Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim.  The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing.

Background.  The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes.

Design.  A prospective cross-sectional survey design.

Method.  All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions.

Results.  Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%).

Conclusion.  The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes.

A summative scoring system for evaluation of human kinematic performance

Evaluation of human kinematic performance is essential in rehabilitation and skill assessment. These services are in high demand where the improvements made due to exercises need to be regularly assessed. In some relevant industries there is a need to evaluate their employee capabilities quantitatively for accident compensation and insurance purposes. In particular, these assessments are preferred to be based on more quantifiable measures in a standardized form ensuring accuracy, reliability, ease of use and anywhere anytime information to the clinician. Therefore, it is necessary to have an efficient mechanism for evaluation and assessment of human kinematic movements as the current motion matching and recognition algorithms fall short due to characteristically strict specifications required in numerous health care applications. In this paper, we propose a summative approach using a double integral to define a closeness between two trajectories typically generated by human movement. This approach can be considered as a spatial scoring mechanism in the evaluation of human kinematic performance as well as in movement recognition applications. Several experiments based on computer simulations as well as real data were set up to examine the performance of the proposed approach as a scoring mechanism for the evaluation of human kinematic performances. The results demonstrated better characterization of the movement assessment and motion recognition ability, with a recognition rate of 86.19%, than the currently used methods such as Gaussian mixture models and pose normalization employed in motion recognition tasks. Finally, we use the scoring mechanism to analyze the proximity in human kinematic performance.

Post-anaesthetic discharge scoring criteria: key findings from a systematic review

Background
Patient safety depends on nurses' clinical judgment. In post-anaesthetic care, objective scoring systems are commonly used to help nurses assess when a patient is ready to go back to the ward or be discharged home after day surgery. Although there are several criteria used to assess patient readiness for discharge from the post-anaesthetic care unit, evaluation of the validity and reliability of these criteria is scarce.

Aims
This article presents key findings from a systematic review conducted to identify the essential components of an effective and feasible scoring system to assess patients following surgical anaesthesia for discharge from the post-anaesthetic care unit.

Methods
The protocol for the systematic review of quantitative studies investigating assessment criteria for discharge of adult patients from the post-anaesthetic care unit was approved by the Joanna Briggs Institute and conducted consistent with the methodology of the Institute. Twelve databases and grey literature, such as conference proceedings, were searched for published studies between 1970 and 2010. Two reviewers independently assessed study eligibility for inclusion. Reference lists of included studies were appraised.

Results
Eight studies met the inclusion criteria; only one was a randomised controlled trial. Variables identified as essential when assessing a patient's readiness for discharge from the post-anaesthetic care unit were conscious state, blood pressure, nausea and vomiting, and pain. Assessment of psychomotor and cognitive recovery and other vital signs were also identified as relevant variables to consider.

Conclusions
There was limited high-quality research regarding criteria to assess patient readiness for discharge from the post-anaesthetic unit. The key recommendations, with moderate to high risk of bias, include that assessment of specific variables (pain, conscious state, blood pressure, and nausea and vomiting) should be made before patient discharge. These key findings have informed a subsequent study to reach international consensus on effective assessment criteria and a project to test the clinical reliability of a tool for use by nurses in assessing patient readiness for discharge from post-anaesthetic care.

Doing it with dominoes

Discusses the use of domino game in teaching mathematics. Mechanics of the scoring system for the game; Variants of the game; Conceptualizing domino games.

Defining plant resistance to Phytophthora cinnamomi : a standardized approach to assessment

Phytophthora cinnamomi is a soil-borne plant pathogen that causes devastating disease in agricultural and natural systems worldwide. While a small number of species survive infection by the pathogen without producing disease symptoms, the nature of resistance, especially under controlled conditions, remains poorly understood. At present, there are no standardized criteria by which resistance or susceptibility to P. cinnamomi can be assessed, and we have used five parameters consisting of plant fresh weight, root growth, lesion length, relative chlorophyll content of leaves and pathogen colonization of roots to analyse responses to the pathogen. The parameters were tested using two plant species, Zea mays and Lupinus angustifolius, through a time course study of the interactions and resistance and susceptibility defined 7days after inoculation. A scoring system was devised to enable differentiation of these responses. In the resistant interaction with Z. mays, there was no significant difference in fresh weight, root length and relative chlorophyll content in inoculated compared with control plants. Both lesion size and pathogen colonization of root tissues were limited to the site of inoculation. Following inoculation L. angustifolius showed a significant reduction in plant fresh weight and relative leaf chlorophyll content, cessation of root growth and increased lesion lengths and pathogen colonization. We propose that this technique provides a standardized method for plant-P. cinnamomi interactions that could be widely used to differentiate resistant from susceptible species.

