Building a programme theory of a specialist paediatric palliative and hospice care programme: development process and methodological reflection.

BACKGROUND: Paediatric palliative and hospice care aims to improve the quality of life of children with life-limiting and life-threatening conditions and their families. The number of these patients has risen significantly in recent years, resulting in an increased need for palliative care for this population. Although the need for paediatric palliative and hospice care is growing, meaningful outcome evaluation to demonstrate its effectiveness as a complex healthcare intervention is in its early stages. For complex interventions (programmes), theory-based evaluations have grown in prominence in recent years. They seek to understand how and why an intervention works by uncovering its underlying mechanisms by means of programme theory. To support both outcome evaluation in paediatric palliative care and a reflective practice of programme theorizing, we aimed to describe the construction of a programme theory for a specialist paediatric palliative and hospice care programme in Austria and to offer a reflective account of its development process. METHODS: We drew on a combination of theory-based evaluation frameworks to construct a programme theory consisting of an action and a change component. Through multiple iterations, incorporating different stakeholders' perspectives and drawing on different sources of knowledge and theory, we theorized how and why the programme likely achieves its intended outcomes. RESULTS: The programme theory outlines the proposed chains of events, causal mechanisms and outcomes of a specialist paediatric palliative and hospice care programme for children and families in several areas corresponding to its main conceptual tenets. Through a range of activities and interventions, the programme triggers coping and adaptation mechanisms that ultimately contribute to family and child wellbeing in physical, psychological, social, and spiritual dimensions. Established trust and partnership between children/families and healthcare professionals as well as a person-centered and family-centered approach were identified as enabling factors. CONCLUSIONS: Our findings provide insights into how a specialized paediatric palliative and hospice care programme works to achieve its intended outcomes for children and families. This helps demonstrate its impact, contributing to meaningful outcome evaluation and service improvement.

Mapping information regarding the work-related disability of depression and long-term musculoskeletal pain to the International Classification of Functioning, Disability and Health and ICF Core Sets.

Introduction: The International Classification of Functioning, Disability and Health is the WHO coding scheme for functioning-related data. Clear and unambiguous information regarding patients' work-related disabilities is important not only for the assessment of entitlement to paid sickness benefits but also for planning rehabilitation and return to work. The objective was to validate the content of ICF and ICF Core Sets for information on work-related disability in sick leave due to depression and long-term musculoskeletal pain. Specific aims: To describe to what extent (1) such data could be linked to ICF and (2) the result of the ICF linking in terms of ICF categories was represented in relevant ICF Core Sets. Methods: An ICF-linking study following the ICF-linking rules. A random sample of sick leave certificates issued in primary care for either depression (n = 25) or long-term musculoskeletal pain (n = 34) was collected from a community with 55,000 inhabitants in Stockholm County, Sweden. Results: The results of the ICF linking consisted of codings for (1) ICF categories and (2) other health information not possible to link to ICF. The ICF categories were compared to ICF Core Sets for coverage. The majority of the meaning units, 83% for depression and 75% for long-term musculoskeletal pain, were linked to ICF categories. The Comprehensive ICF Core Set for depression covered 14/16 (88%) of the ICF categories derived from the ICF linking. The corresponding figures were lower for both the Brief ICF Core Set for depression 7/16 (44%) and ICF Core Set for disability evaluation in social security 12/20 (60%). Conclusion: The results indicates that ICF is a feasible code scheme for categorising information on work-related disability in sick leave certificates for depression and long-term musculoskeletal pain. As expected, the Comprehensive ICF Core Set for depression covered the ICF categories derived from the certificates for depression to a high degree. However, the results indicate that (1) sleep- and memory functions should be added to the Brief ICF Core Set for depression, and (2) energy-, attention- and sleep functions should be added to the ICF Core Set for disability evaluation in social security when used in this context.

Prioritisation processes for programme implementation and evaluation in public health: A scoping review.

