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Clinical assessment schedule (CLAS) is a core part of the ICF-based implementation of functioning reporting across health conditions and along the continuum of care.
The Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists (UEMS PRM) workshop held in January 2016 aimed to develop and specify a CLAS within the context of rehabilitation services.
UEMS PRM Workshop in Nottwil, Switzerland, January 2016.PRM physicians representatives from 12 European countries, as well as Israel and Japan, mostly delegates of UEMS PRM Section and Board, and experts with other rehabilitation professional backgrounds.Participants were divided into 6 working groups and asked to specify what functioning aspects would be essential to document using the available ICF sets for the identified rehabilitation services contained in the newly developed service classification (ICSO-R): acute, post-acute and long-term rehabilitation services.
The 7 ICF Generic and 23 Rehabilitation Set categories were confirmed as well as specific health condition categories for acute rehabilitation services (mobile team), for postacute rehabilitation services (general outpatient rehabilitation, musculoskeletal and neurological rehabilitation, as well as specialized SCI rehabilitation), and for long-term rehabilitation services (day clinic and rehabilitation provided in the community). While general principles of the CLAS were defined, the need to align the CLAS for a specific service, as well as across services along the continuum of care was highlighted.
All groups deliberated on this topic; however, no conclusive statement was presented yet.The groups recognized a need for a systematic effort to identify data collection tools currently used.CLASs will serve in the future to ensure that functioning information is systematically and consistently collected across services, and thus respond also to various global reports and initiatives which stress the need for improving data collection on people's functioning.
As part of international efforts to develop and implement national models including the specification of ICF-based clinical data collection tools, the Italian rehabilitation community initiated a project to develop simple, intuitive descriptions of the ICF Rehabilitation Set, highlighting the core concept of each category in user-friendly language.
This paper outlines the Italian experience in developing simple, intuitive descriptions of the ICF Rehabilitation Set as an ICF-based clinical data collection tool for Italy.Consensus process.Expert conference.
Multidisciplinary group of rehabilitation professionals.The first of a two-stage consensus process involved developing an initial proposal for simple, intuitive descriptions of each ICF Rehabilitation Set category based on descriptions generated in a similar process in China.
Stage two involved a consensus conference. Divided into three working groups, participants discussed and voted (vote A) whether the initially proposed descriptions of each ICF Rehabilitation Set category was simple and intuitive enough for use in daily practice.
Afterwards the categories with descriptions considered ambiguous i.e. not simple and intuitive enough, were divided among the working groups, who were asked to propose a new description for the allocated categories. These proposals were then voted (vote B) on in a plenary session.
The last step of the consensus conference required each working group to develop a new proposal for each and the same categories with descriptions still considered ambiguous.
Participants then voted (final vote) for which of the three proposed descriptions they preferred.Nineteen clinicians from diverse rehabilitation disciplines from various regions of Italy participated in the consensus process. Three ICF categories already achieved consensus in vote A, while 20 ICF categories were accepted in vote B.
The remaining 7 categories were decided in the final vote.The findings were discussed in light of current efforts toward developing strategies for ICF implementation, specifically for the application of an ICF-based clinical data collection tool, not only for Italy but also for the rest of Europe.
Promising as minimal standards for monitoring the impact of interventions and for standardized reporting of functioning as a relevant outcome in rehabilitation.
Background: The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization’s standard for describing health and health-related states. Examples of how the ICF has been used in Electronic Health Records (EHRs) have not been systematically summarized and described yet.
Objectives: To provide a systematic review of peer-reviewed literature about the ICF’s use in EHRs, including related challenges and benefits.
Methods: Peer-reviewed literature, published between January 2001 and July 2015 was retrieved from Medline®, CINAHL®, Scopus®, and ProQuest® Social Sciences using search terms related to ICF and EHR concepts. Publications were categorized according to three groups: Requirement specification, development and implementation. Information extraction was conducted according to a qualitative content analysis method, deductively informed by the evaluation framework for Health Information Systems: Human, Organization and Technology-fit (HOT-fit).
Results: Of 325 retrieved articles, 17 publications were included; 4 were categorized as requirement specification, 7 as development, and 6 as implementation publications. Information regarding the HOT-fit evaluation framework was summarized. Main benefits of using the ICF in EHRs were its unique comprehensive perspective on health and its interdisciplinary focus.
Main challenges included the fact that the ICF is not structured as a formal terminology as well as the need for a reduced number of ICF codes for more feasible and practical use.
