- Predictive Early Assessment: Reading Language (PEARL)
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What does p.e.a.r.l. stand for and what are we testingClinical Pearls in General Internal Medicine - PMC - 2022 PEARL Award Winners
The Program to Encourage Active, Rewarding Lives PEARLS educates older adults about what depression is and is not and helps them develop the skills they need for self-sufficiency and more active lives.
PEARLS is simple and easy to administer by staff at community-based organizations who might not have previous counseling experience or a higher education. Organizations screen potential participants for depressive symptoms using tools we can provide. It is adaptable to various community needs and helps expand access to depression care in underserved communities, including rural ones. RP is a genetic condition passed down in families.
It has no clear cause, and medications, infections, or eye injuries trigger it. Learn more about benign essential blepharospasm, a rare eye condition that causes uncontrolled eyelid movements. How Well Do You Sleep? Skin Care. Medically reviewed by Ann Marie Griff, O. What does it stand for? What do the results mean? As the main purpose of the surveys is to stimulate reflective learning by the local teams, all free text feedback will be returned to the local teams. If staff are named in this feedback the names will be redacted from the full reports, but made known to the project leads.
If allegations relating to patient safety or staff probity were to be made, these will be reported unredacted to the non-executive director chairing the local project team. This workstream has two phases. Phase 2 will focus on observations of co-design workshops, and of the implementation and piloting of components of the toolkit in practice.
Findings from both phases will be used to inform the development of the reflective learning framework and toolkit in workstream 4. Observations and interviews will be conducted by ethnographers social scientists experienced in making observations in the clinical environment. Publicly visible information sheets describing the project will be provided in clinical areas.
Informed written consent will be obtained for formal interviews. Analysis of data will occur over the course of the fieldwork period. Interviews and field notes will be transcribed verbatim and coded using NVivo.
Analysis will draw on elements of grounded theory, in particular, the constant comparative approach and will remain grounded in the data. We will use techniques developed through our experience of conducting large scale ethnographic studies to enable us to manage the large amounts of data generated, and to move quickly from data to interpretation.
These include regular debriefs and the production of summaries of data by site and across sites, organised by research questions and emerging themes. The co-design workshops will use creative co-production, which has collective making as its central approach to ensure meaningful engagement and creative responses from all participants.
Workstream 4 will therefore consist of 13 co-design meetings table 1. The co-design meetings will consist of four plenary workshops for the whole collaboration over the period of the project; and three local meetings in year two for each local project team conducted on-site at each trust nine local meetings in total.
Attendees will include patients and relatives, clinical staff and the non-executive directors. Co-design aims and outputs are shown in table 1.
We anticipate that while the teams are becoming established, the process of reflection may be accompanied by release of emotions related to personal experiences. Project team members have expertise in managing emotionally challenging situations, and will ensure that individual experiences are channelled into creative outputs by the local teams.
In this respect, reflection will have both therapeutical and educational value for the project as a whole. Following workshop 3, local project teams will be invited to develop behavioural specifications for embedding a maximum of three interventions into routine clinical activities.
Teams will use COM-B as an analytical tool figure 2 to identify gaps in reflective practice which can be addressed through these behavioural specifications. The teams will present their experiences of selecting, specifying and piloting interventions in the final plenary workshop 4. Toolkit development: Outputs from each of the 13 co-design meetings will be documented by the ethnographers and members of the core project team and will feed into toolkit development.
The members of the core project team will collate their findings from the co-design meetings and cross-reference them with ethnographic findings from site visits to produce short guidance notes and resource materials under the following headings: Aims of the toolkit, What is reflection? The reflective learning framework and toolkit will be evaluated locally by the participating units.
Staff will be asked to offer their views on the specific interventions. This feedback will be incorporated in the final version. The PEARL project puts patients and relatives at the centre of the research and they were involved at inception in the initial design, contributing as full collaborators. PEARL is a developmental project which uses co-design to develop the reflective learning framework. To develop the framework, patients and relatives from the acute medical units and intensive care units of four hospitals in three trusts will work together collaboratively in 12 facilitated workshops as well as being full members of each local project team.
They are helping to design the patient and staff surveys, and have informed decisions about the extent to which patient and public involvements can contribute to this type of co-design process. They are co-authors in publications and will participate in dissemination activities. Patient experience data demonstrate important opportunities to improve the quality of healthcare, particularly those relating to attitudes, behaviours and staff-patient relationships.
However, these data are not used optimally by organisations or frontline staff to make improvements. Reflective learning should hold the key to converting experience into action, but there is little evidence about how reflection can most effectively be incorporated in routine clinical practice for individuals and teams. The PEARL project aims to develop a framework and toolkit to support effective reflection in the workplace. The apparent simplicity of this aim disguises the underlying complexity of the relationships linking the various theories of reflection, learning and behaviour change, as demonstrated in the introduction and in figure 1.
