PROM-ED: Development and Testing of a Patient-Reported Outcome Measure for Emergency Department Patients Who Are Discharged Home.

STUDY OBJECTIVE: Common outcomes of care valued by emergency department (ED) patients who are not hospitalized have been characterized, but no measurement instrument has been developed to date. We developed and validated a patient-reported outcome measure for use with adult ED patients who are discharged home (PROM-ED). METHODS: In previous research, 4 main outcomes of importance to ED patients were defined: symptom relief, understanding, reassurance, and having a plan. We developed a bank of potential questions (phase 1) that were first tested for suitability through cognitive debriefing with patients (phase 2). Revised questions were then tested quantitatively with a large panel of participants who had recently received ED care (phase 3). Informed by these results, a panel of experts used a modified Delphi process to make decisions on item reduction. The resulting instrument (PROM-ED 1.0) was then evaluated for its measurement properties (structural validity, hypothesis testing, and reliability). RESULTS: Sixty-seven questions divided among 4 scales (1 for each outcome domain) were assembled. In accordance with cognitive debriefing with 8 patients (phase 2), 15 questions were modified and 13 removed. Testing of these questions with 444 participants (phase 3) identified problematic floor or ceiling effects (n=10), excessive correlations between items (n=11), and low item-total correlations (n=7). The expert panel (22 participants, phase 4) made decisions using this information on the exclusion of items, resulting in 22 questions across 4 scales that together constitute the PROM-ED 1.0. Testing provided good evidence of validity and test-retest reliability (n=200). CONCLUSION: The PROM-ED enables the measurement of patient-centered outcomes of importance to patients receiving care in the ED who are not hospitalized. These data could have important applications in research and care improvement.

An Overview of Cardiac Management in Neuromuscular Disease.

Muscular dystrophy and myasthenia gravis are two neuromuscular disorders that can involve significant cardiovascular complications. The frequency and severity of cardiac pathology varies widely among the muscular dystrophies. In some, it is nearly inevitable and requires regular evaluation. In others, assessment of cardiac function can be more symptom-driven. On-ly a minority of myasthenic patients manifest disease-related cardiovascular complications; however, their presentation can be rapidly progressive and life-threatening..

Win-shift, lose-stay: contingent switching and contextual interference in motor learning.

Learners (n = 48) practiced three multisegment movements with distinct target movement times. Four practice groups were compared: blocked, random, and two groups who had a win-shift/lose-stay schedule (WSLS1 and WSLS2). For these latter groups switching between practice tasks was performance-contingent: within 5% of target time for 1 or 2 consecutive trials, respectively. During acquisition, blocked performance was more accurate than for both random and WSLS2 groups. The WSLS1 group performed between blocked and random groups, but did not differ from either. In a next-day retention test, the random group scored better than the blocked group. The WSLS1 group performed similarly to the random practice while the WSLS2 group's scores were similar to those of the blocked group. Results encourage further study of similar practice schedules.

Self-selected visual information during discrete manual aiming.

The authors examined strategic selection of visual samples during manual aiming. Participants (N = 12) wore liquid-crystal goggles while performing discrete movements to a small target. Initially, participants controlled a 40-ms visual sample via a switch in their nonaiming hand. Subsequently, experimenter-imposed strategies required participants to take visual samples before movement initiation or early or late in the movement. Although participants adopted a variety of strategies to optimize the use of vision, they were more likely to select a sample during the early stages of the movement. Experimenter-imposed early and late instructions resulted in longer movement times than did self-selected sampling. Compared with late sampling, early sampling resulted in a temporal advantage with similar accuracy.