Background: Programme evaluation is an essential and systematic activity for improving public health programmes through useful, feasible, ethical, and accurate methods. Finite budgets require prioritisation of which programmes can be funded, first, for implementation, and second, evaluation. While criteria for programme funding have been discussed in the literature, a similar discussion around criteria for which programmes are to be evaluated is limited. We reviewed the criteria and frameworks used for prioritisation in public health more broadly, and those used in the prioritisation of programmes for evaluation. We also report on stakeholder involvement in prioritisation processes, and evidence on the use and utility of the frameworks or sets of criteria identified. Our review aims to inform discussion around which criteria and domains are best suited for the prioritisation of public health programmes for evaluation. Methods: We reviewed the peer-reviewed literature through OVID MEDLINE (PubMed) on 11 March 2022. We also searched the grey literature through Google and across key websites including World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), and the International Association of National Public Health Institutes (IANPHI) (14 March 2022). Articles were limited to those published between 2002 and March 2022, in English, French or German. Results: We extracted over 300 unique criteria from 40 studies included in the analysis. These criteria were categorised into 16 high-level conceptual domains to allow synthesis of the findings. The domains most frequently considered in the studies were "burden of disease" (33 studies), "social considerations" (30 studies) and "health impacts of the intervention" (28 studies). We only identified one paper which proposed criteria for use in the prioritisation of public health programmes for evaluation. Few prioritisation frameworks had evidence of use outside of the setting in which they were developed, and there was limited assessment of their utility. The existing evidence suggested that prioritisation frameworks can be used successfully in budget allocation, and have been reported to make prioritisation more robust, systematic, transparent, and collaborative. Conclusion: Our findings reflect the complexity of prioritisation in public health. Development of a framework for the prioritisation of programmes to be evaluated would fill an evidence gap, as would formal assessment of its utility. The process itself should be formal and transparent, with the aim of engaging a diverse group of stakeholders including patient/public representatives.

Development and Feasibility Testing of the Clinical-Community Linkage Self-Assessment Survey for Community Organizations.

Introduction: Clinical-community linkages (CCLs) can improve health, but few instruments exist to evaluate these partnerships. To address this gap, we develop and test the Clinical-Community Linkage Self-Assessment Survey (CCL Self-Assessment). Materials and Methods: We built on an existing framework and conducted a literature review to guide the design of our survey, and obtained feedback from academic, clinical, and community-based experts. To pretest the instrument, we conducted 10 think-aloud interviews with community-based health-promotion organizations. We performed feasibility testing with 38 staff from 20 community organizations, followed by criterion-validity testing. Results: The 15-item final instrument includes five domains: Nature of the Relationship, Communication, Referral Process, Feedback Loop, and Timeliness. Expert feedback included keeping the CCL Self-Assessment brief and actionable. Think-aloud interviews produced a range of revisions related to item wording, instructions, brevity, and formatting. Feasibility testing showed high response rate and ease of administration. Sites scoring high on the CCL Self-Assessment also scored high on the criterion measure. Discussion: We demonstrate feasibility, as well as face, content, construct, and criterion validity. Initial results suggest the CCL Self-Assessment survey may be used by community organizations to identify strengths and weaknesses of their linkages. Next steps include additional statistical validation and testing to determine how the CCL Self-Assessment survey works in the field as well as providing specific tools to improve linkages.

The perceived importance of prognostic aspects considered by physicians during work disability evaluation: a survey.

BACKGROUND: Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment. METHODS: Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both "in general" and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses. RESULTS: Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0-9.0), with less differing opinions among participants (IQR 1.0-3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0-8.0, with IQR 2.0-5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence. CONCLUSIONS: Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.

Pronóstico en pacientes con ataque cerebrovascular isquémico de circulación posterior / Functional outcome in posterior circulation acute ischemic stroke patients

