Validity and accuracy of maternal tactile assessment for fever in under-five children in north central Nigeria: a cross-sectional study

Evaluation of Scissor Glide Characteristics Through Surgeons' Subjective Assessment: The Application of Nitriding in Scissor Hardening Tests

INTRODUCTION

In robotic surgery, studies on providing tactile feedback to users are ongoing. However, the accuracy of the subjective sensations of surgeons, as users, has been largely unassessed. This study aimed to assess the validity of surgeons' subjective evaluations of scissors resistance through interindividual, inter-surgeon, and objective evaluations. Furthermore, in this study, we explored the possibility of using nitriding to increase the hardness of the scissors and assessed changes in subjective resistance values before and after nitriding using this approach.

METHOD

Five surgeons conducted validation of five curved surgical scissors (145 mm; Arakawa Seisakujyo Co., Ltd., Tokyo, Japan) and assessed their subjective resistance using a scale from 0 to 10, where a rating of 10 signified significant resistance impeding the scissors' closure. The temporal changes in subjective resistance values, from maximum open to close, were graphically recorded. To demonstrate the reproducibility of subjective resistance values, the subjective resistance values of the same control scissors were measured at intervals of at least two weeks, and the correlation coefficient was calculated. To analyze the closing characteristics of subjective resistance values between different pairs of scissors, the effect of scissor type and scissor closure position was compared as two independent variables using a two-factor analysis of variance. A comparative evaluation was conducted to assess the frictional properties of scissors after nitriding, comparing the subjective assessment by surgeons with the objective assessment using a digital force gauge.

RESULTS

The correlation coefficient of subjective resistance values measured by surgeons demonstrated a high reproducibility of 0.746. A two-factor analysis of variance conducted on subjective resistance values demonstrated the presence of a primary effect for the sample factor (scissors), as well as for the position factor (closing process), with the additional observation of the interaction between these two factors. The results from the two-factor analysis of variance above provide evidence supporting the validity of the subjective resistance measurements. There was a significant increase in subjective resistance after the nitriding process. The graph of subjective resistance values and objective resistance values showed similarity.

CONCLUSIONS

The surgeons' subjective assessment of scissors resistance showed high reproducibility and validity, as evidenced by distinguishable differences in scissor movement interactions and pre- and post-nitriding resistance. Further studies are warranted to expand on these findings.

A Cross-Sectional Study on Subjective Fever Assessment in Children by Palpation: Are Fathers as Reliable as Mothers?

Background

Fever is common in pediatric patients. Often, parents rely solely on palpation when assessing their child's fever. The objective of the current study was to determine the accuracy of parents in detecting their child's fever by palpation.

Methods

A prospective cross-sectional study was conducted at the emergency department (ED) of a tertiary pediatric hospital. Infants and children, 0-4 years of age, presenting to the ED with both parents were included. Parents were separately asked if their child had a fever and, if so, were asked to assess the temperature by palpation. A nurse obtained the rectal temperature. The primary outcome measure was the accuracy of fathers and mothers in detecting fever.

Results

A total of 170 children with their parents were enrolled. The mean ages of the children, mothers, and fathers were 18.9 (SD 0.8) months, 31.1 (SD 6.4) years, and 33.7 (SD 6.9) years, respectively. No statistically significant difference was found between mothers and fathers in the ability to assess fever by palpation (OR 0.65, 95% CI 0.39,-1.08). Sensitivities for detecting fever by palpation for mothers and father were 86.4% and 88.2%, respectively (specificity among mothers: 54.2% and specificity among fathers: 43.1%). The overall negative and positive predictive values were 65.9% (95% CI 55%-75.7%) and 75.7% (95% CI 69.9%-80.8%), respectively.

Conclusions

Mothers and fathers do not differ in their ability to accurately assess their child's fever by palpation. The low positive and negative predictive values indicate that if temperature was not measured, physicians cannot rely on parents' reports.

Accuracy of Tactile Assessment of Fever in Children by Caregivers: A Systematic Review and Meta-analysis

CONTEXT

Fever is the most common complaint in the pediatric and emergency departments. Caregivers prefer to detect fever in their children by tactile assessment.

OBJECTIVE

To summarize the evidence on the accuracy of caregivers' tactile assessment for detecting fever in children.

EVIDENCE-ACQUISITION

We performed a literature search of Cochrane Library, PubMed, Web of Knowledge, EMBASE (ovid), EBSCO and Google Scholar, without restriction of publication date, to identify English articles assessing caregivers' ability of detecting fever in children by tactile assessment. Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Pooled estimates of sensitivity and specificity were calculated with use of bivariate model and summary receiver operation characteristics plots for meta-analysis.

RESULTS

11 articles were included in our analysis. The summary estimates for tactile assessment as a diagnostic tool revealed a sensitivity of 87.5% (95% CI 79.3% to 92.8%) and specificity of 54.6% (95% CI 38.5% to 69.9%). The pooled positive likelihood ratio was 1.93 (95% CI 1.39 to 2.67) and negative likelihood ratio was 0.23 (95% CI 0.15 to 0.36). Area under curve was 0.82 (95% CI 0.7 to 0.85). The pooled diagnostic odds ratio was 8.46 (95% CI 4.54 to 15.76).

CONCLUSION

Tactile assessment of fever in children by palpation has moderate diagnostic value. Caregivers' assessment as "no fever" by touch is quite accurate in ruling out fever, while assessment as "fever" can be considered but needs confirmation.

Considerations for an Access-Centered Design of the Fever Thermometer in Low-Resource Settings: A Literature Review

Background

The lack of adequate information about fever in low-resource settings, its unreliable self-assessment, and poor diagnostic practices may result in delayed care and under-or-overdiagnosis of diseases such as malaria. The mismatches of existing fever thermometers in the context of use imply that the diagnostic tools and connected services need to be studied further to address the challenges of fever-related illnesses and their diagnostics.

Objective

This study aims to inform a product-service system approach to design a reliable and accessible fever thermometer and connected services, as well as contribute to the identification of innovative opportunities to improve health care in low-resource settings.

Methods

To determine what factors impede febrile people seeking health care to access adequate fever diagnostics, a literature search was conducted in Google Scholar and PubMed with relevant keywords. Next, these factors were combined with a patient journey model to design a new product-service system for fever diagnostics in low-resource settings.

Results

In total, 37 articles were reviewed. The five As framework was used to categorize the identified barriers. The results indicate that there is a poor distribution of reliable fever diagnostic practices among remote communities. This paper speaks to the global public health and design communities. Three complementary considerations are discussed that support the idea of a more holistic approach to the design of fever diagnostics: (1) understanding of the fever diagnostics patient journey, (2) identifying user groups of the thermometers in a specific health care system, and (3) assessing different needs and interests of the different users.

Conclusions

Access to basic, primary health care may be enhanced with better information and technology design made through the involvement of system users.