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To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD). Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN). Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five. There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted.Implication for rehabilitationAssessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information.Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable.Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments.Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD. Assessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information. Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable. Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments. Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD.

Vragenlijsten duidelijker en toegankelijker maken?Maak gebruik van deze leidraad!De leidraad helpt u om in kaart te brengen hoe duidelijk de vragenlijst is die u wilt gebruiken.De leidraad biedt actiepunten om deze vragenlijst toegankelijk te maken, ook voor mensen diecommunicatiekwetsbaar zijn.Per actiepunt vindt u uitleg en tips zodat u deze kunt aanpakken.VerderMensen zijn communicatiekwetsbaar als ze moeite hebben met begrijpen.Mensen zijn ook communicatiekwetsbaar als ze zich moeilijk kunnen uiten.Iedereen is wel eens communicatiekwetsbaar in bepaalde situaties.

Background Ageing in place has recently gained visibility in healthcare policies and services. Technology has the potential to facilitate independence at home. The objective of this systematic review is to identify technologies that have been rigorously evaluated for supporting the ageing in place of healthy older adults. As well we explored the methods in engagement with technology in healthy older adults. Methods Databases Pubmed, Scopus, PsycInfo and Cinahl were consulted for clinical controlled trials or randomised controlled trials between 2014 and 2019. Studies were included if they contained a technological intervention and focussed on supporting healthy older adults’ independent living. PRISMA guidelines and the risk of bias tool of the Cochrane Collaboration were applied. Results The search identified 3662 articles of which only 7 made the final analysis. Through narrative analysis, technologies were categorised into three groups: accessible communication, emergency assistance and physical and mental well-being. Patient-centredness was extensively addressed by exploring how the participants engaged in the development and evaluation of the technology and how they were trained and monitored. Conclusions Literature concerning technology to support ageing, based on controlled trials and research performed in authentic home situations, is scarce. Thus, there is a need to investigate the subject in depth. The use of a neurofeedback headband, an accessible computer system, a wristband with pedometer, a biofeedback device and an online video platform can bring added value to ageing in place for healthy older adults. A patient-centred approach for developing, implementing and evaluating technology benefits ageing in place.

Additional file 1. Supplemental Data.

As drug delivery activity to outpatients in precarious situation is rising continuously, the goal of this work was to perform an assessment of the professional practices of the care pathway of these patients, called PASS in France (permanence d'acces aux soins de sante). At first, two pharmacists did an audit of this care pathway. Then, options for improvement were suggested and established after a multidisciplinary work with pharmacists, physicians and social workers of the relevant services. Finally, after six months, those actions and their impact were evaluated. Over a three-year period, the audit showed an increase by a factor of 1.77 of the average number of prescriptions provided per year. Over the same period, the number of dispensed lines was increased by 2.2 and the annual costs were multiplied per 1.82. The pharmacy department suggested several corrective actions: at first, initiating new schedules suited to the activity; then, making adjustments in the reception zone; but also, establishing two new specific prescriptions and 89 helps cards about the most frequently delivered medications. As a result, the time dedicated to drug delivery has been cut in half while the number of pharmaceutical actions remained constant. This assessment of the professional practices showed how hard it is to formalize a transversal circuit as the PASS in hospital. The actions established had improved the organization and the drug delivery activity in the pharmacy department.

Onderzoek en dienstverlening via het expertisecentrum 'onderwijsinnovatie' in de periode 2016-2019 werden volgende onderzoeksprojecten uitgevoerd: - High impact learning: opleiden in flexibele en uitdagende leeromgevingen - Innovatieve en differentiërende houding - Blend - Diverse leraarskamer - Quid Pro Quo: naar een kwaliteitsvolle lerarenopleiding voor M/V met talent - Didactische taalondersteuning voor zaakvakleerkrachten met ex-OKAN-leerlingen in de klas - Context is the key - op weg naar een taalsterk vrijetijdsaanbod voor anderstalige lagereschoolkinderen - Design@school: STEM-didactiek en STEM-effectiviteit in de overgang van basis- naar secundair onderwijs - Wiskunde & computationeel denken via een STEM aanpak status: published

The objective is to systematically review the psychometric properties and the clinical utility of patient-reported outcome measures (PROMs) and proxy-reported outcome measures that assess health-related quality of life (HRQoL) among patients receiving enteral feeding to make recommendations for use in clinical practice and research. The purpose of this systematic review is to evaluate the psychometric properties and the clinical utility of:The research question is: What are the psychometric properties and the clinical utility of these measures? We will summarize evidence on the following properties: validity (content validity, criterion-related validity, construct validity, floor and ceiling effects), reliability (reproducibility and internal consistency) and responsiveness and clinical utility (interpretability and feasibility to complete the PROM and the proxy-reported outcome measure).