RESUMEN INTRODUCCIÓN: El ochenta por ciento de los ataques cerebrovasculares son isquémicos, y uno de cada cinco afecta la circulación posterior. Su diagnóstico es difícil y los datos disponibles sobre el pronóstico y la mortalidad son discordantes. OBJETIVO: Evaluar el desenlace funcional a 180 días de los pacientes con ataque cerebrovascular (ACV) isquémico de circulación posterior (CP). MATERIALES Y MÉTODOS: Seguimiento prospectivo a pacientes con ACV de CP que ingresaron al Instituto Neurológico de Colombia entre septiembre del 2017 y septiembre del 2018. El desenlace clínico fue determinado mediante la escala Rankin modificada (mRS) al mes, a los seis meses y al año. RESULTADOS: Fueron incluidos 68 pacientes. La edad promedio fue 61 ±17 años y 60,3 % fueron hombres. El 85% tenía un mRS previo al ACV ≤ 1 y el 63 % un NIHSS basal ≤ 4. Nueve pacientes (13,2 %) recibieron terapia de reperfusión aguda (rtPA, TEV o ambas) y siete (10,3 %) adicionales arteriografía diferida. Dieciséis pacientes (23,5 %) presentaron una mejoría del NIHSS basal ≥ 4 puntos. Cuarenta y seis pacientes (74,2 %) presentaron un desenlace excelente mRS 0-1 a los seis meses y 87,1 % fueron categorizados mRS favorable (mRS 0-2). En el análisis ajustado, el NIHSS ≥ 4 fue un predictor de desenlace desfavorable a seis meses (RR 6,4; IC95 % 2,9-14,2). Seis pacientes (9,0 %) fallecieron, cuatro relacionados con el episodio actual o su recurencia. CONCLUSIONES: La mayoría de los pacientes con ACV de CP tienen desdenlaces favorables y una baja mor%talidad. La escala de NIHSS basal es un factor pronóstico independiente.

SUMMARY BACKGROUND: Ischemic strokes account for 80 % of all strokes, and one of every five compromises the posterior circulation. The diagnosis is difficult, and the data available about the outcome and mortality are discordant in the literature. OBJECTIVE: To investigate the clinicai outcome of patients at 180 days after posterior circulation ischemic stroke METHODS: Patients with diagnosis of posterior circulation stroke admitted to Instituto Neurológico de Colombia between September 2017 to 2018 were prospective included. The functional outcome by modified Rankin scale score (mRS) was determined at 1-month, 6-month, and 12-month after disease onset. RESULTS: 68 patients were included. The median age was 61 years ± 17 and 60.3 % were male. 85 % had a baseline mRS ≤ 1, and 63 % had a baseline National Institute Stroke Scale (NIHSS) ≤ 4. Nine patients were taken to acute recanalization therapies (rtPA, endovascular therapy or both) and seven more delayed arteriography. Sixteen patients (23.5 %) demonstrated an improvement of four or more points over the baseline NIHSS. Forty-six patients (74.2 %) had an excellent outcome 0-1 at six months and 87,1 % were categorized favorable mRS (mRS 0-2). In the adjusted analysis an NIHSS > 4 was a predictor of an unfavorable outcome at 6-month (RR 6.4; IC95 % 2.9-14.2). Six patients died (9 %); four of them in relation to the current event or an ischemic stroke recurrence. CONCLUSION: Most of the patients with posterior ischemic stroke have favorable outcomes and a low mortality. The baseline NIHSS is an independent prognostic risk factor.

Enhancing Resilience in Canadian Military Families and Communities: A Qualitative Analysis of the Reaching In Reaching Out and Bounce Back and Thrive! Resiliency Skills Training Programs.

Introduction: A new vision of resilience and well-being for Canadian military service members (SMs), Veterans and their families has been championed by the Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC). Operationalizing this vision, which aims to support those who serve/have served and their families as they navigate life during and post-service, requires the support of service providers (SPs). Training SPs to deliver complementary resilience-training programs Reaching In… Reaching Out (RIRO; for adults working with parents of young children) and Bounce Back and Thrive! (BBT; for parents of children aged 0-8 years of age) may support this vision. Objective: To assess the appropriateness of RIRO/BBT trainer training for SPs, and RIRO and BBT resilience-training for military populations and families. Methods: This qualitative descriptive study involved the delivery of RIRO/BBT trainer training to SPs (n = 20), followed by focus groups (n = 6) with SPs and organisational leaders (n = 4). Focus groups were recorded, and data were transcribed and thematically-analysed. Results: Several themes emerged: (1) RIRO/BBT trainer training enabled SPs to model resilience and deliver the resilience-training programs, (2) training was appropriate and adaptable for the CAF and SMs/CMFs, and (3) training could support the development of resilient communities. Discussion: RIRO/BBT trainer training and RIRO and BBT resilience-training programs use a holistic, integrated, experiential, and community approach to resilience-building and align with CAF and VAC initiatives. Once contextualised, such programs could support resilience-building in the military context.

Interventions developed with the Intervention Mapping protocol in the field of cancer: A systematic review.

