9/29 Reading & Key in database

Reading:Interpreting rehabilitation outcome Measurement
Objective:with the increased use of Standardized outcome instrument (this article use AM-PAC dor example)in rehabilitation field,question frequently arise as to how to interpret the scores that are derived from these standardized outcome instruments.There are illustrate 4 different data analysis and presentation strategiesthan can used to yield meaning ful outcome.
1.Interpreting a single scale score :SEE, SD,CI,95%confidence band

2.interpreting clinical significance of score change :clinical significance(MCID), statistical significance(MDC,SD,SEM)

3.a percentile ranking method:PR(%)
4.a functional staging approach :IRT (MCID)

9/28 Renai branch clinical assessment & Discussion article

Mission:
1.Today finished 2 BIB.
2.Next MOnday & Tuesday morning will go there, afternoon will plan to go to NTUH.
3.Next Monday will contact to the MHH PT therapist


Discussion:
1.Likert Scale -Multipoint ratings scale:
Multipoint Ratings: use a linear scale to give responses on a gradual basis.

Likert Scale: multipoint ratings where strength of agreement is identified against a clear statement.
順序尺度：此尺度資料可表示事物間的等級或順序，但不能衡量不同等級間的距離。只有大小沒有距離，例如Likert五點計分量表所得數據，可能是１～５分，亦可能是-2～+2分，且若5>4，但5-4≠1。

9/27 Renai branch clinical assessment

Mission:
1.Today completed 4FAI,3BI&5BIB,but failure assessing 2 BIB because one p't have dizzy(HTN) another who are easy fatigue.They have just done one motion or position change such as sit -->lie down and pick up the pen in sitting balance.Next time will depend of his health condition.
2.Tomorrow will go to Renai branch in the morning.
3.phone to MHH's PT therapist to arrange next time assessment.

9/26 Renai branch clinical assessment

Mission:
1.today completed one assessment because some p't had forgotten the appointment!Next time remember to give him a slip of paper to remind him.
2.Tomorrow will go there for whole day to conpleted afternoon p't who can accept assessment.
3.Future plan: arrange time table for going three places such as NTUH,Renai Branch,MHH. May be i will arrange up to the number of the p't of Renai.

9/21 Renai Branch clinical assessment

Mission:
1.Future plan:next week i will go to NTUH on Friday afternoon,Wednesday noon will take lift,and Wednesday &Thursday &Friday morning will go to Renai branch.
2.Today completed 2FAI,1BI.


Question:
1.how i want to conclusion after assessed the FAI & BI to P't?

9/20 Taipei city hospital, Renai branch

i will have to take lift for one and half hours today afternoon.
Mission:
1.Today completed 2BIB,2FAI,1BI.
2.Today also had one p't reject to continue the BIB or BADL assessment.There are few reason of he rejected because he felt tired after testing Cognition assessment , he didnt have enough time to continue that he have to go to other treatment, and he felt boring on this kinds of assessment.He didnt finish listening my explaination,and he immediately said "No".

9/19 Taipei City Hospital,Renai Branch clinical assessment

9/18 typhonic vacation
9/19
Mission:
1.Future plan:After this week, begin next week i will arrange some time(may be i will go there in afternoon) go to NTUH.

2.Go to taipei city hospital,Renai branch for assess BI,FAI,ans most important is BIB.
3.Today i have completed 4 BIB,1 BI, 1 BADL.

Question:
BIB
1.Most of the p't couldn't squat down totally,or maintain the position for longly.Besides this, most of the p't can't complete the items after item 34-41
2.when p't in standing position, and need to pick up the pen up,but they always need to squat down.

9/17 仁愛醫院clinical assessment

Mission:
1.Today completed 3 papers of BI and 1 FAI
2.Tomorrow i will also go to 仁愛醫院.
3.Remind the therapists about the concern to the p't's inner feeling after the test.

Question:(FAI)
1.If the p't who have 小兒麻痺症（Poliomyelitis) and had stroke ,is he include in our protocol?If his disease not influenced by stroke,may be he can received.
2.And this p't is using wheelchair is the item of waliking outside>15mins &Driving car/bus travel,can i give him about NA. NA,his disability not affected by stroke,but is the Poliomyelitis.

9/14 仁愛醫院 clinical assessment

Mission:
1.today had completed 5 papers of BI
2.Next Monday also will go for whole day
3.I had already built 仁愛醫院's data base bank.
4.Plan: next Monday(9/17) also will go there for whole day!
5.Remember to console the idea of p't who had retest of cognition assessment
6.Console about p't feeling after taken the cognition assessment or we can get this information through their therapists.

