Faculty Bibliography

Nurses and physicians share responsibility for improving quality and safety in healthcare systems, arguing for shared learning about these concepts. This module contains materials to conduct the first of two modules on quality improvement principles with medical and nursing students. The module uses the Team-Based Learning method, and assumes that users are familiar with Team-Based Learning terminology and procedures. Included in this resource are a suggested timeline, student preparation assignment, readiness assurance tests, application activities, and powerpoint slides. While we have used this resource mainly with nursing and medical students, we feel that it may also be useful for a variety of other professional students, including Physician Assistants, Pharm-Ds, Nurse Practitioners, and potentially others. This module represents an initial attempt to combine Team-Based Learning, Interprofessional Education, and Quality Improvement concepts. Team-Based Learning may provide an ideal method for quality improvement content in an interprofessional context, because it requires students of various backgrounds to work together to solve real-world, application-based problems. By working together on such activities, our hope is that nursing and medical students will learn how to build relationships across professional boundaries and see opportunities for improvement in the healthcare system

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a multisystem disorder in which frontotemporal dysfunction without overt dementia is relatively common. Accordingly, there is need for a valid, brief, motor-free cognitive examination conducive to the ALS Clinic. OBJECTIVE: To validate a brief examination against a comprehensive neuropsychological battery to determine its sensitivity in identifying deficits in judgment and problem solving. We enrolled 13 individuals with intact brief examinations, 25 individuals with 1 or more impaired brief examination measures, and 18 healthy volunteers. Cognitive brief examination measures were classified into factors based on Guilford's Structure of Intellect theory. Cognitive anosognosia ratios were calculated to examine the degree of "unawareness of cognitive deficit." RESULTS: Statistically significant correlations were evidenced for each brief examination and comprehensive examination measure categorized by the same Guilford factor. In comparison to healthy controls, insight to level of cognitive abilities was significantly compromised for cognitively impaired ALS patients, with respect to their ratings of their responses to comprehension tasks assessing convergent and divergent production. CONCLUSIONS: Brief examination measures of verbal fluency and problem solving may serve as sensitive indicators of emerging difficulties in ALS patients with frontotemporal dysfunction. The prevalence of cognitive anosognosia warrants further attention because of its impact on treatment compliance, safety and quality of life for ALS patients with frontotemporal dysfunction.

Object naming tests are commonly included in neuropsychological test batteries. Differential item functioning (DIF) in these tests due to cultural and language differences may compromise the validity of cognitive measures in diverse populations. We evaluated 26 object naming items for DIF due to Spanish and English language translations among Latinos (n=1,159), mean age of 70.5 years old (Standard Deviation (SD)+/-7.2), using the following four item response theory-based approaches: Mplus/Multiple Indicator, Multiple Causes (Mplus/MIMIC; Muthen & Muthen, 1998-2011), Item Response Theory Likelihood Ratio Differential Item Functioning (IRTLRDIF/MULTILOG; Thissen, 1991, 2001), difwithpar/Parscale (Crane, Gibbons, Jolley, & van Belle, 2006; Muraki & Bock, 2003), and Differential Functioning of Items and Tests/MULTILOG (DFIT/MULTILOG; Flowers, Oshima, & Raju, 1999; Thissen, 1991). Overall, there was moderate to near perfect agreement across methods. Fourteen items were found to exhibit DIF and 5 items observed consistently across all methods, which were more likely to be answered correctly by individuals tested in Spanish after controlling for overall ability.