These theories show that reflective learning — which has almost achieved the status of received wisdom in medical education — is itself a form of behaviour subject to multiple influences, summarised in the COM-B model. Individuals and groups vary in their capacity, opportunity and motivation to reflect, and to do so in a manner which promotes personal growth. It is perhaps not surprising that health systems have difficulty using patient and staff experience data to improve care quality.
Most interactions between patients and healthcare staff are associated with positive experiences. This is an asset in terms of reflection and behaviour modification, for two reasons. First, there are many excellent role models available, and a systematic approach for identifying and learning from them can help others to acquire similar skills.
Second, it takes courage and resilience to cope with the discovery of imperfections, and this may be easier if the setting is one which prioritises learning from excellence.
Potential limitations of the co-design process involve self-selection of participants naturally predisposed to favour reflection rather than sceptics. We will mitigate this by considering reflective personae when developing the interventions.
A limitation of the patient survey is that respondents may have difficulty distinguishing locations for example acute medical units vs ordinary wards. The accompanying patient information sheets will explain the the survey is focused on the initial period of care immediately following admission through the emergency department.
The framework and toolkit will use patient and staff experience to support workplace-based effective reflection and improvement during routine clinical practice for individuals and teams.
Our intent in subsequent research is to evaluate the logic model figure 1 and the toolkit in a mixed-methods step-wedge cluster randomised trial.
The precise form this will take will become apparent in the final year of the project; it will be classed as a complex intervention, and the workstreams described above will test the methodologies to be deployed during larger scale roll-out. Implied consent will apply to the return of completed questionnaires. Informed consent will be sought from participants of ethnographic interviews. Research findings will be submitted for publication by scientific journals and presentation at conferences in the disciplines of patient safety, health services research, implementation science and intensive care medicine.
We will also propose a national cluster randomised step-wedge trial of the toolkit for large-scale evaluation of impact on patient outcomes. We will offer this as a resource for national multidisciplinary training programmes through our partner organisations in acute and intensive care medicine, nursing and allied health professional programmes.
Dr Remi Bec and Cheryl Grindell were instrumental in the planning of the co-design workshops. Contributors: OB as project manager and collaborator will manage the day-to-day running of the project under the CI, managing governance and study set-up, processing, analysis and presentation of study findings.
CB has a strong academic background in pedagogical research at the University of Warwick, and is the lead for medical education and reflection in PEARL, workstream 4.
She will contribute to our understanding of how reflection is used to achieve learning. She is the lead for the ethnographic workstream workstream 3 , directing a group of ethnographers making original observations of practice. He is our expert on multisource feedback, advising on how to convert feedback into effective reflection. DB and LMB are patient and relative representatives with extensive experience of the totality of the emergency care pathway. They will provide insights into patient-staff interactions.
He will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. FE is the statistician for the project and will oversee the quantitative analysis from the patient and staff survey instruments.
FG Smith is the local lead for the intensive care unit at Heartlands Hospital. She will advise on practical aspects of reflective learning and will help co-design the reflection toolkit. JJ is the ethnography research fellow, organising and collating information from interviews and near-patient observations, and responsible for the analysis of qualitative data.
RM is the local lead for the intensive care unit at the Queen Elizabeth Hospital. GP is the trainee representative for the project, also part of the intensive care local team at Queen Elizabeth Hospital. He will analyse data from the GMC survey. A year-old man was diagnosed as having prostate cancer 3 years ago after an area of induration was found on rectal examination.
He was treated with a course of external-beam radiation therapy that was well tolerated, and his prostate-specific antigen PSA level decreased from a baseline level of 2. He continued to feel well but had a biochemical recurrence of his cancer, and his PSA increased 9 months ago to 2. This prompted the initiation of androgen deprivation therapy with leuprolide and bicalutamide.
At presentation, the patient has mild hot flashes but otherwise feels well. He specifically denies any pain, dyspnea, neurologic symptoms, abdominal discomfort, melena, or hematochezia. Findings on examination are unremarkable. Findings on a screening colonoscopy performed 2 years previously were normal. Which one of the following would be the most appropriate next step in the evaluation of this patient's anemia? Biochemically castrated men thus would be expected to have concentrations of serum hemoglobin within the normal female range.
This has been documented in studies of men with localized prostate cancer who begin androgen deprivation therapy. The mean decrease in hemoglobin over 6 months was 1. In those who discontinue androgen deprivation therapy, the recovery is slow and parallels the recovery of testosterone.
In this patient, iron deficiency is not suggested by the data, and the reasons for the decrease in hemoglobin concentration are well understood, making a ferritin assay or a second colonoscopy unnecessary.
Although omeprazole may interfere with iron absorption in those who are receiving iron replacement therapy, it should not produce a de novo normocytic anemia. The patient's prostate cancer is biochemically in remission, and he has no bone symptoms. Androgen deprivation therapy produces a predictable decrease in hemoglobin; in the absence of bleeding or other causes of anemia, this decrease does not require additional diagnostic testing and may simply be periodically monitored for stability.
