Application of telemedicine system for older adults postoperative patients in community: a feasibility study.

Purpose: In response to the growing challenges posed by an aging society, a telemedicine system was developed specifically for older adults postoperative patients, and its effectiveness was thoroughly investigated. Methods: Between May 2020 and May 2022, a total of 88 older adults postoperative patients were enrolled and randomly allocated into an experimental group and a control group. The experimental group received telemedicine services after discharge, while the control group received conventional medical services following the traditional protocol. One month after discharge, various indicators were evaluated for both groups, including number of visits, medical expenditures, postoperative recovery, anxiety, depression and satisfaction. Results: The number of visits and medical expenditures of the experimental group were less than those of the control group [1 (0, 1) vs. 1 (1, 2), Z = -3.977, p < 0.001; 25.25 (0.00, 277.40) yuan vs. 174.65 (49.63, 446.10) yuan, Z = -2.150, p = 0.032]. In both groups, there were 2 cases of incision infection, respectively. No significant difference was observed between the two groups (Fisher χ2, p = 0.259). In both groups, there was no instance of incision bleeding, incision dehiscence, readmission, or reoperation. Additionally, there was no significant difference in physical status between the two groups at discharge and after discharge (66.06 ± 8.92 vs. 65.45 ± 7.39 t = 0.287, p = 0.775; 73.33 ± 9.97 vs. 70.91 ± 7.50, t = 1.202, p = 0.235). And there was no significant difference in the change of physical status between the two groups after discharge [10.00 (0.00, 10.00) vs. 5.00 (0.00, 10.00), Z = -1.077, p = 0.281]. There was no significant difference in body weight change between the two groups after discharge [1.05 (0.38, 1.60) Kg vs. 0.80 (0.50, 1.43) Kg, Z = -0.265, p = 0.791]. There was no significant difference in the levels of anxiety and depression between the two groups at discharge (45.64 ± 8.10 vs. 44.60 ± 8.24, t = 0.520, p = 0.604, 48.33 ± 8.46 vs. 47.50 ± 6.85, t = 0.418, p = 0.677). But the levels of anxiety and depression in the experimental group were lower than those in the control group after discharge (34.92 ± 7.38 vs. 39.03 ± 8.42, t = -2.183, p = 0.032, 37.86 ± 7.29 vs. 41.93 ± 7.13, t = -2.281, p = 0.025); The change of anxiety level and depression level of the experimental group were more than those of the control group [-10.00 (-11.25, -8.75) vs. -5.00 (-7.81, -3.75), Z = -5.277, p < 0.001; -10.00 (-12.50, -7.50) vs. -5.00 (-7.75, -3.44), Z = -4.596, p < 0.001]. The level of satisfaction regarding medical services, daily care, and psychological comfort was higher in the experimental group compared to the control group [3 (3, 3.25) vs. 2 (1, 2), Z = -5.931, p < 0.001; 3 (3, 4) vs. 3 (2, 3), Z = -2.286, p = 0.022; 2 (1, 3) vs. 1 (0.75, 2), Z = -2.081, p = 0.037]. Conclusion: In the context of an aging society, telemedicine system can offer improved healthcare to older adults postoperative patients. This includes benefits such as reducing number of visits, saving medical expenditures, enhancing psychological comfort and daily care.

A Linked Data Mosaic for Policy-Relevant Research on Science and Innovation: Value, Transparency, Rigor, and Community.

This article presents a new framework for realizing the value of linked data understood as a strategic asset and increasingly necessary form of infrastructure for policy-making and research in many domains. We outline a framework, the 'data mosaic' approach, which combines socio-organizational and technical aspects. After demonstrating the value of linked data, we highlight key concepts and dangers for community-developed data infrastructures. We concretize the framework in the context of work on science and innovation generally. Next we consider how a new partnership to link federal survey data, university data, and a range of public and proprietary data represents a concrete step toward building and sustaining a valuable data mosaic. We discuss technical issues surrounding linked data but emphasize that linking data involves addressing the varied concerns of wide-ranging data holders, including privacy, confidentiality, and security, as well as ensuring that all parties receive value from participating. The core of successful data mosaic projects, we contend, is as much institutional and organizational as it is technical. As such, sustained efforts to fully engage and develop diverse, innovative communities are essential.

Developing the Occupational Therapy-Specific Mini-Clinical Evaluation Exercise (Mini-CEX) for Evaluating Interns' Clinical Skills and Attitudes in Pediatric Occupational Therapy.

