Establishment of a Medication Acuity Scoring Tool at a Tertiary Pediatric Teaching Hospital: A 2-Phase Process

2018 ◽  
Vol 33 (2) ◽  
pp. 164-172
Author(s):  
Kailynn DeRonde ◽  
Claire Palmer ◽  
Jane Gralla ◽  
Kevin Poel
Keyword(s):  
Phase I ◽  
Clinical Experience ◽  
Phase Ii ◽  
Rating System ◽  
Intrarater Reliability ◽  
Safety Standards ◽  
Objective Rating ◽  
The Individual ◽  
Scoring Tool ◽  
Phase Process

Background: Currently, there is no validated objective rating system to address the acuity of medication orders that pharmacists review. Objective: The objective was to assess the acuity of a given medication through creating and validating an acuity scoring tool. Methods: Phase I included the development of the medication acuity scoring tool (MAST) from national safety standards and clinical experience. A survey was administered to pharmacists nationwide to establish a consensus on the individual components of the tool and their associated weighted scores. Phase II was designed to assess MAST's predictive validity by comparing a medication acuity rating generated by MAST to a rating assigned based upon clinical experience of experts. Additionally, in phase II, interrater and intrarater reliability of MAST was evaluated. Results: In phase I, most of MAST’s components and their associated scores achieved >75% agreement for inclusion in the final tool. In phase II, without MAST, approximately 50% of pharmacist-assigned acuity ratings were statistically consistent with tool-generated acuity ratings, and there was fair agreement between respondents (k=0.31). With the use of MAST, agreement in acuity ratings improved to substantial (k=0.69), and intrarater reliability was almost perfect (k=0.88). Conclusion: MAST is a validated rating system that captures the acuity of medications.

Model Validation of Functional Responses Across Experimental Regions Using Functional Regression Extensions to the CORA Objective Rating System

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Scott M. Storm ◽  
Raymond R. Hill ◽  
Joseph J. Pignatiello ◽  
G. Geoffrey Vining ◽  
Edward D. White
Keyword(s):  
Functional Data ◽  
Rating System ◽  
System Response ◽  
Functional Regression ◽  
Response Functions ◽  
Weighted Linear Combination ◽  
Functional Responses ◽  
Parameter Configuration ◽  
Objective Rating ◽  
The Individual

As we continue to model more complex systems, the validation of dynamical responses has come to the forefront of modeling and simulation. One form of dynamic response is when the output is a function of time. The proper evaluation of functional data over an array of desired input parameters is critical to achieving a robust validation assessment of a simulation model. We extend the correlation analysis (CORA) objective rating system to validate functional data across experimental regions. Functional regression analysis is used to generate surrogate estimations of the system response functions at points within the region where experimental observations are absent. These CORA scores provide a measure of disagreement at each desired parameter configuration. An overall score for model validity is achieved using a weighted linear combination of the individual CORA scores. Finally, an improved CORA size scoring metric is introduced.

Influence of phase I duration on phase II V̇o2 kinetics parameter estimates in older and young adults

2011 ◽  
Vol 301 (1) ◽  
pp. R218-R224 ◽  
Author(s):  
Juan M. Murias ◽  
Matthew D. Spencer ◽  
John M. Kowalchuk ◽  
Donald H. Paterson
Keyword(s):  
Young Adults ◽  
Phase I ◽  
Phase Ii ◽  
Moderate Intensity ◽  
Parameter Estimates ◽  
Moderate Intensity Exercise ◽  
Kinetics Parameters ◽  
Exercise Transitions ◽  
The Individual ◽  
Kinetics Parameter