A year-old man whose type 2 diabetes mellitus has been well controlled with metformin for the past 5 years presents with mild paresthesia and decreased sensation in his toes during the past year. He has hypertension and hyperlipidemia, both of which are well controlled with lisinopril and simvastatin. Otherwise, he is healthy.
Which one of the following additional tests would be most useful to conduct at this visit? Metformin has been associated with vitamin B 12 deficiency, and this is more likely to occur after more than 3 years of use. It is a dose-related phenomenon and more prevalent at dosages of more than 1. The mechanism is thought to be malabsorption of food cobalamin in the distal ileum.
The ileal cell surface receptor depends on intraluminal calcium to function effectively, and metformin interferes with this interaction. In fact, one report of patients taking metformin indicated significant improvement in vitamin B 12 absorption with increased intake of calcium. It would be reasonable to check a vitamin B 12 level periodically in patients who have been taking metformin for several years.
Significant deficiency of vitamin B 12 may develop in patients who have been taking metformin for several years. A year-old woman presents with proximal myalgia and morning stiffness, with an elevated erythrocyte sedimentation rate and clinical picture compatible with polymyalgia rheumatica.
One double-strength tablet of trimethoprim-sulfamethoxazole daily is prescribed for Pneumocystis prophylaxis. She is taking no other medications. Two weeks later, the patient returns for a follow-up visit. She feels well and has no new symptoms.
Her laboratory results are as follows:. Please contact us via the chat icon or email us at contact pearl-fertility. You can take this when you experience early signs and symptoms, like a missed period, nausea, and increased urination. You can inform Pearl if pregnancy has occurred, and the App will stop asking you to test, and accompany you in your new journey. The results are due to be published. Pearl does not collect any personally identifiable information. The app sends anonymized data to our cloud in order for us learn and to improve our algorithms.
The data is aggregated in a database with encryption technology that makes it impossible to trace back to a user. We encourage users to keep their phones locked and password protected, if someones gets hold of their phone or their data may be exposed.
Pearl measures LH and FSH relative values, but it does not display them — instead it interprets the values and shows the chance of conception via the user interface the flower.
Advising users of hormone levels directly is under development. No, in order to protect privacy, Pearl will not communicate to private individuals, it will be up to the user if she wants to share her private information or not.
A token is assigned once some data is submitted. Usually this happens after the first measurement or after inputting the latest period start date. Pearl does not recommend days for a boy or girl. In fact, even though scientists have tried to find a link between the sex of the baby and the days of intercourse, the results yielded no significant correlations. If no control line appears, it's likely you didn't expose the test strip to enough urine.
If you don't see the line appear after waiting the 15 minutes, please test again to make sure you don't miss a measurement.
When you are using the holder to expose test strips directly to the urine stream, they should be exposed for 3 seconds each. It is best to expose one strip at a time so that each get the 3 seconds and are not over or under exposed.
If dipping the tests strip in a cup of urine, expose each for 5 seconds. Hormone release during the day is different, and this would create inconsistencies with your measurements.
You can buy Pearl online, either through our website or on Amazon. Pearl is not yet available at retail stores or pharmacies. Your Pearl App will indicate when it is time to take your pregnancy test, generally days after a missed period. The pregnancy test strips included with Pearl are used similarly to the other testing strips. Expose the white end of the test strip to urine for 5 seconds, then wait minutes prior to reading the results.
One line indicates not pregnant, two lines indicate pregnancy. You can manually enter a yes or no result, but Pearl does not upload these results to your graph.
No; hormonal test strips are used with first morning urine because hormones are cyclical and accumulate overnight, making them highly accurate first thing in the morning. If you miss taking the picture, however, you can easily add it to the app later in the day.
These tests can tell if you are pregnant with We recommend to do the second test two days after the first. You can additionally buy Proov Progesterone strips directly from Proov, and track your progesterone levels, as they are compatible with our app.
The Pearl Kit comes with all the hormonal strips you need for the Pearl app to detect your hormonal profile and build your personalised fertile window. However, if the hormonal measurements are interrupted not done when prompted , Pearl might need more hormonal input to build your fertile window. Also, if your period is longer than 35 days, we recommend to have at least two Pearl Kits at hand.
Please keep in mind that you should only use Pearl if you do not have any medical conditions affecting your fertility.
Such conditions can only be diagnosed by a medical professional. On average, our customers use the Pearl Kit for about 3 months before seeing results. During this time, continuous hormonal measurements allow Pearl to detect a hormonal pattern. Insufficient measurements can unfortunately hinder Pearl from detecting any pattern. If pregnancy has not occured after 6 months, we recommend consulting a medical professional.
Pearl works with daily measurements over time. For Pearl Kits powered by Proov, PdG tests are typically done at the beginning of the cycle and after the expected ovulation date. When Pearl detects a hormonal pattern, the app notifies you and the Fertility Window prediction gets updated.
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