Clinical tools for evaluating the severity of overactive bladder: A systematic review of psychometric properties.

OBJECTIVES: To systematically evaluate the evidence describing the psychometric properties of clinical measures for assessing overactive bladder symptoms (urinary urgency with or without urge urinary incontinence, urinary frequency and nocturia). To evaluate the quality of this evidence-base using the COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools. DATA SOURCES: Five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from dataset inception to August 2023. REVIEW METHODS: Study screening, data extraction and quality appraisal were performed by two independent authors. Inclusion criteria were studies testing one or more psychometric properties of clinical tools for the assessment of overactive bladder symptoms among adults aged 18 years and older for both sexes. The methodological quality and quality of the evidence were evaluated using the COSMIN checklist and GRADE tools, respectively. RESULTS: The search identified 40 studies totalling 10,634 participants evaluating the psychometric properties of 15 clinical tools. The COSMIN methodological quality was rated good for most measures, and the GRADE quality of evidence ranged from low (13%) to high (33%). The Overactive Bladder Symptom Score, Overactive Bladder Questionnaire and Neurogenic Bladder Symptom Score were of good methodological and high-GRADE evidence qualities. CONCLUSION: Overactive Bladder Symptom Score, the Overactive Bladder Questionnaire and the Neurogenic Bladder Symptoms Score are promising psychometrically sound measures. The Overactive Bladder Symptom Score has been applied to the most culturally diverse populations supported by studies of good methodological and high-GRADE evidence quality.

Barriers and facilitators to the implementation of family cancer history collection tools in oncology clinical practices.

INTRODUCTION: This study aimed to identify barriers and facilitators to the implementation of family cancer history (FCH) collection tools in clinical practices and community settings by assessing clinicians' perceptions of implementing a chatbot interface to collect FCH information and provide personalized results to patients and providers. OBJECTIVES: By identifying design and implementation features that facilitate tool adoption and integration into clinical workflows, this study can inform future FCH tool development and adoption in healthcare settings. MATERIALS AND METHODS: Quantitative data were collected using survey to evaluate the implementation outcomes of acceptability, adoption, appropriateness, feasibility, and sustainability of the chatbot tool for collecting FCH. Semistructured interviews were conducted to gather qualitative data on respondents' experiences using the tool and recommendations for enhancements. RESULTS: We completed data collection with 19 providers (n = 9, 47%), clinical staff (n = 5, 26%), administrators (n = 4, 21%), and other staff (n = 1, 5%) affiliated with the NCI Community Oncology Research Program. FCH was systematically collected using a wide range of tools at sites, with information being inserted into the patient's medical record. Participants found the chatbot tool to be highly acceptable, with the tool aligning with existing workflows, and were open to adopting the tool into their practice. DISCUSSION AND CONCLUSIONS: We further the evidence base about the appropriateness of scripted chatbots to support FCH collection. Although the tool had strong support, the varying clinical workflows across clinic sites necessitate that future FCH tool development accommodates customizable implementation strategies. Implementation support is necessary to overcome technical and logistical barriers to enhance the uptake of FCH tools in clinical practices and community settings.

The Index of Severity for Eosinophilic Esophagitis (I-SEE) Reflects Longitudinal Clinicopathologic Changes in Children.

BACKGROUND AND AIMS: The Index of Severity for Eosinophilic Esophagitis (I-SEE) was recently developed. We aimed to understand I-SEE scores in a longitudinal pediatric cohort and to determine the relationship between I-SEE and clinical features in children. METHODS: We performed a retrospective analysis on a prospectively enrolled cohort of children at a single center who were treated as part of routine clinical care. I-SEE was calculated at the diagnostic and follow-up endoscopies over a mean of 6.6 years. Scoring was 0 for inactive, 1-6 for mild, 7-14 for moderate, and ≥15 for severe eosinophilic esophagitis (EoE). We analyzed clinical, endoscopic, and histologic features at each instance. Symptoms were analyzed at the baseline, first follow-up, and last endoscopic instance. RESULTS: Of 67 children who met study criteria of at least 3 endoscopies over at least 2 years of follow-up time, 43%, 36%, and 21% had mild, moderate, and severe I-SEE scores at baseline, respectively. Between the first and second endoscopic instances, there was a decrease in the group mean I-SEE from 9.7 ± 7.2 to 6.1 ± 5.9 (P < .001). By the last instance, the overall I-SEE score dropped to 3.9 (P < .001). Body mass index <5% and poor feeding were more common in the children with severe I-SEE scores at baseline, and both improved by the last instance. Fibrosis was improved by the last instance biopsy (P < .01). CONCLUSIONS: I-SEE is a responsive severity metric in children treated long term during routine clinical care. Baseline low body mass index and poor feeding were more common in children with severe I-SEE scores.

