Using Cognitive Pre-Testing Methods in the Development of a New Evidenced-Based Pressure Ulcer Risk Assessment Instrument

Background: Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056). This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods: A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results: Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions: The pre-test was an important step in the development of the preliminary PURPOSE-T and the methods used may have wider instrument development application. PURPOSE-T proposes a new approach to pressure ulcer risk assessment, incorporating a screening stage, the inclusion of skin status to distinguish between those who require primary prevention and those who require secondary prevention/treatment and the use of colour to support pathway allocation and decision making. Further clinical evaluation is planned to assess the reliability and validity of PURPOSE-T and it’s impact on care processes and patient outcomes

Lee-side flow structures of very low aspect ratio cruciform wing–body configurations

Anumerical and experimental investigation was performed to study the dominant flow structures in the lee side of a cruciform wing-body configuration at supersonic speeds in the + orientation. The wings or strakes are of very low aspect ratio of order 0.025 with taper ratio ̃1 with a length of 11.25D mounted on a 19D tangent ogive body. The numerical simulations were performed using Fluent with the Spalart-Allmaras turbulence model. The Mach numbers simulated were 2.0, 2.5, and 3.0 up to angles of attack of 25 deg. The simulations revealed that the flow at low angles resembles that of a body and a strake, with the dominant separated flow feature being the rolled up side-edge vortex sheet. For angles of attack =10 deg, the flow resembles that of a body only configuration with two symmetric vortices at the moderate angles instead of two body and two strake vortices because the body vortex coalesces with the strake vortex. Vortex shedding is initiated at crossflowMachnumbers greater than 0.55 where the coalesced body and strake vortex separates into two symmetric pairs of vortices. Copyright © 2012 by Charlotte Lücking. Published by the American Institute of Aeronautics and Astronautics, Inc

Can social workers and police be partners when dealing with bikie-gang related domestic violence and sexual assault?

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