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Sample records for clinical assessment incorporating

  1. Creating clinical trial designs that incorporate clinical outcome assessments.

    Science.gov (United States)

    Gilbert, Mark R; Rubinstein, Lawrence; Lesser, Glenn

    2016-03-01

    Clinical outcome assessments (COAs) are increasingly being used in determining the efficacy of new treatment regimens. This was typified in the recent use of a symptom-based instrument combined with an organ-based measure of response for the approval of ruxolitinib in myelofibrosis. There are challenges in incorporating these COAs into clinical trials, including designating the level of priority, incorporating these measures into a combined or composite endpoint, and dealing with issues related to compliance and interpretation of results accounting for missing data. This article describes the results of a recent panel discussion that attempted to address these issues and provide guidance to the incorporation of COAs into clinical trials, including novel statistical designs, so that the testing of new treatments in patients with cancers of the central nervous system can incorporate these important clinical endpoints. PMID:26989129

  2. Building Information Modelling Incorporating Technology Based Assessment

    OpenAIRE

    Murphy, Maurice; Scott, Lloyd

    2011-01-01

    Building Information Modelling (BIM) is currently being developed as a virtual learning tool for construction and surveying students in the Dublin Institute of Technology. This advanced technology is also used to develop a technology based assessment practice for enhancing the learning environment of construction and surveying students. A theoretical design framework is presented in this paper, which combines advanced technology and assessment theory to create a virtual learning environment. ...

  3. Classification and clinical assessment

    Directory of Open Access Journals (Sweden)

    F. Cantini

    2012-06-01

    Full Text Available There are at least nine classification criteria for psoriatic arthritis (PsA that have been proposed and used in clinical studies. With the exception of the ESSG and Bennett rules, all of the other criteria sets have a good performance in identifying PsA patients. As the CASPAR criteria are based on a robust study methodology, they are considered the current reference standard. However, if there seems to be no doubt that they are very good to classify PsA patients (very high specificity, they might be not sensitive enough to diagnose patients with unknown early PsA. The vast clinical heterogeneity of PsA makes its assessment very challenging. Peripheral joint involvement is measured by 78/76 joint counts, spine involvement by the instruments used for ankylosing spondylitis (AS, dactylitis by involved digit count or by the Leeds dactylitis index, enthesitis by the number of affected entheses (several indices available and psoriasis by the Psoriasis Area and Severity Index (PASI. Peripheral joint damage can be assessed by a modified van der Heijde-Sharp scoring system and axial damage by the methods used for AS or by the Psoriatic Arthritis Spondylitis Radiology Index (PASRI. As in other arthritides, global evaluation of disease activity and severity by patient and physician and assessment of disability and quality of life are widely used. Finally, composite indices that capture several clinical manifestations of PsA have been proposed and a new instrument, the Psoriatic ARthritis Disease Activity Score (PASDAS, is currently being developed.

  4. INCORPORATING CATASTROPHES INTO INTEGRATED ASSESSMENT: SCIENCE, IMPACTS, AND ADAPTATION

    Science.gov (United States)

    Incorporating potential catastrophic consequences into integrated assessment models of climate change has been a top priority of policymakers and modelers alike. We review the current state of scientific understanding regarding three frequently mentioned geophysical catastrophes,...

  5. Incorporating comorbidities into latent treatment pattern mining for clinical pathways.

    Science.gov (United States)

    Huang, Zhengxing; Dong, Wei; Ji, Lei; He, Chunhua; Duan, Huilong

    2016-02-01

    In healthcare organizational settings, the design of a clinical pathway (CP) is challenging since patients following a particular pathway may have not only one single first-diagnosis but also several typical comorbidities, and thus it requires different disciplines involved to put together their partial knowledge about the overall pathway. Although many data mining techniques have been proposed to discover latent treatment information for CP analysis and reconstruction from a large volume of clinical data, they are specific to extract nontrivial information about the therapy and treatment of the first-diagnosis. The influence of comorbidities on adopting essential treatments is crucial for a pathway but has seldom been explored. This study proposes to extract latent treatment patterns that characterize essential treatments for both first-diagnosis and typical comorbidities from the execution data of a pathway. In particular, we propose a generative statistical model to extract underlying treatment patterns, unveil the latent associations between diagnosis labels (including both first-diagnosis and comorbidities) and treatments, and compute the contribution of comorbidities in these patterns. The proposed model extends latent Dirichlet allocation with an additional layer for diagnosis modeling. It first generates a set of latent treatment patterns from diagnosis labels, followed by sampling treatments from each pattern. We verify the effectiveness of the proposed model on a real clinical dataset containing 12,120 patient traces, which pertain to the unstable angina CP. Three treatment patterns are discovered from data, indicating latent correlations between comorbidities and treatments in the pathway. In addition, a possible medical application in terms of treatment recommendation is provided to illustrate the potential of the proposed model. Experimental results indicate that our approach can discover not only meaningful latent treatment patterns exhibiting

  6. Quality Assessment for Clinical Proteomics

    OpenAIRE

    Tabb, David L.

    2012-01-01

    Proteomics has emerged from the labs of technologists to enter widespread application in clinical contexts. This transition, however, has been hindered by overstated early claims of accuracy, concerns about reproducibility, and the challenges of handling batch effects properly. New efforts have produced sets of performance metrics and measurements of variability that establish sound expectations for experiments in clinical proteomics. As researchers begin incorporating these metrics in a qual...

  7. Incorporating Contaminant Bioavailability into Sediment Quality Assessment Frameworks

    Science.gov (United States)

    The recently adopted sediment quality assessment framework for evaluating bay and estuarine sediments in the State of California incorporates bulk sediment chemistry as a key line of evidence(LOE) but does not address the bioavailability of measured contaminants. Thus, the chemis...

  8. Transient stability risk assessment of power systems incorporating wind farms

    DEFF Research Database (Denmark)

    Miao, Lu; Fang, Jiakun; Wen, Jinyu;

    2013-01-01

    Large-scale wind farm integration has brought several aspects of challenges to the transient stability of power systems. This paper focuses on the research of the transient stability of power systems incorporating with wind farms by utilizing risk assessment methods. The detailed model of double ...

  9. Incorporating alternative design clinical trials in network meta-analyses

    Directory of Open Access Journals (Sweden)

    Thorlund K

    2014-12-01

    Full Text Available Kristian Thorlund,1–3 Eric Druyts,1,4 Kabirraaj Toor,1,5 Jeroen P Jansen,1,6 Edward J Mills1,3 1Redwood Outcomes, Vancouver, BC, 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; 3Stanford Prevention Research Center, Stanford University, Stanford, CA, USA; 4Department of Medicine, Faculty of Medicine, 5School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; 6Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA Introduction: Network meta-analysis (NMA is an extension of conventional pairwise meta-analysis that allows for simultaneous comparison of multiple interventions. Well-established drug class efficacies have become commonplace in many disease areas. Thus, for reasons of ethics and equipoise, it is not practical to randomize patients to placebo or older drug classes. Unique randomized clinical trial designs are an attempt to navigate these obstacles. These alternative designs, however, pose challenges when attempting to incorporate data into NMAs. Using ulcerative colitis as an example, we illustrate an example of a method where data provided by these trials are used to populate treatment networks. Methods: We present the methods used to convert data from the PURSUIT trial into a typical parallel design for inclusion in our NMA. Data were required for three arms: golimumab 100 mg; golimumab 50 mg; and placebo. Golimumab 100 mg induction data were available; however, data regarding those individuals who were nonresponders at induction and those who were responders at maintenance were not reported, and as such, had to be imputed using data from the rerandomization phase. Golimumab 50 mg data regarding responses at week 6 were not available. Existing relationships between the available components were used to impute the expected proportions in this missing subpopulation. Data for placebo maintenance

  10. Assessing the clinical probability of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Miniati, M. [Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, Pisa (Italy); Pistolesi, M. [University of Florence, Dept. of Section of Nuclear Medicine Critical Care, Florence (Italy)

    2001-12-01

    Clinical assessment is a cornerstone of the recently validated diagnostic strategies for pulmonary embolism (PE). Although the diagnostic yield of individual symptoms, signs, and common laboratory tests is limited, the combination of these variables, either by empirical assessment or by a prediction rule, can be used to express a clinical probability of PE. The latter may serve as pretest probability to predict the probability of PE after further objective testing (posterior or post-test probability). Over the last few years, attempts have been made to develop structured prediction models for PE. In a Canadian multicenter prospective study, the clinical probability of PE was rated as low, intermediate, or high according to a model which included assessment of presenting symptoms and signs, risk factors, and presence or absence of an alternative diagnosis at least as likely as PE. Recently, a simple clinical score was developed to stratify outpatients with suspected PE into groups with low, intermediate, or high clinical probability. Logistic regression was used to predict parameters associated with PE. A score {<=} 4 identified patients with low probability of whom 10% had PE. The prevalence of PE in patients with intermediate (score 5-8) and high probability (score {>=} 9) was 38 and 81%, respectively. As opposed to the Canadian model, this clinical score is standardized. The predictor variables identified in the model, however, were derived from a database of emergency ward patients. This model may, therefore, not be valid in assessing the clinical probability of PE in inpatients. In the PISA-PED study, a clinical diagnostic algorithm was developed which rests on the identification of three relevant clinical symptoms and on their association with electrocardiographic and/or radiographic abnormalities specific for PE. Among patients who, according to the model, had been rated as having a high clinical probability, the prevalence of proven PE was 97%, while it was

  11. Assessing the clinical probability of pulmonary embolism

    International Nuclear Information System (INIS)

    Clinical assessment is a cornerstone of the recently validated diagnostic strategies for pulmonary embolism (PE). Although the diagnostic yield of individual symptoms, signs, and common laboratory tests is limited, the combination of these variables, either by empirical assessment or by a prediction rule, can be used to express a clinical probability of PE. The latter may serve as pretest probability to predict the probability of PE after further objective testing (posterior or post-test probability). Over the last few years, attempts have been made to develop structured prediction models for PE. In a Canadian multicenter prospective study, the clinical probability of PE was rated as low, intermediate, or high according to a model which included assessment of presenting symptoms and signs, risk factors, and presence or absence of an alternative diagnosis at least as likely as PE. Recently, a simple clinical score was developed to stratify outpatients with suspected PE into groups with low, intermediate, or high clinical probability. Logistic regression was used to predict parameters associated with PE. A score ≤ 4 identified patients with low probability of whom 10% had PE. The prevalence of PE in patients with intermediate (score 5-8) and high probability (score ≥ 9) was 38 and 81%, respectively. As opposed to the Canadian model, this clinical score is standardized. The predictor variables identified in the model, however, were derived from a database of emergency ward patients. This model may, therefore, not be valid in assessing the clinical probability of PE in inpatients. In the PISA-PED study, a clinical diagnostic algorithm was developed which rests on the identification of three relevant clinical symptoms and on their association with electrocardiographic and/or radiographic abnormalities specific for PE. Among patients who, according to the model, had been rated as having a high clinical probability, the prevalence of proven PE was 97%, while it was 3

  12. Pain assessment in clinical Rheumatology

    Directory of Open Access Journals (Sweden)

    L. Sinigaglia

    2011-09-01

    Full Text Available The diagnostic approach in clinical practice in Rheumatology is mainly based on the recognition of pain origin. Patient’s experience of pain may be similar in different diseases involving bones, joints, tendons, muscles or peripheral nervous system. The analysis of some characteristics of pain may be helpful in the diagnostic approach. In this perspective pain must be analyzed according to the type, localization, occurrence, elicitation and concomitant clinical signs. In the majority of cases this analysis allows a preliminary differential diagnosis which is essential to drive further assessments. The diagnostic approach to arthropaties is based on a group of indicative criteria which include diffusion of the arthropathy, the involved sites, the course of the joint disease, the joint damage, the history of preceding events and the presence of extra-articular features which accompany joint disease. This kind of clinical approach helps the clinician in saving time and reducing costs of diagnosis by driving any further investigation.