Improved bioimpedance spectroscopy tissue classification through data augmentation from generative adversarial networks.

Bioimpedance spectroscopy is a tissue classification technique with many clinical applications. Similarly to other data-driven methods, it requires large amounts of data to accurately distinguish similar classes of tissue. Classifiers trained on small datasets typically suffer from over-fitting and lack the ability to generalise to previously unseen data. However, a large in or ex vivo spectral database is difficult to attain. Data collection is usually limited to studies that occur infrequently, and publicly available data is often not available. A solution to this problem is to artificially increase the training dataset by creating modified, yet accurate, copies of the original dataset. The most common techniques in spectral classification are to add noise to copies of the original data, over-sample it, or randomly interpolate pairs of the original data. However, simply perturbing or interpolating the data does not guarantee that the new dataset captures the key features of the original data needed for accurate classification. This study proposes a novel way to augment bioimpedance spectral data. It uses generative adversarial networks (GAN)-a model in which two neural networks (NN) compete with each other: while one NN artificially manufactures data that could be mistaken for real data, the role of the second NN is to identify which data it receives has been artificially created. The first NN then interactively adapts its output until the second NN can no longer flag artificially created data. The result is a new dataset that truly represents the features of the original data. In this study, three GAN architectures are used, i.e., the vanilla GAN, the deep convolutional GAN, and the Wasserstein GAN. Then, the generated data is used to train five classification methods, and their results are compared to a baseline that only uses the original data. The results from a dataset of 13 different tissue classes show that the deep convolutional GAN is most statistically similar to the original data and improves classification accuracy by 15% when compared to the same model trained only on the original data. The Wasserstein-GAN architecture also provides significant improvements of up to 24% better accuracy.

Assessing Stroke-Related Sarcopenia in Chronic Stroke: Identification of Clinical Assessment Tools-A Pilot Study.

Stroke-related sarcopenia has recently been defined as the muscle atrophy consequent to stroke and assessing it following the guidelines with simple clinical tools is crucial in chronic stroke survivors. The aim of this study was to determine the characteristics of patient-friendly instruments sarcopenia in a chronic stroke sample (SG) compared to non-stroke counterparts (CG). Each participant underwent a single assessment which consisted of: SARC-F questionnaire, assessment of muscle strength (hand grip and five-times sit-to-stand test, 5STS), the calf circumference (CC) of both legs, the short physical performance battery (SPPB), and the 10 m walk test. A total of 68 participants were included (SG, n = 34 and CG, n = 34). All variables showed statistical differences (p < 0.05) between the SG and the CG, except handgrip although it showed lower values for SG. The values of the 5STS (16.26 s) and the SPPB (7 points) were below to the cutoff values for the SG. The five-times sit-to-stand test, SPPB, and gait speed can lead clinicians to detect stroke-related sarcopenia. Maximum handgrip shows a trend of low values for men and women in the SG, however, CC did not detect sarcopenia in our sample.

Detecting Time Concept Competence in Children with Autism Spectrum and Attention Disorders.