IMPORTANCE: The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns' performance. OBJECTIVE: To develop a pediatric occupational therapy-specific Mini-CEX and examine its psychometrics. DESIGN: Stage 1 had a retrospective design; Stage 2 had a prospective design. SETTING: Pediatric occupational therapy unit in a hospital in Taiwan. PARTICIPANTS: Thirty-four occupational therapy interns were evaluated with the Mini-CEX (physician version), and 57 were evaluated with the occupational therapy-specific Mini-CEX. OUTCOMES AND MEASURES: The occupational therapy-specific Mini-CEX was developed with seven items on a 9-point scale categorized into three levels (unsatisfactory, satisfactory, highly satisfactory). RESULTS: In Stage 1, the frequency of Mini-CEX (physician version) items receiving a rating of not applicable ranged from 1.9% to 88.1%. In Stage 2, the frequency of occupational therapy-specific Mini-CEX items receiving a rating of not applicable ranged from 3.5% to 31.6%. With the theme of evaluation taken into consideration, the frequency of not-applicable ratings was 0% to 8.8%. For the occupational therapy-specific Mini-CEX, content validity (item-level content validity index = 1, scale-level content validity index = 1) and internal consistency (Cronbach's α = .93) were excellent. The interns' scores on the second evaluation were significantly higher than those on their first evaluation, indicating good discriminant validity. CONCLUSIONS AND RELEVANCE: The occupational therapy-specific Mini-CEX appears to be reliable and valid, and it is appropriate for evaluating interns' skills and attitudes in pediatric occupational therapy practice. What This Article Adds: The results support the development of the occupational therapy-specific Mini-CEX and its application in pediatric internship training.

Man versus machine? Self-reports versus algorithmic measurement of publications.

This paper uses newly available data from Web of Science on publications matched to researchers in Survey of Doctorate Recipients to compare the quality of scientific publication data collected by surveys versus algorithmic approaches. We illustrate the different types of measurement errors in self-reported and machine-generated data by estimating how publication measures from the two approaches are related to career outcomes (e.g., salaries and faculty rankings). We find that the potential biases in the self-reports are smaller relative to the algorithmic data. Moreover, the errors in the two approaches are quite intuitive: the measurement errors in algorithmic data are mainly due to the accuracy of matching, which primarily depends on the frequency of names and the data that was available to make matches, while the noise in self reports increases over the career as researchers' publication records become more complex, harder to recall, and less immediately relevant for career progress. At a methodological level, we show how the approaches can be evaluated using accepted statistical methods without gold standard data. We also provide guidance on how to use the new linked data.

Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. DESIGN: A single-blind, randomized controlled trial. SETTING: Four hospitals. PARTICIPANTS: Outpatients with chronic stroke and mild to moderate motor impairment (N=44). INTERVENTION: UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. MAIN OUTCOME MEASURES: Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. RESULTS: The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01). CONCLUSIONS: BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.

How do impairments in cognitive functions affect activities of daily living functions in older adults?

The assessment of daily living activities could provide information about daily functions and participation restrictions to develop intervention strategies. The purposes of this study were to assess the scores of the Barthel Index (BI) and Lawton Instrumental Activities of Daily Living (IADL) scale in older adults with cognitive impairment and to explore the different effects that levels of cognitive functions have on changes in IADL functions. We recruited 31 participants with dementia, 36 with mild cognitive impairment (MCI), and 35 normal controls (NCs) from the neurology outpatient department of a regional hospital. The results of the demographic and clinical characteristics through the Lawton IADL scale, BI, Quick Mild Cognitive Impairment (Qmci) screen, Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE), were collected on the same day and compared with the Kruskal-Wallis test, Wilcoxon rank-sum test, Fisher's exact test, and a multiple linear regression analysis, as appropriate. In the BI, bathing was the most discriminating activity to differentiate patients with MCI and dementia; in the Lawton IADL scale, medication responsibility and shopping were the most discriminating activities to differentiate NCs and patients with MCI, and patients with MCI and dementia, respectively. In addition, the predictors of changes in Lawton IADL scale scores were the problem-solving score of the Clinical Dementia Rating scale, a Qmci score of > 20.4 and an age of ≤ 81.2 years, a MoCA score of < 9.4 and an age of > 81.2 years, and the MMSE score and an age of > 81.2 years. This study adds to the evidence that the description of basic and instrumental daily activities is integrated in older adults with cognitive impairment. Notably, the Qmci is the most significant predictor of changes in IADL function for "young" older adults, as are the MoCA and MMSE for "old" older adults.

Psychometric and diagnostic properties of the Taiwan version of the Quick Mild Cognitive Impairment screen.

