Assessment tools and incidence of hospital-associated disability in older adults: a rapid systematic review

Background During hospitalization older adults have a high risk of developing functional impairments unrelated to the reasons for their admission. This is termed hospital-associated disability (HAD). This systematic review aimed to assess the incidence of HAD in older adults admitted to acute care with two outcomes: firstly in at least one activity of daily living from a set of functional tasks (e.g., Katz Index) and secondly the incidence of functional decline in an individual functional task (e.g., bathing), and to identify any tools or functional tasks used to assess activities of daily living (ADL) in hospitalized older patients. Methods A rapid systematic review was performed according to the recommendations of the Cochrane Rapid Reviews Methods Group and reported the data according the PRISMA statement. A literature search was performed in Medline (via Ovid), EMBASE, and Cochrane Central Register of Controlled Trials databases on 26 August 2021. Inclusion criteria: older adults (≥65 years), assessment of individual items of activities of daily living at baseline and discharge. Exclusion criterion: studies investigating a specific condition that could affect functional decline and studies that primarily examined a population with cognitive impairment. The protocol was registered on OSF registries (https://osf.io/9jez4/) identifier: DOI 10.17605/OSF.IO/9JEZ4. Results Ten studies were included in the final review. Incidence of HAD (overall score) was 37% (95% CI 0.30–0.43). Insufficient data prevented meta-analysis of the individual items. One study provided sufficient data to calculate incidence, with the following values for patients’ self-reported dependencies: 32% for bathing, 27% for dressing, 27% for toileting, 30% for eating and 27% for transferring. The proxy reported the following values for patients’ dependencies: 70% for bathing, 66% for dressing, 70% for toileting, 61% for eating and 59% for transferring. The review identified four assessment tools, two sets of tasks, and individual items assessing activities of daily living in such patients. Conclusions Incidence of hospital-associated disability in older patients might be overestimated, due to the combination of disease-related disability and hospital-associated disability. The tools used to assess these patients presented some limitations. These results should be interpreted with caution as only one study reported adequate information to assess the HAD incidence. At the item level, the latter was higher when disability was reported by the proxies than when it was reported by patients. This review highlights the lack of systematic reporting of data used to calculate HAD incidence. The methodological quality and the risk of bias in the included studies raised some concerns

Effectiveness of educational interventions to increase skills in evidence-based practice among nurses: the EDITcare systematic review

Background: Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge–action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals’ (HCPs) expertise. Methods: Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022. Results: The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments. Conclusions: Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers’ characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes.info:eu-repo/semantics/publishedVersio

Gaze, behavioral, and clinical data for phantom limbs after hand amputation from 15 amputees and 29 controls

Despite recent advances in prosthetics, many upper limb amputees still use prostheses with some reluctance. They often do not feel able to incorporate the artificial hand into their bodily self. Furthermore, prosthesis fitting is not usually tailored to accommodate the characteristics of an individual's phantom limb sensations. These are experienced by almost all persons with an acquired amputation and comprise the motor and postural properties of the lost limb. This article presents and validates a multimodal dataset including an extensive qualitative and quantitative assessment of phantom limb sensations in 15 transradial amputees, surface electromyography and accelerometry data of the forearm, and measurements of gaze behavior during exercises requiring pointing or repositioning of the forearm and the phantom hand. The data also include acquisitions from 29 able-bodied participants, matched for gender and age. Special emphasis was given to tracking the visuo-motor coupling between eye-hand/eye-phantom during these exercises

Gaze, visual, myoelectric, and inertial data of grasps for intelligent prosthetics

A hand amputation is a highly disabling event, having severe physical and psychological repercussions on a person’s life. Despite extensive efforts devoted to restoring the missing functionality via dexterous myoelectric hand prostheses, natural and robust control usable in everyday life is still challenging. Novel techniques have been proposed to overcome the current limitations, among them the fusion of surface electromyography with other sources of contextual information. We present a dataset to investigate the inclusion of eye tracking and first person video to provide more stable intent recognition for prosthetic control. This multimodal dataset contains surface electromyography and accelerometry of the forearm, and gaze, first person video, and inertial measurements of the head recorded from 15 transradial amputees and 30 able-bodied subjects performing grasping tasks. Besides the intended application for upper-limb prosthetics, we also foresee uses for this dataset to study eye-hand coordination in the context of psychophysics, neuroscience, and assistive robotics

Gaze, visual, myoelectric, and inertial data of grasps for intelligent prosthetics

A hand amputation is a highly disabling event, having severe physical and psychological repercussions on a person’s life. Despite extensive efforts devoted to restoring the missing functionality via dexterous myoelectric hand prostheses, natural and robust control usable in everyday life is still challenging. Novel techniques have been proposed to overcome the current limitations, among them the fusion of surface electromyography with other sources of contextual information. We present a dataset to investigate the inclusion of eye tracking and first person video to provide more stable intent recognition for prosthetic control. This multimodal dataset contains surface electromyography and accelerometry of the forearm, and gaze, first person video, and inertial measurements of the head recorded from 15 transradial amputees and 30 able-bodied subjects performing grasping tasks. Besides the intended application for upper-limb prosthetics, we also foresee uses for this dataset to study eye-hand coordination in the context of psychophysics, neuroscience, and assistive robotics

The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education ::a systematic review and meta-analysis with integrated meta-regression

