889 resultados para Clinical Assessment Tools


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The length weight relationship of three benthic bivalves namely, Senilia (= Anadara) senilis (bloody cockle), Tagelus adansonii (knife clam), Tellina nymphalis (soft shell clam) from the Andoni Flats were determined. The bivalves which are of ecological importance were obtained from the intertidal areas of the Andoni Flats. Shell lengths of the bivalves were measured and corresponding dry weight measurements were also taken. The data obtained were then subjected to regression analysis using the FAO-ICLARM Fish Stock Assessment Tools (FiSAT). The length weight relationships obtained from the FiSAT analysis indicated isometric growth for Senilia (= Anadara) senilis, with slope (b) value of 2.942; positive allometric growth for Tagelus adansonii, with a ‘b’ value of 3.395 and negative allometric growth for Tellina nymphalis with ‘b’ value of 2.633. KEYWORDS: bivalves, length-weight, isometric growth, allometric growth, cockle, clam.

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Os avanços e a disseminação do uso das Tecnologias de Informação e Comunicação (TIC) descortinam novas perspetivas para a educação com suporte em ambientes digitais de aprendizagem usados via internet (Fiolhais & Trindade, 2003). A plataforma usada no Projeto Matemática Ensino (PmatE) da Universidade de Aveiro (UA) é uma das ferramentas informáticas que suporta esses ambientes através da avaliação baseada no Modelo Gerador de Questões (MGQ), possibilitando a obtenção da imagem do progresso feito pelos alunos (Vieira, Carvalho & Oliveira, 2004). Reconhecendo a importância didática desta ferramenta, já demonstrada noutras investigações (por exemplo, Carvalho, 2011; Pais de Aquino, 2013; Peixoto, 2009), o presente estudo tem como objetivo geral desenvolver material didático digital de Física, no contexto do programa moçambicano de Física da 12ª classe, para alunos e professores sobre radiações e conteúdos da Física Moderna. Pretendeu-se, ainda, propor estratégias de trabalho com recurso às TIC para a melhoria da qualidade das aprendizagens nesta disciplina. O estudo assentou nas três seguintes questões de investigação: (a) Como conceber instrumentos de avaliação das aprendizagens baseadas no modelo gerador de questões para o estudo das radiações e conteúdos da Física Moderna, no contexto do programa moçambicano de Física da 12ª classe? (b) Que potencialidades e constrangimentos apresentam esses instrumentos quando implementados com alunos e professores? (c) De que forma o conhecimento construído pode ser mobilizado para outros temas da Física e para o ensino das ciências em geral? O estudo seguiu uma metodologia de Estudos de Desenvolvimento, de natureza mista, que compreendeu as fases da Análise, Design, Desenvolvimento e Avaliação, seguindo como paradigma um estudo de cariz exploratório, com uma vertente de estudo de caso. Assim, na Análise, foi discutido o contexto da educação em Moçambique e a problemática da abordagem das radiações e conteúdos de Física Moderna no ensino secundário no quadro desafiante que se coloca atualmente à educação científica. No Design foram avaliadas as abordagens dasTIC no ensino e aprendizagem da Física e das ciências em geral e construída a árvore de objetivos nos conteúdos referidos na fase anterior. Na fase do Desenvolvimento foram construídos os instrumentos de recolha de dados, elaborados os protótipos de MGQ e sua posterior programação, validação e testagem em formato impresso no estudo exploratório. Na Avaliação, foi conduzido o estudo principal com a aplicação dos modelos no formato digital e feita sua avaliação, o que incluiu a administração de inquéritos por questionário a alunos e professores. Os resultados indicam que na conceção de MGQ, a definição dos objetivos de aprendizagem em termos comportamentais é fundamental na formulação de questões e na análise dos resultados da avaliação com o objetivo de reajustar as estratégias didáticas. Apontam também que a plataforma do PmatE que suporta os MGQ, embora possua constrangimentos devido a sua dependência da internet e limitações de ordem didática, contribui positivamente na aprendizagem e na identificação das dificuldades e principais erros dos alunos, por um lado. Por outro, estimula através da avaliação os processos de assimilação e acomodação do conhecimento. O estudo recomenda a necessidade de mudanças nas práticas de ensino e de aprendizagem para que seja possível a utilização de conteúdos digitais como complemento à abordagem didática de conteúdos.