Older adults (O) may have a longer phase I pulmonary O2 uptake kinetics (V̇o2p) than young adults (Y); this may affect parameter estimates of phase II V̇o2p. Therefore, we sought to: 1) experimentally estimate the duration of phase I V̇o2p (EE phase I) in O and Y subjects during moderate-intensity exercise transitions; 2) examine the effects of selected phase I durations (i.e., different start times for modeling phase II) on parameter estimates of the phase II V̇o2p response; and 3) thereby determine whether slower phase II kinetics in O subjects represent a physiological difference or a by-product of fitting strategy. V̇o2p was measured breath-by-breath in 19 O (68 ± 6 yr; mean ± SD) and 19 Y (24 ± 5 yr) using a volume turbine and mass spectrometer. Phase I V̇o2p was longer in O (31 ± 4 s) than Y (20 ± 7 s) ( P < 0.05). In O, phase II τV̇o2p was larger ( P < 0.05) when fitting started at 15 s (49 ± 12 s) compared with fits starting at the individual EE phase I (43 ± 12 s), 25 s (42 ± 10 s), 35 s (42 ± 12 s), and 45 s (45 ± 15 s). In Y, τV̇o2p was not affected by the time at which phase II V̇o2p fitting started (τV̇o2p = 31 ± 7 s, 29 ± 9 s, 30 ± 10 s, 32 ± 11 s, and 30 ± 8 s for fittings starting at 15 s, 25 s, 35 s, 45 s, and EE phase I, respectively). Fitting from EE phase I, 25 s, or 35 s resulted in the smallest CI τV̇o2p in both O and Y. Thus, fitting phase II V̇o2p from (but not constrained to) 25 s or 35 s provides consistent estimates of V̇o2p kinetics parameters in Y and O, despite the longer phase I V̇o2p in O.

Stop the Bleed®: Medical Students as Instructors of the Bleeding Control Basics Course

2021 ◽  
pp. 000313482110111
Author(s):  
Kelsey M. Evans ◽  
Bryan Lake ◽  
Kelly M. Harrell ◽  
Shannon W. Longshore ◽  
Eric A. Toschlog ◽  
...  
Keyword(s):  
Medical Students ◽  
Phase I ◽  
Clinical Experience ◽  
Phase Ii ◽  
Analysis Of Covariance ◽  
First Year ◽  
Bleeding Control ◽  
The Public ◽  
Confounding Variables ◽  
Control Knowledge

Background The Bleeding Control Basics (B-Con) Course was developed to teach lifesaving hemorrhage control techniques to the public. Currently, medical students (MS) without prior clinical experience (CE) may not act as autonomous instructors, limiting the instructor pool. Purpose To assess the bleeding control knowledge of MS (phase I) and compare the knowledge of students taught by a certified instructor vs a medical student (phase II). Methods Phase I: 20 MS, 6 with prior CE and 14 without clinical experience (NCE) completed a pre-course and post-course knowledge assessment. Results were assessed by independent sample t-tests. Phase II: 91 first-year MS were taught the B-Con Course by either a third-year MS (n = 45) or certified instructor (n = 46). An analysis of covariance (ANCOVA) was performed to compare scores by instructor type (certified vs MS) using prior CE and pretest scores as confounding variables. Results In Phase I, the CE group scored higher on the pretest assessment compared to the NCE group ( P = .003). All students improved in posttest scoring, and there was no difference in posttest scores between the groups ( P = .597). In Phase II, despite no difference in pretest scores between groups, the MS taught learners scored significantly higher on the posttest compared to the certified instructor group ( P < .01). Prior CE did not correlate to posttest scores ( P = .719). Discussion Medical students are as effective as certified instructors at conveying the B-Con learning objectives. Based on near-perfect assimilation of content by students, MS should be permitted to teach B-Con Courses.

Betting Behavior in Sexually Homogeneous and Heterogeneous Groups

1974 ◽  
Vol 34 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Richard H. Bauer ◽  
James H. Turner
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Group Pressure ◽  
Group Condition ◽  
Heterogeneous Groups ◽  
Group Members ◽  
Betting Behavior ◽  
The Individual ◽  
Individual Condition

Groups of undergraduates, 4 males, 4 females, 3 males-1 female, or 3 females-1 male made bets in an individual condition (Phase I). One-half the groups were then transferred to a group condition in which Ss knew the bets of other group members and one-half continued to make bets in the individual condition (Phase II). In Phase I males were more risky than females. In Phase II Ss in the group condition were more risky than those in the individual condition and males were more risky than females in both the individual and group conditions. In the group condition males in all-male groups and with one female in the group shifted toward risk, but males with three females in the group shifted toward caution. In the group condition females in all-female groups were cautious, became slightly more risky with one male in the group, and showed a marked shift toward risk with three males in the group These results are similar to the Asch (1952) conformity studies and suggest that shifts toward risk or caution are due to conformity to group pressure.