OBJECTIVES: The Intervention Mapping (IM) protocol provides a structured framework to develop, implement, and evaluate complex interventions. The main objective of this review was to identify and describe the content of the interventions developed in the field of cancer with the IM protocol. Secondary objectives were to assess their fidelity to the IM protocol and to review their theoretical frameworks. METHODS: Medline, Web of Science, PsycINFO, PASCAL, FRANCIS, and BDSP databases were searched. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by 2 reviewers blinded to each other. RESULTS: Sixteen studies were identified, and these reported 15 interventions. The objectives were to increase cancer screening participation (n = 7), early consultation (n = 1), and aftercare/quality of life among cancer survivors (n = 7). Six reported a complete participatory planning group, and 7 described a complete logic model of the problem. Ten studies described a complete logic model of change. The main theoretical frameworks used were the theory of planned behaviour (n = 8), the transtheoretical model (n = 6), the health belief model (n = 6), and the social cognitive theory (n = 6). The environment was rarely integrated in the interventions (n = 4). Five interventions were reported as effective. CONCLUSIONS: Culturally relevant interventions were developed with the IM protocol that were effective to increase cancer screening and reduce social disparities, particularly when they were developed through a participative approach and integrated the environment. Stakeholders' involvement and the role of the environment were heterogeneously integrated in the interventions.

Revisión sistemática de estudios de costo-efectividad del test de portadores para fibrosis quística / Systematic review of studies on cost-effectiveness of cystic fibrosis carrier testing

Resumen Introducción. La fibrosis quística es considerada la enfermedad autosómica con afecciones multisistémicas más común en población blanca no hispánica. Objetivo. Revisar la evidencia disponible sobre costo-efectividad del test de portador para fibrosis quística en comparación con la no intervención. Materiales y métodos. Se realizó una revisión sistemática de evaluación de costo-efectividad del test genético para portadores de fibrosis quística a través de las base de datos MEDLINE, Embase, NHS, EBM Reviews - Cochrane Database of Systematic Reviews, LILACS, Health Technology Assessment, Genetests.org, Genetsickkids.org y Web of Science. Fueron incluidos estudios de costo-efectividad sin restricción de lenguaje ni fecha de publicación. Resultados. Solo 13 estudios fueron relevantes para su revisión completa. Se encontraron estrategias de tamizaje prenatal, preconcepcional y mixto. La perspectiva en salud fue la más usada; la tasa de descuento aplicada fue heterogénea entre 3.5% y 5%; la unidad de análisis principal fue el costo por pareja portadora detectada seguida de costo por nacimiento evitado con fibrosis quística. Se evidenció que la estrategia más costo-efectiva fue la del tamizaje preconcepcional asociada al test prenatal. Conclusiones. Se encontró marcada heterogeneidad en la metodología aplicada, lo que llevo a que los resultados no fueran comparables y se concluyera que existen diferentes enfoques de este test genético.

Abstract Introduction: Cystic fibrosis is considered the most common autosomal disease with multisystem complications in non-Hispanic white population. Objective: To review the available evidence on cost-effectiveness of the cystic fibrosis carrier testing compared to no intervention. Materials and methods: The databases of MEDLINE, Embase, NHS, EBM Reviews - Cochrane Database of Systematic Reviews, LILACS, Health Technology Assessment, Genetests.org, Genetsickkids.org and Web of Science were used to conduct a systematic review of the cost-effectiveness of performing the genetic test in cystic fibrosis patients. Cost-effectiveness studies were included without language or date of publication restrictions. Results: Only 13 studies were relevant for full review. Prenatal, preconception and mixed screening strategies were found. Health perspective was the most used; the discount rate applied was heterogeneous between 3.5% and 5%; the main analysis unit was the cost per detected carrier couple, followed by cost per averted birth with cystic fibrosis. It was evident that the most cost- effective strategy was preconception screening associated with prenatal test. Conclusions: A marked heterogeneity in the methodology was found, which led to incomparable results and to conclude that there are different approaches to this genetic test.