The importance of time concept in human existence is "ancient history" celebrated in the biblical book Ecclesiastes. Indeed, our time-sensitive mechanisms are literally carved into our biology and neurology on a molecular level, gifting us with neural clocks. However, time in human consciousness is not the time indicated by physical clocks: time is a subjective reality in our psychological makeup due to the nature of the temporal neural mechanisms and unique properties of physical time. Nonetheless, subjective time requires anchoring to physical time which permeates our language, endeavors, and entire existence, a process hinging on time-related skills such as estimates and measures of passage and duration of time. Moreover, accurate time reading, a critical adaptive life-skill, is imperative for effective function in all societal activities. Because it embodies the complexity of the time construct, it is central to instruction of time concept in primary education. It is often measured in children by clock drawings, a cognitive integrative skill with errors pointing to neuroanatomical differences impacting the integrity of executive function. Time competence in children with atypical neurobiological development and high prevalence, as in autism spectrum disorders (ASD), and attention disorders (ADHD), is often compromised, calling for investigation of its function. This thematic review article aims to: 1) discuss the complexity of time concept and its underlying bio-neurological mechanisms, 2) elucidate difficulties children with ASD and those with ADHD exhibit in temporal development, and 3) demonstrate the use of a set of clinical tools in uncovering temporal competence and ecological executive function in two children with ASD, and a child with ADHD, using a clock drawing task and error analyses; children's time knowledge questionnaire; a behavior rating parent questionnaire examining ecological executive function, and parent open-ended questions related to their children's time difficulties. A discussion, directions, and a take-home message round out the article.

Development of a Cardiac Anesthesia Tool (CAT) to Predict Intensive Care Unit (ICU) Admission for Pediatric Cardiac Patients Undergoing Non-cardiac Surgery: A Retrospective Cohort Study.

Background and aim: of the work: Pediatric cardiac patients often undergo non-cardiac surgical procedures and many of these patients would require intensive care unit admission, but can we predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Numerous preoperative and intraoperative variables were strongly associated with ICU admission. Given the variations in the underlying cardiac physiology and the diversity of noncardiac surgical procedures along with the scarce predictive clinical tools, we aimed to develop a simple and practical tool to predict the need for ICU admission in pediatric cardiac patients undergoing non-cardiac procedures. Material and methods: This is a retrospective study, where all files of pediatric cardiac patients who underwent noncardiac surgical procedures from January 1, 2015, to December 31, 2019, were reviewed. We retrieved details of the preoperative and intraoperative variables including age, weight, comorbid conditions, and underlying cardiac physiology. The primary outcome was the need for ICU admission. We performed multiple logistic regression analyses and analyses of the area under receiver operating characteristics (ROC) curves to develop a predictive tool. Results: In total, 519 patients were included. The mean age and weight were 4.6 ± 3.4 year and 16 ± 13 Kg respectively. A small proportion (n = 90, 17%) required ICU admission. Statistically, there was strong association between each of American society of anesthesiologist's physical status (ASA-PS) class III and IV, difficult intubation, operative time more than 2 hours, requirement of transfusion and the failure of a deliberately planned extubation and ICU admission. Additional analysis was done to develop a Cardiac Anesthesia Tool (CAT) based on the weight of each variable derived from the regression coefficient. The CAT list is composed of the ASA-PS, operative time, and requirement of transfusion, difficult intubation and the failure of deliberately planned extubation. The minimum score is zero and the maximum is eight. The probability of ICU admission is proportional to the score. Conclusion: CAT is a practical and simple clinical tool to predict the need for ICU admission based on simple additive score. We propose using this tool for pediatric cardiac patients undergoing non-cardiac procedure.

Comprehensive and Innovative Clinical Tools for Nurses and Parents to Help Promote Family and Sibling Adaptation in the NICU.

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.

Provider and Manager Perspectives on the Use of an Integrated Clinical Pathway for Community-Dwelling Older Adults: A Qualitative Case Study.

BACKGROUND: Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs. THEORY AND METHODS: A case study based on eleven semi-structured interviews and analysis of documents was carried out in an urban home care unit. The Normalization Process Theory was used for mixed thematic analysis. RESULTS: While its capacity to store data and enhance interprofessional information exchange was appreciated by home care staff, the broad scope, and automated features of the ICP tool were often problematic. Concerns about increased provider workloads, disruption to provider-client relationships during clinical encounters, and difficulties engaging clients in decision-making were main obstacles in the use of the ICP. CONCLUSION: Given the importance of ICPs in advancing clinical integration, it is critical to continuously adjust their design to align with providers' realities in order to optimize their potential in real life contexts.

Inter-rater and test-retest reliability of computerized clinical vestibular tools.

BACKGROUND: Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints. OBJECTIVE: The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures. METHODS: Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions. RESULTS: Most measures fell within the moderate ICC range (0.50-0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup. CONCLUSIONS: Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems.

Development and Validation of a Risk Score for Liver Cirrhosis Prediction in Untreated and Treated Chronic Hepatitis B.