There is a need for a screening tool with capacities of accurate detection of early mild cognitive impairment (MCI) and dementia and is suitable for use in a range of languages and cultural contexts. This research aims to evaluate the psychometric and diagnostic properties of the Taiwan version of Qmci (Qmci-TW) screen and to explore the discriminating ability of the Qmci-TW in differentiating among normal controls (NCs), MCI and dementia. Thirty-one participants with dementia and 36 with MCI and 35 NCs were recruited from a neurology department of regional hospital in Taiwan. Their results on the Qmci-TW, Taiwanese version of the Montreal Cognitive Assessment (MoCA), and Traditional Chinese version of the Mini-Mental State Examination (MMSE) were compared. For analysis, we used Cronbach's α, intraclass correlation coefficient, Spearman's ρ, Kruskal-Wallis test, receiver operating characteristic curve analysis, and multivariate analysis, as appropriate. The Qmci-TW exhibited satisfactory test-retest reliability, internal consistency, and interrater reliability as well as a strong positive correlation with results from the MoCA and MMSE. The optimal cut-off score on the Qmci-TW for differentiating MCI from NC was ≤ 51.5/100 and dementia from MCI was ≤ 31/100. The MoCA exhibited the highest accuracy in differentiating MCI from NC, followed by the Qmci-TW and then MMSE; whereas, the Qmci-TW and MMSE exhibited the same accuracy in differentiating dementia from MCI, followed by the MoCA. The Qmci-TW may be a useful clinical screening tool for a spectrum of cognitive impairments.

Using children as standardized patients in OSCE in pediatric occupational therapy.

BACKGROUND: Objective structured clinical examinations (OSCEs) have been administered in physical and psychiatric occupational therapy (OT) education, but not in pediatric OT education. The objectives were to examine the satisfaction and the influences of OSCE in pediatric OT on all participants. METHODS: The OSCE contained evaluation, intervention, and parent education stations. Sixty examinees, 44 child standardized patients (SPs), 44 chaperones, three playroom managers, 14 OSCE assistants, and 15 examiners participated in the OSCE. An OSCE video and three playrooms were prepared for child SPs. RESULTS: Ninety percent of the child SPs liked taking part in the OSCE and 75-85% expressed interest in participating in an OSCE the following year. Their parents appreciated the chaperones accompanying their children and giving them a memorable day. 88.3% of the examinees thought that the OSCE was helpful for their upcoming clinical training. 73.3% preferred the OSCE over the written exam. 60-93.4% considered the implementation appropriate. Most of the examiners thought that the content (80-100%) and the implementation (93.3-100%) were appropriate. Many chaperones reported having valuable experiences. CONCLUSIONS: It is practical using child SPs in OSCE in pediatric OT. The OSCE was beneficial to all participants. It is recommended that OSCEs be included in pediatric OT education.

Concurrent and Predictive Validity of Arm Kinematics With and Without a Trunk Restraint During a Reaching Task in Individuals With Stroke.

OBJECTIVE: To examine the concurrent and predictive validity of measurements of kinematic variables during reaching tasks with and without a trunk constraint in individuals with stroke. DESIGN: Randomized controlled trials. SETTINGS: Hospitals and a laboratory. PARTICIPANTS: Individuals with stroke (N=95) enrolled in previous and ongoing clinical trials. INTERVENTIONS: Upper limb training protocols were 90 to 120 minutes of intervention every weekday for 3 to 4 weeks. MAIN OUTCOME MEASURES: Functional capacity was assessed using the Action Research Arm Test and motor impairment using the Fugl-Meyer Assessment for the Upper Extremity. Movement kinematics were measured during a reaching task with and without a trunk constraint. We derived 5 endpoint control variables and 3 joint recruitment variables for estimating concurrent and predictive validity. RESULTS: The adjusted R(2) values for the constraint tasks ranged from .24 to .38 and for the unconstraint tasks from .29 to .40. Movement time was the most prominent kinematic variable for the Fugl-Meyer Assessment for the Upper Extremity before and after the intervention (P<.05). For the Action Research Arm Test, movement time and endpoint displacement were the most significant variables before and after the intervention, respectively (P<.05). CONCLUSIONS: Measuring kinematic performance during an unconstrained task is appropriate and possibly sufficient to represent motor impairment and functional capacity of individuals with stroke. Movement time is the dominant variable associated with motor impairment and functional capacity, and endpoint displacement is unique in reflecting functional capacity of individuals with stroke.

Serologic, trace element, and fecal parasite survey of free-ranging, female mule deer (Odocoileus hemionus) in eastern Washington, USA.