The role of objective and subjective evaluation in the production and marketing of goats for meat

Objective and subjective evaluations of goats for meat production are related to important determinants of production and profitability. The most important attributes in assessment of goats for market are: live weight; body condition score; and the age of goats. As goats grow, their carcass and body organs increase in weight in proportion to the empty body weight. For farmers and field workers the linear regression approach for estimating carcass weight by measuring live weight is the most suitable as it accounts for 88 to 97% of the variation in carcass, offal and boneless meat weight. Live weight scales or heart girth tapes should be used and the risks and errors associated with these methods are summarized. The proportion of a live goat that is the carcass, known as dressing percentage, increases from 35% to about 50% as goats grow. The usefulness and errors associated with dressing percentage in field estimation are discussed. A valuable subjective method for estimating the nutritional status of goats is the use of body condition scoring as it accounts for 60 to 67% of the variation in live weight change, carcass weight and fat reserves of goats. A method for body condition scoring and a similar fat scoring system are explained. Body condition score is also associated with mortality risk and reproductive performance of goats. The number of permanent incisors in the lower jaw of goats is a method of estimating the age of goats but is biased by differences in live weights of goats. The value and role of ultrasound scanning the carcasses of goats is summarized. For the marketing of kid meat no permanent incisors should have erupted. Other useful practices for the successful marketing of goat meat are discussed including: knowing market specifications and chemical withholding periods; animal health; prevention of bruising; identification of goats; size of consignments; timeliness; provision of paperwork. A checklist is provided. The use of subjective and objective assessment techniques in evaluating goats for meat production will provide the best results. Where only subjective assessment techniques are available they will provide satisfactory performance provided the skills have been learnt and are applied.

Influence of field position and phase of play on the physical demands of match-play in professional rugby league forwards

This article describes the utilisation of an unsupervised machine learning technique and statistical approaches (e.g., the Kolmogorov-Smirnov test) that assist cycling experts in the crucial decision-making processes for athlete selection, training, and strategic planning in the track cycling Omnium. The Omnium is a multi-event competition that will be included in the summer Olympic Games for the first time in 2012. Presently, selectors and cycling coaches make decisions based on experience and intuition. They rarely have access to objective data. We analysed both the old five-event (first raced internationally in 2007) and new six-event (first raced internationally in 2011) Omniums and found that the addition of the elimination race component to the Omnium has, contrary to expectations, not favoured track endurance riders. We analysed the Omnium data and also determined the inter-relationships between different individual events as well as between those events and the final standings of riders. In further analysis, we found that there is no maximum ranking (poorest performance) in each individual event that riders can afford whilst still winning a medal. We also found the required times for riders to finish the timed components that are necessary for medal winning. The results of this study consider the scoring system of the Omnium and inform decision-making toward successful participation in future major Omnium competitions.

Modelling and analysing track cycling Omnium performances using statistical and machine learning techniques

This article describes the utilisation of an unsupervised machine learning technique and statistical approaches (e.g., the Kolmogorov-Smirnov test) that assist cycling experts in the crucial decision-making processes for athlete selection, training, and strategic planning in the track cycling Omnium. The Omnium is a multi-event competition that will be included in the summer Olympic Games for the first time in 2012. Presently, selectors and cycling coaches make decisions based on experience and intuition. They rarely have access to objective data. We analysed both the old five-event (first raced internationally in 2007) and new six-event (first raced internationally in 2011) Omniums and found that the addition of the elimination race component to the Omnium has, contrary to expectations, not favoured track endurance riders. We analysed the Omnium data and also determined the inter-relationships between different individual events as well as between those events and the final standings of riders. In further analysis, we found that there is no maximum ranking (poorest performance) in each individual event that riders can afford whilst still winning a medal. We also found the required times for riders to finish the timed components that are necessary for medal winning. The results of this study consider the scoring system of the Omnium and inform decision-making toward successful participation in future major Omnium competitions.