Background The aim of this study was to investigate the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech pathologists, to become part of a comprehensive clinical swallowing examination. Methods A multicentre study in 132 elderly subjects was conducted by speech pathologists. The inter-rater, test–retest and intra-rater reliabilities of the OHAT were assessed in R statistics, version 3.0.1. Intraclass correlation coefficients (ICCs) were used for the total OHAT, and Kappa statistics were used for the individual categories. Results Total OHAT scores showed good inter-rater (ICC = 0.96), intra-rater (ICC ≥ 0.95) and test–retest (ICC ≥ 0.78) agreement. The inter-rater Kappa statistics were almost perfect (κ ≥ 0.83) for seven of the eight individual categories of the OHAT and perfect for ‘dental pain’ (κ = 1.00). The test–retest Kappa statistics indicated excellent agreement for ‘natural teeth’ and ‘dentures’ (κ ≥ 0.86). The intra-rater per cent agreement was excellent for all categories except ‘gums and tissues’. Conclusions This is the first study to examine the feasibility and reliability of the OHAT as used by speech pathologists. As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. However, future research investigating actual referral strategies and adaptation of care strategies following assessment with OHAT is needed.

Representation of the 5-point response categories for the different subscales of the aDSWAL-QoL. These pictures demonstrate how the 5-point response categories for the different subscales are presented in the aDSWAL-QoL with respect to the real size. Note that the translation of the response format into English can slightly deviate from the formulation in the Flemish language. (DOCX 149Â kb)

Scoring structure after the adjustments as suggested by the Rasch model. (DOCX 22Â kb)

The Swallowing Quality-of-Life questionnaire (SWAL-QoL) is considered the gold standard for assessing health-related quality of life in people with dysphagia. However, many dysphagic patients struggle to complete this questionnaire because of additional functional sequelae such as language impairment and cognitive disorders. In this study, we sought to develop an adjusted Dutch version of the SWAL-QoL (aDSWALQoL) and to evaluate its psychometric properties and feasibility compared with the original questionnaire. We developed the aDSWAL-QoL based on recommendations from previous literature. The feasibility, internal consistency, testretest reliability, and criterion validity of the aDSWAL-QoL were evaluated in 78 dysphagic patients, among whom 43 had additional language and/or cognitive impairments (DysLC). Statistical analyses were performed using SPSS 20.0. The aDSWAL-QoL had a higher degree of feasibility for the DysLC group. We obtained high Cronbachs α coefficients for total scale and for almost all subscales. Total aDSWAL-QoL scores showed excellent testretest agreement and good criterion validity with respect to the DSWAL-QoL. Almost all subscales showed significantly moderate to good testretest agreement and criterion validity. However, the psychometric properties of the Food selection subscale were inadequate. The aDSWAL-QoL is a feasible, reliable, and valid tool for use with DysLC patients. Conversion of the aDSWAL-QoL into an audio computer-assisted self-administered format should be investigated. The construct validity of the aDSWAL-QoL will be evaluated in a separate report.

As drug delivery activity to outpatients in precarious situation is rising continuously, the goal of this work was to perform an assessment of the professional practices of the care pathway of these patients, called PASS in France (permanence d'accès aux soins de santé). At first, two pharmacists did an audit of this care pathway. Then, options for improvement were suggested and established after a multidisciplinary work with pharmacists, physicians and social workers of the relevant services. Finally, after six months, those actions and their impact were evaluated. Over a three-year period, the audit showed an increase by a factor of 1.77 of the average number of prescriptions provided per year. Over the same period, the number of dispensed lines was increased by 2.2 and the annual costs were multiplied per 1.82. The pharmacy department suggested several corrective actions: at first, initiating new schedules suited to the activity; then, making adjustments in the reception zone; but also, establishing two new specific prescriptions and 89 helps cards about the most frequently delivered medications. As a result, the time dedicated to drug delivery has been cut in half while the number of pharmaceutical actions remained constant. This assessment of the professional practices showed how hard it is to formalize a transversal circuit as the PASS in hospital. The actions established had improved the organization and the drug delivery activity in the pharmacy department.