BACKGROUND: Chronic hepatitis B (CHB) can progress to cirrhosis, but there are limited noninvasive tools available to estimate cirrhosis risk, including in patients receiving antiviral therapy. This study developed and validated a simple model to assess risk in CHB patients. METHODS: The derivation cohort included 3000 CHB patients from 6 centers in the United States, with 52.60% receiving antiviral therapy. External validation was performed for 4552 CHB individuals from similar cohorts in Taiwan, with 21.27% receiving therapy. Cox proportional hazards regression analyses were used to screen predictors and develop the risk score for cirrhosis. Areas under receiver operating characteristic curves (AUROCs) were calculated for predictive value. RESULTS: Sex, age, diabetes, antiviral treatment status/duration, hepatitis B e-antigen, and baseline alanine aminotransferase/aspartate aminotransferase levels were significantly associated with increased cirrhosis risk. A 13-point risk score was developed based on these predictors. The AUROCs for predicting cirrhosis risk were 0.82 at 3 years, 0.85 at 5 years, and 0.89 at 10 years in the derivation cohort, and 0.82, 0.79, and 0.77 in the validation cohort, respectively. CONCLUSIONS: We developed and validated a simple cirrhosis prediction model with an independent external cohort that can be applied to both treatment-naive and treatment-experienced CHB patients in diverse settings and locations.

Management of Children With Fever at Risk for Pediatric Sepsis: A Prospective Study in Pediatric Emergency Care.

Objective: To study warning signs of serious infections in febrile children presenting to PED, ascertain their risk of having sepsis, and evaluate their management. Design: Prospective observational study. Setting: A single pediatric emergency department (PED). Participants: Febrile children, aged 1 month-16 years, with >= 1 warning signs of sepsis. Interventions and Main outcome measures: Clinical characteristics, including different thresholds for tachycardia and tachypnoea, and their association with (1) delivery of pediatric sepsis 6 (PS6) interventions, (2) final diagnosis of invasive bacterial infection (IBI), (3) the risk for pediatric intensive care unit (PICU) admission, and (4) death. Results: Forty-one percent of 5,156 febrile children had warning signs of sepsis. 1,606 (34%) children had tachypnoea and 1,907 (39%) children had tachycardia when using APLS threshold values. Using the NICE sepsis guidelines thresholds resulted in 1,512 (32%) children having tachypnoea (kappa 0.56) and 2,769 (57%) children having tachycardia (kappa 0.66). Of 1,628 PED visits spanning 1,551 disease episodes, six children (0.4%) had IBI, with one death (0.06%), corresponding with 256 children requiring escalation of care according to sepsis guideline recommendations for each child with IBI. There were five additional PICU admissions (0.4%). 121 (7%) had intravenous antibiotics in PED; 39 children (2%) had an intravenous fluid bolus, inotrope drugs were started in one child. 440 children (27%) were reviewed by a senior clinician. In 4/11 children with IBI or PICU admission or death, PS6 interventions were delivered within 60 min after arriving. 1,062 (65%) visits had no PS6 interventions. Diagnostic performance of vital signs or sepsis criteria for predicting serious illness yielded a large proportion of false positives. Lactataemia was not associated with giving iv fluid boluses (p = 0.19) or presence of serious bacterial infections (p = 0.128). Conclusion: Many febrile children (41%) present with warning signs for sepsis, with only few of them undergoing investigations or treatment for true sepsis. Children with positive isolates in blood or CSF culture presented in a heterogeneous manner, with varying levels of urgency and severity of illness. Delivery of sepsis care can be improved in only a minority of children with IBI or admitted to PICU.

Screening for economic hardship for child welfare-involved families during the COVID-19 pandemic: A rapid partnership response.

BACKGROUND: Pandemics have a wide range of economic, health and social consequences related to both the spread of a disease and efforts made by government leaders to contain it which may be particularly detrimental for the child welfare-involved population. This is because child welfare agencies serve some of the highest needs children and families. A significant proportion of these families face economic hardship, and as a result of containment measures for COVID-19, more families inevitably will. OBJECTIVE: Given the range of negative consequences related to the pandemic and the evolving supports available to families, child protection workers needed a clinical tool to guide and support work with families informed by an understanding of economic hardship. The objective of this paper is to report on the development and implementation strategy of a tool to be used for practice intervention during the pandemic. METHODS: Action research methodology was utilized in the creation of the clinical tool. The tool's development and implementation occurred through an academic/child welfare sector partnership involving child welfare agencies representing diverse regions and populations in Ontario, Canada. Factor analysis of representative child welfare data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) on economic hardship was used to inform the development of questions on the clinical tool. RESULTS: The development and implementation strategy of the clinical tool are described, including the results from analyses of the OIS-2018. CONCLUSIONS: Future directions for the project are discussed, including considerations for using this tool beyond the pandemic.