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Spasticity is a common disorder in people who have upper motor neuron injury. The involvement may occur at different levels. The Modified Ashworth Scale (MAS) is the most used method to measure involvement levels. But it corresponds to a subjective evaluation. Mechanomyography (MMG) is an objective technique that quantifies the muscle vibration during the contraction and stretching events. So, it may assess the level of spasticity accurately. This study aimed to investigate the correlation between spasticity levels determined by MAS with MMG signal in spastic and not spastic muscles. In the experimental protocol, we evaluated 34 members of 22 volunteers, of both genders, with a mean age of 39.91 ± 13.77 years. We evaluated the levels of spasticity by MAS in flexor and extensor muscle groups of the knee and/or elbow, where one muscle group was the agonist and one antagonist. Simultaneously the assessment by the MAS, caught up the MMG signals. We used a custom MMG equipment to register and record the signals, configured in LabView platform. Using the MatLab computer program, it was processed the MMG signals in the time domain (median energy) and spectral domain (median frequency) for the three motion axes: X (transversal), Y (longitudinal) and Z (perpendicular). For bandwidth delimitation, we used a 3rd order Butterworth filter, acting in the range of 5-50 Hz. Statistical tests as Spearman's correlation coefficient, Kruskal-Wallis test and linear correlation test were applied. As results in the time domain, the Kruskal-Wallis test showed differences in median energy (MMGME) between MAS groups. The linear correlation test showed high linear correlation between MAS and MMGME for the agonist muscle as well as for the antagonist group. The largest linear correlation occurred between the MAS and MMG ME for the Z axis of the agonist muscle group (R2 = 0.9557) and the lowest correlation occurred in the X axis, for the antagonist muscle group (R2 = 0.8862). The Spearman correlation test also confirmed high correlation for all axes in the time domain analysis. In the spectral domain, the analysis showed an increase in the median frequency (MMGMF) in MAS’ greater levels. The highest correlation coefficient between MAS and MMGMF signal occurred in the Z axis for the agonist muscle group (R2 = 0.4883), and the lowest value occurred on the Y axis for the antagonist group (R2 = 0.1657). By means of the Spearman correlation test, the highest correlation occurred between the Y axis of the agonist group (0.6951; p <0.001) and the lowest value on the X axis of the antagonist group (0.3592; p <0.001). We conclude that there was a significantly high correlation between the MMGME and MAS in both muscle groups. Also between MMG and MAS occurred a significant correlation, however moderate for the agonist group, and low for the antagonist group. So, the MMGME proved to be more an appropriate descriptor to correlate with the degree of spasticity defined by the MAS.

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Rapport de stage présenté à la Faculté des Études Supérieures des arts et sciences, Département de criminologie, en vue de l’obtention du grade de Maîtrise (M. Sc.) en criminologie, option intervention

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Dynamic knee valgus is a multi-planar motion that has been associated with anterior cruciate ligament injuries and patellofemoral pain syndrome. Clinical assessment of dynamic knee valgus can be made by looking for the visual appearance of excessive medial knee displacement (MKD) in the double-leg squat (DLS). The purpose of this dissertation was to identify the movement patterns and neuromuscular strategies associated with MKD during the DLS. Twenty-four control subjects and eight individuals showing MKD during the DLS participated in the study. Significant differences were verified between subjects that demonstrated MKD and a control (CON) group for the eletromyographic amplitude of adductor magnus, biceps femoris, vastus lateralis and vastus medialis muscles (p < 0.05), during the descending phase of the DLS. During the ascending phase were found group differences for adductor magnus and rectus femoris muscles (p < 0.05). Results from kinematic analysis revealed higher minimum and maximum values of ankle abduction and knee internal rotation angles (p < 0.05) for the MKD group. Also, individuals showing excessive MKD had higher hip adduction/abduction excursion. Our results suggested that higher tibial internal rotation and knee internal rotation angles in the initial position of the DLS are associated with MKD. The neuromuscular strategies that contributed to MKD were higher adductor magnus activation, whereas biceps femoris, vastus lateralis and vastus medialis activated more to stabilize the knee in response to the internal rotation moment.