Introduction. Respiratory cancer and its treatment are known to contribute to muscle weakness and functional impairment.Aim. To assess the effects of rehabilitation in patients with respiratory cancer.Methods. Radically treated respiratory cancer patients were included in a 12-week multidisciplinary rehabilitation program.Results. 16 patients (age: 61 ± 7 years; FEV1: 57 ± 16% pred.) showed a reduced exercise tolerance (VO2max: 56 ± 15% pred.; 6 MWD: 67 ± 11% pred.), muscle force (PImax: 54 ± 22% pred.; QF: 67 ± 16% pred.), and quality of life (CRDQd: 17 ± 5 points; CRDQf: 16 ± 5 points). Exercise tolerance, muscle force, and quality of life improved significantly after rehabilitation.Conclusion. Radically treated patients with respiratory cancer have a decreased exercise capacity, muscle force, and quality of life. 12 weeks of rehabilitation leads to a significant improvement in exercise capacity, respiratory muscle force, and quality of life.

INTRODUCTION: Magnetic Resonance enterography (MRE) is an imaging modality avoiding ionizing radiation and the discomfort associated with enteroclysis. The results of MRE at diagnosis in the patients of the Belgian pediatric Crohn registry (Belcro) are compared to endoscopical and histological results. METHODS: Results of MRE, endoscopy and histology were obtained from the medical charts and assigned to one of the following segments: jejunum, ileum, ascending colon, transverse colon, descending colon or rectosigmoid. MRE images were reviewed in a blinded way by 4 radiologists with specific interest in pediatric MRE. RESULTS: From the Belcro registry, twenty-two patients underwent a MRE during their work-up for Crohn disease. The results of endoscopy, histology and MRE were concordant (either all negative or positive) in the ileum in 16/18 patients and in the rectosigmoid, descending colon, transverse colon and ascending colon in resp 9, 8, 8 and 8/22 patients. In the non-concordantcases (MRE colon negative but endoscopy and/or histology positive), MRE could not reflect the subtle endoscopic or histologic lesions such as erosions that were described.In 4 cases where ileocaecal valve intubation was impossible ileal MRE findings were abnormal. MRE detected ileal stenosis, jejunal lesions and fistula in resp 4/22, 3/22 en 2/22 patients. The 100% and 75% interobserver agreement was resp 50-82% and 773-100% according to the different intestinal segments. CONCLUSIONS: MRE is a promising imaging modality avoiding radiation in Crohn disease. It should probably become the technique of first choice for the evaluation of extensive small bowel disease in children with Crohn disease.

In many situations, both deterministic and probabilistic, one is interested in measure theory in local behaviours, for example in local dimensions, local entropies or local Lyapunov exponents. It has been relevant to study dynamical systems, since the study of multifractal can be further developed for a large class of measures invariant under some map, particularly when there exist strange attractors or repelers (hyperbolic case). Multifractal refers to a notion of size, which emphasizes the local variations of the weight of a measure, of the entropy or the Lyapunov exponents. All these notions are explicited in the case of digraph recursive fractal studied by Edgar & Mauldin where some questions are given. We study the extremal measures and introduce the notion of multi-multifractality which may be useful in problems of rigidity.

In measure theory, one is interested in local behaviours, for example in local dimensions, local entropies or local Lyapunov exponents. It has been relevant to study dynamical systems where one can develop further the study of multifractal and multi-multifractal, particularly when there exist strange attractors or repellers. Multifractal and multi-multifractal refer to a notion of size, which emphasizes the local variations of different values coming from the theory of dynamical systems and generated by the dimension theory of invariant measures. This paper gives some part of the literature in this field. Many results are already known, but the large deviations approach allows us to reprove these results and to obtain quite easily results concerning extremal points and extremal measures.

We analyse the multifractal properties of Gibbs measures and Markov type measures defined on the complementary set of the Appolonian tiling of the plane into circles or into spheres in higher dimension. Multifractal refers to a notion of size that involves the variations of the weight of the measures. We associate thermodynamical quantities such as free energy functions with partitions of exponentially decreasing diameters, and prove some regularity. Finally we introduce the correlation dimension which refers to a quantity that is the most accessible in numerical computations.