  13. A risk assessment methodology for incorporating uncertainties using fuzzy concepts

    International Nuclear Information System (INIS)

    This paper proposes a new methodology for incorporating uncertainties using fuzzy concepts into conventional risk assessment frameworks. This paper also introduces new forms of fuzzy membership curves, designed to consider the uncertainty range that represents the degree of uncertainties involved in both probabilistic parameter estimates and subjective judgments, since it is often difficult or even impossible to precisely estimate the occurrence rate of an event in terms of one single crisp probability. It is to be noted that simple linguistic variables such as 'High/Low' and 'Good/Bad' have the limitations in quantifying the various risks inherent in construction projects, but only represent subjective mental cognition adequately. Therefore, in this paper, the statements that include some quantification with giving specific value or scale, such as 'Close to any value' or 'Higher/Lower than analyzed value', are used in order to get over the limitations. It may be stated that the proposed methodology will be very useful for the systematic and rational risk assessment of construction projects

  14. Advances and challenges of incorporating ecosystem services into impact assessment.

    Science.gov (United States)

    Rosa, Josianne Claudia Sales; Sánchez, Luis E

    2016-09-15

    An ecosystem services approach (ESA) to assess the environmental and social impacts of projects is a conceptual innovation that contributes to overcome two widely acknowledged deficiencies of impact assessment (IA): integration of knowledge areas and participation of affected communities. This potential was demonstrated through a practical application to a large mining project, showing evidence of advances in relation to current practice and identifying challenges. Data was obtained from the environmental impact study of the reviewed project and its supplements; additional data to fulfill the needs of the ESA were collected using rapid appraisal techniques. Results show that the ESA provides: (i) a more effective scoping; (ii) a contribution to delimitate the study area; (iii) a more detailed identification of impacts; (iv) a determination of significance inclusive of the perspective of affected communities; (v) a design of mitigation focused on human well-being. The challenges of using the ESA fall into two groups: the limitations inherent to the concept and those that can be overcome by furthering research and advancing practical applications. This research added evidence to previous studies showing that incorporating ecosystem services into IA can improve practice. PMID:27285950

  15. An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques

    Science.gov (United States)

    Duxbury, Mark

    2004-01-01

    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  16. The Student's Dilemma, Liver Edition: Incorporating the Sonographer's Language into Clinical Anatomy Education

    Science.gov (United States)

    Hall, M. Kennedy; Mirjalili, S. Ali; Moore, Christopher L.; Rizzolo, Lawrence J.

    2015-01-01

    Anatomy students are often confused by multiple names ascribed to the same structure by different clinical disciplines. Increasingly, sonography is being incorporated into clinical anatomical education, but ultrasound textbooks often use names unfamiliar to the anatomist. Confusion is worsened when ultrasound names ascribed to the same structure…

  17. Web-based teaching tool incorporating peer assessment and self-assessment

    DEFF Research Database (Denmark)

    McEvoy, Fintan; McEvoy, Peter M.; Svalastoga, Eiliv L.

    2010-01-01

    OBJECTIVE. Our objective was to create an electronic learning tool that incorporates the pedagogic advantages of peer assessment and self-assessment into report-generating skills. CONCLUSION. The tool was created using Web programming software. It was tested with 12 veterinary students and provid...... peer-peer and tutor-student interactions that supported learning. The tool is suited for training any professional concerned with the interpretation of images, particularly resident radiologists....

  18. Implementation of bioassay methods to improve assessment of incorporated radionuclides

    International Nuclear Information System (INIS)

    Full text: Internal exposure to uranium and thorium can principally be assessed from external radiation measurements, exhalation measurements, or the assay of these elements excreted in urine or feces. Since both 232Th and 238U emit only photon radiations of low energy and with low emission probabilities, their detection limits by in vivo counting are of the order of kBq even when sophisticated devices are used. Consequently, usually bioassay methods are used for the incorporation monitoring of workers. Alpha spectrometry is the commonly applied technique, usually employed to measure 232Th and 238U in urine or fecel samples. For accurate analysis of body contents, 24 hours collections of urine or feces are usually used. The fecal activity, however, resembles predominantly the intake by ingestion of these nuclides during the last few days whereas the urinary excretion is more closely related to the body content of the nuclides. However, urinary excretion is also varying with the actual intake of 232Th and/or 238U. The measurement of these nuclides in urine by alpha-spectrometry requires tedious and time-consuming chemical work-up to prepare the samples for spectrometric analysis. Therefore, the number of analyses, which can be carried out is quite low and the results are available only after a time lag of several days. Additionally, under certain conditions the alpha-spectrometry is not sensitive enough. Other methods that have been developed may be confined to the availability of certain devices being difficult to access (e.g. nuclear reactors for radiochemical neutron activation analysis). Much better suitable as routine method is the application of inductively coupled plasma mass spectrometry (ICP-MS) for measurements of 232Th and 238U concentrations in urine. For elemental analyses, ICP-MS can already be considered as commonly used method. The present work which was carried out in the framework of an EU project (IDEA: Internal Dosimetry - Enhancements in

  19. Integrating Academic and Clinical Learning Using a Clinical Swallowing Assessment

    Science.gov (United States)

    Phillips, Daniel E.

    2013-01-01

    This article describes an experiential learning activity designed to integrate classroom knowledge and a clinical swallowing assessment. Twenty master's-level graduate students in a dysphagia course conducted a clinical swallowing assessment with a resident of an independent retirement community. The exercise was designed to allow students an…

  20. Physician Barriers to Incorporating Pharmacogenetic Treatment Strategies for Nicotine Dependence Into Clinical Practice

    OpenAIRE

    Schnoll, RA; Shields, AE

    2011-01-01

    Advances in genomics research may improve health outcomes by tailoring treatment according to patients’ genetic profiles. The treatment of nicotine dependence, in particular, may soon encompass pharmacogenetic treatment models. Realizing the benefits of such treatment strategies may depend on physicians’ preparedness to incorporate genetic testing into clinical practice. This article describes barriers to clinical integration of pharmacogenetic treatments that will need to be addressed to rea...

  1. Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support

    Directory of Open Access Journals (Sweden)

    Hoath James I

    2010-10-01

    Full Text Available Abstract In pursuing personalized medicine, pharmacogenomic (PGx knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1 analyzing clinically relevant knowledge contained in PGx knowledge resources; 2 evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant knowledge contained in PGx knowledge resources; and, 3 evaluating the ability of an electronic medical record/electronic health record (EMR/EHR to provide computable forms of clinical data needed for PGx clinical decision support. Findings suggest that the PharmGKB is a good source for PGx knowledge to supplement information contained in FDA approved drug labels. Furthermore, we found that with supporting knowledge (e.g. IF age

  2. Incorporating the principles of the patient- centered medical home into a student-run free clinic

    Directory of Open Access Journals (Sweden)

    Riddle MC

    2014-09-01

    Full Text Available Megan C Riddle,1,* Jiahui Lin,3,* Jonathan B Steinman,2 Joshua D Salvi,2 Margaret M Reynolds,3 Anne S Kastor,3,† Christina Harris,4 Carla Boutin-Foster3 1Department of Psychiatry and Behavioral Sciences, University of Washington, 2Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program, 3Department of Internal Medicine, Weill Cornell Medical College, New York, NY, 4Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, LA, USA *These authors contributed equally to this work †Anne S Kastor passed away on July 5, 2013. Abstract: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC, a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87

  3. Incorporating Concepts of Hospitality into Theological Library Assessment

    Directory of Open Access Journals (Sweden)

    Jenifer Gundry

    2015-01-01

    Full Text Available Following the completion of a year-long library space utilization study, the Princeton Theological Seminary Library sought new ways of shaping questions about library space and library assessment overall. The concept of “hospitality,” as it has been so interestingly articulated in the literature of theological librarianship, provided the library with a challenging conceptual foothold in shaping new assessment questions. This essay reflects on the “hospitality” concept in relation to three assessment areas of interest to theological libraries: information literacy, scholarly impact, and the library as workplace.

  4. Probabilistic assessment of power system transient stability incorporating SMES

    Science.gov (United States)

    Fang, Jiakun; Yao, Wei; Wen, Jinyu; Cheng, Shijie; Tang, Yuejin; Cheng, Zhuo

    2013-01-01

    This paper presents a stochastic-based approach to evaluate the probabilistic transient stability index of the power system incorporating the wind farm and the SMES. Uncertain factors include both sequence of disturbance in power grid and stochastic generation of the wind farm. The spectrums of disturbance in the grid as the fault type, the fault location, the fault clearing time and the automatic reclosing process with their probabilities of occurrence are used to calculate the probability indices, while the wind speed statistics and parameters of the wind generator are used in a Monte Carlo simulation to generate samples for the studies. With the proposed method, system stability is ”measured”. Quantitative relationship of penetration level, SMES coil size and system stability is established. Considering the stability versus coil size to be the production curve, together with the cost function, the coil size is optimized economically.

  5. Incorporating exposure science into life-cycle assessment

    Science.gov (United States)

    Life-cycle assessment (LCA) is used to estimate the potential for environmental damage that may be caused by a product or process, ideally before the product or process begins. LCA includes all of the steps from extracting natural resources through manufacturing through product u...