scholarly journals Understanding the Los Angeles County Coronavirus Epidemic: The Critical Role of Intrahousehold Transmission

2020 ◽  
Author(s):  
Jeffrey E. Harris
Keyword(s):  
Los Angeles ◽  
Phase I ◽  
Phase Ii ◽  
Los Angeles County ◽  
Critical Role ◽  
Phase Iii ◽  
Strongly Correlated ◽  
The Individual ◽  
County Public Health

AbstractWe tracked the course of the COVID-19 epidemic among the approximately 300 communities comprising Los Angeles County. The epidemic, we found, had three distinct phases. During Phase I, from early March through about April 4, initial seeding of infection in relatively affluent areas was followed by radial geographic extension to adjoining communities. During Phase II, lasting until about July 11, COVID-19 cases continued to rise at a slower rate, and became increasingly concentrated in four geographic foci of infection across the county. Those communities with larger reductions in social mobility during April - as measured by the proportion of smartphones staying at home and number of smartphones visiting a gym - reported fewer COVID-19 cases in May. During Phase III, COVID-19 incidence only gradually declined, remaining as high as the incidence seen at the end of Phase I. Across communities, the prevalence of households at high risk for intergenerational transmission was strongly correlated with the persistence of continued COVID-19 propagation. This association was even stronger in those communities with a higher rate of gym attendance in Phase II. The map of the prevalence of at-risk households in Los Angeles County coincided strikingly with the map of cumulative COVID-19 incidence. These findings, taken together, support the critical role of household structure in the persistent propagation of COVID-19 infections in Los Angeles County. Public health policy needs to be reoriented from a focus on protecting the individual to a focus on protecting the household.

Bewegungstherapie und körperliche Aktivität bei Patienten mit Herzinsuffizienz

Praxis ◽  
2018 ◽  
Vol 107 (17-18) ◽  
pp. 951-958 ◽  
Author(s):  
Matthias Wilhelm
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Körperliche Aktivität ◽  
Phase Iii

Zusammenfassung. Herzinsuffizienz ist ein klinisches Syndrom mit unterschiedlichen Ätiologien und Phänotypen. Die überwachte Bewegungstherapie und individuelle körperliche Aktivität ist bei allen Formen eine Klasse-IA-Empfehlung in aktuellen Leitlinien. Eine Bewegungstherapie kann unmittelbar nach Stabilisierung einer akuten Herzinsuffizienz im Spital begonnen werden (Phase I). Sie kann nach Entlassung in einem stationären oder ambulanten Präventions- und Rehabilitationsprogramm fortgesetzt werden (Phase II). Typische Elemente sind Ausdauer-, Kraft- und Atemtraining. Die Kosten werden von der Krankenversicherung für drei bis sechs Monate übernommen. In erfahrenen Zentren können auch Patienten mit implantierten Defibrillatoren oder linksventrikulären Unterstützungssystemen trainieren. Wichtiges Ziel der Phase II ist neben muskulärer Rekonditionierung auch die Steigerung der Gesundheitskompetenz, um die Langzeit-Adhärenz bezüglich körperlicher Aktivität zu verbessern. In Phase III bieten Herzgruppen Unterstützung.

How to Make COVID-19 Contact Tracing Apps work: Insights from Behavioral Economics (Preprint)

2021 ◽  
Author(s):  
Ian Ayres ◽  
Alessandro Romano ◽  
Chiara Sotis
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Network Effects ◽  
Risky Behaviors ◽  
Contact Tracing ◽  
Risk Compensation ◽  
Main Function ◽  
Double Blind ◽  
Compensation Theory ◽  
Pros And Cons

