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Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Initial and ongoing competency evaluation of RDNs is essential to ensure that safe and effective patient care is provided, and to satisfy the verification of skills required by healthcare accreditation and regulatory agencies. Competency is defined as “the knowledge, skills, ability and behaviors that a person possesses in order to perform skills correctly and skillfully”.24 Evaluating the RDN’s initial hands-on NFPE skills should be part of a comprehensive competency assessment, and it is critical to re-assess competence at regular intervals to maintain and improve their skills. A focus-group study among NFPE experts in 2021 suggested that the NFPE competency evaluation should be conducted annually and is best administered by the RDN’s direct supervisor, provided that the supervisor is also competent to perform an NFPE. If time is an issue, the NFPE experts agreed that at a minimum alternate-year evaluation should be considered.25
Haematological system
Published in Pankaj Desai, Pre-eclampsia, 2020
Studies by Kelton et al. could be a pointer to this phenomenon of competence.7 Rise in bleeding time in absence of significant fall in circulating levels of thrombocytes indicates that in the presence of pre-eclampsia the competence of platelets gets compromised. As a result, their levels on haematological investigations do not reduce, but bleeding time increases. This concept of competency evaluation and competence alteration opens up many exciting possibilities of understanding disease processes and their laboratory parameters in a totally different light.
The Dementia Workup
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Neuropsychological (NP) testing consists of the administration of a series of tests by a trained examiner to measure both the qualitative and quantitative aspects of a variety of cognitive skills. It builds on the mental status examination by providing greater detail across a broader range of cognitive domains. NP testing helps to characterize the patient's existing cognitive strengths and weaknesses, and it then correlates them with other aspects of brain structure and function. The resulting picture enables the clinician to construct the best possible diagnostic picture, and it provides a baseline against which the dementia can be tracked. The results also provide information on the individual's functional capacity in order to understand how his or her cognitive changes affect daily activities. This information can help the clinician sculpt the appropriate treatment interventions, including cognitive rehabilitation, counseling and psychotherapy, psychopharmacotherapy, and therapeutic activities. NP testing may also be part of a competency evaluation conducted to determine an individual's decision-making capacity.
The MacCAT-CA and the ECST-R in Competency to Stand Trial Evaluations: A Critical Review and Practical Implications
Published in Journal of Personality Assessment, 2022
Jaime L. Anderson, Jake Plantz, Sabine Glocker, Patricia A. Zapf
In concluding this review, we now offer a practical discussion regarding the use of these instruments in competency evaluation. The empirical evidence reviewed above for the ECST-R and the MacCAT-CA indicates that these instruments have established psychometric properties that provide evidence of their scientific reliability and for which error rates can be calculated. In addition, each has been the subject of peer review and, as an evaluation procedure, has been generally accepted by the relevant scientific community as indicated by a review of available literature and case law on competency evaluation. Thus, in and of themselves, these two instruments appear to meet the admissibility requirements outlined in Daubert v. Merrell Dow Pharmaceuticals, Inc. (1993). Further, there is limited case law to suggest clinicians should have concern about facing admissibility challenges related to their use and we have discussed some potential points that may be the subject of cross-examination. However, it is important to consider the role of these instruments within the broader context of competency evaluation to understand their utility.
Legal Admissibility of the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR)
Published in Journal of Personality Assessment, 2022
Mary E. Wood, Kimberly P. Brown, Amanda R. Bitting, Christopher Slobogin, Brooke Bowerman
It is also worth considering the value of an instrument that is designed and normed for a narrow subset of individuals (i.e., defendants with ID). Broadly speaking, the relative comparison that is of most interest to the court in a competency evaluation is not how the defendant compares to other defendants with ID, but instead how their performance falls in relation to a representative population of defendants. In other words, understanding how a defendant performs relative to other defendants with ID is of minimal value for the court in determining a defendant’s competency. Instead, the inquiry should center on how the defendant compares to other defendants, both competent and incompetent. The validity of these concerns is supported by prior studies that suggest poor convergence between the CAST-MR and the MacCAT-CA (i.e., suggesting these two competence assessment instruments are measuring the construct differently in this population), but that also find a difference between defendants with and without ID, regardless of competency (i.e., suggesting the CAST-MR may be measuring something other than competence alone). Indeed, if the CAST-MR is truly assessing competence-related abilities, competent defendants with and without ID should theoretically score similarly, which is not the case. Instead, these data suggest that scores on the CAST-MR may reflect some other deficit specific to ID, meaning that lower scores on the instrument may not entirely correspond to the competence-related deficits it was intended to measure. Further research is needed to clarify this issue.
Quality Management of Prehospital Pediatric Respiratory Distress and Airway Programs: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Maria Mandt, Matthew Harris, John Lyng, Brian Moore, Toni Gross, Marianne Gausche-Hill, J. Joelle Donofrio-Odmann
If pediatric endotracheal intubation is part of an agency’s approved clinician scope of practice, we recommend conducting competency maintenance activities on a quarterly basis. These sessions should include not only psychomotor practice, but also educational content to improve topic-focused knowledge and understanding, and cognitive decision-making processes. When developing competency evaluation and maintenance programs, it is important to view airway and respiratory management as a cognitive process, rather than as a group of discrete psychomotor skills. Ultimately, multiple teaching methods and training modalities should be used to establish and maintain clinician competency, as when these are coupled with a robust quality management program, improvements in EMS clinician airway skill performance can be realized (44).