'Being and becoming a practice educator': An AHP online programme.

BACKGROUND: Five higher education institutions (HEIs) in Scotland with qualifying allied health professional (AHP) programmes developed an online programme in practice education. This paper focuses on the design, development and evaluation of this programme. APPROACH: The programme was developed using the ADDIE approach for instructional design and was launched on TURAS (NHS e-learning platform) in November 2020. In November 2021, an online questionnaire was distributed to evaluate the e-learning programme and AHPs' preferences for future practice education training. EVALUATION: Of the 407 responses, 95% (n = 388) were working in the NHS. There was no preference for online or face-to-face format of training. For the majority, having flexibility of time and place was deemed to be important to manage learning particularly given high workloads and staff shortages. Out of the 29% (n = 118) who answered questions regarding the programme, more than 60% (n > 75) of respondents reported it was well organised, the content relevant and would support their learning. Free text comments suggested a desire for networking opportunities to discuss learning. IMPLICATIONS: An e-learning programme for new and existing AHP practice educators in Scotland was developed and launched in November 2020. Key feedback from participants was that they wanted to have opportunities for interaction with other learners to discuss and share their learning whether this was online or face-to-face. The programme now forms the foundation education in practice education for AHPs in Scotland and is supplemented with networking opportunities through synchronous online training with HEIs and via NHS Education for Scotland's virtual community.

The Balance Recovery Confidence (BRC) Scale.

BACKGROUND: Falls efficacy posits an understanding of the perceived ability to prevent and manage falls. There have been no validated self-reported instruments to measure the perceived ability to recover balance in response to destabilizing perturbations. PURPOSE: To develop a scale of balance recovery confidence. METHODS: Stage one had candidate items generated by 12 community-dwelling adults aged 65 and older using the nominal group technique. Stage two had the scale's name, instructions, response options, recall period and the items validated for appropriateness with 28 healthcare professionals and 10 older adults using an e-Delphi technique. Stage three had the scale's psychometric properties evaluated with 84 older adults who had completed self-reported and performance measures. Factor analysis was applied to confirm unidimensionality. The internal structure, reliability and validity of the scale were evaluated using the classical test theory and Rasch measurement theory. RESULTS: The 19-item scale was developed and validated with experts' consensus. The scale is unidimensional with excellent internal structure (Cronbach's α = 0.975) and test-retest reliability with Intraclass Correlation Coefficient (ICC3,1) = 0.944. Construct validity of the scale was supported by its relationships with the other measures (Activities-specific Balance Confidence scale, Falls Efficacy Scale-International, Late-Life Function and Disability International-Function, handgrip strength dynamometry, 30-second chair stand test, and mini-BESTest). CONCLUSION: The balance recovery confidence scale is a distinct instrument that measures perceived reactive balance recovery. The scale has good psychometric properties and can be used to complement other measurement instruments to help older adults cope with challenges to balance.

Interventions and measurement instruments used for falls efficacy in community-dwelling older adults: A systematic review.

Falls efficacy has been defined as perceived self-belief in the prevention and management of falls. In the case of community-dwelling older adults, it is essential that interventions should address the different aspects of falls efficacy in terms of balance confidence, balance recovery confidence, safe landing confidence and post-fall recovery confidence to improve their agency to deal with falls. This review aims to provide the current landscape of falls efficacy interventions and measurement instruments. A literature search of five electronic databases was conducted to extract relevant trials from January 2010 to September 2021, and the CASP tool for critical appraisal was applied to assess the quality and applicability of the studies. Eligibility criteria included randomised controlled trials evaluating falls efficacy as a primary or secondary outcome for community-dwelling older adults. A total of 302 full texts were reviewed, with 47 selected for inclusion involving 7,259 participants across 14 countries. A total of 63 interventions were identified, using exercise and other components to target different aspects of falls efficacy. The novel contribution of this article is to highlight that those interventions were applied to address the different fall-related self-efficacies across pre-fall, near-fall, fall landing and completed fall stages. Appropriate measurement instruments need to be used to support empirical evidence of clinical effectiveness.

Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls.

Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual's perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.

Falls efficacy instruments for community-dwelling older adults: a COSMIN-based systematic review.

