The primary purpose of this study was to describe the error in 61 healthy subjects' perceptions of weight-bearing at three target levels during bilateral upright stance. The secondary purpose was to describe the effects of age, sex, lower extremity dominance and target weightbearing level on the error in perceptions of weightbearing. Weightbearing was determined while subjects stood on digital scales. They adjusted their weight in an attempt to bear 25, 50, and 75% of their weight through a designated lower extremity. Three trials were allowed at each weightbearing target, and the results were averaged. Each subject's error in perception of weightbearing at each target level was determined by taking the absolute value of the target percent weightbearing minus the mean actual percent weightbearing. The mean errors at the 25, 50, and 75% targets were 7.3, 3.3, and 7.7%, respectively. The magnitude of the error was unrelated to age. An analysis of variance showed that error was not dependent on sex or whether the dominant lower extremity was used for making judgements. The error did differ between target levels. Clinicians cannot assume, based on the findings of this study, that individuals can accurately judge the percent weightbearing they are placing through one of their lower extremities during bilateral upright stance.
The purpose of this retrospective document analysis was to describe the association of age, function, and discharge disposition among 1055 patients (aged 60 years or more) who were referred for physical therapy over a 30-month period in an acute care hospital. Bed mobility, transfer, locomotion, and stair-climbing functions were described by the Functional Independence Measure system. Discharge disposition was described by a five-level ordinal scoring system (0 = death to 4 = home). Patients were assigned to orthopedic and other (nonorthopedic) groups. Age was associated significantly with both discharge disposition and functional scores. The correlations of age with function were higher for the orthopedic group than the other group. Functional scores had higher correlations with discharge disposition than did age. As function is potentially alterable, the findings of this study should be encouraging to professionals involved in the rehabilitation of hospitalized patients.
Abstract Background Competency based medical education has become the new standard for medical education which shifts the focus of training toward a competency, rather than time-based in framework known in Canada as ‘Competence by Design’ (CBD). CBD assesses a physician trainee’s ability to demonstrate competence in CanMEDS roles via entrustable professional activities (EPAs). EPAs utilize the O-SCORE as the metric for assessing competence. This score was developed and validated for surgical/procedural subspecialties; however, CBD currently coopts this scale for both procedural and non-procedural (cognitive) EPAs. Assessor expertise has also been shown to have an important role in performance assessments, but has not been studied in the context of CBD. Aims Our study aims to assess for differences in O-SCORE utilization between cognitive and procedural EPAs, and whether assessor characteristics are associated with trends in assessment. Methods Anonymized data for all Adult GI subspecialty EPAs completed from Jun 2019 to Jan 2023 at the University of Alberta was obtained. Evaluator sex, clinical vs academic practice, advanced training expertise, and EPA score was extracted. Locally a score of 5 denotes competence, while a 1-3 indicates competence was not yet achieved. A score of 4 may be accepted as evidence of competence (neutral score), at the discretion of the local competency committee. Data was analyzed via T-tests and ANOVA with post hoc Games-Howell testing with 95% confidence intervals (CI). A p-value of ampersand:003C0.05 was significant. Results 2264 EPAs were assessed including 1385 cognitive and 879 procedural EPAs. The number of EPAs completed by evaluators ranged from 11 to 165 with a mean of 60 (standard deviation: 40). Results of O-SCORE usage is summarized in Figure 1A-B. The majority of EPAs indicate competence, with 20-25% neutral, and ampersand:003C10% did not achieve competence. Less than one of third of evaluators utilized a score of 1 or 2 across all EPAs, and zero evaluators utilized a score of 1 for cognitive EPAs. Most commonly evaluators to utilized 3/5 options of the O-SCORE. Separated by EPA type, it was most common to utilize 2/5 and 4/5 options for cognitive and procedural EPAs respectively. Results of demographic comparisons are outlined if Figure 1C-E. Male and clinical evaluators submitted higher scores on average. Hepatologists submitted higher scores than all other advanced training areas for total, cognitive, and procedural EPAs. Conclusions Across total, cognitive, and procedural EPAs there are