Development and validation of the Approach-Iron Skill Test for use in golf

The primary aim of this study was to develop and validate a golf-specific approach-iron test for use with elite and high-level amateur golfers. Elite (n=26) and high-level amateur (n=23) golfers were recruited for this study. The ‘Approach-Iron Skill Test’ requires players to hit a total of 27 shots. Specifically, three shots are hit at each of nine targets on a specially constructed driving range in a randomised order. A real-time launch monitor positioned behind the player, measured the carry distance for each of these shots. A scoring system was developed based on the percentage error index of each shot, meaning that 81 points was the maximum score possible (with a maximum of three points per shot). Two rounds of the test were performed. For both rounds of the test, elite-level golfers scored significantly higher than their high-level amateur counterparts (56.3±5.6 and 58.5±4.6 points versus 46.0±6.3 and 46.1±6.7 points, respectively) (P<0.05). For both elite and high-level players, 95% limits of agreement statistics also indicated that the test showed good test–retest reliability (2.1±7.9 and 0.2±10.8, respectively). Due to the clinimetric properties of the test, we conclude that the Approach-Iron Skill Test is suitable for further examination with the players examined in this study.

A recognition tool for transient ischaemic attack

Background: Scoring systems exist to assist rapid identification of acute stroke but not for the more challenging diagnosis of transient ischaemic attack (TIA). Aim: To develop a clinical scoring system to assist with diagnosis of TIA. Methods: We developed and validated a clinical scoring system for identification of TIA patients. Logistic regression analysis was employed. Results: Our development cohort comprised 3216 patients. The scoring system included nine clinically useful predictive variables. After adjustment to reflect the greater seriousness of missing true TIA patients (a 2:1 cost ratio), 97% of TIA and 24% of non-TIA patients were accurately identified. Our results were confirmed during prospective validation. Conclusions: This simple scoring system performs well and could be used to facilitate accurate detection of TIA.

Development and measurement properties of a putting skill test for high-level golf

Despite a recent increase in the amount of research investigating performance in golf, a comprehensive putting skill test has not been reported in the peer-reviewed literature. In this study, the Golf Australia Putting Test (GAPT) was developed and a series of measurement properties were assessed. Elite (n = 18) and high-level amateur (HLA; n = 22) participants completed six single putts from various areas on six concentric circles (circle radii = 0.9, 1.5, 3.0, 4.6, 6.1 and 7.6 m). Using a scoring system that rewarded participants for holing putts from longer distances, the maximum score from a single round of the test (i.e. 36 putts) was 27 points. After two rounds of the test were completed by all players, a subsample of participants (elite, n = 15; HLA, n = 7) had their putting performance recorded during tournament play for a period of 90 days to assess criterion (predictive) validity of the test. The reliability, sensitivity and discriminative validity of the GAPT were also assessed. Better agreement between Rounds 1 and 2 scores was noted in the elite group, whilst reliability values were similar for both groups. Further, the GAPT scores were shown to predict players from the elite and high-ability groups with a low classification error. An equation for predicting on-course performance from GAPT scores was also developed. Findings from this study indicate that the GAPT is a valid and reliable tool for high-level players and the GAPT may be used for player evaluation in the field.

Mortality and use of the auxiliary score in extensive toxic epidermal necrolysis patients admitted to an adult burns referral centre

 Background: Toxic epidermal necrolysis (TEN) is a rare but fatal condition characterised by cutaneous exfoliation of the dermoepidermal layer and mucosal surfaces. Extensive TEN with epidermal detachment >30% of the total body surface area has been associated with a high mortality. Objective: This study aims to evaluate factors associated with mortality in extensive TEN. In the absence of data to qualify scoring systems such as SCORTEN, this study also aims to evaluate the use of the auxiliary score as a tool for calculating expected mortality. Methods: A retrospective chart review of all patients presenting to our burns service with extensive TEN was undertaken. Application and evaluation of the auxiliary score was also undertaken for this patient population. Results: In extensive TEN, age and delay in admission to a burns centre were factors associated with mortality. Applying the auxiliary score to our patient population, there were no significant differences between expected mortality and observed mortality. Conclusion: Mortality was associated with age and delay in definitive treatment in extensive TEN. Whilst SCORTEN is the gold standard prognostic tool for patients with TEN, in the absence of SCORTEN values, the auxiliary score provides an alternative scoring system to evaluate expected mortality.

A systematic evaluation of field-based screening methods for the assessment of anterior cruciate ligament (ACL) injury risk

BACKGROUND: Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings. OBJECTIVE: The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings. DATA SOURCES: An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken. STUDY SELECTION: Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies. RESULTS: Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified. LIMITATIONS: Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk. CONCLUSIONS: Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.