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Background: Obesity ignites numerous health and psychosocial problems and is associated with various comorbidities. Body mass index (BMI) is also independently associated with improved risk for numerous kidney disorders. As renal length is considered a vital parameter in the clinical assessment of renal patients, normal renal length has to be defined in accordance to BMI. Objectives: The aim of this study was to define normal kidney length in obese children, comparing ultrasound measurements of the kidney length in obese and non-obese children and adolescents, in order to reduce unnecessary evaluations for nephromegaly. Patients and Methods: Fifty obese children and adolescents and 50 non-obese children and adolescents, aged 1-19 years, were selected from patients of pediatric clinics in two hospitals (Rasoul-e-Akram and Shahid Fahmideh) in Tehran between June 2010 and 2012. After the nephrologist’s and endocrinologist’s approval, the largest longitudinal renal dimension was measured in deep inspiration position by abdomino-pelvic ultrasonography in both groups. Results: It was revealed that both kidneys in obese group were significantly larger than in control group (P = 0.044 and 0.040, respectively). Obesity status, height and age were proven to be significant and independent predictors of length of both kidneys. In both groups length of left kidney was significantly larger than that of right kidney (P < 0.001). Conclusions: A specific standard cut-point limit or norm gram has to be formulated for obese children and adolescents in order to facilitate the diagnosis of kidney diseases, including organomegaly, in these patients.

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El presente trabajo titulado “Guía Didáctica de Rúbricas de Evaluación para el Bloque Uno de Números y Funciones, dirigida a docentes de matemática de Segundo Año de Bachillerato” ha sido diseñado con la intención de fortalecer el proceso de evaluación a través de la utilización de un nuevo instrumento, la rúbrica; con el objetivo de facilitarla tarea evaluadora del docente. En el primer capítulo, se da a conocer de manera general los cambios que ha sufrido la educación en los últimos años, la necesidad de conocer y relacionar las corrientes pedagógicas innovadoras como el constructivismo y la teoría del aprendizaje significativo con la evaluación del proceso educativo, la didáctica en el ámbito de la matemática, y la implementación de guías didácticas y rúbricas como instrumentos de apoyo para el docente. En el segundo capítulo se busca dar sustento a la propuesta mediante la aplicación de una encuesta, en la cual se evidenciala falta de instrumentos de evaluación que rompan el estigma de la utilización únicamente de pruebas en este proceso, además la factibilidad del uso de una guía didáctica de rúbricas para la matemática. Finalmente, en el tercer capítulo se presentan20 modelos de rúbricas holísticas y analíticas desarrolladas por cada actividad, referidas al Bloque Uno de “Números y Funciones” en base a las Destrezas con Criterio de Desempeño de acuerdo a lo que se establece en el Currículo del sistema educativo ecuatoriano.