  6. Probabilistic assessment of power system transient stability incorporating SMES

    International Nuclear Information System (INIS)

    Highlights: ► Probabilistic study of power system with wind farm and SMES is proposed. ► Quantitative relationship between system stability and SMES capacity is given. ► System stability increases with the capacity of the SMES. ► System stability decreases with the penetration of wind power. ► Together with the cost function, the coil size is optimized. -- Abstract: This paper presents a stochastic-based approach to evaluate the probabilistic transient stability index of the power system incorporating the wind farm and the SMES. Uncertain factors include both sequence of disturbance in power grid and stochastic generation of the wind farm. The spectrums of disturbance in the grid as the fault type, the fault location, the fault clearing time and the automatic reclosing process with their probabilities of occurrence are used to calculate the probability indices, while the wind speed statistics and parameters of the wind generator are used in a Monte Carlo simulation to generate samples for the studies. With the proposed method, system stability is ”measured”. Quantitative relationship of penetration level, SMES coil size and system stability is established. Considering the stability versus coil size to be the production curve, together with the cost function, the coil size is optimized economically

  7. Probabilistic assessment of power system transient stability incorporating SMES

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Jiakun, E-mail: Jiakun.Fang@gmail.com [State Key Lab of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, No. 1037, Luoyu Road, Wuhan 430074 (China); Yao, Wei [State Key Lab of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, No. 1037, Luoyu Road, Wuhan 430074 (China); Wen, Jinyu, E-mail: jinyu.wen@hust.edu.cn [State Key Lab of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, No. 1037, Luoyu Road, Wuhan 430074 (China); Cheng, Shijie; Tang, Yuejin; Cheng, Zhuo [State Key Lab of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, No. 1037, Luoyu Road, Wuhan 430074 (China)

    2013-01-15

    Highlights: ► Probabilistic study of power system with wind farm and SMES is proposed. ► Quantitative relationship between system stability and SMES capacity is given. ► System stability increases with the capacity of the SMES. ► System stability decreases with the penetration of wind power. ► Together with the cost function, the coil size is optimized. -- Abstract: This paper presents a stochastic-based approach to evaluate the probabilistic transient stability index of the power system incorporating the wind farm and the SMES. Uncertain factors include both sequence of disturbance in power grid and stochastic generation of the wind farm. The spectrums of disturbance in the grid as the fault type, the fault location, the fault clearing time and the automatic reclosing process with their probabilities of occurrence are used to calculate the probability indices, while the wind speed statistics and parameters of the wind generator are used in a Monte Carlo simulation to generate samples for the studies. With the proposed method, system stability is ”measured”. Quantitative relationship of penetration level, SMES coil size and system stability is established. Considering the stability versus coil size to be the production curve, together with the cost function, the coil size is optimized economically.

  8. Incorporating the Technology Roadmap Uncertainties into the Project Risk Assessment

    International Nuclear Information System (INIS)

    This paper describes two methods, Technology Roadmapping and Project Risk Assessment, which were used to identify and manage the technical risks relating to the treatment of sodium bearing waste at the Idaho National Engineering and Environmental Laboratory. The waste treatment technology under consideration was Direct Vitrification. The primary objective of the Technology Roadmap is to identify technical data uncertainties for the technologies involved and to prioritize the testing or development studies to fill the data gaps. Similarly, project management's objective for a multi-million dollar construction project includes managing all the key risks in accordance to DOE O 413.3 - ''Program and Project Management for the Acquisition of Capital Assets.'' In the early stages, the Project Risk Assessment is based upon a qualitative analysis for each risk's probability and consequence. In order to clearly prioritize the work to resolve the technical issues identified in the Technology Roadmap, the issues must be cross- referenced to the project's Risk Assessment. This will enable the project to get the best value for the cost to mitigate the risks

  9. Incorporation of aging model in probabilistics safety assessment

    International Nuclear Information System (INIS)

    Probabilistic safety assessment (PSA) is a means of evaluating the comprehensive safety of nuclear power reactor including reactor design and operation. In general safety is analyzed assuming that reactor equipment and system are in average operating condition. But As reactor becomes aged the equipment malfunction rate increases. Many effort has been in progress for the effect of reactor aging to be reflected on PSA. Up to present PSA method has been applied mainly to active components like pumps and valves. This is because passive components like pipings generally demonstrates higher confidence than active components during initial reactor operation period. However accidents occurs often not only by active components, but also by passive components like that happened in Japan. In order to find out that how much does the degraded passive components' confidence affect power reactor safety the efforts have been made for aging of passive components to be reflected on PSA. This paper intends to introduce such activities to reflect aging effect on PSA. (Hong, J. S.)

  10. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines.

    Science.gov (United States)

    Eslava-Schmalbach, Javier; Sandoval-Vargas, Gisella; Mosquera, Paola

    2011-04-01

    Clinical practice guidelines (CPG) are useful tools for clinical decision making, processes standardization and quality of care improvements. The current General Social Security and Health System (GSSHS) in Colombia is promoting the initiative of developing and implementing CPG based on evidence in order to improve efficiency and quality of care. The reduction of inequalities in health should be an objective of the GSSHS. The main propose of this analysis is to argue why it is necessary to consider the incorporation of equity considerations in the development and implementation of clinical practice guidelines based on the evidence. A series of reflections were made. Narrative description was used for showing the arguments that support the main findings. Among them are: 1. Differential effectiveness by social groups of interventions could diminish final effectiveness of CPG in the GSSHS; 2. To not consider geographical, ethnic, socioeconomic, cultural and access diversity issues within the CPG could have a potential negative impacts of the CPG; 3. Overall effectiveness of GPC could be better if equity issues are included in the quality verification checklist of the guideline questions; 4. Incorporating equity issues in the process of developing CPG could be cost effective, because improve overall effectiveness of CPG. Conclusions To include equity issues in CPG can help in achieving more equitable health outcomes. From this point of view CPG could be key tools to promote equity in care and health outcomes. PMID:22030891

  11. Teaching and Assessing Clinical Reasoning Skills.

    Science.gov (United States)

    Modi, Jyoti Nath; Anshu; Gupta, Piyush; Singh, Tejinder

    2015-09-01

    Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors. PMID:26519715

  12. Assessment of paediatric clinical audit.

    LENUS (Irish Health Repository)

    Perrem, L M

    2012-02-01

    Consultant paediatricians in Ireland were surveyed to evaluate their perceptions of the hospital audit environment and assess their involvement in the audit process. Eighty nine (77%) replied of whom 66 (74%) had an audit department and 23 (26%) did not. Sixteen (18%) felt their hospital was well resourced for audit and 25 (28%) felt the culture was very positive but only 1 (1%) had protected time. For 61 (69%) consultants audit was very important with 38 (43%) being very actively involved in the process. The most frequent trigger for audit was non consultant hospital doctor (NCHD) career development, cited by 77 (87%). The new Professional Competence Scheme and the National Quality and Risk Management Standards will require the deficiencies identified in this survey be addressed.

  13. Assessing clinical competency in the health sciences

    Science.gov (United States)

    Panzarella, Karen Joanne

    To test the success of integrated curricula in schools of health sciences, meaningful measurements of student performance are required to assess clinical competency. This research project analyzed a new performance assessment tool, the Integrated Standardized Patient Examination (ISPE), for assessing clinical competency: specifically, to assess Doctor of Physical Therapy (DPT) students' clinical competence as the ability to integrate basic science knowledge with clinical communication skills. Thirty-four DPT students performed two ISPE cases, one of a patient who sustained a stroke and the other a patient with a herniated lumbar disc. Cases were portrayed by standardized patients (SPs) in a simulated clinical setting. Each case was scored by an expert evaluator in the exam room and then by one investigator and the students themselves via videotape. The SPs scored each student on an overall encounter rubric. Written feedback was obtained from all participants in the study. Acceptable reliability was demonstrated via inter-rater agreement as well as inter-rater correlations on items that used a dichotomous scale, whereas the items requiring the use of the 4-point rubric were somewhat less reliable. For the entire scale both cases had a significant correlation between the Expert-Investigator pair of raters, for the CVA case r = .547, p process of developing cases and patient scenarios that were used in this study. Construct validity was obtained from the survey results analyzed from the experts and students. Future studies should examine the effect of rater training upon the reliability. Criterion or predictive validity could be further studied by comparing students' performances on the ISPE with other independent estimates of students' competence. The unique integration questions of the ISPE were judged to have good content validity from experts and students, suggestive that integration, a most crucial element of clinical competence, while done in the mind of the

  14. Pediatric insomnia: new insights in clinical assessment and treatment options.

    Science.gov (United States)

    Bruni, Oliviero; Angriman, Marco

    2015-01-01

    Sleep disorders in children can compromise quality of life of both children and families and chronic sleep deprivations is associated with poorer developmental outcome, overweight and behavioral disturbances. Clinicians should incorporate questions about sleep into their routine health assessment, and the assessment of insomnia should follow a medical approach primary and secondary contributing factors should be assessed, as well as maladaptive behaviors related to sleep. A careful examination of sleep/wake schedule, abnormal movements or behavior during sleep, and daytime consequences of sleep disruption or deprivation is mandatory. Sleeping environment, and bedtime routines should be examined to identify behavioral issues related to sleep. Polysomnography is not routinely indicated for children with insomnia, but actigraphy can give an objective estimation of sleep parameters. The Authors propose a new classification of pediatric insomnia, based on both genetic and clinical aspects, and suggest specific treatment options, including sleep hygiene, behavioral strategies and pharmacological treatment. PMID:26742668

  15. Personality Assessment Use by Clinical Neuropsychologists

    Science.gov (United States)

    Smith, Steven R.; Gorske, Tad T.; Wiggins, Chauntel; Little, Jessica A.

    2010-01-01

    The present study is an exploration of the personality assessment practices of clinical neuropsychologists. Professional members of the National Academy of Neuropsychology and the International Neuropsychological Society (N = 404) were surveyed to examine use of several forms of personality, behavior, and emotional function measures. Results…

  16. Developing assessment: involving the sessional clinical teacher.

    Science.gov (United States)

    Bateman, H; Thomason, J M; McCracken, G; Ellis, J

    2016-02-12

    Assessment development is a fundamental element of curriculum management and a requirement for providers of education to consistently demonstrate attainment of educational standards. Development of authentic, valid and reliable assessment is, however, both challenging and resource intensive. In the UK, dental education standards are regulated by the General Dental Council (GDC). The 'safe beginner' is the threshold determined by the GDC for the passing student - but how do we apply this? This article describes an approach the School of Dental Sciences at Newcastle University has adopted to address the challenges associated with developing assessments. Sessional clinical teachers contribute a significant proportion of the clinical supervision within the BDS programme and also have a good appreciation of both the standard and concept of the 'safe beginner'. By implementing a process of active timetable management, we have identified time where this group could contribute to assessment development. We believe that aspects, which could be enhanced by their involvement, include writing, validation, standard-setting and utilisation of assessment. To achieve this, we recognise a requirement for investment in careful manpower planning and training, but consider that it is realistic and beneficial to include sessional clinical teachers in this essential part of learning and teaching. PMID:26868802

  17. Incorporating Experiential Learning Techniques to Improve Self-Efficacy in Clinical Special Care Dentistry Education.

