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Concept: Completeness

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To summarise logistical aspects of recently completed systematic reviews that were registered in the International Prospective Register of Systematic Reviews (PROSPERO) registry to quantify the time and resources required to complete such projects.

Concepts: Medicine, Completeness, Logic, Windows Registry, Register, Steve Davis

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Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people’s preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record.

Concepts: Medicine, Medical ethics, Completeness, Metalogic, Consistency, Health care proxy, Advance health care directive, Five Wishes

28

BACKGROUND: The World Health Organization (WHO) Hand Hygiene Self-Assessment Framework (HHSAF) was conceived as a structured self-assessment tool to provide a situation analysis of hand hygiene resources, promotion and practices within healthcare facilities. AIM: To perform usability pretesting and reliability testing of the HHSAF. METHODS: The HHSAF draft was developed in consultation with experts to reflect key elements of the WHO Multimodal Hand Hygiene Improvement Strategy. Forty-two facilities were invited to pretest the draft HHSAF and complete a feedback survey. For reliability testing, two users in each facility completed the HHSAF independently. The reliability of each indicator, component subtotal and the overall score were estimated using the variance components model. After each phase, the tool was re-examined and modified as appropriate. FINDINGS: Twenty-seven indicators were selected during drafting. Twenty-six facilities in 19 countries completed pretesting (62% response rate), with total scores ranging from 35 to 480 (mean 262). The HHSAF took less than 2 h to complete for 21 facilities. Most agreed that the HHSAF was ‘easy to use’ (23/26) and ‘useful for establishing facility status with regard to hand hygiene promotion’ (24/26). Complete reliability responses were received from 41 facilities in 16 countries. Reliability for the total score for the HHSAF and the subtotal of each of the five components ranged from 0.54 to 0.86. Seven indicators had poor reliability; these were examined for potential flaws and modified accordingly. CONCLUSION: This process confirmed the usability and reliability of this tool for the promotion of hand hygiene in health care.

Concepts: Health care, Health, Completeness, Analysis of variance, World Health Organization, Hygiene, The Promotion, Reliability theory

26

Older adults (OAs) with mild cognitive impairment (MCI) are traditionally thought to have preservation of activities of daily living (ADLs). However, recent evidence suggests OAs with MCI may have difficulty completing ADLs and specifically instrumental ADLs (IADLs). The ADLs are frequently evaluated through self- or collateral report questionnaires, while performance-based measures are infrequently utilized, despite the decreased bias and increased accuracy and sensitivity associated with these instruments. This investigation compared ADLs between community-dwelling OAs with (n = 20) and without MCI (n = 30) using a self-report questionnaire (Older American Resources and Services Activities of Daily Living Scale; OARS), a collateral report questionnaire (OARS), and a performance-based measure (the Direct Assessment of Functional Status-Revised). Consistent with our hypothesis, OAs with MCI had decreased ADLs and IADLs on the performance-based measure compared to cognitively intact OAs, while there were no differences in ADLs or IADLs on self-report questionnaires or collateral report questionnaires. Our results suggest OAs with MCI have decreased ability to complete IADLs. However, this investigation suggests these deficits may not be detected by questionnaires and are more likely to be found with performance-based testing.

Concepts: Critical thinking, Completeness, Measurement, Cognition, Metalogic, Quantitative marketing research, Questionnaire, Evidence

24

Few eligible children participate in early intervention (EI) programs. The objective of this study was to determine feasibility and outcomes of a novel patient navigation program on EI referrals among a diverse group of at-risk children. During a 6-month period, a patient navigator was assigned to an urban pediatric clinic to engage families, provide education on early child development and EI, and assist families with completing multidisciplinary evaluations. Families were eligible to participate if they spoke English, had a child <34 months old with a suspected developmental delay, and were referred to EI for evaluation. Families completed measures of demographics, language preference, and the Newest Vital Sign, a validated literacy measure. Outcomes on completion of EI referrals were obtained from the county EI provider. Of 88 EI referrals during the study period, 53 patients were eligible and enrolled. Patients were predominantly male, racially diverse, on public health insurance, with a mean age of 18.4 months. Most caregivers of patients had less than a high school education, spoke a non-English language at home, and had limited literacy. Forty-2 families (79.2%) completed a referral, and 34 (81.0%) of those were eligible for EI services. There were no significant differences in demographic, language, or literacy measures between those who completed and did not complete EI referrals. A patient navigation program to facilitate EI referrals was feasible in a diverse urban patient population. Preliminary results of the patient navigation program on EI referral completion were promising and warrant further study. (PsycINFO Database Record

Concepts: Patient, Completeness, Hospital, Physician, Patience, Child, Developmental psychology, Human development

23

The aim of this study was to investigate whether advanced simulation parameters, such as simulation exam scores, number of student self-evaluations, time to complete the simulation, and time to complete self-evaluations, served as predictors of dental students' preclinical performance. Students from three consecutive classes (n=282) at one U.S. dental school completed advanced simulation training and exams within the first four months of their dental curriculum. The students then completed conventional preclinical instruction and exams in operative dentistry (OD) and fixed prosthodontics (FP) courses, taken during the first and second years of dental school, respectively. Two advanced simulation exam scores (ASES1 and ASES2) were tested as predictors of performance in the two preclinical courses based on final course grades. ASES1 and ASES2 were found to be predictors of OD and FP preclinical course grades. Other advanced simulation parameters were not significantly related to grades in the preclinical courses. These results highlight the value of an early psychomotor skills assessment in dentistry. Advanced simulation scores may allow early intervention in students' learning process and assist in efficient allocation of resources such as faculty coverage and tutor assignment.