Uso de instrumentos clínicos para la evaluación de pacientes y resultados de tratamiento en trastornos por uso de sustancias (TUS) / Using clinical tools for assessing patients and treatment outcomes for Substance Use Disorders

Resumen Introducción. En la actualidad resulta imprescindible contar con instrumentos que permitan evaluar los resultados de tratamiento en pacientes con trastornos por uso de sustancias. Objetivo. Revisar la literatura científica de los últimos 10 años relacionada con la validación y el uso de instrumentos o de otros indicadores de resultado para la evaluación de tratamientos de trastornos por uso de sustancias. Materiales y métodos. Se realizó una búsqueda de artículos científicos publicados entre 2005 y 2015 que abordaran el tema de instrumentos de medida de los trastornos por uso de sustancias y la efectividad de los tratamientos. Se utilizó la base de datos MEDLINE y se limitó la búsqueda a títulos, resúmenes y textos completos disponibles. Resultados. Se seleccionaron 21 estudios de validación de instrumentos, 14 de evaluación de resultados utilizando instrumentos, 5 revisiones narrativas y 2 sistemáticas. Conclusiones. Los instrumentos encontrados exploran diferentes áreas según el tipo de tratamiento y los objetivos propuestos, sin embargo no hay una prueba única que permita evaluar de manera íntegra los resultados del tratamiento debido a la complejidad del tema. Se recomienda continuar con el desarrollo y validación de instrumentos específicos para tratamientos complejos en instituciones que trabajan con modelos terapéuticos integrales.

Abstract Introduction: Having tools to assess the outcomes of treatment in patients with substance use disorders is highly important. Objective: To review the last 10 years of scientific literature related to the validation and use of instruments or other performance measures in treatment evaluation. Materials and methods: A search of scientific papers, published between 2005 and 2015, addressing measurement instruments for substance use disorders and effectiveness of treatments was performed. The MEDLINE database was used and the search was limited to titles, abstracts and full texts available. Results: 21 instrument validation studies, 14 performance evaluations using instruments, 5 narrative reviews and 2 systematic reviews were selected. Conclusions: The found instruments explore different areas depending on the type of treatment and proposed objectives; however, there is not a unique test to fully assess the results of treatment due to the complexity of the topic. It is recommended to continue the development and validation of specific tools for complex treatments in institutions working with comprehensive therapeutic models.

Consistencia interna de la batería de evaluación propioceptiva en personas con amputación transtibial (BEPAT) en el Hospital Militar Central / Internal consistency of a proprioceptive assessment battery for patients with below-knee amputation (BEPAT, by its acronym in Spanish) in Hospital Militar Central

Resumen Introducción. Varías pruebas clínicas han sido diseñadas para evaluar la propiocepción, sin embargo ninguna cuenta con la suficiente validez para ser empleada en población amputada. Por esta razón, el Grupo de Investigación de Profundización en Kinesioterapia de la Universidad Nacional de Colombia ha desarrollado una batería de evaluación propioceptiva para personas con amputación transtibial ya protetizadas (BEPAT). La presente investigación evalúa la consistencia interna de la batería. Objetivo. Establecer la consistencia interna de la batería de evaluación propioceptiva (BEPAT) en un grupo de amputados del Hospital Militar Central. Materiales y métodos. Estudio de tipo transversal en el que participaron 12 sujetos (25.4 ± 4.23 años) con amputación transtibial por mina, de género masculino (100%), y con tipo de prótesis de bloqueo-pin (75%). Los participantes asistieron al servicio de prótesis y amputados del Hospital Militar Central entre junio y julio de 2014, cumpliendo con los criterios de inclusión en el estudio. La consistencia interna se evaluó con el coeficiente alfa de Cronbach (α). Resultados. La BEPAT cuenta con una alta confiabilidad de tipo consistencia interna, con un valor global de coeficiente alfa α=0.758, mientras que este valor para los dominios de actividades efectoras, cinestesia y estatestesia fue de (α=-0.264), (α=0.829) y (α=0.763), respectivamente. Conclusiones. Se determinó que la BEPAT puede ser aplicable en el ámbito clínico, obteniendo en las primeras pruebas de confiabilidad un alto valor alfa de Cronbach α=0.758. Las variables que componen los dominios tienen una influencia positiva en la consistencia interna de toda la batería y las calificaciones para la pierna amputada se reducen, reportando valores inferiores a 26, lo que indica una regular respuesta propioceptiva.