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Las úlceras por presión causadas por una presión sostenida sobre la piel y sus tejidos adyacentes es una problemática considerada de salud pública, dada su alta prevalencia, se presentan mayormente en personas que tienen restricción en su movilidad, en el 3 a 10 % de los pacientes hospitalizados; con una tasa de incidencia que oscila entre 7,7 y 26,9 %, con consecuencias para la institución por altos costos, la comunidad, el paciente y su familia. En Colombia solo se cuenta con algunos estudios en instituciones en Bogotá, Cartagena, Bucaramanga y Medellín. Los estudios de prevalencia son importantes porque permiten visualizar la situación de la problemática, incentiva la implementación de medidas preventivas y la formulación de políticas institucionales que promuevan la seguridad del paciente y la calidad de la atención. En el Hospital Universitario Fundación Santa Fe de Bogotá no se conoce con exactitud la prevalencia pero se sabe que está presente por las complicaciones y consecuencias ya mencionadas, por ende el objetivo de este estudio fue determinar la prevalencia de punto de úlceras por presión en los pacientes hospitalizados, y al finalizar ser insumo para un estudio posterior que genere un Programa de Piel Sana institucional. El estudio se realizó mediante la medición en 1 día donde se valoró todos los pacientes hospitalizados, se realizó un análisis descriptivo de cada variable, y con un análisis bivariado se obtuvo medidas de asociación para identificar la relación entre los factores de riesgo y el desarrollo de ulceras por presión.

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A educação pré-escolar assume um papel fundamental no desenvolvimento das crianças que se quer cada vez mais abrangente e transversal. O nosso estudo tem como objectivo compreender se o desenvolvimento do potencial das crianças em idade pré-escolar está associado à frequência de actividades extracurriculares e ao meio onde residem. Realizou-se com uma amostra de 46 crianças, em dois Jardins de Infância, um de meio urbano e outro rural, nos concelhos de Évora e Viana do Alentejo. Utilizámos os instrumentos de avaliação do Modelo de Spectrum (Krechevsky 2001). A análise de resultados demonstrou que a população urbana apresentou um desenvolvimento do potencial superior à população rural em quase todas as actividades. A concluir destacamos as implicações deste estudo para a educação pré-escolar, nomeadamente no que se refere à sua organização e avaliação. ABSTRACT: The pre-school education plays a key role in the development of children needing to be more comprehensive and cross. Our study aims to understand if the potential development of children in preschool is associated with the frequency of extracurricular activities and the environment in which they reside. Conducted with a sample of 46 children in two kindergartens, one urban and another one rural, in the districts of Évora, Viana do Alentejo. We used the assessment tools of the Spectrum Model (Krechevsky 2001). The analysis results showed that the urban population had a higher potential development of the rural population in almost all activities. Finally, we highlight the implications of this study for pre-school education, particularly as regards their organization and evaluation.

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Fibromyalgia (FM) is a chronic, rheumatic disease characterized by widespread myofascial pain, of unknown aetiology, having a major impact on quality of life (QOL). Available pharmacotherapy for FM is marginally effective. FM is associated with co-morbidities of gastrointestinal (GI) disorders and Irritable Bowel Syndrome (IBS). There is growing evidence that diets low in FODMAPs, “fermentable oligo-, di- or mono-saccharides and polyols” [Low FODMAP Diet (LFD)], are effective in treating IBS. The aim of this pilot study was to examine the effects of LFDs on symptoms of FM, especially with regard to pain, QOL and GI disorders. Methods A longitudinal study using LFD intervention was performed on 38, 51 ± 10 year-old, female patients diagnosed with FM for an average of 10 years, based on ACR (American College of Rheumatology) 2010 criteria. The study was conducted from January through May, 2015, using a four-week, repeated-assessment model, as follows: Moment 0 – introduction of the protocol to participants; Moment 1 – first assessment and delivery of individual LFD dietary plans; Moment 2 – second assessment and reintroduction of FODMAPs; Moment 3 – last assessment and final nutritional counselling. Assessment tools used were the following: RFIQ (Revised Fibromyalgia Impact Questionnaire), FSQ (Fibromyalgia Survey Questionnaire), IBS-SSS (Severity Score System), EQ-5D (Euro-QOL quality of life instrument), and VAS (Visual Analogue Scale). Daily consumption of FODMAPs was quantified based on published food content analyses. Statistical analyses included ANOVA, non-parametric Friedman, t-student and Chi-square tests, using SPSS 22 software. Results The mean scores of the 38 participants at the beginning of the study were: FSQ (severity of FM, 0–31) – 22 ± 4.4; RFIQ (0–100) – 65 ± 17; IBS-SSS (0–500) – 275 ± 101; and EQ-5D (0–100) – 48 ± 19. Mean adherence to dietary regimens was 86%, confirmed by significant difference in FODMAP intakes (25 g/day vs. 2.5 g/day; p < 0.01). Comparisons between the three moments of assessment showed significant (p < 0.01) declines in scores in VAS, FSQ, and RFIQ scores, in all domains measured. An important improvement was observed with a reduction in the severity of GI symptoms, with 50% reduction in IBS scores to 138 ± 117, following LFD therapy. A significant correlation (r = 0.36; p < 0.05) was found between improvements in FM impact (declined scores) and gastrointestinal scores. There was also a significant correlation (r = 0.65; p < 0.01) between “satisfaction with improvement” after introduction of LFDs and “diet adherence”, with satisfaction of the diet achieving 77% among participants. A significant difference was observed between patients who improved as compared to those that did not improve (Chi-square χ2 = 6.16; p < .05), showing that the probability of improvement, depends on the severity of the RFIQ score. Conclusions Implementation of diet therapy involving FODMAP restrictions, in this cohort of FM patients, resulted in a significant reduction in GI disorders and FM symptoms, including pain scores. These results need to be extended in future larger studies on dietary therapy for treatment of FM. Implications According to current scientific knowledge, these are the first relevant results found in an intervention with LFD therapy in FM and must be reproduced looking for a future dietetic approach in FM.

