions of an individual including information processing speed, working memory, work list learning and recall, along with variations of these tasks. Immersive and non-immersive systems and methods are disclosed. Testing and results feedback using the present invention may be completed in real time, typically in less than 15 minutes.Emory UniversityGeorgia Tech Research Corporatio

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

Computerized Dynamic Posturography Testing in Concussion: A Systematic Review

Title: Computerized Dynamic Posturography Testing in Concussion: A Systematic Review Purpose/Hypothesis: Computerized dynamic posturography (CDP) has been utilized within research and clinical practice for assessment of sensory deficits following concussion. However, it is unclear if current evidence on psychometric properties supports its use. The purpose of this systematic review is to compile evidence on psychometric properties of CDP for individuals following concussion. Number/Subjects: 7 research articles including 1239 participants that met inclusion criteria. Materials/Methods: Relevant studies published between 1980 and September 2018 extracted from the following electronic databases: PubMed, CINAHL, SPORTDiscus, ScienceDirect, Cochrane Library, ProQuest Central, and PEDro. Additional resources identified by searching references of included articles. Results: Eight articles met all selection criteria. Validity is assessed in two articles, sensitivity in five, specificity in four, likelihood ratio in one, MCID in one, and learning effect in one. Conclusion: Although there is a high prevalence of concussions in military and athletic populations, there is currently no gold standard for concussion diagnosis, making return to sport and active duty decisions difficult for clinicians. When accessible, computerized dynamic posturography is useful for detecting sensory deficits secondary to concussion as evidenced by sensitivity and specificity measures. Further research is necessary to evaluate the psychometric properties in assessment of individuals who have sustained a concussion