Acceptability of a Mobile Clinical Decision Tool Among Emergency Department Clinicians: Development and Evaluation of The Ottawa Rules App.

BACKGROUND: The Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule-together known as The Ottawa Rules-are a set of internationally validated clinical decision rules developed to decrease unnecessary diagnostic imaging in the emergency department. In this study, we sought to develop and evaluate the use of a mobile app version of The Ottawa Rules. OBJECTIVE: The primary objective of this study was to determine acceptability of The Ottawa Rules app among emergency department clinicians. The secondary objective was to evaluate the effect of publicity efforts on uptake of The Ottawa Rules app. METHODS: The Ottawa Rules app was developed and publicly released for free on iOS and Android operating systems in April 2016. Local and national news and academic media coverage coincided with app release. This study was conducted at a large tertiary trauma care center in Ottawa, Canada. The study was advertised through posters and electronically by email. Emergency department clinicians were approached in person to enroll via in-app consent for a 1-month study during which time they were encouraged to use the app when evaluating patients with suspected knee, foot, or neck injuries. A 23-question survey was administered at the end of the study period via email to determine self-reported frequency, perceived ease of use of the app, and participant Technology Readiness Index scores. RESULTS: A total of 108 emergency department clinicians completed the study including 42 nurses, 33 residents, 20 attending physicians, and 13 medical students completing emergency department rotations. The median Technology Readiness Index for this group was 3.56, indicating a moderate degree of openness for technological adoption. The majority of survey respondents indicated favorable receptivity to the app including finding it helpful to applying the rules (73/108, 67.6%), that they would recommend the app to colleagues (81/108, 75.0%), and that they would continue using the app (73/108, 67.6%). Feedback from study participants highlighted a desire for access to more clinical decision rules and a higher degree of interactivity of the app. Between April 21, 2016, and June 1, 2017, The Ottawa Rules app was downloaded approximately 4000 times across 89 countries. CONCLUSIONS: We have found The Ottawa Rules app to be an effective means to disseminate the Ottawa Ankle Rules, Ottawa Knee Rule, and Canadian C-Spine Rule among all levels of emergency department clinicians. We have been successful in monitoring uptake and access of the rules in the app as a result of our publicity efforts. Mobile technology can be leveraged to improve the accessibility of clinical decision tools to health professionals.

Medical Device Integrated Vital Signs Monitoring Application with Real-Time Clinical Decision Support.

This research involves the design and development of a novel Android smartphone application for real-time vital signs monitoring and decision support. The proposed application integrates market available, wireless and Bluetooth connected medical devices for collecting vital signs. The medical device data collected by the app includes heart rate, oxygen saturation and electrocardiograph (ECG). The collated data is streamed/displayed on the smartphone in real-time. This application was designed by adopting six screens approach (6S) mobile development framework and focused on user-centered approach and considered clinicians-as-a-user. The clinical engagement, consultations, feedback and usability of the application in the everyday practices were considered critical from the initial phase of the design and development. Furthermore, the proposed application is capable to deliver rich clinical decision support in real-time using the integrated medical device data.

Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review.

BACKGROUND: Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. AIM: To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. DATA SOURCES: A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. CONCLUSIONS: Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

The Spanish Adaptation of the Palliative Performance Scale (Version 2) Among Cancer Patients at the End of Life: Psychometric Properties.

