The development, validation and reliability testing of an assessment of functional ingestive skills of elderly persons with neurogenic dysphagia /
Bibliographic record
Abstract
Disorders of feeding and swallowing are thought to impact up to 60% of residents of long-term care facilities. Traditional methods of evaluating feeding are inappropriate for use with an elderly population or have poor reliability and validity. The objective of this project was to create a new assessment of feeding skills, that could be administered during the observation of a meal in the patient's own environment. Potential items for inclusion in the McGill Ingestive Skills Assessment (MISA) were generated from a review of the literature. A focus group of 10 professionals actively involved in dysphagia was recruited to select the items, generate additional items based on clinical expertise, divide the items into scales and develop a method for scoring each item. At the end of this process, the MISA had 190 items in 7 scales. Each item was scored using a 2, 3, 4, or 5 point ordinal scale. A field test on 50 elderly individuals provided data on which inter-rater reliability, item-total and item scale correlations could be evaluated. A second focus group eliminated all but 50 items from the assessment using the results of these statistical analyses as a guide. The scoring was made uniform, with four descriptors per item. A small field test of 33 patients indicated that the MISA showed signs of sufficient psychometric rigor to warrant large-scale reliability and validity testing. One hundred and two individuals were tested in the psychometric study. The analysis of inter-item correlations and item reliability permitted the removal of an additional 8 items and the collapse of the scoring to 3 points per item. The inter-rater and intra-rater reliability, the stability of scores over time, the concurrent validity and predictive validity of the MISA were analysed using the data from the remaining 42 items, on the 3 point scale. MISA scale and total scores were related as hypothesized to measures of related constructs. Linear and flexible survival analyses indicated that the MISA total score and the score on selected scales is predictive of time to death and time to pulmonary infection. It was determined that the MISA has sufficient psychometric rigor to permit the evaluation of, and treatment planning for, individual patients. The availability of this important assessment tool will improve the quality of care that professionals can offer to elderly persons with ingestive skill loss.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".