Abstract Introduction: Several clinical trials are designed to assess proprioception, however, none of them has sufficient validity to be used in amputee population. For this reason, the Kinesiotherapy Research Group from Universidad Nacional de Colombia has developed a proprioceptive test battery for below-knee amputation (BEPAT) with prosthetics. This research evaluates the internal consistency of the battery. Objective: To establish the internal consistency of a proprioceptive test battery (BEPAT) in a group of amputees treated at Hospital Militar Central. Materials and methods: Cross-sectional study which involved 12 male subjects (100%) (aged 25.4 ± 4.23) with transtibial amputation caused by landmine, and pin locking prosthesis (75%). Participants attended the prosthesis and amputees service at Hospital Militar Central between June and July 2014, meeting the criteria for inclusion in the study. Internal consistency was assessed with Cronbach's alpha (α). Results: BEPAT has a high internal consistency reliability, with a total alpha coefficient value of α=0.758. This value, for the domains of effector activities, kinesthesia and statesthesia, was (α=-0.264), (α=0.829) and (α=0.763), respectively. Conclusions: It was determined that BEPAT may be applicable in a clinical setting, obtaining in a high Cronbach's of α=0.758 during the first tests of reliability. The variables that comprise the domains have a positive influence on the internal consistency of the entire battery, and qualifications for the amputated leg are reduced, reporting values below 26, which indicates a regular proprioceptive response.

Adherencia a procesos de neurorrehabilitación funcional y su relación con la discapacidad y la calidad de vida en adultos colombianos con lesión medular / Adherence to functional neurorehabilitation processes and their relation to disability and quality of life in Colombian adults with spinal cord injury

Resumen Introducción. El conocimiento de la adherencia terapéutica en condiciones crónicas de salud como la lesión medular y su relación con la discapacidad y la calidad de vida puede reflejar mejores resultados en procesos de rehabilitación. Objetivo. Establecer el nivel de adherencia a procesos de neurorrehabilitación funcional y su relación con la discapacidad y la calidad de vida relacionada con la salud (CVRS) en adultos colombianos con lesión medular. Materiales y métodos. Estudio descriptivo correlacional con 330 participantes en el que se aplicaron diferentes instrumentos de medición: SMAN para adherencia a procesos de neurorrehabilitación funcional, SCI-DAS para discapacidad en lesiones medulares y WHOQOL-BREF para CVRS. Resultados. En el 80% la discapacidad global fue leve y moderada. 66% de los participantes reportaron niveles medio y alto de adherencia. El promedio de calidad de vida general fue de 68/100. Se encontró correlación significativa, por un lado, entre el componente ambiental de la discapacidad con la adherencia global y sus factores socio-económico, equipo de asistencia sanitaria, tratamiento y paciente y, por el otro, entre el dominio ambiental de la CVRS con la adherencia global y todos sus factores (p<0.001). Conclusión. Los principales determinantes de la adherencia a procesos de neurorrehabilitación funcional son los componentes ambientales de la discapacidad y la CVRS.

Abstract Introduction: Knowledge on adherence to treatment in chronic health conditions, such as spinal cord injury, and their relation with disability and quality of life may reflect better results in rehabilitation processes. Objective: To establish the level of adherence to functional neurorehabilitation processes and its relation to disability and health-related quality of life (HRQOL) in Colombian adults with spinal cord injury. Materials and methods: Descriptive correlational study with 330 participants in which different measuring instruments were applied: SMAN for adherence to functional neurorehabilitation processes, SCI-DAS for disability in spinal cord injuries, and WHOQOL-BREF for HRQOL. Results: In 80% of cases, overall disability was mild to moderate. 66% of participants reported medium and high adhesion levels. The average overall quality of life was 68/100. On the one hand, significant correlation between the environmental component of disability regarding adherence and the socio-economic, health care team, treatment and patient factors were found, and on the other, between the environmental domain of HRQOL and the overall adherence and all its factors (p<0.001). Conclusion: The main determinants of adherence to functional neurorehabilitation processes are environmental components of disability and HRQOL.