Concepts: Completeness, Education, Skill, Learning, Resource allocation, Final examination, Prosthodontics, Fixed prosthodontics

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Third generation sequencing technologies provide the opportunity to improve genome assemblies by generating long reads spanning most repeat sequences. However, current analysis methods require substantial amounts of sequence data and computational resources to overcome the high error rates. Furthermore, they can only perform analysis after sequencing has completed, resulting in either over-sequencing, or in a low quality assembly due to under-sequencing. Here we present npScarf, which can scaffold and complete short read assemblies while the long read sequencing run is in progress. It reports assembly metrics in real-time so the sequencing run can be terminated once an assembly of sufficient quality is obtained. In assembling four bacterial and one eukaryotic genomes, we show that npScarf can construct more complete and accurate assemblies while requiring less sequencing data and computational resources than existing methods. Our approach offers a time- and resource-effective strategy for completing short read assemblies.

Concepts: DNA, Bacteria, Completeness, Organism, Sequence, Assembly language, Logic, Computational complexity theory

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The global response to HIV has started over 18 million persons on life-saving antiretroviral therapy (ART)-the vast majority in low- and middle-income countries (LMIC)-yet substantial gaps remain: up to 40% of persons living with HIV (PLHIV) know their status, while another 30% of those who enter care are inadequately retained after starting treatment. Identifying strategies to enhance use of treatment is urgently needed, but the conceptualization and specification of implementation interventions is not always complete. We sought to assess the completeness of intervention reporting in research to advance uptake of treatment for HIV globally.

Concepts: Antiretroviral drug, HIV, AIDS, Protease inhibitor, Viral load, Completeness, Intervention, Globalization

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Chronic living at altitudes ~2500m causes consistent hematological acclimatization in most, but not all, groups of athletes; however, responses of erythropoietin (EPO) and red cell mass to a given altitude show substantial individual variability. We hypothesized that athletes living at higher altitudes would experience greater improvements in sea level performance, secondary to greater hematological acclimatization, compared to athletes living at lower altitudes. After 4 weeks of group sea level training and testing, 48 collegiate distance runners (32M, 16W) were randomly assigned to one of four living altitudes (1780m, 2085m, 2454m, or 2800m). All athletes trained together daily at a common altitude from 1250m - 3000m following a modified Live High - Train Low model. Subjects completed hematological, metabolic, and performance measures at sea level, before and after altitude training; EPO was assessed at various time points while at altitude. Upon return from altitude, 3000m time trial performance was significantly improved in groups living at the middle two altitudes (2085m and 2454m) but not in groups living at 1780m and 2800m. EPO was significantly higher in all groups at 24h and 48h, but returned to sea level baseline after 72h in the 1780m group. Erythrocyte volume was significantly higher within all groups after return from altitude, and was not different between groups. These data suggest that when completing a 4 week altitude camp following the Live High - Train Low model, there is a target altitude between 2000m and 2500m that produces an optimal acclimatization response for sea level performance.

Concepts: Completeness, Red blood cell, Oceanography, Training, Metalogic, Ocean, Altitude sickness, Altimeter

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Rituals are found in all types of performance domains, from high-stakes athletics and military to the daily morning preparations of the working family. Yet despite their ubiquity and widespread importance for humans, we know very little of ritual’s causal basis and how (if at all) they facilitate goal-directed performance. Here, in a fully pre-registered pre/post experimental design, we examine a candidate proximal mechanism, the error-related negativity (ERN), in testing the prediction that ritual modulates neural performance-monitoring. Participants completed an arbitrary ritual-novel actions repeated at home over one week-followed by an executive function task in the lab during electroencephalographic (EEG) recording. Results revealed that relative to pre rounds, participants showed a reduced ERN in the post rounds, after completing the ritual in the lab. Despite a muted ERN, there was no evidence that the reduction in neural monitoring led to performance deficit (nor a performance improvement). Generally, the findings are consistent with the longstanding view that ritual buffers against uncertainty and anxiety. Our results indicate that ritual guides goal-directed performance by regulating the brain’s response to personal failure.

Concepts: Brain, Completeness, Human brain, Cognitive science, Electroencephalography, Experiment, Metalogic, Consistency