Blood and fecal samples collected from 97 free-ranging mule deer (Odocoileus hemionus), from four distinct herds during the spring of 2000 or 2001 in eastern Washington, US, were tested for exposure to selected pathogens, concentrations of trace elements, and presence of parasites in feces. Antibodies were detected to the following: Leptospira interrogans serovar Bratislava (4%), Leptospira interrogans serovar Canicola (1%), Leptospira interrogans serovar Grippotyphosa (13%), Bovine viral diarrhea virus 1 (57%), Bovine respiratory syncytial virus (71%), Infectious bovine rhinotracheitis virus (51%), Bovine parainfluenza virus 3 (61%), Bluetongue virus (25%), and Epizootic hemorrhagic disease virus (25%); 3 of 63 (5%) samples had antibody to Neospora spp. All samples tested for antibody to Brucella abortus and L. interrogans serovar Icterohaemorrhagiae, L. interrogans serovar Pomona, and L. interrogans serovar Hardjo samples were negative. Trace element concentrations from 97 sera were deficient for selenium (17%), copper (19%), iron (34%), calcium (3%), and phosphorus (2%) compared with thresholds established for domestic livestock. Parasites detected in 97 fecal samples included dorsal-spined larvae (probably Parelaphostrongylus sp.) (40%), abomasal nematode eggs (1%), Capillaria sp. eggs (1%), Nematodirus sp. eggs (26%), Moniezia sp. eggs (1%), and Eimeria sp. (2%).

Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial.

OBJECTIVE: To compare the outcome of robot-assisted therapy with dose-matched active control therapy by using accelerometers to study functional recovery in chronic stroke patients. DESIGN: Prospective, randomized, controlled trial. SETTING: Stroke units in three medical centres. SUBJECTS: Twenty patients post stroke for a mean of 22 months. INTERVENTION: Robot-assisted therapy (n = 10) or dose-matched active control therapy (n = 10). All patients received either of these two therapies for 90-105 minutes each day, 5 days per week, for four weeks. MAIN MEASURES: Outcome measures included arm activity ratio (the ratio of mean activity between the impaired and unimpaired arm) and scores on the Fugl-Meyer Assessment Scale, Functional Independence Measure, Motor Activity Log and ABILHAND questionnaire. RESULTS: The robot-assisted therapy group significantly increased motor function, hemiplegic arm activity and bilateral arm coordination (Fugl-Meyer Assessment Scale: 51.20 ± 8.82, P = 0.002; mean arm activity ratio: 0.76 ± 0.10, P = 0.026; ABILHAND questionnaire: 1.24 ± 0.28, P = 0.043) compared with the dose-matched active control group (Fugl-Meyer Assessment Scale: 40.90 ± 13.14; mean arm movement ratio: 0.69 ± 0.11; ABILHAND questionnaire: 0.95 ± 0.43). CONCLUSIONS: Symmetrical and bilateral robotic practice, combined with functional task training, can significantly improve motor function, arm activity, and self-perceived bilateral arm ability in patients late after stroke.

Responsiveness and validity of three dexterous function measures in stroke rehabilitation.

In this study, we compared the responsiveness and validity of the Box and Block Test (BBT), the Nine-Hole Peg Test (NHPT), and the Action Research Arm Test (ARAT). We randomized 59 patients with stroke into one of three rehabilitation treatments for 3 weeks. We administered six outcome measures (BBT, NHPT, ARAT, Fugl-Meyer Assessment [FMA], Motor Activity Log [MAL], and Stroke Impact Scale [SIS] hand function domain) pretreatment and posttreatment. We used the standardized response mean (SRM) to examine responsiveness and the Spearman rank correlation coefficient (rho) to examine concurrent validity. The BBT, NHPT, and ARAT were moderately responsive to change and not significantly different (SRM = 0.64-0.79). The correlations within the BBT, NHPT, and ARAT were moderate to good at pretreatment (rho = -0.55 to -0.80) and posttreatment (rho = -0.57 to -0.71). The BBT and ARAT showed fair to moderate correlations with the FMA, MAL, and SIS hand function domain at pretreatment and posttreatment (rho = 0.31-0.59), whereas the NHPT demonstrated low to fair correlations with the FMA and MAL (rho = -0.16 to -0.33) and moderate correlations with the SIS hand function domain (rho = -0.58 to -0.66). Our results indicate that the BBT, NHPT, and ARAT are suitable to detect changes over time. While simultaneously considering the responsiveness and validity attributes, the BBT and ARAT can be considered more appropriate for evaluating dexterous function than the NHPT. Further studies with larger samples are needed to validate these findings.