BACKGROUND: Falls efficacy is a widely-studied latent construct in community-dwelling older adults. Various self-reported instruments have been used to measure falls efficacy. In order to be informed of the choice of the best measurement instrument for a specific purpose, empirical evidence of the development and measurement properties of falls efficacy related instruments is needed. METHODS: The Consensus-based Standards for the Selection of Health Measurement Intruments (COSMIN) checklist was used to summarise evidence on the development, content validity, and structural validity of instruments measuring falls efficacy in community-dwelling older adults. Databases including MEDLINE, Web of Science, PsychINFO, SCOPUS, CINAHL were searched (May 2019). Records on the development of instruments and studies assessing content validity or structural validity of falls efficacy related scales were included. COSMIN methodology was used to guide the review of eligible studies and in the assessment of their methodological quality. Evidence of content validity: relevance, comprehensiveness and comprehensibility and unidimensionality for structural validity were synthesised. A modified GRADE approach was applied to evidence synthesis. RESULTS: Thirty-five studies, of which 18 instruments had been identified, were included in the review. High-quality evidence showed that the Modified Falls Efficacy Scale (FES)-13 items (MFES-13) has sufficient relevance, yet insufficient comprehensiveness for measuring falls efficacy. Moderate quality evidence supported that the FES-10 has sufficient relevance, and MFES-14 has sufficient comprehensibility. Activities-specific Balance Confidence (ABC) Scale-Simplified (ABC-15) has sufficient relevance in measuring balance confidence supported by moderate-quality evidence. Low to very low-quality evidence underpinned the content validity of other instruments. High-quality evidence supported sufficient unidimensionality for eight instruments (FES-10, MFES-14, ABC-6, ABC-15, ABC-16, Iconographical FES (Icon-FES), FES-International (FES-I) and Perceived Ability to Prevent and Manage Fall Risks (PAPMFR)). CONCLUSION: Content validity of instruments to measure falls efficacy is understudied. Structural validity is sufficient for a number of widely-used instruments. Measuring balance confidence is a subset of falls efficacy. Further work is needed to investigate a broader construct for falls efficacy.

Near-falls in Singapore community-dwelling older adults: a feasibility study.

BACKGROUND: A near-fall is defined as a loss of balance that would result in a fall if sufficient balance recovery manoeuvres are not executed. Compared to falls, near-falls and its associated balance recovery manoeuvres have been understudied. Older adults may not recognise a near-fall or identify the use of their balance recovery manoeuvres to prevent a fall. The consensus on the methods to collect near-fall data is lacking. The primary objective of this study was to determine the feasibility of recruitment and retention. Secondary objectives were to establish evidence that Singapore community-dwelling older adults can identify near-falls and associated balance recovery manoeuvres. Texting and calling methods were explored as reporting methods. METHODS: This study took place in Singapore (September to October 2019). Participants were healthy, community-dwelling adults aged 65 or older. Recruitment was done through poster advertisement, and all participants gave informed consent. Participants attended a briefing session and reported their near-fall or fall incidence over 21 days using either daily texting or calling. The primary outcome measures were the recruitment rate, retention rate, preferred modes for data reporting and ability to report near-falls or falls. Secondary outcomes included the self-reported incidence of falls and near-falls. RESULTS: Thirty older adults were recruited in 5 weeks. All participants completed the study. They understood near-fall concepts and were able to report the occurrence and relevant balance recovery manoeuvres used to prevent a fall. 87% (26/30) chose to text while 13% (4/30) selected calling as their reporting method. One actual fall (0.16%) out of 630 responses was reported. Thirty-six incidents (5.7%) of near-falls were recorded. Sixteen participants (53.3%) experienced near-falls and half of this group experienced two or more near-falls. The use of reach-to-grasp strategy (36%), compensatory stepping (52.8%), and other body regions (11.2%) were used to prevent the fall. CONCLUSIONS: The study provided evidence that studying near-falls in Singapore community-dwelling older adults is feasible and can be applied to a large-scale study. Recruitment and retention rates were good. Older adults were able to identify near-falls and balance recovery manoeuvres. Both texting and calling were feasible reporting methods, but texting was preferred. TRIAL REGISTRATION: ClinicalTrials identifier: NCT04087551 . Registered on September 12, 2019.