Repetitieve transcraniële magnetische stimulatie of rTMS is een non-invasieve techniek voor hersenstimulatie die reeds in AZ Sint Jan Brugge Oostende AV wordt aangewend als therapeutische toepassing bij de rehabilitatie van afasiepatiënten. Om het therapeutisch effect van deze behandeling te kunnen meten is een specifiek evaluatie-instrument ontwikkeld om de invloed van een rTMS behandeling op de diverse taalaspecten in kaart te brengen.Dit evaluatie-instrument is tot stand gekomen door middel van een meta-analyse en een identificatie en aanvulling van hiaten in het onderzoeksprotocol dat wordt aangewend in de internationale literatuur. Uit de resultaten van de meta-analyse blijkt dat rTMS vooral een positieve evolutie teweeg brengt op vlak van benoemen en vloeiendheid. Ook spontane spraak en opdrachtbegrip laten een vooruitgang zien. Ten slotte wordt de opbouw van het evaluatie-instrument besproken en gemotiveerd. ispartof: Logopedie vol:26 issue:5 pages:22-29 status: published

We calculate the value of teh average of the singularities of a Gibbs measure μ invariant with respect to an expansiveC2 diffeomorphism of a one-compact manifold. This is the value related to dimension that one computes numerically. We then define and study a function, known as the correlation dimension, which is related to a free energy function, and we generalize the results in higher dimension with an axiomA transformation acting on a two-compact manifold.

We analyse the multifractal decomposition of a measure defined on a general Sierpinski carpet. We compute the dimension spectrum f(α) and we show that this function is real-analytic on a certain domain when it is not degenerated. Actually, we prove that f is the Legendre-Fenchel transformation of a free energy function F which is also real-analytic. These two functions have the typical behaviours. In particular, F is strictly increasing and is in general strictly concave (respectively linear in the degenerate case), and f, on its domain, has a typical shape of a strictly concave function (respectively defined in one point in the degenerate case). We associate also to the singularity sets Cα measures which are singular with respect to each other, and we see that these measures are very well fitted to these singularity sets. This work completes with (D. Simpelaere, Chaos, Solitons and Fractals 4(12), 2223–2235 (1994)) the study of the multifractal analysis of the Sierpinski carpets.

We compute the correlation dimension of a measure defined on a general Sierpinski carpet. We relate this function to a free energy function associated to a partition composed of ‘nearly squares’ and well fitted to the planar Cantor set. Actually, we prove that these functions are real analytic on R , are strictly increasing and are strictly concave (respectively linear in the degenerate case). This is an example of a two-dimensional dynamical system contracting in the two directions with different ratios. We first study measures of Gibbsian type before generalizing to Markovian measures.

We compute the limit distribution of the recurrence and of the normalizedk th return times to small sets of the Sierpinski carpet with respect to a natural measure defined on it. It is proved that this dynamical system follows the Poisson law, as one could have expected for such schemes. We study different sequences which converge in finite distribution to the Poisson point process. This limit in law is very interesting in ergodic theory, and it seems to appear for chaotic dynamical systems such as the one we study.

We compute the dimension spectrum f(ct) of the singularity sets of the BowenMargulis measure defined on a two-dimensional compact manifold and invariant with respect to a C 2 Axiom A diffeomorphism. It is proved that f is the Legendre-Fenchel transform of a free energy function which is real analytic (linear in the degenerate case). The function f is also real analytic on its definition domain (defined in one point in the degenerate case) and is related to the Hausdorff dimensions of Gibbs measures singular with respect to each other and whose supports are the singularity sets, and we decompose these sets.

Video-endoscopic surgical treatment of the fetus may, in the future, become an alternative to open fetal operation. Six 95-day-old fetal lambs were examined through intrauterine endoscopy using amnioinfusion and specially designed balloon-tipped cannulas. The fetuses were monitored endoscopically for oxygen saturation, heart rate and temperature throughout the procedure. With a rigid 5 millimeter telescope and a flexible 3 millimeter endoscope, the respiratory and upper gastrointestinal tracts could be examined. No mucosal or other trauma was noted upon completion of the endoscopy; all lambs survived the procedure. While the applications of fetal endosurgery are likely to be similar to those of open fetal operation, fetal endoscopy (looking in the fetus) is a new entity for which clinical relevance (rather than mere feasibility) remains to be demonstrated. This technique, however, could become a valuable research tool to study fetal gastrointestinal and pulmonary physiologic factors in situ.