The predictive validity of three self-report screening instruments for identifying frail older people in the community

Background: If brief and easy to use self report screening tools are available to identify frail elderly, this may avoid costs and unnecessary assessment of healthy people. This study investigates the predictive validity of three self-report instruments for identifying community-dwelling frail elderly. Methods: This is a prospective study with 1-year follow-up among community-dwelling elderly aged 70 or older (n = 430) to test sensitivity, specificity, and positive and negative predicted values of the Groningen Frailty Indicator, Tilburg Frailty Indicator and Sherbrooke Postal Questionnaire on development of disabilities, hospital admission and mortality. Odds ratios were calculated to compare frail versus non-frail groups for their risk for the adverse outcomes. Results: Adjusted odds ratios show that those identified as frail have more than twice the risk (GFI, 2.62; TFI, 2.00; SPQ, 2,49) for developing disabilities compared to the non-frail group; those identified as frail by the TFI and SPQ have more than twice the risk of being admitted to a hospital. Sensitivity and specificity for development of disabilities are 71% and 63% (GFI), 62% and 71% (TFI) and 83% and 48% (SPQ). Regarding mortality, sensitivity for all tools are about 70% and specificity between 41% and 61%. For hospital admission, SPQ scores the highest for sensitivity (76%). Conclusion: All three instruments do have potential to identify older persons at risk, but their predictive power is not sufficient yet. Further research on these and other instruments is needed to improve targeting frail elderly

Miller Early Childhood Sustained Home-visiting (MECSH) trial: design, method and sample description

<p>Abstract</p> <p>Background</p> <p>Home visiting programs comprising intensive and sustained visits by professionals (usually nurses) over the first two years of life show promise in promoting child health and family functioning, and ameliorating disadvantage. Australian evidence of the effectiveness of sustained nurse home visiting in early childhood is limited. This paper describes the method and cohort characteristics of the first Australian study of sustained home visiting commencing antenatally and continuing to child-age two years for at-risk mothers in a disadvantaged community (the Miller Early Childhood Sustained Home-visiting trial).</p> <p>Methods and design</p> <p>Mothers reporting risks for poorer parenting outcomes residing in an area of socioeconomic disadvantage were recruited between February 2003 and March 2005. Mothers randomised to the intervention group received a standardised program of nurse home visiting. Interviews and observations covering child, maternal, family and environmental issues were undertaken with mothers antenatally and at 1, 12 and 24 months postpartum. Standardised tests of child development and maternal-child interaction were undertaken at 18 and 30 months postpartum. Information from hospital and community heath records was also obtained.</p> <p>Discussion</p> <p>A total of 338 women were identified and invited to participate, and 208 were recruited to the study. Rates of active follow-up were 86% at 12 months, 74% at 24 months and 63% at 30 months postpartum. Participation in particular data points ranged from 66% at 1 month to 51% at 24 months postpartum. Rates of active follow-up and data point participation were not significantly different for the intervention or comparison group at any data point. Mothers who presented for antenatal care prior to 20 weeks pregnant, those with household income from full-time employment and those who reported being abused themselves as a child were more likely to be retained in the study. The Miller Early Childhood Sustained Home-visiting trial will provide Australian evidence of the effectiveness of sustained nurse home visiting for children at risk of poorer health and developmental outcomes.</p> <p>Trial registration</p> <p>ACTRN12608000473369</p

The psychometric properties of three self-report screening instruments for identifying frail older people in the community

Background: Frailty is highly prevalent in older people. Its serious adverse consequences, such as disability, are considered to be a public health problem. Therefore, disability prevention in community-dwelling frail older people is considered to be a priority for research and clinical practice in geriatric care. With regard to disability prevention, valid screening instruments are needed to identify frail older people in time. The aim of this study was to evaluate and compare the psychometric properties of three screening instruments: the Groningen Frailty Indicator (GFI), the Tilburg Frailty Indicator (TFI) and the Sherbrooke Postal Questionnaire (SPQ). For validation purposes the Groningen Activity Restriction Scale (GARS) was added. Methods: A questionnaire was sent to 687 community-dwelling older people (>= 70 years). Agreement between instruments, internal consistency, and construct validity of instruments were evaluated and compared. Results: The response rate was 77%. Prevalence estimates of frailty ranged from 40% to 59%. The highest agreement was found between the GFI and the TFI (Cohen's kappa = 0.74). Cronbach's alpha for the GFI, the TFI and the SPQ was 0.73, 0.79 and 0.26, respectively. Scores on the three instruments correlated significantly with each other (GFI - TFI, r = 0.87; GFI - SPQ, r = 0.47; TFI - SPQ, r = 0.42) and with the GARS (GFI - GARS, r = 0.57; TFI - GARS, r = 0.61; SPQ - GARS, r = 0.46). The GFI and the TFI scores were, as expected, significantly related to age, sex, education and income. Conclusions: The GFI and the TFI showed high internal consistency and construct validity in contrast to the SPQ. Based on these findings it is not yet possible to conclude whether the GFI or the TFI should be preferred; data on the predictive values of both instruments are needed. The SPQ seems less appropriate for postal screening of frailty among community-dwelling older peopl