BACKGROUND: Palliative Performance Scale (PPS) is a reliable tool to assess performance status in cancer patients receiving palliative care (PC). Spanish validated and culturally adapted tools are needed. OBJECTIVES: The objectives are to develop PPS translation and cross-cultural adaptation into Spanish and to assess its psychometric properties. DESIGN: Translation process with cross-cultural adaptation to produce Spanish Palliative Performance Scale (PPS-SPANISH). SETTINGS: PC Team at one University hospital in Spain. PARTICIPANTS: Fifteen advanced cancer patients (60 assessments) were included for PPS translation and validation and 250 patients for cross-sectional analysis. All participants were recruited at oncology ward, emergency area, and outpatient clinic by PC team professionals. Informed consent was given. Average age was 66.4 ± 13 years (60% men). METHODS: The process is designed in three steps. In Step 1, PPS translation and reverse translation into Spanish (three bilingual speakers) and linguistic complexity measurement were performed. In Step 2, readability and intelligibility assessment was carried out. In Step 3, a pilot study was conducted to assess test-retest reliability followed by a cross-sectional study to measure internal consistency. Inclusion criteria were the same for two samples. Demographic data were also analyzed by descriptive statistics. RESULTS: Following cultural, linguistic, and grammatical adaptation, PPS-SPANISH was readable and reliable. The analysis of the test-retest reliability after 48 hours showed intraclass correlations >0.60. Cronbach's alpha coefficient was 0.99 (0.988-0.992). There was high agreement with other functional assessment tools (Barthel Index and Karnofsky Performance Status Index). CONCLUSIONS: PPS-SPANISH showed reliability and validity, and it is suitable to assess performance status in cancer patients receiving PC.

A experiência com a Metodologia IRDI em creches: pré-venir um sujeito / IRDI methodology in daycare: prevention for a subject / L’expérience avec la méthode IRDI dans les crèches : prévenir un sujet / Una experiencia con la metodología IRDI en guarderías infantiles: prevenir un sujeto / Die Erfahrungen mit der IRDI Methode in Kinderkrippen: ein Subjekt vorbeugen

A Metodologia IRDI é um dispositivo de avaliação e acompanhamento de bebês de zero a 18 meses na sua constituição psíquica. Foi construído a partir de quatro operações constitutivas: suposição do sujeito, estabelecimento da demanda, alternância presença/ausência e função paterna — que aparecem na relação do bebê com o cuidador. Este artigo visa relatar uma intervenção realizada em uma creche municipal com um bebê de 10 meses que estava com dificuldades na sua constituição psíquica, caracterizado pela ausência dos indicadores esperados e que se presentificaram a partir da intervenção.

IRDI methodology (Clinical Risk Indicators in Child Development) is a tool for the assessment and monitoring of the psychic constitution of babies from age zero to 18 months. It was established based on four constitutive operations: assumption of the subject, establishment of demand, presence/absence alternation, and paternal function — which all appear in the baby’s relationship with caregivers. This paper reports an intervention carried out in a municipal daycare center with a 10-month baby suffering from psychic constitution problems, as characterized by the absence of expected indicators that appeared following the intervention.

La méthode IRDI (facteurs de risque du développement de l’enfant) est un dispositif qui permet d’évaluer et de suivre les bébés de zéro à 18 mois quant à leur constitution psychique. Cette méthode est basée sur quatre opérations constitutives: la supposition du sujet, l’établissement de la demande, l’alternance présence/absence et la fonction paternelle — qui surgissent dans le rapport du bébé avec son soignant. Cet article a pour but de faire le rapport d’une intervention réalisée dans une crèche municipale sur un bébé de 10 mois qui présentait des difficultés dans sa constitution psychique, caractérisée par l’absence des indicateurs attendus et qui se sont manifestés qu’après l’intervention.

La metodología IRDI (indicadores de riesgo para el desarrollo infantil) es un dispositivo de evaluación y seguimiento de la constitución psíquica de bebés de cero a 18 meses. Fue construida a partir de cuatro operaciones constitutivas, que aparecen en la relación del bebé con el cuidador: suposición del sujeto, establecimiento de la demanda, alternancia de la presencia/ausencia y función paterna. Este artículo tiene como objetivo relatar la intervención realizada en una guardería infantil municipal con un bebé de 10 meses que tenía dificultades en su constitución psíquica, caracterizada por la ausencia de los indicadores esperados, indicadores que se hicieron presentes a partir de la intervención.