BACKGROUND Due to network effects, Contact Tracing Apps (CTAs) are only effective if many people download them. However, the response to CTAs has been tepid. For example, in France less than 2 million people (roughly 3% of the population) downloaded the CTA. Consequently, CTAs need to be fundamentally rethought to increase their effectiveness. OBJECTIVE This study aimed to show that CTAs can still play a key role in containing the pandemic, provided that they take into account insights from behavioral sciences. Moreover, we study whether emphasizing the virtues of CTA to induce people to download them makes app users engage in more risky behaviors (risk compensation theory) and whether feedback on a user’s behavior affects future behaviors. METHODS We perform a double-blind online experiment (n=1500) divided in two phases. In Phase I respondents are randomly assigned to one of three different groups: Pros of the app, Pros and Cons of the app and Control I. Respondents in the Pros group were shown information on the advantages of CTAs. Participants in the Pros and Cons group were shown information on both the advantages and the problems that characterize CTAs. Last, respondents in the Control I group were not given any information on CTAs. All participants are then asked how worried they are about the pandemic, how likely they are to download the app, and on how they intend to behave (e.g. attend small and large gathering, wear a mask, etc.). A week later we carried out Phase II. Participants in Phase II were randomly assigned to different in-app notifications in which they were informed on how much risk they were taking compared to the average user. We then ask participants their intentions for future behaviors to investigate whether these notifications were effective in making respondents more prudent. RESULTS All 1500 participants completed phase I of the experiment, whereas 1303 (86.9%) completed also phase 2. The main findings are: i) informing people on the pros of the app make them less worried about the pandemic (p=.004), ii) informing people about both the pros and the cons of the app makes them more likely to download the app (p=.07); iii) carefully devised in-app notification induce people to state that they will: attend less large gatherings (p= .05) and less small gatherings (p= .001), see less people at risk (p=.004), that they stay more at home (p=.006) and wear more often the mask (p=.09). We do not find support for the risk-compensation theory. CONCLUSIONS we suggest that CTAs should be re-framed as Behavioral Feedback Apps (BFAs). The main function of BFAs would be providing users with information on how to minimize the risk of contracting COVID-19, e.g. to provide information on how crowded a store is likely to be at a given time of the day. Moreover, the BFA could have a rating system that allows users to flag stores that do not respect safety norms, such as mandating customers to wear a mask or not respecting social distancing. These functions can inform the behavior of app users, thus playing a key role in containing the spread of the virus even if a small percentage of people download the BFA. While effective contact tracing is impossible when only 3% of the population downloads the app, less risk taking by small portions of the population can produce large benefits. BFAs can be programmed so that users can also activate a tracing function akin to the one currently carried out by CTAs. Making contact tracing an ancillary, opt-in function might facilitate a wider acceptance of BFAs.

scholarly journals Analysis of the ex-vivo transformation of semen, saliva and urine as they dry out using ATR-FTIR spectroscopy and chemometric approach

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tanurup Das ◽  
Abhimanyu Harshey ◽  
Ankit Srivastava ◽  
Kriti Nigam ◽  
Vijay Kumar Yadav ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Body Fluids ◽  
Biochemical Changes ◽  
Partial Least Square ◽  
The Body ◽  
Slow Phase ◽  
Time Since Deposition ◽  
Dry Out

AbstractThe ex-vivo biochemical changes of different body fluids also referred as aging of fluids are potential marker for the estimation of Time since deposition. Infrared spectroscopy has great potential to reveal the biochemical changes in these fluids as previously reported by several researchers. The present study is focused to analyze the spectral changes in the ATR-FTIR spectra of three body fluids, commonly encountered in violent crimes i.e., semen, saliva, and urine as they dry out. The whole analytical timeline is divided into relatively slow phase I due to the major contribution of water and faster Phase II due to significant evaporation of water. Two spectral regions i.e., 3200–3400 cm−1 and 1600–1000 cm−1 are the major contributors to the spectra of these fluids. Several peaks in the spectral region between 1600 and 1000 cm−1 showed highly significant regression equation with a higher coefficient of determination values in Phase II in contrary to the slow passing Phase I. Principal component and Partial Least Square Regression analysis are the two chemometric tool used to estimate the time since deposition of the aforesaid fluids as they dry out. Additionally, this study potentially estimates the time since deposition of an offense from the aging of the body fluids at the early stages after its occurrence as well as works as the precursor for further studies on an extended timeframe.

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