Conclusion: Different approaches and technical solutions exist for integrating the ICF in EHRs, such as combining the ICF with other existing standards for EHR or selecting ICF codes with natural language processing.
Though the use of the ICF in EHRs is beneficial as this review revealed, the ICF could profit from further improvements such as formalizing the knowledge representation in the ICF to support and enhance interoperability.
The classical results of the binomial and negative binomial probability distribution are generalized by means of homogeneous Discrete Time Markov Chains to series of stochastically independent random trials. These have not only two possible outcomes but two groups of them -- different kinds of successes and failures with occurrence probabilities depending on the outcome of the previous trial. This generalization allows a uniform view of occupation time, first passage time and recurrence time. Our results are consequently derived and presented in matrix form, the probabilities as well as the moments. They can be applied to all Discrete Time Markov Chains, especially in computer capacity planning, performability and economics.
This paper concerns the development and validation of Finite Element Methods (FEM) to simulate the dynamic response of a dowelled-joist timber floor. This is a solid floor comprised of timber joists connected using timber dowels with individual assemblies connected using inclined metal screws. The focus is on the structural dynamics in the low-frequency range up to 200 Hz which is the relevant range for impact sound insulation and vibration serviceability. Dowel connections between the joists that formed each assembly were modelled using either rigid or spring connectors in the FEM models. The validation against experimental modal analysis showed that both approaches were valid in terms of the eigenfrequencies, Modal Assurance Criterion (MAC) and the spatial-average velocity with point excitation. Whilst the FEM model with spring connectors had a higher number of correlated modes in the MAC analysis, this required removal of many spurious modes before predicting the response. The validated models were used to demonstrate the potential in predicting assessment parameters for vibration serviceability that are contained in EN 1995-1-1 (Eurocode 5). This predictive approach to the evaluation of vibration serviceability has the advantage in that it can be used for non-standard timber floors with non-standard boundary conditions or floor plans.
Due to the application of elastic interlayers for acoustic decoupling, wood screws to connect timber elements are stressed beneath axial and shear loads additionally by a bending moment. The equations to calculate the load carrying capacity of wood-wood-connections according to the Eurocode 5, lose their validity in case of application of interlayers with low shear resistance. Furthermore, the increasing flexibilities of the joints should be considered for a realistic static modelling.
Aim of the present work is to analyze the mechanical load bearing characteristics of wall-ceiling-connections of cross laminated timber with and without elastic interlayers. On the basis of experiments as well as analytical approaches, the load-deformation-behavior is discussed and contrasted to the current standards.
Background
acquired joint contractures have significant effects on quality of life and functioning.
Objective
to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures.
Methods
systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal.
Results
seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed.
Conclusion
the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes.
Wooden building systems, including cross-laminated timber elements, are becoming more common. The last few years have seen new developments and documentation of innovative types of cross-laminated timber floor assemblies. Regarding impact sound associated to walking persons, running or jumping children, such floor assemblies can be regarded as a weak part. So far, there are no reliable standardized calculation models available, for prediction of impact sound in the entire frequency range. Therefore the design is always based upon previous experiences and available measurements. This article presents the results of a number of well controlled sound insulation measurements of cross-laminated timber/massive wood floor constructions conducted in laboratories. The collection of data and results analysis highlight some basic phenomena. For instance, how structural differences related to the grouping of the constructions change the frequency distribution of the impact sound level and the single number quantities. Another significant result is the influence of the dynamic stiffness of the resilient interlayer of floating floor systems and the mass per unit area of the floors. Based on this analysis, the aim is to identify similarities and carry out simplifications. The data will be further processed and used in the development of prediction models and optimization process of cross-laminated timber floor assemblies.
In this methodological note on applying the ICF in rehabilitation, we introduce suitable tools that allow us to document comprehensively and systematically the lived experience of health to guide clinical practice, the management of services, evidence-informed policy and scientific inquiry.
The objective of this methodological note is to present the currently available tools with respect to four questions: 1) what ICF domains to document; 2) what perspective to take; 3) what data collection tools to apply; and 4) which approach to use for reporting. The application of these tools is illustrated using the Swiss Spinal Cord Injury (SwiSCI) Cohort Study.
Existing ICF Sets provide a practical approach for identifying the domains to document. One can document from the perspective of biological health, lived health, and appraised health. For identifying suitable data collection tools, either existing tools can be linked to the ICF or available ICF-based data collection tools can be used.
For reporting, an interval scale metric is suggested. The four step approach presented provides users with a logical sequence to follow when planning the documentation of functioning using the ICF as a health information reference system in practice and research.