    Science.gov (United States)

    Watters, Amber L; Stabulas-Savage, Jeanine; Toppin, James D; Janal, Malvin N; Robbins, Miriam R

    2015-09-01

    The New York University College of Dentistry has introduced a clinical rotation for fourth-year dental students that focuses on treating people with special health care needs (PSN). The aim of this study was to investigate the hypothesis that clinical experience in treating patients with special health care needs during predoctoral education is associated with increased self-assessed student ability and comfort and therefore self-efficacy. The study also investigated whether other characteristics, such as prior personal or volunteer experience with this population, service-mindedness, and/or the inclination to treat underserved populations, were associated with comfort in treating PSN. A survey was used to assess changes in students' perceived knowledge, beliefs, and attitudes regarding treating PSN before and after the clinical experience for July 2012-June 2013. The survey included questions about students' service-mindedness, comfort, perceptions of abilities of PSN and educational importance of learning to treat PSN, desire for clinical experience, and future intent or interest in treating PSN. Out of 364 students invited to participate, 127 surveys were returned, for a response rate of 34.9%. The results showed statistically significant increases on six items following training: impressions about the importance of oral health among PSN, comfort in treating people with cognitive disabilities and with medical complexities, intent to treat PSN in future practice, interest in including PSN in postgraduate training, and belief that PSN could be treated in the private practice setting. These students reported preferring to learn in the clinical setting over didactic instruction. This clinical experience was associated with improved self-efficacy in treating PSN and increased intentions to treat this population in future practice. Improvements were particularly evident among those with the least prior experience with PSN and were independent of other aspects of the

  18. Clinical outcomes assessment in clinical trials to assess treatment of femoroacetabular impingement

    DEFF Research Database (Denmark)

    Harris-Hayes, Marcie; McDonough, Christine M; Leunig, Michael;

    2013-01-01

    Patient-reported outcome measures are an important component of outcomes assessment in clinical trials to assess the treatment of femoroacetabular impingement (FAI). This review of disease-specific measures and instruments used to assess the generic quality of life and physical activity levels of...

  19. Assessing Students – Clinical Competence Versus Performance

    Directory of Open Access Journals (Sweden)

    John Ruedy

    2007-06-01

    Full Text Available The recent elaboration of the range of physiciancompetencies upon which the quality of health care isdependent has fostered the development of a variety ofmethods of assessing medical student competencies andperformance. Such assessments are essential inproviding feedback to students to guide their learningand to faculty on the success of the curriculum inachieving competency outcomes. In addition theyprovide evidence that students have achieved minimumrequirements for progressing. Well-designed ObservedStructured Clinical Examinations (OSCEs, MiniClinical Examinations (Mini-CEXs and some forms ofMulti-Source Feedback (MSF can meet acceptablestandards of validity and reliability and are feasible.Competency assessments are limited in predicting howa student will actually act in the work situationparticularly in humanistic skills. More emphasis needsto be placed on student performance, in suchcompetencies as communication and professionalism, ina variety of settings by a number of observers.

  20. The Clinical Assessment of Intraventricular Flows

    Science.gov (United States)

    Bermejo, Javier; Martínez-Legazpi, Pablo; del Álamo, Juan C.

    2015-01-01

    Recent advances in imaging techniques have allowed physicians to obtain robust measurements of intracardiac flows in the clinical setting. Consequently, the physiological implications of intraventricular fluid dynamics are beginning to be understood. Initial data show that these flows involve complex fluid-structure interactions and mixing phenomena that are modified by disease. Here we critically review the most important aspects of intraventricular fluid mechanics relevant for clinical applications. We discuss current image and numerical methods for assessing intraventricular flows, as well as implemented approaches to analyze their impact on cardiac function. The physiological and clinical insights provided by such techniques are discussed both in health and in disease. The final goal is to encourage research in the application of fluid dynamic foundations to patient-based clinical data. A huge potential is anticipated not only in terms of the basic science of large-scale biological systems, but also in practical terms of improving patient care.

  1. Incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models.

    Science.gov (United States)

    Garibaldi, Jonathan M; Zhou, Shang-Ming; Wang, Xiao-Ying; John, Robert I; Ellis, Ian O

    2012-06-01

    It has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. In contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. Furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. In this paper, we describe a novel approach to incorporate variability within a fuzzy inference system using non-stationary fuzzy sets in order to replicate human variability. We apply our approach to a decision problem concerning the recommendation of post-operative breast cancer treatment; specifically, whether or not to administer chemotherapy based on assessment of five clinical variables: NPI (the Nottingham Prognostic Index), estrogen receptor status, vascular invasion, age and lymph node status. In doing so, we explore whether such explicit modeling of variability provides any performance advantage over a more conventional fuzzy approach, when tested on a set of 1310 unselected cases collected over a fourteen year period at the Nottingham University Hospitals NHS Trust, UK. The experimental results show that the standard fuzzy inference system (that does not model variability) achieves overall agreement to clinical practice around 84.6% (95% CI: 84.1-84.9%), while the non-stationary fuzzy model can significantly increase performance to around 88.1% (95% CI: 88.0-88.2%), pdecision support systems in any application domain. PMID:22265814

  2. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  3. Investigating the incorporation of precision teaching assessment methods within a structured approach for children with autism

    OpenAIRE

    Beeson, Paul

    2013-01-01

    The aim of this research was to investigate the incorporation of a 'structured approach' to teaching children with autism, with precision teaching assessment methods. The rationale for the research focused on the limited evidence base regarding educational approaches for children with autism (Jones, 2002), and the growing need to provide appropriate educational provision for this group (Ali & Frederickson, 2006). One of the more widely used approaches in the UK is 'Treatment and Education of ...

  4. Using Reflective Practice to Incorporate Formative Assessment in a Middle School Science Classroom: A Participatory Action Research Study

    Science.gov (United States)

    Trauth-Nare, Amy; Buck, Gayle

    2011-01-01

    Our purpose was to investigate the efficacy of using reflective practice to guide our action research study of incorporating formative assessment into middle school science teaching and learning. Using participatory action research, we worked collaboratively to incorporate formative assessment into two instructional units, and then engaged in…

  5. Clinical Assessment of Cardiovascular and Autonomic Function

    Directory of Open Access Journals (Sweden)

    Diego Benitez

    2004-10-01

    Full Text Available This paper presents a non-invasive virtual medical instrument for the clinical assessment of cardiovascular and autonomic function. The virtual instrument was developed with the aim of analysing and understanding the physiological changes that occurs in the heart and circulation during vasovagal blackout attacks. The automated virtual instrument allows impedance cardiography analysis, time and frequency heart rate and blood pressure variability analysis, invasive and non-invasive baroreflex sensitivity assessment and forearm blood flow measurements. Using this virtual instrument five control subjects (3 male, mean age 30.6 ± 5.4 and five vasovagal syncope suffers (2 male, mean age 38.6 ± 6.3 were used in a study to try to identify the differences between the two groups to tilt induced syncope. The results obtained suggest that there are fundamental differences in the physiological responses to orthostatic stress between vasovagal patients and controls, which are evident before the onset of major haemodynamic changes.

  6. Clinical assessment of bone mass in children

    Directory of Open Access Journals (Sweden)

    L A Sheplyagina

    2005-02-01

    Full Text Available Objective. To give clinical assessment of bone mass main indices in healthy children living in Moscow and Moscow region. Material and methods. 357 healthy children aged 5-16 years (194 male, 163 female were included. Physical development, bone mineral density (BMD by 2-power radiological absorptiometry, bone mineral content (BMC were evaluated. Results. Significant variability of height in children age groups was revealed. 40,2% had disharmonious physical development. BMC and BMD were closely associated with height (r=0,8, p=0,0001 and body mass (r=0,7, p=0,0001. Bone mass indices were proved to be significantly less in children with height and body mass less then 10% percentile. BMD growth rate was less than mineral accumulation rate. Method of body mass clinical assessment in children was elaborated. Conclusion. Application of elaborated tables of conjugated values of anthropometric and densitometric indices allows to decrease of osteopenia overdiagnosis in children and determine causes of insufficient bone mineral content.

  7. Theoretical foundations of personality assessment in clinical psychology

    OpenAIRE

    Emil Benedik

    2010-01-01

    The paper emphasizes an important role of personality assessment in clinical psychology, leading theoretical and methodological perspectives, as well as the need for integrating different concepts and methods in personality assessment. Personality assessment in clinical psychology represents methodological frame for better understanding and treatment of psychological (mental) disorders. Two principles for personality assessment prevail: one is based on psychological concepts of personality an...

  8. Quality assessment of clinical computed tomography

    Science.gov (United States)

    Berndt, Dorothea; Luckow, Marlen; Lambrecht, J. Thomas; Beckmann, Felix; Müller, Bert

    2008-08-01

    Three-dimensional images are vital for the diagnosis in dentistry and cranio-maxillofacial surgery. Artifacts caused by highly absorbing components such as metallic implants, however, limit the value of the tomograms. The dominant artifacts observed are blowout and streaks. Investigating the artifacts generated by metallic implants in a pig jaw, the data acquisition for the patients in dentistry should be optimized in a quantitative manner. A freshly explanted pig jaw including related soft-tissues served as a model system. Images were recorded varying the accelerating voltage and the beam current. The comparison with multi-slice and micro computed tomography (CT) helps to validate the approach with the dental CT system (3D-Accuitomo, Morita, Japan). The data are rigidly registered to comparatively quantify their quality. The micro CT data provide a reasonable standard for quantitative data assessment of clinical CT.

  9. Clinical Oral Examinations: Assessment of Competency in Radiation Therapy

    OpenAIRE

    Leech, Michelle; POOLE, CLAIRE; CRAIG, AGNELLA; COFFEY, MARY ANNE; NI CHUINNEAGAIN, SIOBHAN

    2009-01-01

    Matching assessment strategies to learning outcomes in radiation therapy education is of the utmost importance. Assessing clinical competence requires that `competence? be clearly defined prior to the start of any clinical programme. In this article, we report on our experience in using clinical oral examinations in assessing competence in second year undergraduate radiation therapy students. The shortcomings of clinical oral examinations such as `leaking? of the agenda are addressed and more...