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Objective: International nutritional screening tools are recommended for screening hospitalized patients for nutritional risk, but no tool has been specifically evaluated in the Brazilian population. The aim of this study was to identify the most appropriate nutritional screening tool for predicting unfavorable clinical outcomes in patients admitted to a Brazilian public university hospital. Methods: The Nutritional Risk Screening 2002 (NRS 2002), Mini-Nutritional Assessment-Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) were administered to 705 patients within 48 h of hospital admission. Tool performance in predicting complications, very long length of hospital stay (LOS), and death was analyzed using receiver operating characteristic curves. Results: NRS 2002, MUST, and MNA-SF identified nutritional risk in 27.9%, 39.6%, and 73.2% of the patients, respectively. NRS 2002 (complications: 0.6531; very long LOS: 0.6508; death: 0.7948) and MNA-SF(complications: 0.6495; very long LOS: 0.6197; death: 0.7583) had largest areas under the ROC curve compared to MUST (complications: 0.6036; very long LOS: 0.6109; death: 0.6363). For elderly patients, NRS 2002 was not significantly different than MNA-SF (P>0.05) for predicting outcomes. Conclusion: Considering current criteria for nutritional risk, NRS 2002 and MNA-SF have similar performance to predict outcomes but NRS 2002 seems to provide a best yield. (C) 2010 Elsevier Inc. All rights reserved.

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A workshop was convened to discuss best practices for the assessment of drug-induced liver injury (DILI) in clinical trials. In a breakout session, workshop attendees discussed necessary data elements and standards for the accurate measurement of DILI risk associated with new therapeutic agents in clinical trials. There was agreement that in order to achieve this goal the systematic acquisition of protocol-specified clinical measures and lab specimens from all study subjects is crucial. In addition, standard DILI terms that address the diverse clinical and pathologic signatures of DILI were considered essential. There was a strong consensus that clinical and lab analyses necessary for the evaluation of cases of acute liver injury should be consistent with the US Food and Drug Administration (FDA) guidance on pre-marketing risk assessment of DILI in clinical trials issued in 2009. A recommendation that liver injury case review and management be guided by clinicians with hepatologic expertise was made. Of note, there was agreement that emerging DILI signals should prompt the systematic collection of candidate pharmacogenomic, proteomic and/or metabonomic biomarkers from all study subjects. The use of emerging standardized clinical terminology, CRFs and graphic tools for data review to enable harmonization across clinical trials was strongly encouraged. Many of the recommendations made in the breakout session are in alignment with those made in the other parallel sessions on methodology to assess clinical liver safety data, causality assessment for suspected DILI, and liver safety assessment in special populations (hepatitis B, C, and oncology trials). Nonetheless, a few outstanding issues remain for future consideration.