Personality, function and satisfaction in patients undergoing total hip or knee replacement.

BACKGROUND: The aim of this study was to investigate the relationships between personality and joint-specific function, general physical and general mental health in patients undergoing total hip (THA) and knee arthroplasty (TKA). METHODS: One hundred and eighty-four patients undergoing THA and 205 undergoing TKA were assessed using the Eysneck Personality Questionnaire, brief version (EPQ-BV). General physical and mental health was measured using the Short-Form 12 (SF-12) questionnaire and the EuroQol (EQ-5D). Joint-specific function was measured using the Oxford hip or knee score. RESULTS: The "unstable introvert" personality type was associated with poorer pre-operative function and health in patients with hip arthrosis. In patients with knee arthrosis, there was poorer general health in those with "stable extrovert" and "unstable introvert" types. Personality was not an independent predictor of outcome following TKA or THA. The main predictor was pre-operative function and health. Comorbidity was an important covariate of both pre-operative and postoperative function. CONCLUSIONS: Personality may play a role in the interaction of these disease processes with function and health perception. It may also affect the response and interpretation of psychometric and patient-reported outcome measures. It may be important to characterise and identify these traits in potential arthroplasty patients as it may help deliver targeted education and management to improve outcomes in certain groups.

The Knee Injury and Osteoarthritis Outcome Score (KOOS): a review of its psychometric properties in people undergoing total knee arthroplasty.

STUDY DESIGN: Systematic literature review, clinical measurement. OBJECTIVE: To review and summarize the evidence regarding the psychometric properties of the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing total knee arthroplasty (TKA). METHODS: A comprehensive review of the existing literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review guidelines. Studies were included if they reported the psychometric properties of the KOOS or the KOOS-Physical Function Shortform (KOOS-PS). Papers written in both English and German were analyzed. Studies of patients undergoing primary total TKA or TKA revision, or those with severe osteoarthritis and awaiting TKA, were considered. The methodological quality of the included articles was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. RESULTS: Six studies fulfilled the inclusion criteria. Of these, 5 evaluated psychometric properties of the KOOS and 1 evaluated the KOOS-PS. Both the KOOS and KOOS-PS have moderate-to-high construct validity with existing validated self-report measures. However, construct validity of the KOOS function in sport and recreation subscale was weak. Further, these instruments demonstrated a high level of responsiveness, with effect sizes and standard response means of greater than 0.80. Overall, both questionnaires demonstrated clinically acceptable reliability (intraclass correlation coefficient of 0.70 or greater). However, somewhat lower reliability was observed for the KOOS function in sport and recreation subscale (intraclass correlation coefficients of 0.45 and 0.65, respectively) and the other symptoms subscale (internal consistency, α = .56). CONCLUSION: The KOOS and KOOS-PS exhibit clinically acceptable psychometric properties. Their strength is in large effect sizes to measure outcomes over time and their weakness is in weak-to-moderate reliability and weak construct validity in some subscales of the KOOS.

Hospital prenotification of stroke patients by emergency medical services improves stroke time targets.

BACKGROUND: Prenotification to hospitals by emergency medical services of patients with suspected stroke is recommended to reduce delays in time-dependent therapies. We hypothesized that hospital prenotification would reduce recommended stroke time targets. METHODS: We used the Robert Wood Johnson University Hospital (RWJUH) Brain Attack Database, which includes demographic and clinical data on all emergency department (ED) patients alerted as a Brain Attack between January 1, 2009 and June 30, 2010. Outcome variables included the time from door to stroke team arrival, computed tomographic (CT) scan completion, CT scan interpretation, electrocardiogram, laboratory results, treatment decision, and intravenous (IV) tissue plasminogen activator (tPA) administration. The primary independent variable was brain attack activation before arrival to the emergency department (ED; prenotification) versus on or after ED arrival (no prenotification). Analysis of covariance was used with patient predictors as covariates in addition to the one of interest (prenotification vs no prenotification). P ≤ .05 was considered statistically significant. RESULTS: There were 229 patients (114 prenotification and 115 no prenotification) alerted as having a brain attack within the study period. Patients with prehospital notification were older (69.5 years vs 61.5 years; P = .0002), had more severe strokes (National Institutes of Health Stroke Scale score of 11.1 vs 6.9; P < .0001), and received IV tPA twice as often (27% vs 15%; P = .024). Prenotification resulted in a significant reduction in all stroke time targets except door to treatment decision and tPA administration. CONCLUSIONS: Prehospital notification of suspected stroke patients reduces time to stroke team arrival, CT scan completion, and CT scan interpretation. IV thrombolysis occurred twice as often in the prenotification group.

Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose.

PURPOSE: To retrospectively compare image quality, radiation dose, and blood vessel assessability for coronary artery computed tomographic (CT) angiograms obtained with a prospectively gated transverse (PGT) CT technique and a retrospectively gated helical (RGH) CT technique. MATERIALS AND METHODS: This HIPAA-compliant study received a waiver for approval from the institutional review board, including one for informed consent. Coronary CT angiograms obtained with 64-detector row CT were retrospectively evaluated in 203 clinical patients. A routine RGH technique was evaluated in 82 consecutive patients (44 males, 38 females; mean age, 55.6 years). The PGT technique was then evaluated in 121 additional patients (71 males, 50 females; mean age, 56.7 years). All images were evaluated for image quality, estimated radiation dose, and coronary artery segment assessability. Differences in image quality score were evaluated by using a proportional odds logistic regression model, with main effects for three readers, two techniques, and four arteries. RESULTS: The mean effective dose for the group with the PGT technique was 2.8 mSv; this represents an 83% reduction as compared with that for the group with the RGH technique (mean, 18.4 mSv; P < .001). The image quality score for each of the arteries, as well as the overall combined score, was significantly greater for images obtained with PGT technique than for images obtained with RGH technique. The combined mean image quality score was 4.791 for images obtained with PGT technique versus 4.514 for images obtained with RGH technique (proportional odds model odds ratio, 2.8; 95% confidence interval: 1.7, 4.8). The percentage of assessable coronary artery segments was 98.6% (1196 of 1213) for images obtained with PGT technique versus 97.9% (1741 of 1778) for images obtained with RGH technique (P = .83). CONCLUSION: PGT coronary CT angiography offers improved image quality and substantially reduced effective radiation dose compared with traditional RGH coronary CT angiography.

HIV, syphilis, herpes simplex virus 2, and behavioral surveillance among conflict-affected populations in Yei and Rumbek, southern Sudan.

Little is known about the HIV epidemic in conflict-affected southern Sudan. During 2002-2003, we conducted behavioral and biological surveillance surveys and sequential sampling in antenatal clinics in Yei, Western Equatoria, and Rumbek, Bar-el-Ghazal. HIV prevalence among individuals aged 15-49 years ranged between 0.4% in Rumbek town and 4.4% in Yei town, and among pregnant women between 0.8 and 3.0%, respectively. After the recent peace agreement, targeted prevention programmes are urgently needed to prevent further spread.

A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients.

OBJECTIVES: To test the hypothesis that scores on 4 falls risk measures will differ significantly in patients reporting recurrent falls compared with those who do not; and to explore the validity of each measure to predict such falls status. DESIGN: A convenience sample was tested to establish the sensitivity and specificity of the Functional Reach Test, Timed Up & Go test, one-leg stance test (OLST), and balance subsection of the Performance Oriented Mobility Assessment (B-POMA). A 12-month retrospective falls history was used to identify recurrent fallers. SETTING: A day hospital for the elderly. PARTICIPANTS: Convenience sample of 30 day hospital patients. The inclusion criteria were: ability to rise from a chair and walk 6m; no severe cognitive impairment or blindness; age 65 years or older. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Scores on the 4 tests and retrospective falls histories. RESULTS: Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers (P<.05). An OLST time of 1.02 seconds or less (odds ratio [OR]=15.2; 95% confidence interval [CI], 1.72-133.95) and B-POMA score of 11 or less (OR=18.5; 95% CI, 2.05-167.79) were predictive of day hospital patients having a history of recurrent falls. CONCLUSIONS: OLST and B-POMA both have potential as screening tools for risk of falls, but this observation requires confirmation in a prospective study.