  10. Clinical Omics Analysis of Colorectal Cancer Incorporating Copy Number Aberrations and Gene Expression Data

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Yoshida

    2010-07-01

    Full Text Available Background: Colorectal cancer (CRC is one of the most frequently occurring cancers in Japan, and thus a wide range of methods have been deployed to study the molecular mechanisms of CRC. In this study, we performed a comprehensive analysis of CRC, incorporating copy number aberration (CRC and gene expression data. For the last four years, we have been collecting data from CRC cases and organizing the information as an “omics” study by integrating many kinds of analysis into a single comprehensive investigation. In our previous studies, we had experienced difficulty in finding genes related to CRC, as we observed higher noise levels in the expression data than in the data for other cancers. Because chromosomal aberrations are often observed in CRC, here, we have performed a combination of CNA analysis and expression analysis in order to identify some new genes responsible for CRC. This study was performed as part of the Clinical Omics Database Project at Tokyo Medical and Dental University. The purpose of this study was to investigate the mechanism of genetic instability in CRC by this combination of expression analysis and CNA, and to establish a new method for the diagnosis and treatment of CRC. Materials and methods: Comprehensive gene expression analysis was performed on 79 CRC cases using an Affymetrix Gene Chip, and comprehensive CNA analysis was performed using an Affymetrix DNA Sty array. To avoid the contamination of cancer tissue with normal cells, laser micro-dissection was performed before DNA/RNA extraction. Data analysis was performed using original software written in the R language. Result: We observed a high percentage of CNA in colorectal cancer, including copy number gains at 7, 8q, 13 and 20q, and copy number losses at 8p, 17p and 18. Gene expression analysis provided many candidates for CRC-related genes, but their association with CRC did not reach the level of statistical significance. The combination of CNA and gene

  11. Physiotherapy students and clinical educators perceive several ways in which incorporating peer-assisted learning could improve clinical placements: a qualitative study

    Directory of Open Access Journals (Sweden)

    Samantha Sevenhuysen

    2015-04-01

    Full Text Available Question: What are the experiences of students and clinical educators in a paired student placement model incorporating facilitated peer-assisted learning (PAL activities, compared to a traditional paired teaching approach? Design: Qualitative study utilising focus groups. Participants: Twenty-four physiotherapy students and 12 clinical educators. Intervention: Participants in this study had experienced two models of physiotherapy clinical undergraduate education: a traditional paired model (usual clinical supervision and learning activities led by clinical educators supervising pairs of students and a PAL model (a standardised series of learning activities undertaken by student pairs and clinical educators to facilitate peer interaction using guided strategies. Results: Peer-assisted learning appears to reduce the students’ anxiety, enhance their sense of safety in the learning environment, reduce educator burden, maximise the use of downtime, and build professional skills including collaboration and feedback. While PAL adds to the clinical learning experience, it is not considered to be a substitute for observation of the clinical educator, expert feedback and guidance, or hands-on immersive learning activities. Cohesion of the student-student relationship was seen as an enabler of successful PAL. Conclusion: Students and educators perceive that PAL can help to position students as active learners through reduced dependence on the clinical educator, heightened roles in observing practice, and making and communicating evaluative judgments about quality of practice. The role of the clinical educator is not diminished with PAL, but rather is central in designing flexible and meaningful peer-based experiences and in balancing PAL with independent learning opportunities. Registration: ACTRN12610000859088. [Sevenhuysen S, Farlie MK, Keating JL, Haines TP, Molloy E (2015 Physiotherapy students and clinical educators perceive several ways in which

  12. Reliability assessment of power pole infrastructure incorporating deterioration and network maintenance

    International Nuclear Information System (INIS)

    There is considerable investment in timber utility poles worldwide, and there is a need to examine the structural reliability and probability based management optimisation of these power distribution infrastructure elements. The work presented in this paper builds on the existing studies in this area through assessment of both treated and untreated timber power poles, with the effects of deterioration and network maintenance incorporated in the analysis. This more realistic assessment approach, with deterioration and maintenance considered, was achieved using event-based Monte Carlo simulation. The output from the probabilistic model is used to illustrate the importance of considering network maintenance in the time-dependent structural reliability assessment of timber power poles. Under wind load, treated and untreated poles designed and maintained in accordance with existing Australian standards were found to have similar failure rates. However, untreated pole networks required approximately twice as many maintenance based pole replacements to sustain the same level of reliability. The effect of four different network maintenance strategies on infrastructure performance was also investigated herein. This assessment highlighted the fact that slight alterations to network maintenance practices can lead to significant changes in performance of timber power pole networks. - Highlights: • A time-dependent structural reliability model was developed for timber power poles. • Deterioration and network maintenance were incorporated into this event based model. • Network maintenance had a significant impact on power pole wind vulnerability. • Treated and untreated poles designed to Australian standards had similar reliability. • Minor alterations to maintenance strategies had large effects on network performance

  13. Theoretical foundations of personality assessment in clinical psychology

    Directory of Open Access Journals (Sweden)

    Emil Benedik

    2010-07-01

    Full Text Available The paper emphasizes an important role of personality assessment in clinical psychology, leading theoretical and methodological perspectives, as well as the need for integrating different concepts and methods in personality assessment. Personality assessment in clinical psychology represents methodological frame for better understanding and treatment of psychological (mental disorders. Two principles for personality assessment prevail: one is based on psychological concepts of personality and statistical methodology, and the other relies on findings from clinical practice (clinical psychology, psychiatry and related fields. Since we do not yet have a generally accepted paradigm of personality assessment, clinical psychology needs unified concepts and methodology for personality assessment. Several authors have attempted to integrate and unify psychological concepts and methodology of assessment in the last decade. This is the path to development of clinical psychology and psychological science in general.

  14. An Applied Framework for Incorporating Multiple Sources of Uncertainty in Fisheries Stock Assessments

    Science.gov (United States)

    Scott, Finlay; Jardim, Ernesto; Millar, Colin P.; Cerviño, Santiago

    2016-01-01

    Estimating fish stock status is very challenging given the many sources and high levels of uncertainty surrounding the biological processes (e.g. natural variability in the demographic rates), model selection (e.g. choosing growth or stock assessment models) and parameter estimation. Incorporating multiple sources of uncertainty in a stock assessment allows advice to better account for the risks associated with proposed management options, promoting decisions that are more robust to such uncertainty. However, a typical assessment only reports the model fit and variance of estimated parameters, thereby underreporting the overall uncertainty. Additionally, although multiple candidate models may be considered, only one is selected as the ‘best’ result, effectively rejecting the plausible assumptions behind the other models. We present an applied framework to integrate multiple sources of uncertainty in the stock assessment process. The first step is the generation and conditioning of a suite of stock assessment models that contain different assumptions about the stock and the fishery. The second step is the estimation of parameters, including fitting of the stock assessment models. The final step integrates across all of the results to reconcile the multi-model outcome. The framework is flexible enough to be tailored to particular stocks and fisheries and can draw on information from multiple sources to implement a broad variety of assumptions, making it applicable to stocks with varying levels of data availability The Iberian hake stock in International Council for the Exploration of the Sea (ICES) Divisions VIIIc and IXa is used to demonstrate the framework, starting from length-based stock and indices data. Process and model uncertainty are considered through the growth, natural mortality, fishing mortality, survey catchability and stock-recruitment relationship. Estimation uncertainty is included as part of the fitting process. Simple model averaging is used

  15. Clinical Legal Education Models: Recommended Assessment Regimes

    OpenAIRE

    Riette (MA) du Plessis

    2015-01-01

    Clinical legal education (CLE) forms part of the LLB curriculum at most South African Universities. There are many similarities in the approach to CLE, but often also many differences. The clinical models of four South African university law clinics are reviewed in an effort to find suitable models. It is indicated that formulating a mission for the law clinic will have a direct impact on the clinical model chosen. The integration of CLE courses into the core curriculum of the law school will...

  16. Forms of Knowledge Incorporated in Clinical Decision-making among Newly-Graduated Nurses: A Metasynthesis

    DEFF Research Database (Denmark)

    Voldbjerg, Siri; Elgaard Sørensen, Erik; Grønkjær, Mette;

    2013-01-01

    Clinical-decision-making is of decisive importance to how evidence-based practice is put into practice. Schools of Nursing have a responsibility to teach and train nursing students to make clinical decisions within a frame of evidence-based practice. Clinical decision-making among nurses has been...... knowledge that informs clinical decision-making among newly-graduated nurses. Qualitative studies were retrieved from CINAHL, PubMed, SCOPE, ERIC and GOOGLE-Scholar and subsequently selected by pre-defined inclusion criteria and critically appraised using CASP. Metaphors identified in the analytical process...... will contribute to theory development and have implications for clinical and educational practice regarding the professional development of clinical decision making within a frame of evidence-based practice. The presentation highlights the main findings from the metasynthesis and provides perspectives...

  17. Incorporating formative assessment and science content into elementary science methods---A case study

    Science.gov (United States)

    Brower, Derek John

    and students also expressed a desire to incorporate formative assessment into their future teaching. Final reflections on this case study recognize the value of formative assessment as a means for improved communication between students and teachers about student understanding in an effort to provide and model more effective science instruction.

  18. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines

    OpenAIRE

    Eslava-Schmalbach, Javier; Sandoval-Vargas, Gisella; Mosquera, Paola

    2012-01-01

    Clinical practice guidelines (CPG) are useful tools for clinical decision making, processes standardization and quality of care improvements. The current General Social Security and Health System (GSSHS) in Colombia is promoting the initiative of developing and implementing CPG based on evidence in order to improve efficiency and quality of care. The reduction of inequalities in health should be an objective of the GSSHS. The main propose of this analysis is to argue why it is necessary to co...

  19. Incorporating INTERACT II Clinical Decision Support Tools into Nursing Home Health Information Technology

    OpenAIRE

    Handler, Steven M.; Sharkey, Siobhan S.; Hudak, Sandra; Ouslander, Joseph G.

    2011-01-01

    A substantial reduction in hospitalization rates has been associated with the implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement intervention using the accompanying paper-based clinical practice tools (INTERACT II). There is significant potential to further increase the impact of INTERACT by integrating INTERACT II tools into nursing home (NH) health information technology (HIT) via standalone or integrated clinical decision support (CDS) systems...