Proprioceptive assessment battery for patients with below-knee amputation (BEPAT in Spanish) / Batería de evaluación propioceptiva en personas con amputación transtibial, ya protetizadas-BEPAT

Abstract Introduction: Amputation generates various biomechanical and structural changes, creating deficiencies in balance, equilibrium and proprioception. Altered proprioception affects the bodily-space component, as well as postural control and other physical qualities, which require a specific management with physiotherapy intervention. This research was conducted considering that proprioceptive assessment is an adequate and effective tool in physiotherapy but is poorly documented in the literature regarding this population. Objective: To propose and validate a proprioceptive assessment battery in transtibial amputees with prostheses. Materials and methods: Descriptive-purposeful study in which information was gathered to propose a battery test based on scientific evidence available. Results: The propioceptive assessment battery for people with transtibial amputation with prostheses (BEPAT, for its acronym in Spanish), has a high validity of content and construct, according to Palisano criteria, considering that the results for all the items in the battery were above 70%. Conclusions: By means of the BEPAT it will possible to obtain objective and quantitative information on functional alterations, which will improve prosthesis prescription and rehabilitative treatment, as well as strengthen investigative processes in this field.

Resumen Introducción. La amputación trae diversos cambios biomecánicos y estructurales que generan deficiencias en el balance, el equilibrio y la propiocepción. Asimismo, la alteración de la propiocepción afecta el componente corpóreo-espacial, el control postural y demás cualidades físicas, lo cual requiere un manejo específico desde la Fisioterapia. Esta investigación se realizó teniendo en cuenta su función como herramienta adecuada y eficaz dentro de la Fisioterapia, debido a la poca documentación en la literatura de la evaluación propioceptiva en la población escogida. Objetivo. Proponer y validar una batería de evaluación propioceptiva para personas con amputación transtibial, ya protetizadas. Materiales y métodos. Estudio de tipo descriptivo-propositivo que requirió un proceso de recolección de información para proponer una batería de evaluación, basada en la evidencia científica disponible. Resultados. La batería de evaluación de la propiocepción para personas con amputación transtibial ya protetizada (BEPAT), cuenta con alta validez de contenido y constructo según los criterios de Palisano, considerando que los resultados para todos los ítems en la batería se encontraron por encima del 70%. Conclusiones. La creación de la BEPAT permitirá la obtención de información objetiva y cuantitativa sobre las alteraciones funcionales, lo que mejorará la prescripción de prótesis y el tratamiento rehabilitador y fortalecerá los procesos investigativos en el tema.

Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study.

BACKGROUND: Work capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants' functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits. METHODS/DESIGN: We will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants' functional limitations. Our primary outcome measure is the evaluation of claimant's work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process. DISCUSSION: We hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.

Which Environmental Factors Have the Highest Impact on the Performance of People Experiencing Difficulties in Capacity?

Disability is understood by the World Health Organization (WHO) as the outcome of the interaction between a health condition and personal and environmental factors. Comprehensive data about environmental factors is therefore essential to understand and influence disability. We aimed to identify which environmental factors have the highest impact on the performance of people with mild, moderate and severe difficulties in capacity, who are at risk of experiencing disability to different extents, using data from a pilot study of the WHO Model Disability Survey in Cambodia and random forest regression. Hindering or facilitating aspects of places to socialize in community activities, transportation and natural environment as well as use and need of personal assistance and use of medication on a regular basis were the most important environmental factors across groups. Hindering or facilitating aspects of the general environment were the most relevant in persons experiencing mild levels of difficulties in capacity, while social support, attitudes of others and use of medication on a regular basis were highly relevant for the performance of persons experiencing moderate to higher levels of difficulties in capacity. Additionally, we corroborate the high importance of the use and need of assistive devices for people with severe difficulties in capacity.

Model for the evaluation of implementation programs and professional pharmacy services.

Pharmacy practice and pharmaceutical care research of professional services has largely focused on patient outcomes and cost-effectiveness. Research studies have been, for the most part, conducted in controlled conditions prior to full scale implementation. There appears to be a dearth of process and evaluation of implementation reported. Conducting implementation research or adding implementation measures to an impact study, adds external validity to service and patient outcomes. Evaluations are required for all aspects of implementation including indicators of movement through the implementation stages (formative and summative implementation process evaluation), measures of influencing factors (barriers and facilitators) and change in factors over time (implementation impact), assessment of strategies and/or the implementation program, and overall measures to generate a level of implementation (implementation outcomes). The level of implementation of a professional pharmacy service can be estimated from the level of service delivery (reach and fidelity) and level as a service provider (integration and strength of support in the service environment). The model may be used for evaluating professional pharmacy services and for evaluating implementation programs.