Question:
1.If p't who have psychotic nerosis diseases eg.depression,and he also a stroke p't ,is that ok to accept them? I think that is ok for the psychotic syndrome didn't imfluence his cognition or representation.
特別註明在資料
2.For item 3(individual hygiene bathing):got one p't that his mother help him to tie up his hairs.Others activities he can completed by himslef.

9/13 仁愛醫院 clinical assessment

Question:
1.Because if we do too many assessment at p't, that will make the p't felt uncomfortable,tired or bother to continue finishing it.So the therepist of 仁愛醫院 suggested that my assessment will seprate for two times (15mins/per time)and continue do the assessment after the Cognition Assessment.Besides this, the cognition assessment also had taken so much time for assessed p't!
2.The p't who had already tested may be better to have a assessment again after 2 weeks later, that means may be they will forget about this matter,and their emotion will better than now .
3.The agreement still need to give them sign another one(mine one)?

Solution:
1.the suggestion of the therepist of 仁愛醫院,that will also make to gather the p't's data will decrease because their criteria more higher than mine!!!
2.Or i will go there on the other time for assess p't again!

Mission:
1.Tomorrow i will also go there for whole day!
2.Today completed 3 BI paper.


#Mr.周already had fixed the stream-cat server,below is the message that he gave me yesterday!
問題應該出在更改了Server的名字
以上供你參考

#仁愛醫院地址 : 台北市大安區仁愛路四段 10 號
公車：
1. 大安路口： 36,37,261,263,270,311 藍 ,621,630,仁愛 - 公車 ,仁愛 - 大有
2. 仁愛醫院： 41, 74, 204, 278
3. 仁愛國中： 33, 52, 275, 278, 285, 292, 626, 630

#捷運忠孝復興站右轉尊龍客運直走後到達福華飯店左轉就可以看到了!

9/12 clinical assessment

Mission:
1.Tomorrow or the next day will plan to go to 仁愛醫院! otherwise will also need to plan go to 榮總
2.contact to the 湘萍(薛老師's assistant),discuss about the plan
3.Completed 3 ADL assessment
4.Tomorrow(9/13) will go to 仁愛醫院 for whole day.

9/11 Clinical assessment

Mission:
1.Arrange the time go to MMH again.(about p't 's details and others thinngs)
2.contact with MMH PT therepist

9/10 Discussion & Key in data

Discussion:
Question:
1.BADL :
-->item 1:always will choke with water will give mark with 1 ,but not always will give it to 2? yes,of course
-->item 7,8,9,10 : if he just can't did one matter is the tie shoelaces, or unbutton. if p't is wear a shoe that have shoelaces or wear clothes
-->**compare the different ADL between before and after stroke!

2.IADL:
-->item 40 :健身跑步車 ,if their house didnt have such instrument, the can give it with NA or just put zero. NA
-->item 43,44: where did the housewife include in? in got job with salary or another one? In without salary blank or you can state it at blank.
-->item 18:if he come out with the 康護車,can i include in and give it one because he need medium assisst? NA
--> item 32,33,34 ,some p't have presbyopia 遠視眼;老花眼 or cataract 白內障 ,they couldn't reading ,is that we will give him zero or NA? That need to figure out that is this kind of disease influenced his/her ADL after stroke or not?If not ,NA.
--> If they will not do a activities recently,but he can do it ,may we give them 3?how to different the two kinds of this ? First, u just determine that p't didn't do this week, give zero. In other hand , we can ask him/her next week again same question! Second, you can use common sense to determine that he/she can do such activities!

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http://www.peboking.com/modules/booklists/viewcat.php?cid=180&min=0&orderby=titleA&show=15#class1616

9/7 MHH clinical

Mission:
1.check out the p't's diagnosis and other details such as the date of his/her went to Hospital and began the PT.
2.photocopy ADL assessment about 50 .
3.Today had assessed about 18.

Question:
1.BADL :
-->item 1:always will choke with water will give mark with 1 ,but not always will give it to 2?
-->item 7,8,9,10 : if he just can't did one matter is the tie shoelaces, or unbutton.


2.IADL:
-->item 40 :健身跑步車 ,if their house didnt have such instrument, the can give it with NA or just put zero.
-->item 43,44: where did the housewife include in? in got job with salary or another one?
-->item 18:if he come out with the 康護車,can i include in and give it one because he need medium assisst?
--> item 32,33,34 ,some p't have presbyopia 遠視眼;老花眼 or cataract 白內障 ,they couldn't reading ,is that we will give him zero or NA?
--> If they will not do a activities recently,but he can do it ,may we give them 3?how to different the two kinds of this ?