  20. Teaching trainers to incorporate evidence-based medicine (EBM teaching in clinical practice: the EU-EBM project

    Directory of Open Access Journals (Sweden)

    Kaleta Anna

    2009-09-01

    Full Text Available Abstract Background Evidence based medicine (EBM is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. Methods We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. Results The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. Conclusion This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical

  1. Incorporating organizational factors into probabilistic safety assessment of nuclear power plants through canonical probabilistic models

    International Nuclear Information System (INIS)

    The ω-factor approach is a method that explicitly incorporates organizational factors into Probabilistic safety assessment of nuclear power plants. Bayesian networks (BNs) are the underlying formalism used in this approach. They have a structural part formed by a graph whose nodes represent organizational variables, and a parametric part that consists of conditional probabilities, each of them quantifying organizational influences between one variable and its parents in the graph. The aim of this paper is twofold. First, we discuss some important limitations of current procedures in the ω-factor approach for either assessing conditional probabilities from experts or estimating them from data. We illustrate the discussion with an example that uses data from Licensee Events Reports of nuclear power plants for the estimation task. Second, we introduce significant improvements in the way BNs for the ω-factor approach can be constructed, so that parameter acquisition becomes easier and more intuitive. The improvements are based on the use of noisy-OR gates as model of multicausal interaction between each BN node and its parents

  2. Incorporating organizational factors into probabilistic safety assessment of nuclear power plants through canonical probabilistic models

    Energy Technology Data Exchange (ETDEWEB)

    Galan, S.F. [Dpto. de Inteligencia Artificial, E.T.S.I. Informatica (UNED), Juan del Rosal, 16, 28040 Madrid (Spain)]. E-mail: seve@dia.uned.es; Mosleh, A. [2100A Marie Mount Hall, Materials and Nuclear Engineering Department, University of Maryland, College Park, MD 20742 (United States)]. E-mail: mosleh@umd.edu; Izquierdo, J.M. [Area de Modelado y Simulacion, Consejo de Seguridad Nuclear, Justo Dorado, 11, 28040 Madrid (Spain)]. E-mail: jmir@csn.es

    2007-08-15

    The {omega}-factor approach is a method that explicitly incorporates organizational factors into Probabilistic safety assessment of nuclear power plants. Bayesian networks (BNs) are the underlying formalism used in this approach. They have a structural part formed by a graph whose nodes represent organizational variables, and a parametric part that consists of conditional probabilities, each of them quantifying organizational influences between one variable and its parents in the graph. The aim of this paper is twofold. First, we discuss some important limitations of current procedures in the {omega}-factor approach for either assessing conditional probabilities from experts or estimating them from data. We illustrate the discussion with an example that uses data from Licensee Events Reports of nuclear power plants for the estimation task. Second, we introduce significant improvements in the way BNs for the {omega}-factor approach can be constructed, so that parameter acquisition becomes easier and more intuitive. The improvements are based on the use of noisy-OR gates as model of multicausal interaction between each BN node and its parents.

  3. Incorporating ethical principles into clinical research protocols: a tool for protocol writers and ethics committees

    Science.gov (United States)

    Li, Rebecca H; Wacholtz, Mary C; Barnes, Mark; Boggs, Liam; Callery-D'Amico, Susan; Davis, Amy; Digilova, Alla; Forster, David; Heffernan, Kate; Luthin, Maeve; Lynch, Holly Fernandez; McNair, Lindsay; Miller, Jennifer E; Murphy, Jacquelyn; Van Campen, Luann; Wilenzick, Mark; Wolf, Delia; Woolston, Cris; Aldinger, Carmen; Bierer, Barbara E

    2016-01-01

    A novel Protocol Ethics Tool Kit (‘Ethics Tool Kit’) has been developed by a multi-stakeholder group of the Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard. The purpose of the Ethics Tool Kit is to facilitate effective recognition, consideration and deliberation of critical ethical issues in clinical trial protocols. The Ethics Tool Kit may be used by investigators and sponsors to develop a dedicated Ethics Section within a protocol to improve the consistency and transparency between clinical trial protocols and research ethics committee reviews. It may also streamline ethics review and may facilitate and expedite the review process by anticipating the concerns of ethics committee reviewers. Specific attention was given to issues arising in multinational settings. With the use of this Tool Kit, researchers have the opportunity to address critical research ethics issues proactively, potentially speeding the time and easing the process to final protocol approval. PMID:26811365

  4. Incorporating ethical principles into clinical research protocols: a tool for protocol writers and ethics committees.

    Science.gov (United States)

    Li, Rebecca H; Wacholtz, Mary C; Barnes, Mark; Boggs, Liam; Callery-D'Amico, Susan; Davis, Amy; Digilova, Alla; Forster, David; Heffernan, Kate; Luthin, Maeve; Lynch, Holly Fernandez; McNair, Lindsay; Miller, Jennifer E; Murphy, Jacquelyn; Van Campen, Luann; Wilenzick, Mark; Wolf, Delia; Woolston, Cris; Aldinger, Carmen; Bierer, Barbara E

    2016-04-01

    A novel Protocol Ethics Tool Kit ('Ethics Tool Kit') has been developed by a multi-stakeholder group of the Multi-Regional Clinical Trials Center of Brigham and Women's Hospital and Harvard. The purpose of the Ethics Tool Kit is to facilitate effective recognition, consideration and deliberation of critical ethical issues in clinical trial protocols. The Ethics Tool Kit may be used by investigators and sponsors to develop a dedicated Ethics Section within a protocol to improve the consistency and transparency between clinical trial protocols and research ethics committee reviews. It may also streamline ethics review and may facilitate and expedite the review process by anticipating the concerns of ethics committee reviewers. Specific attention was given to issues arising in multinational settings. With the use of this Tool Kit, researchers have the opportunity to address critical research ethics issues proactively, potentially speeding the time and easing the process to final protocol approval. PMID:26811365

  5. Clinical learning & assessment in simulated & virtual worlds

    OpenAIRE

    Harper, Mick; WILLIAMS Andy

    2012-01-01

    •To provide an overview of current simulation modalities available •To provide an understanding of the underpinning educational theory for learning & assessment in simulated & VR environments •To outline current research into learning & assessment through simulation

  6. In-vitro assessment and pharmacodynamics of nimesulide incorporated Aloe vera transemulgel.

    Science.gov (United States)

    Vandana, K R; Yalavarthi, Prasanna R; Sundaresan, C R; Sriramaneni, Raghava N; Vadlamudi, Harini C

    2014-06-01

    The aim of the investigation was to prepare nimesulide emulsion for incorporation in Aloe vera gel base to formulate 'nimesulide - Aloe vera transemulgel' (NAE) and to carryout in-vitro assessment and in-vivo anti-inflammatory studies of the product. Although the use of nimesulide is banned for oral administration, due to its potential for inducing hepatotoxicity and thrombocytopenia, the use of nimesulide for topical delivery is prominent in the treatment of many inflammatory conditions including rheumatoid arthritis. The drug loading capacity of transdermal gels is low for hydrophobic drugs such as nimesulide. Nimesulide can be effectively incorporated into emulgels (a combination of emulsion and gel). Aloe vera has a mild anti-inflammatory effect and in the present study Aloe vera gel was formulated and used as a gel base to prepare NAE. The emulgels thus prepared were evaluated for viscosity, pH, in-vitro permeation, stability and skin irritation test. In-vivo anti-inflammatory studies were performed using carrageenan induced hind paw edema method in Wistar rats. The results were compared with that of commercial nimesulide gel (CNG). From the in-vitro studies, effective permeation of nimesulide from NAE (53.04 %) was observed compared to CNG (44.72 %) at 30 min indicating better drug release from NAE. Topical application of the emulgel found no skin irritation. Stability studies proved the integrity of the formulation. The percentage of inhibition of edema was highest for the prepared NAE (67.4 % inhibition after 240 min) compared to CNG (59.6 %). From our results, it was concluded that the Aloe vera gel acts as an effective gel base to prepare nimesulide emulgel with high drug loading capacity (86.4 % drug content) compared to CNG (70.5 % drug content) with significant anti-inflammatory effect. PMID:24295369

  7. How should training of graduates in clinical pharmacology and therapeutics be delivered and assessed?

    OpenAIRE

    Jackson, Peter

    2012-01-01

    The UK postgraduate curriculum in clinical pharmacology and therapeutics (CPT) incorporates the common competencies required of all physicians and shows how trainees from other specialties, including primary care, can train in CPT. Various models of training and assessment are possible. Evolution of the current system to meet new challenges would maintain an established tradition, with a ready source of training funds. However, this would require greater input from all consultants in CPT, inc...

  8. Clinical Symptoms as a Function of Client Personality in College Students: Incorporating the Five-Factor Model of Personality

    Science.gov (United States)

    Hammond, Marie S.; Lockman, Jennifer D.; Temple, Rebecca A.

    2013-01-01

    In this study, the relationship between personality characteristics and presenting clinical symptoms of individuals at a college counseling center was examined. Analysis of assessments of personality (Costa & McCrae, 1992) and mental health symptoms (Farrell & McCullough, 1989) suggests that the personality characteristics of individuals…

  9. Incorporating uncertainties into risk assessment with an application to the exploratory studies facilities at Yucca Mountain

    Energy Technology Data Exchange (ETDEWEB)

    Fathauer, P.M.

    1995-08-01

    A methodology that incorporates variability and reducible sources of uncertainty into the probabilistic and consequence components of risk was developed. The method was applied to the north tunnel of the Exploratory Studies Facility at Yucca Mountain in Nevada. In this assessment, variability and reducible sources of uncertainty were characterized and propagated through the risk assessment models using a Monte Carlo based software package. The results were then manipulated into risk curves at the 5% and 95% confidence levels for both the variability and overall uncertainty analyses, thus distinguishing between variability and reducible sources of uncertainty. In the Yucca Mountain application, the designation of the north tunnel as an item important to public safety, as defined by 10 CFR 60, was determined. Specifically, the annual frequency of a rock fall breaching a waste package causing an off-site dose of 500 mrem (5x10{sup -3} Sv) was calculated. The annual frequency, taking variability into account, ranged from 1.9x10{sup -9} per year at the 5% confidence level to 2.5x10{sup -9} per year at the 95% confidence level. The frequency range after including all uncertainty was 9.5x10{sup -10} to 1.8x10{sup -8} per year. The maximum observable frequency, at the 100% confidence level, was 4.9x10{sup -8} per year. This is below the 10{sup -6} per year frequency criteria of 10 CFR 60. Therefore, based on this work, the north tunnel does not fall under the items important to public safety designation for the event studied.

  10. Total Transfer Capability Assessment Incorporating Corrective Controls for Transient Stability using TSCOPF

    Science.gov (United States)

    Hakim, Lukmanul; Kubokawa, Junji; Yorino, Naoto; Zoka, Yoshifumi; Sasaki, Yutaka

    Advancements have been made towards inclusion of both static and dynamic security into transfer capability calculation. However, to the authors' knowledge, work on considering corrective controls into the calculation has not been reported yet. Therefore, we propose a Total Transfer Capability (TTC) assessment considering transient stability corrective controls. The method is based on the Newton interior point method for nonlinear programming and transfer capability is approached as a maximization of power transfer with both static and transient stability constraints are incorporated into our Transient Stability Constrained Optimal Power Flow (TSCOPF) formulation. An interconnected power system is simulated to be subjected to a severe unbalanced 3-phase 4-line to ground fault and following the fault, generator and load are shed in a pre-defined sequence to mimic actual corrective controls. In a deregulated electricity market, both generator companies and large load customers are encouraged to actively participate in maintaining power system stability as corrective controls upon agreement of compensation for being shed following a disturbance. Implementation of this proposal on the actual power system operation should be carried out through combining it with the existing transient stabilization controller system. Utilization of these corrective controls results in increasing TTC as suggested in our numerical simulation. As Lagrange multipliers can also describe sensitivity of both inequality and equality constraints to the objective function, then selection of which generator or load to be shed can be carried out on the basis of values of Lagrange multipliers of its respective generator's rotor angle stability and active power balance equation. Hence, the proposal in this paper can be utilized by system operator to assess the maximum TTC for specific loads and network conditions.