Background : Acquisition of procedures is an important element in health professions education. Traditionally procedures are taught using a “see one - do one” approach. That is a teacher demonstrates and describes a procedure and afterwards the students practice the procedure. A more recent teaching approach for the acquisition of procedural skills was presented by Walker and Peyton. Peyton’s teaching approach is a stepwise teaching approach and consists of the following four steps: demonstration, deconstruction, comprehension and performance. The aims of this study were (i) to systematically evaluate the effectiveness of Peyton’s 4–step teaching approach on the acquisition of procedural skills in health professions education and (ii) to evaluate whether studies with fewer students per teacher showed a larger between group difference than studies with more students per teacher. Methods : We searched in Medline, PsycInfo, Embase and ERIC for eligible studies. Records were screened by two independent reviewers. A random effects meta-analysis was performed to evaluate skill acquisition and time needed to perform the procedures at post-acquisition and retention tests. A meta-regression was used to explore the effect of the number of students per teacher on the estimated effect of the educational interventions. Results : An effect size of 0.45 SMD (95% CI [0.15; 0.75]) at post-acquisition and 0.7 SMD (95% CI [−0.09; 1.49]) at retention testing were in favour of Peyton’s teaching approach for skill acquisition. The groups using Peyton’s teaching approach needed considerably less time to perform the procedure at post-acquisition (SMD: −0.8; 95% [CI −2.13 to 1.62]) and retention (SMD: −2.65; 95% CI [−7.77 to 2.47]) testing. The effectiveness of Peyton’s teaching approach was less clear in subgroup analyses using peer teachers. Meta-regression showed that the number of students per teacher was an important moderator variable. Conclusion : Peyton’s teaching approach is an effective teaching approach for skill acquisition of procedural skills in health professions education. When peer students or student tutors are used as teachers the effectiveness of Peyton’s teaching approach is less clear. Peyton’s teaching approach is more effective when small groups with few students per teacher are used

Effectiveness of educational interventions to increase skills inevidence-based practice among nurses ::the EDITcare systematic review

Background: Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge–action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals’ (HCPs) expertise. Methods: Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022. Results: The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments. Conclusions: Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers’ characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes

First steps towards a risk of bias corpus of randomized controlled trials

Risk of bias (RoB) assessment of randomized clinical trials (RCTs) is vital to conducting systematic reviews. Manual RoB assessment for hundreds of RCTs is a cognitively demanding, lengthy process and is prone to subjective judgment. Supervised machine learning (ML) can help to accelerate this process but requires a hand-labelled corpus. There are currently no RoB annotation guidelines for randomized clinical trials or annotated corpora. In this pilot project, we test the practicality of directly using the revised Cochrane RoB 2.0 guidelines for developing an RoB annotated corpus using a novel multi-level annotation scheme.We report interannotator agreement among four annotators who used Cochrane RoB 2.0 guidelines. The agreement ranges between 0% for some bias classes and 76% for others. Finally, we discuss the shortcomings of this direct translation ofannotation guidelines and scheme and suggest approaches to improve them to obtain an RoB annotated corpus suitable for ML

Development of an exercise programme for balance abilities in people with multiple sclerosis ::a development of concept study using Rasch analysis

Background : People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual’s abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme. Methods : A “construct map” approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses. Results : Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait “balance exercises in PwMS” comprised three subdimensions (“stable BOS”, “sway” and “step and walk”). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS. Conclusion : A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate

RoBuster: A Corpus Annotated with Risk of Bias Text Spans in Randomized Controlled Trials (Preprint)

BACKGROUND Background: Risk of bias (RoB) assessment of randomized clinical trials (RCTs) is vital to answering systematic review questions accurately. Manual RoB assessment for hundreds of RCTs is a cognitively demanding and lengthy process. Automation has the potential to assist reviewers in rapidly identifying text descriptions in RCTs that indicate potential risks of bias. However, no RoB text span annotated corpus could be used to fine-tune or evaluate large language models (LLMs), and there are no established guidelines for annotating the RoB spans in RCTs. OBJECTIVE Objective: The revised Cochrane RoB Assessment 2 (RoB 2) tool provides comprehensive guidelines for RoB assessment; however, due to the inherent subjectivity of this tool, it cannot be directly used as RoB annotation guidelines. Our objective was to develop precise RoB text span annotation instructions that could address this subjectivity and thus aid the corpus annotation. METHODS Methods: We leveraged RoB 2 guidelines to develop visual instructional placards that serve as text annotation guidelines for RoB spans and risk judgments. Expert annotators employed these visual placards to annotate a dataset named RoBuster, consisting of 41 full-text RCTs from the domains of physiotherapy and rehabilitation. We report inter-annotator agreement (IAA) between two expert annotators for text span annotations before and after applying visual instructions on a subset (9 out of 41) of RoBuster. We also provide IAA on bias risk judgments using Cohen's Kappa. Moreover, we utilized a portion of RoBuster (10 out of 41) to evaluate an LLM using a straightforward evaluation framework. This evaluation aimed to gauge the performance of LLM (here GPT 3.5) in the challenging task of RoB span extraction and demonstrate the utility of this corpus using a straightforward evaluation framework. RESULTS Results: We present a corpus of 41 RCTs with fine-grained text span annotations comprising more than 28,427 tokens belonging to 22 RoB classes. The IAA at the text span level calculated using the F1 measure varies from 0% to 90%, while Cohen's kappa for risk judgments ranges between -0.235 and 1.0. Employing visual instructions for annotation increases the IAA by more than 17 percent points. LLM (GPT-3.5) shows promising but varied observed agreements with the expert annotation across the different bias questions. CONCLUSIONS Conclusions: Despite having comprehensive bias assessment guidelines and visual instructional placards, RoB annotation remains a complex task. Utilizing visual placards for bias assessment and annotation enhances IAA compared to cases where visual placards are absent; however, text annotation remains challenging for the subjective questions and the questions for which annotation data is unavailable in RCTs. Similarly, while GPT-3.5 demonstrates effectiveness, its accuracy diminishes with more subjective RoB questions and low information availability