low rates in the utilization of the whole O-SCORE scale, and our study highlights a discrepancy between procedural and cognitive EPAs. In addition, there small but significant differences in the mean EPAs score awarded between different evaluator demographics (male, clinical, hepatologists providing higher scores). Figure 1. A) Number and proportion of Entrustable Professional Activities (EPA) stratified by type and competence evaluation. B) Number and proportion of Entrustable Professional Activities (EPA) stratified by type with scored 1-5 and percent (%) of staff utilizing each score stratified by EPA type C) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator sex and EPA type. D) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator academic vs clinical status and EPA type. E) Number, mean, and mean difference of Entrustable Professional Activities (EPA) stratified by evaluator advanced training and EPA type. CI: Confidence interval; SD: standard deviation; *: pampersand:003C0.05 Funding Agencies None
Background— This study was designed to investigate long-term effects of the glycoprotein IIb/IIIa inhibitor abciximab in patients with acute coronary syndrome without ST elevation who were not scheduled for coronary intervention. Methods and Results— A total of 7800 patients were included with an acute coronary syndrome without ST elevation, documented by either elevated cardiac troponin or transient or persistent ST-segment depression. They were randomized to abciximab bolus and 24-hour infusion, abciximab bolus and 48-hour infusion, or matching placebo. The overall 1-year mortality rate was 8.3% (649 patients). One-year mortality was 7.8% in the placebo group and 8.2% in the 24-hour and 9.0% in the 48-hour abciximab infusion group. Compared with placebo, the hazard ratio for the 24-hour infusion of abciximab was 1.1 (95% CI 0.86 to 1.29), and for the 48-hour infusion, it was 1.2 (95% CI 0.95 to 1.41). The lack of benefit of abciximab was observed in every subgroup studied. Patients with negative troponin or elevated C-reactive protein had a higher mortality rate after treatment with abciximab for 48 hours than with placebo: 8.5% versus 5.8% in those with negative troponin ( P =0.02), 16.3% versus 12.1% in those with elevated C-reactive protein ( P =0.04). Conclusions— Compared with placebo, abciximab did not provide any survival benefit at 1 year in patients admitted with an acute coronary syndrome with ST depression and/or elevated troponin who were not scheduled to undergo early coronary revascularization. In subgroups of patients, in particular those with low cardiac troponin or elevated C-reactive protein, abciximab was associated with excess mortality.
This retrospective analysis of 52 records of patients who had suffered a stroke was undertaken to describe the level of independence of the patients at floor-to-stand transfers and to identify factors related to that independence. Floor-to-stand and chair-to-mat transfers were graded using the Functional Independence Measure (FIM) scale. Independence at floor-to-stand transfers increased significantly over the course of rehabilitation. Patients, however, remained significantly less independent at floor-to-stand than at chair-to-mat transfers. Scores correlated significantly with length of stay but not with age or gender. The data retrieved and analyzed in this study suggest that independence in floor-to-stand transfers can be graded and trained in patients who have suffered a stroke.
The primary purpose of this study was to describe the error in 61 healthy subjects' perceptions of weight-bearing at three target levels during bilateral upright stance. The secondary purpose was to describe the effects of age, sex, lower extremity dominance and target weightbearing level on the error in perceptions of weightbearing. Weightbearing was determined while subjects stood on digital scales. They adjusted their weight in an attempt to bear 25, 50, and 75% of their weight through a designated lower extremity. Three trials were allowed at each weightbearing target, and the results were averaged. Each subject's error in perception of weightbearing at each target level was determined by taking the absolute value of the target percent weightbearing minus the mean actual percent weightbearing. The mean errors at the 25, 50, and 75% targets were 7.3, 3.3, and 7.7%, respectively. The magnitude of the error was unrelated to age. An analysis of variance showed that error was not dependent on sex or whether the dominant lower extremity was used for making judgements. The error did differ between target levels. Clinicians cannot assume, based on the findings of this study, that individuals can accurately judge the percent weightbearing they are placing through one of their lower extremities during bilateral upright stance.
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