Women from refugee backgrounds and their experiences of attending a specialist antenatal clinic. Narratives from an Australian setting.

PROBLEM: In response to an identified need, a specialist antenatal clinic for women from refugee backgrounds was introduced in 2008, with an evaluation planned and completed in 2010. QUESTION: Can maternity care experiences for women from refugee backgrounds, attending a specialist antenatal clinic in a tertiary Australian public hospital, be improved? METHODS: The evaluation employed mixed methods, generating qualitative and quantitative data from two hospital databases, a chart audit, surveys and interviews with service users, providers and stakeholders. Contributions were received from 202 participants. FINDINGS: The clinic was highly regarded by all participants. Continuity of care throughout the antenatal period was particularly valued by newly arrived women as it afforded them security and support to negotiate an unfamiliar Western maternity system. Positive experiences decreased however; as women transitioned from the clinic to labour and postnatal wards where they reported that their traditional birthing and recuperative practices were often interrupted by the imposition of Western biomedical notions of appropriate care. The centrally located clinic was problematic, frequently requiring complex travel arrangements. Appointment schedules often impacted negatively on traditional spousal and family obligations. CONCLUSIONS: Providing comprehensive and culturally responsive maternity care for women from refugee backgrounds is achievable, however it is also resource intensive. The production of translated information which is high quality in terms of production and content, whilst also taking account of languages which are only rarely encountered, is problematic. Cultural competency programmes for staff, ideally online, require regular updating in light of new knowledge and changing political sensitivities.

Estudio de caso déficit de atención desde la perspectiva clínica y educativa / A case study regarding lack of attention from a clinical and educational perspective

Antecedentes. El enfoque histórico-cultural ha evidenciado la utilidad en la implementación de programas preventivos y correctivos de problemas en el desarrollo y del aprendizaje, especialmente en lo que se refiere al déficit de atención, utilizando las funciones directivas del lenguaje. Objetivo. Identificar el impacto del método de corrección del déficit de atención, en donde se usan las funciones directivas del lenguaje. Material y métodos. Se presentan dos casos. Uno es considerado como experimental, que participa de un programa de corrección utilizando las funciones directivas del lenguaje; y el otro como control, que participa de tratamiento farmacológico. En los dos casos, se evalúa a los niños a nivel neuropsicológico antes y después de la implementación del programa interventivo. El caso control recibe tratamiento farmacológico. Resultados. La evaluación inicial evidenció fallas en el factor de regulación y control, así como en la consolidación de las imágenes internas de los objetos en los dos casos. La evaluación final mostró cambios positivos en programación y control, así como en la utilización del lenguaje verbal externo en el caso experimental. El caso control no evidenció cambios respecto a la evaluación inicial. Conclusión. Los resultados muestran que el programa en el que se usan las funciones directivas del lenguaje puede tener efectos importantes no sólo en la esfera cognoscitiva, sino sobre todas las esferas de la psique infantil: la esfera emocional-afectiva, de motivos e intereses, comportamental y de personalidad; esto se evidencia porque el niño experimental logró avances importantes en todas las actividades que requieren de la regulación y control de la actividad. Además, el niño empezó a utilizar su propio lenguaje para organizar, dirigir y regular sus actividades a nivel escolar.

Background. A historical-cultural approach has shown the usefulness of implementing preventative and corrective programmes regarding development and learning problems, especially regarding lack of attention, using directive functions of language. Objective. Identifying the impact of a method involving directive functions of language for correcting lack of attention. Materials and methods. Two cases are presented. One was considered experimental involving a correction programme using directive functions of language and the other was a control involving pharmacological treatment. The children were neuro-psychologically evaluated in both cases before and after the intervention programme being implemented. The control child received pharmacological treatment. Results. Initial evaluation revealed regulation and control flaws and consolidation of internal images of objects in both cases. Final evaluation revealed positive changes in programming and control, as well as in using external verbal language in the experimental case. No changes were noted in the control case regarding initial evaluation. Conclusion. The results showed that a programme involving directive functions of language could have important effects regarding the cognitive sphere and all spheres of an infant's psyche. This was seen regarding the emotional-affective sphere involving behavioural and personality, motives and interests, as the experimental child achieved important advances in all activities requiring regulation and control of such activity. The child also began to use his own language to organise, direct and regulate his academic activities.