9/6 Reading &key in data

Improving Patient Reported Outcomes using item respone theory and computerized adaptive testing.
PRO (include physical function or disability,side effects,medical care costs, pain, and other content areas) are easier to administer and less expensive than physician-observed health status measures.But in this time, have a limitation of these standard measurement is pricision.Besides this, there also have a major limitation is the "one size fits all", that will makes a standard questionaire contain many items that are irrelevant and uninformative for the particular patient.
So we have planned to develop a comprehensive bank of questionaire items to measure the latent trait of interrest(e.g.,physical function/disability),use of a psychometric technique called item response theory(IRT) and use of computerized adaptive testing(CAT)to administer the items.
First step,the development of a comprehensive item bank -construct a domain hierarchy--from global constructs(health) to more specific domains(physical,mental ,and social health).

Clinical Question:
1.One p't had a history of old stroke(2007/7/3), but this time is due to left side weakness caused by his abdominal hit the bathroom closet and had a spleen hemorrhage.Besides, his left side motion more badly than first time and have sublaxution . Is this p't still can in clude in our data base again?The onset time of stroke are too close?
ANS: if he has other truama that will make more complicated,that will not include in.
2. Another p't has left caudate head infarct and residual AcomaA aneurysm, in the chart stated this p't right side weakness,but the p't complaint about left hand side and ring leg side have weakness.How i want to determine/compare about this two different information?
ANS: we need to examine her whether p't complaintment isn't right
3.If p't has wound in abdominal, then should the item of bathing will give it NA or zero! ANS :NA and check out the different kind of bathing, which one is the general one?(to take a sponge bath or use water bathing?)

Discussion:
1.rememner to prepare the papers(ADL) and clothes!
2.Ask the Mr.歐 what need to be caused when take assess to p't
3.Need to ask about he would like the data after asessment? If yes , we will give it(photocopies)
to him next week.
4.Arrange the next assessment time with him

9/5 clinical assessment

Question:
1. One p't who had Moyamoya disease with IVH and bilateral ischemic frontal stroke status post bilateralEC-IC bypass,but her upper extremities didn't have effect and just influence on her right lower extremities with weakness developed.This such case i had included into the item bank,did i do wrong?
ANS: That kind of case can include in our data bank, and write down the affected side is the right side.

2. One p't who is deaf and she also include as CVA,she can't heard and speak clearly,but she can understand what you talking; if i want to interview her , can i interview on her caregiver ?
ANS: yes, of course.But we need to comsider about how long the time is the caregiver has take care to the p't, it must more than half month,if we want to interview the item of IADL ! If we just interviewed with BADL ,and the caregiver was take care of her whole day,that's fine.
3. If i couldn't find out the inpatient ICF number from chart,where i can find in other ways? to outpatient is the only way i can do just lend the chart and look through it or the website of NTUH ,have any other ways to solve this problem?
ANS:There is only the way is,may have others efficient ways ,but need to disscuss with Angie.


Remind:
1.Remember to ask sir some information about MHH.
--what do i need to prepare like papers of assessment (BADL,BIB,Stream-CAT),PDA
##歐育志 0930669163 ---ADL

#Transportation to Taipei MMH :take the metro arrive at staion of ShuangLian,entrance one,turn left can see the Hi-life convenience store and turn to the right,go straight end of the corner ,then you will see the MHH on your left hand side.
Bus station:
C. 馬偕醫院站 - 226,518,42,46,613,紅1
D. 馬偕醫院站 - 42,209,518,紅1

9/4 clinical assessment(future plan)

Remind:
1. Next time use email or phone to early inform sir about take lift for one day ,not to use skype!
2.Future plan in MHH that i will arrange is Monday,TuesdayThursday whole day will be at MHH for collect the data,others day like Wednesday,and Friday will go to NTUH on morning.
#MHH (Whole day):Monday,TuesdayThursday
#NTUH(half or whole day):Wednesday, Friday morning or afternoon
@after two weeks may be i will reverse the arrangement ,is that suitable?
3.Because of take lift on Monday,so i will have come on Friday with whole day!
4.Friday(9/7) i will go to MHH whole day for clinical assessment,begin on 9AM.

Question:
1.If p't have bradykinesia, and he also include in CVA criterion,does he will include in our data bank?