  11. Incorporating uncertainties into risk assessment with an application to the exploratory studies facilities at Yucca Mountain

    International Nuclear Information System (INIS)

    A methodology that incorporates variability and reducible sources of uncertainty into the probabilistic and consequence components of risk was developed. The method was applied to the north tunnel of the Exploratory Studies Facility at Yucca Mountain in Nevada. In this assessment, variability and reducible sources of uncertainty were characterized and propagated through the risk assessment models using a Monte Carlo based software package. The results were then manipulated into risk curves at the 5% and 95% confidence levels for both the variability and overall uncertainty analyses, thus distinguishing between variability and reducible sources of uncertainty. In the Yucca Mountain application, the designation of the north tunnel as an item important to public safety, as defined by 10 CFR 60, was determined. Specifically, the annual frequency of a rock fall breaching a waste package causing an off-site dose of 500 mrem (5x10-3 Sv) was calculated. The annual frequency, taking variability into account, ranged from 1.9x10-9 per year at the 5% confidence level to 2.5x10-9 per year at the 95% confidence level. The frequency range after including all uncertainty was 9.5x10-10 to 1.8x10-8 per year. The maximum observable frequency, at the 100% confidence level, was 4.9x10-8 per year. This is below the 10-6 per year frequency criteria of 10 CFR 60. Therefore, based on this work, the north tunnel does not fall under the items important to public safety designation for the event studied

  12. Incorporating long-term climate change in performance assessment for the Waste Isolation Pilot Plant

    Energy Technology Data Exchange (ETDEWEB)

    Swift, P.N. [Sandia National Labs., Albuquerque, NM (United States); Baker, B.L. [Technadyne Engineering Consultants, Inc., Albuquerque, NM (United States); Economy, K. [Ecodynamics Research Associates, Albuquerque, NM (United States); Garner, J.W. [Applied Physics, Inc., Albuquerque, NM (United States); Helton, J.C. [Arizona State Univ., Tempe, AZ (United States); Rudeen, D.K. [New Mexico Engineering Research Institute, Albuquerque, NM (United States)

    1994-03-01

    The United States Department of Energy (DOE) is developing the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico for the disposal of transuranic wastes generated by defense programs. Applicable regulations (40 CFR 191) require the DOE to evaluate disposal-system performance for 10,000 yr. Climatic changes may affect performance by altering groundwater flow. Paleoclimatic data from southeastern New Mexico and the surrounding area indicate that the wettest and coolest Quaternary climate at the site can be represented by that at the last glacial maximum, when mean annual precipitation was approximately twice that of the present. The hottest and driest climates have been similar to that of the present. The regularity of global glacial cycles during the late Pleistocene confirms that the climate of the last glacial maximum is suitable for use as a cooler and wetter bound for variability during the next 10,000 yr. Climate variability is incorporated into groundwater-flow modeling for WIPP PA by causing hydraulic head in a portion of the model-domain boundary to rise to the ground surface with hypothetical increases in precipitation during the next 10,000 yr. Variability in modeled disposal-system performance introduced by allowing had values to vary over this range is insignificant compared to variability resulting from other causes, including incomplete understanding of transport processes. Preliminary performance assessments suggest that climate variability will not affect regulatory compliance.

  13. Incorporating long-term climate change in performance assessment for the Waste Isolation Pilot Plant

    International Nuclear Information System (INIS)

    The United States Department of Energy (DOE) is developing the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico for the disposal of transuranic wastes generated by defense programs. Applicable regulations (40 CFR 191) require the DOE to evaluate disposal-system performance for 10,000 yr. Climatic changes may affect performance by altering groundwater flow. Paleoclimatic data from southeastern New Mexico and the surrounding area indicate that the wettest and coolest Quaternary climate at the site can be represented by that at the last glacial maximum, when mean annual precipitation was approximately twice that of the present. The hottest and driest climates have been similar to that of the present. The regularity of global glacial cycles during the late Pleistocene confirms that the climate of the last glacial maximum is suitable for use as a cooler and wetter bound for variability during the next 10,000 yr. Climate variability is incorporated into groundwater-flow modeling for WIPP PA by causing hydraulic head in a portion of the model-domain boundary to rise to the ground surface with hypothetical increases in precipitation during the next 10,000 yr. Variability in modeled disposal-system performance introduced by allowing head values to vary over this range is insignificant compared to variability resulting from other causes, including incomplete understanding of transport processes. Preliminary performance assessments suggest that climate variability will not affect regulatory compliance

  14. Assessment of methodology for 131I determination in workers exposed to incorporation

    International Nuclear Information System (INIS)

    In this work a technique used to monitor internal contamination of workers exposed to Iodine-131 incorporation from Radioisotope Production Plant was assessed. For the measurements of workers a NaI(Tl) EG and G ORTEC 905-1 were used in specific geometry, and data acquisition was controlled with MaestroTM software. Phantom has been used for calibration of efficiency of detectors placed in the same position as the real monitored person. Moreover, background counting was evaluated by statistical analysis for determination of protocol counting. The results obtained were analyzed under two models for calculating the decision threshold (Lc), and the minimum detectable activity (MDA), finally total uncertainty was calculated. Mean of efficiency was de 0.13% (RSD 6.7%) N = 43 D 6,7%, the MDA was 224 Bq (95% NC), and total propagated uncertainty was ± 13%. We obtained an effective evaluation of thyroid monitoring system for measurement of Iodine-131 in occupationally exposed persons. (author)

  15. Incorporating long-term climate change in performance assessment for the Waste Isolation Pilot Plant

    International Nuclear Information System (INIS)

    The United States Department of Energy (DOE) is developing the Waste Isolation Pilot Plant (WIPP) in southeastern New Mexico for the disposal of transuranic wastes generated by defense programs. Applicable regulations (40 CFR 191) require the DOE to evaluate disposal-system performance for 10,000 yr. Climatic changes may affect performance by altering groundwater flow. Paleoclimatic data from southeastern New Mexico and the surrounding area indicate that the wettest and coolest Quaternary climate at the site can be represented by that at the last glacial maximum, when mean annual precipitation was approximately twice that of the present. The hottest and driest climates have been similar to that of the present. The regularity of global glacial cycles during the late Pleistocene confirms that the climate of the last glacial maximum is suitable for use as a cooler and wetter bound for variability during the next 10,000 yr. Climate variability is incorporated into groundwater-flow modeling for WIPP PA by causing hydraulic head in a portion of the model-domain boundary to rise to the ground surface with hypothetical increases in precipitation during the next 10,000 yr. Variability in modeled disposal-system performance introduced by allowing had values to vary over this range is insignificant compared to variability resulting from other causes, including incomplete understanding of transport processes. Preliminary performance assessments suggest that climate variability will not affect regulatory compliance

  16. Incorporating genomics into breast and prostate cancer screening: assessing the implications.

    Science.gov (United States)

    Chowdhury, Susmita; Dent, Tom; Pashayan, Nora; Hall, Alison; Lyratzopoulos, Georgios; Hallowell, Nina; Hall, Per; Pharoah, Paul; Burton, Hilary

    2013-06-01

    Individual risk prediction and stratification based on polygenic profiling may be useful in disease prevention. Risk-stratified population screening based on multiple factors including a polygenic risk profile has the potential to be more efficient than age-stratified screening. In this article, we summarize the implications of personalized screening for breast and prostate cancers. We report the opinions of multidisciplinary international experts who have explored the scientific, ethical, and logistical aspects of stratified screening. We have identified (i) the need to recognize the benefits and harms of personalized screening as compared with existing screening methods, (ii) that the use of genetic data highlights complex ethical issues including discrimination against high-risk individuals by insurers and employers and patient autonomy in relation to genetic testing of minors, (iii) the need for transparency and clear communication about risk scores, about harms and benefits, and about reasons for inclusion and exclusion from the risk-based screening process, and (iv) the need to develop new professional competences and to assess cost-effectiveness and acceptability of stratified screening programs before implementation. We conclude that health professionals and stakeholders need to consider the implications of incorporating genetic information in intervention strategies for health-care planning in the future. PMID:23412607

  17. The Pattern Method for Incorporating Tidal Uncertainty Into Probabilistic Tsunami Hazard Assessment (PTHA)

    CERN Document Server

    Adams, Loyce M; González, Frank I

    2014-01-01

    In this paper we describe a general framework for incorporating tidal uncertainty into probabilistic tsunami hazard assessment and propose the Pattern Method and a simpler special case called the $\\Delta t$ Method as effective approaches. The general framework also covers the method developed by Mofjeld et.al in 2007 that was used for the 2009 Seaside, Oregon probabilistic study by Gonzalez et.al. We show the Pattern Method is superior to past approaches because it takes advantage of our ability to run the tsunami simulation at multiple tide stages and uses the time history of flow depth at strategic gauge locations to infer the temporal pattern of waves that is unique to each tsunami source. Combining these patterns with knowledge of the tide cycle at a particular location improves the ability to estimate the probability that a wave will arrive at a time when the tidal stage is sufficiently large that a quantity of interest such as the maximum flow depth exceeds a specified level.

  18. On the Assessment Standardization for TCM Clinical Evidence

    Institute of Scientific and Technical Information of China (English)

    Wang Yingying; Yang Jinsheng

    2008-01-01

    @@ Nowadays,the evidence-based medicine has been widely used for assessment of TCM.The assessment based on clinical evidence and the quality is the core of evidence-based medicine.However,the evidencerating methods adopted in the modern medical system are only applicable in a certain degree to the assessment of TCM clinicaI evidence.