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Background & aims: We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) to predict malnutrition related to poor clinical outcomes. Methods: We assessed 705 patients at a public university hospital within 48 h of admission. Logistic regression and number needed to screen (NNS) were calculated to test the complementarity between the tools and their ability to predict very long length of hospital stay (VLLOS), complications, and death. Results: Of the patients screened, 27.9% were at nutritional risk (NRS+) and 38.9% were malnourished (SGA B or C). Compared to those patients not at nutritional risk, NRS+, SGA B or C patients were at increased risk for complications (p = 0.03, 0.02, and 0.003, respectively). NRS+ patients had an increased risk of death (p = 0.03), and SGA B and C patients had an increased likelihood of VLLOS (p = 0.008 and p < 0.0001, respectively). Patients who were both NRS+ and SGA C had lower estimates of NNS than patients who were NRS+ or SGA C only, though their confidence intervals did overlap. Conclusions: The concurrent application of SGA in NRS+ patients might enhance the ability to predict poor clinical outcomes in hospitalized patients in Brazil. (C) 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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BACKGROUND Recommendations from international task forces on geriatric assessment emphasize the need for research including validation of cancer-specific geriatric assessment (C-SGA) tools in oncological settings. The objective of this study was to evaluate the feasibility of the SAKK Cancer-Specific Geriatric Assessment (C-SGA) in clinical practice. METHODS A cross sectional study of cancer patients >=65 years old (N = 51) with pathologically confirmed cancer presenting for initiation of chemotherapy treatment (07/01/2009-03/31/2011) at two oncology departments in Swiss canton hospitals: Kantonsspital Graubunden (KSGR N = 25), Kantonsspital St. Gallen (KSSG N = 26). Data was collected using three instruments, the SAKK C-SGA plus physician and patient evaluation forms. The SAKK C-SGA includes six measures covering five geriatric assessment domains (comorbidity, function, psychosocial, nutrition, cognition) using a mix of medical record abstraction (MRA) and patient interview. Five individual domains and one overall SAKK C-SGA score were calculated and dichotomized as below/above literature-based cut-offs. The SAKK C-SGA was evaluated by: patient and physician estimated time to complete, ease of completing, and difficult or unanswered questions. RESULTS Time to complete the patient questionnaire was considered acceptable by almost all (>=96%) patients and physicians. Patients reported slightly shorter times to complete the questionnaire than physicians (17.33 +/- 7.34 vs. 20.59 +/- 6.53 minutes, p = 0.02). Both groups rated the patient questionnaire as easy/fairly easy to complete (91% vs. 84% respectively, p = 0.14) with few difficult or unanswered questions. The MRA took on average 8.32 +/- 4.72 minutes to complete. Physicians (100%) considered time to complete MRA acceptable, 96% rated it as easy/fairly easy to complete. Individual study site populations differed on health-related characteristics (excellent/good physician-rated general health KSGR 71% vs. KSSG 32%, p = 0.007). The overall mean C-SGA score was 2.4 +/- 1.12. Patients at KSGR had lower C-SGA scores (2.00 +/- 1.19 vs. 2.81 +/- 0.90, p = 0.009) and a smaller proportion (28% vs.65%, p = 0.008) was above the C-SGA cut-off score compared to KSSG. CONCLUSIONS These results suggest the SAKK C-SGA is a feasible practical tool for use in clinical practice. It demonstrated discriminative ability based on objective geriatric assessment measures, but additional investigations on use for clinical decision-making are warranted. The SAKK C-SGA also provides important usable domain information for intervention to optimize outcomes in older cancer patients.