Die IRDI Methode (Risikoindikatoren für die frühkindliche Entwicklung) ist eine Bewertungs — und Überwachungsmethode für die psychische Konstitution von Babys von null bis 18 Monaten. Sie basiert auf vier konstitutiven Operationen: Annahme des Subjekts, Feststellung der Anforderung, Alternanz der Ab — und Anwesenheit und die väterliche Funktion, welche in der Beziehung zwischen dem Baby und dem Betreuer auftreten. Dieser Artikel erläutert eine Intervention in einer städtischen Kinderkrippe mit einem 10 Monate altem Kleinkind. Unsere Analyse zeigt Probleme der psychische Konstitution auf, die Aufgrund der Anwendung der IRDI Bewertungsmethode aufgezeigt werden konnten.

O Acompanhamento Terapêutico e a psicanálise: pequeno histórico e caso clínico / Therapeutic monitoring and psychoanalysis: a small history and clinical case / Suivi thérapeutique et psychanalyse: bref historique et cas clinique / El monitoreo terapéutico y el psicoanálisis: corto historial y caso clínico / Therapeutische Begleitung und Psychoanalyse: kurzer historischer Rückblick und klinischer Fall

A partir de um breve histórico de dispositivos clínicos utilizados no campo da saúde mental, discute-se a prática do Acompanhamento Terapêutico. Tal discussão se instrumentaliza da transferência, como conceito psicanalítico. Levantamos as hipóteses de que nesse trabalho realizado cotidianamente fora dos moldes do consultório, a fala de um usuário instiga a uma articulação entre teoria e prática e que a própria psicanálise pode dela adquirir um novo saber fazer clínico.

We discuss therapeutic monitoring based on a brief history of clinical tools used in the mental health field. This discussion is based on transference as a psychoanalytical concept. We hypothesize that, in everyday work carried out outside doctors’ offices’ models, users’ words instigate us to establish a connection between theory and practice — and that psychoanalysis itself can gain from it new knowledge for its clinical practices.

S’étayant sur un bref historique des dispositifs cliniques utilisés dans le domaine de la santé mentale, cet article discute la pratique du suivi thérapeutique. Cette discussion s’instrumentalise du transfert en tant que notion psychanalytique. Il émet les hypothèses que dans ce travail effectué quotidiennement en dehors du domaine des cabinets, la parole d’un utilisateur suggère un lien entre la théorie et la pratique et que la psychanalyse elle-même acquiert ainsi un nouveau savoir faire clinique.

A partir de un breve historial de los dispositivos clínicos utilizados en el campo de la salud mental, se analiza la práctica del monitoreo terapéutico. Esta discusión se instrumentaliza por la transferencia, como concepto psicoanalítico. Surgen entonces las hipótesis de que en ese trabajo realizado diariamente, por fuera del molde de los consultorios, el discurso de un usuario nos instiga a un enlace entre la teoría y la práctica y el propio psicoanálisis adquiere un nuevo saber-hacer clínico.

Basierend auf einem kurzen historischen Rückblick von klinischen Methoden im Bereich der psychischen Gesundheit, diskutiert der vorliegende Artikel die Praxis der therapeutischen Begleitung. Diese Diskussion leitet sich von der Übertragung ab, in Sinne des psychoanalytischen Konzepts. Wir erstellen die folgenden Hypothesen: 1. In dieser täglichen Arbeit, die außerhalb des Praxismodells stattfindet, unterstützt die Sprache des Benutzers die Verbindung zwischen Theorie und Praxis und 2. die Psychoanalyse kann dadurch neue Erkenntnisse für die klinische Arbeit erwerben.

Clinical tools designed to assess motor abilities in children with cerebral palsy.

OBJECTIVE: This systematic review aimed to list the tools used by rehabilitation professionals to test motor abilities in children with cerebral palsy (CP), to determine if these tools have psychometric properties specifically measured for CP, and to identify the main characteristics of these tools. METHOD: Web of Science, PEDro, PubMed/MEDLINE, Science Direct, and SciELO databases were searched to identify the tools. PubMed/MEDLINE was then searched to identify the studies assessing those tools' psychometric properties. The agreement-based standards for the selection of health measurement tools and the Terwee criteria were used to assess the quality and the results of each included study, respectively. RESULTS: Eighteen tools were identified. The psychometric properties of many of the tools used with children with CP have not been evaluated for this population. CONCLUSION: The psychometric properties evaluated often have a poor methodological quality of measurement. Overall, we suggest the tools with most empirical support to evaluate children with CP.