Understanding the rise of faculty-student coaching: an academic capitalism perspective

We examine the rise of coaching within management education to support student learning. We question the assumption that faculty-student coaching (FSC) is beneficial and propose that there may be some limitations in the use of FSC that have yet to be adequately acknowledged and discussed in the literature. In particular, we propose that there is currently insufficient evidence to conclude that coaching can produce knowledge acquisition and therefore ask why we persist in the use of FSC when we have limited evidence of its efficacy in delivering a core education outcome. We suggest that the theory of academic capitalism provides a useful, critical lens through which to view the growing trend in FSC, identifying that FSC may be utilized as a method of increasing student satisfaction, perceptions of value for money and as a useful marketing tool for business schools competing for students. However, academic capitalism may also explain the use of coaching via its ability to enhance the skills and attitudes of students, providing outcomes that are valued by students, employers and governments. We conclude our essay by providing recommendations to mitigate these proposed dangers and consequently maximise the effectiveness of coaching as a development tool in management education

Old wine in new bottles: Exploring pragmatism as a philosophical framework for the discipline of coaching

The practice and industry of organizational coaching are now well established, but how it is understood theoretically continues to lag behind. In this paper we analyze possible reasons for this state of affairs and argue that the development of coaching as an academic discipline will benefit from adopting philosophical pragmatism as an overarching theoretical framework. This move will enable coaching academics to utilize the contributions to knowledge that different paradigms generate. Positioning pragmatism as a theory of action we argue that organizational coaching is by default a pragmatic enterprise and provide three examples of the considerable benefits to be gained by conceptualizing it this way. (1) Drawing from the pragmatists’ ideas, particularly those of John Dewey, we demonstrate how the theoretical understanding of organizational coaching can be enhanced by considering its nature as a joint inquiry. (2) Pragmatism suggests development as an ultimate purpose for organizational coaching which also helps to resolve fundamental conceptual debates. (3) In light of the complexity and diversity involved in the way that organizational coaching is practiced, pragmatism offers coaches a useful framework for developing the flexibility required for navigating the multiplicity of influences on their practice

Family perceptions of nurses\u27 roles toward family members of critically ill patients: a descriptive study

OBJECTIVES: The purpose of this study was to examine the role of the nurse with families of critically ill patients as perceived by family members and whether meeting family expectations impact family satisfaction. METHODS: A descriptive design was conducted with 29 family members from a 19-bed intensive care unit. Nonparametric statistics, known for their appropriateness for small samples, were used to examine the research questions. RESULTS: Overall, the expectations that family members held regarding nurses\u27 roles with families were not different from their perceptions of what nurses actually did (P = .087). Family members were more satisfied with care when nurses\u27 performance either met or exceeded their expectations (P = .046). CONCLUSION: Nurses did well with regard to meeting family members\u27 expectations. Variations in expectations among family members reflect their diversity and highlight the importance of assessing family needs on a case-by-case basis

Comparison of coping responses to symptoms between first-time sufferers and those with a previous history of acute myocardial infarction

BACKGROUND AND OBJECTIVE: Little is known about how experience with a previous acute myocardial infarction (AMI) impacts individuals\u27 reactions to symptoms of a recurrent episode. Thus, the purpose of this study was to compare the use of coping strategies during an acute cardiac event in patients experiencing a first AMI with those experiencing a recurrent AMI. SUBJECTS AND METHODS: Secondary data analyses were performed to examine differences in the use of coping strategies between individuals with and without a history of AMI. Mann-Whitney U test was performed to compare those with (n = 26) and without (n = 109) a previous AMI with respect to 15 coping strategies, each of which was measured on a 5-point Likert scale. RESULTS AND CONCLUSIONS: Patients with a history of AMI were more likely to use prescribed medications to deal with their symptoms than were patients who did not have a previous AMI (M = 1.5 and 0.20; median = 2.0 and 0.0, respectively; P \u3c .001). However, patients who had no previous AMI were more likely to respond by taking nonprescription medications (M = 0.90 and 0.60; median = 1.0 and 0.0, respectively; P = .04). The results suggest that patients with and without a history of AMI tend to respond to their symptoms with similar coping strategies. When differences occurred, patients with and without a history of AMI differed only with respect to the type of self-medication choices they made. Implications pertaining to these findings are discussed

Severe acute respiratory syndrome: another challenge for critical care nurses.

Severe acute respiratory syndrome (SARS) is a viral disease that may be contracted by exposure to a newly recognized form of the coronavirus. It often manifests through a set of common respiratory symptoms that include fever and nonproductive cough. To date, SARS has no vaccine or definitive treatment. Approximately 20% of SARS patients develop respiratory failure, which requires mechanical ventilation and close cardiopulmonary monitoring. Intensive care unit (ICU) nurses and other healthcare workers who care for SARS patients are at risk of contracting the disease. Thus, it is important that ICU nurses be familiar with the disease and its implications for critical care. This article provides critical care nurses with an update on the first SARS outbreak, its origin, case definition, clinical manifestations, diagnosis, relevant infection control practices, management, and recommendations for the role of ICU nurses in dealing with future outbreaks