  19. Assessment of blinding success among dental implant clinical trials: A systematic review

    Directory of Open Access Journals (Sweden)

    Jafar Kolahi

    2015-01-01

    Full Text Available Introduction: It is widely believed that blinding is a cornerstone of randomized clinical trials and that significant bias may result from unsuccessful blinding. However, it is not enough to claim that a clinical trial is single- or double-blinded and that assessment of the success of blinding is ideal. The aim of this study was to evaluate the prevalence of assessment of blinding success among dental implant clinical trials and to introduce methods of blinding assessment to the implant research community. Methods: In November 2014, PubMed was searched by blinded and experienced researchers with the query "implant AND (blindFNx01 OR maskFNx01" using the following filters: (1 Article type: clinical trial; (2 Journal categories: dental journals; (3 Field: title/abstract. Consequently, title/abstract was reviewed in all relevant articles to find any attempt to assess the success of blinding in dental implant clinical trials. Results: The PubMed search results yielded 86 clinical trials. The point of interest is that when "blindFNx01 OR maskFNx01" was deleted from the query, the number of results increased to 1688 clinical trials. This shows that only 5% of dental implant clinical trials tried to use blinding. Disappointingly, we could not find any dental implant clinical trial reporting any attempt to assess the success of blinding. Conclusion: The current status of turning a blind eye to unblinding in dental implant clinical trials is not tolerable and needs to be improved. Researchers, protocol reviewers, local ethical committees, journal reviewers, and editors should make a concerted effort to incorporate, report, and publish such information to understand its potential impact on study results.

  20. Clinical assessment and management of ankle sprains.

    Science.gov (United States)

    Myrick, Karen M

    2014-01-01

    Ankle sprains are a common occurrence and are frequently either undertreated or overtreated. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the United States alone, this is an orthopaedic injury that providers should be acutely aware of and successfully able to evaluate and treat. This clinical feature will provide a thorough review of the mechanism of injury, the history and physical examination, and the classification and management of these injuries. Clinical red flags are discussed. PMID:25233201

  1. A Clinician’s Perspective on Incorporating Therapeutic Lifestyle Change into Clinical Practice

    Directory of Open Access Journals (Sweden)

    Mark S. McIntosh

    2011-02-01

    Full Text Available This article describes the unique perspective of a clinician who was originally trained as an acute care specialist but in recent years had the opportunity to witness the positive impact of therapeutic lifestyle change (TLC programs in managing chronic diseases. Through experience gained from conducting a multi-center clinical trial investigating the effects of TLC program in people with metabolic syndrome, Dr. Mark S. McIntosh discusses various aspects and challenges pertinent to implementing a successful TLC program. Patients, physicians, lifestyle counselors, work places, and home environment are all critical in forming an alliance for transforming the current sick-care approach to preventive, wellness-focused approach that is far more efficient,rewarding, and financially sustainable.

  2. Clinical assessment of osteoarthritis of the knee.

    OpenAIRE

    Cushnaghan, J; Cooper, C; Dieppe, P; Kirwan, J; McAlindon, T; McCrae, F

    1990-01-01

    The repeatability of physical signs used to assess osteoarthritis of the knee has not been systematically examined. The within and between observer variation of 10 commonly used physical signs to determine osteoarthritis of the knee has been assessed here. The results obtained show variation in the repeatability of these signs. For those examining the tibiofemoral joints the repeatability was greater than for those examining the patellofemoral joint. It would therefore seem vital to take note...

  3. Clinical Assessment And Diagnosis Of Dementia

    Directory of Open Access Journals (Sweden)

    Srikanth S

    2005-01-01

    Full Text Available Dementia is characterized by progressive decline in an alert individual, leading to loss of independence in day-to-day functioning. It is a generic term for a condition that has various causes and hence myriad clinical presentations. It has to be distinguished from age-related cognitive decline, depression and delirium all of which are common in the elderly population. Detailed history and mental status examination are necessary to identify dementia, fit it into one of the various bedside classifications and pursue the differential diagnosis. This teaching review summarizes current information on definition, differential diagnosis and classification of dementia and presents a brief elaboration of bedside cognitive testing pertaining to dementia. A bird′s eye view of the profiles of various dementia subtypes is also provided so that after reading this article the reader will able to recognize dementia, conduct clinical examination to identify the characteristic cognitive profile and formulate the differential diagnosis with confidence.

  4. Clinical Assessment And Diagnosis Of Dementia

    OpenAIRE

    Srikanth S; Shankar V; Shanbhogue Kamakshi

    2005-01-01

    Dementia is characterized by progressive decline in an alert individual, leading to loss of independence in day-to-day functioning. It is a generic term for a condition that has various causes and hence myriad clinical presentations. It has to be distinguished from age-related cognitive decline, depression and delirium all of which are common in the elderly population. Detailed history and mental status examination are necessary to identify dementia, fit it into one of the various bedside ...

  5. Improving glycemic and cholesterol control through an integrated approach incorporating colesevelam – a clinical perspective

    Directory of Open Access Journals (Sweden)

    Ronald B Goldberg

    2009-05-01

    Full Text Available Ronald B GoldbergDivision of Endocrinology, Diabetes and Metabolism, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USAAbstract: Bile sequestrants have been used for almost 50 years to lower low density lipoprotein cholesterol (LDL-C. The advent of colesevelam in 2000 provided a more tolerable add-on LDL-C-lowering agent with an excellent safety record and with likely benefit for coronary heart disease events. Colesevelam lowers LDL-C approximately 15%, and has an additive effect when combined with statin or non-statin lipid-modifying agents. It also tends to increase triglyceride levels. The discovery that bile sequestrants also lower glucose levels led to definitive large-scale clinical trials testing the effect of colesevelam as a dual antihyperglycemic agent with LDL-C-lowering properties in type 2 diabetic subjects on metformin-, sulfonylurea- or insulin-based therapy with inadequate glycemic control. Colesevelam was found to lower hemoglobin A1c (HbA1c by approximately 0.5% compared to placebo over the 16- to 26-week period, and had similar effects on the lipid profile in these diabetic subjects, as had previously been demonstrated in non-diabetic individuals. Colesevelam was well tolerated, with constipation being the most common adverse effect, and did not cause weight gain or excessive hypoglycemia. Colesevelam thus combines antihyperglycemic action with LDL-C-lowering properties, and should be useful in the management of type 2 diabetes.Keywords: colesevelam, treatment, hyperglycemia, LDL-cholesterol

  6. Clinical features, assessment and treatment of essential tremor.

    OpenAIRE

    Panicker, J N; Pal, P K

    2003-01-01

    Essential tremor is the most common of the movement disorders, being 20 times more common than Parkinson's Disease. It is characterised by postural and kinetic tremor which maximally affects the hands. It can be assessed by physiological techniques, subjective clinical methods, objective clinical methods and handicap/disability scales. Accelerometry, spirography and handwriting assessment, volumetry and handicap/disability questionnaires are commonly used methods. Primidone and propranolol ar...

  7. Computerised triage in a prostate assessment clinic.

    Science.gov (United States)

    Rajkumar, G N; Small, D R; Conn, I G

    2004-01-01

    An MS Office package has been developed to score IPSS, take a patient history, compare flows with nomograms and decide on interim management. This is based on these scores, residual volume and laboratory results. A clearly formatted GP letter is produced. The patient uses a touch screen to answer questions on the IPSS and other medical history. These questions and responses are stored in Excel spread sheets. Clinic staff then enter results of flow studies, urinalysis, U&E and PSA. Excel Visual Basic creates a detailed printout for the notes and the MS Office mail merge facility creates a summary printout, which also serves as a letter to the GP. Excel allows embedding of formulae and program code to implement the rules for management. Based on these rules, the program either generates a request for an urgent appointment in the clinic or recommends the use of either an alpha blocker (if not contraindicated by medical history) or 5 alpha reductase inhibitors in the interim period before they are reviewed in clinic. A total of 139 patients have been seen and the computer decisions compared with those of a consultant urologist. Agreement was found in 106, disagreement in 33. However, 21 of the 33 involved computer oversensitivity to flow results. We do not anticipate difficulty improving this and are investigating using an artificial neural network. Of the other 12 patients, the urologist departed from the fixed rules for IPSS, creatinine, PSA and residual urine when only one variable was slightly abnormal. To conclude, this novel user-friendly system shows great potential in the management of prostate outpatients. Some tuning is needed, with particular respect to uroflow results. PMID:15175663

  8. Assessment of clinical depression comorbid with posttraumatic stress disorder

    OpenAIRE

    Simonović Maja; Grbeša Grozdanko; Milenković Tatjana; Radisavljević Miša

    2008-01-01

    Background/Aim. Comorbidity of the posttraumatic stress disorder (PTSD) and depression is often recognized in the clinical practice. The aim of the paper was to determine the severity of depression and the group of symptoms which are the most prominent in clinical depression comorbid with PTSD. Methods. Totally 60 patients were assessed and divided into the experimental and control group using the Structured Clinical Interview for DSM-IV Axis I Disorders, Investigator Version (SCID-I, modifie...

  9. Clinical experimental stress studies: methods and assessment.

    Science.gov (United States)

    Bali, Anjana; Jaggi, Amteshwar Singh

    2015-01-01

    Stress is a state of threatened homeostasis during which a variety of adaptive processes are activated to produce physiological and behavioral changes. Stress induction methods are pivotal for understanding these physiological or pathophysiological changes in the body in response to stress. Furthermore, these methods are also important for the development of novel pharmacological agents for stress management. The well-described methods to induce stress in humans include the cold pressor test, Trier Social Stress Test, Montreal Imaging Stress Task, Maastricht Acute Stress Test, CO2 challenge test, Stroop test, Paced Auditory Serial Addition Task, noise stress, and Mannheim Multicomponent Stress Test. Stress assessment in humans is done by measuring biochemical markers such as cortisol, cortisol awakening response, dexamethasone suppression test, salivary α-amylase, plasma/urinary norepinephrine, norepinephrine spillover rate, and interleukins. Physiological and behavioral changes such as galvanic skin response, heart rate variability, pupil size, and muscle and/or skin sympathetic nerve activity (microneurography) and cardiovascular parameters such as heart rate, blood pressure, and self-reported anxiety are also monitored to assess stress response. This present review describes these commonly employed methods to induce stress in humans along with stress assessment methods. PMID:26020552

  10. Validation of a clinical assessment tool for spinal anaesthesia.

    LENUS (Irish Health Repository)

    Breen, D

    2011-07-01

    There is a need for a procedure-specific means of assessment of clinical performance in anaesthesia. The aim of this study was to devise a tool for assessing the performance of spinal anaesthesia, which has both content and construct validity.

  11. Supporting Sustainable Markets Through Life Cycle Assessment: Evaluating emerging technologies, incorporating uncertainty and the consumer perspective

    Science.gov (United States)

    Merugula, Laura

    As civilization's collective knowledge grows, we are met with the realization that human-induced physical and biological transformations influenced by exogenous psychosocial and economic factors affect virtually every ecosystem on the planet. Despite improvements in energy generation and efficiencies, demand of material goods and energy services increases with no sign of a slowing pace. Sustainable development requires a multi-prong approach that involves reshaping demand, consumer education, sustainability-oriented policy, and supply chain management that does not serve the expansionist mentality. Thus, decision support tools are needed that inform developers, consumers, and policy-makers for short-term and long-term planning. These tools should incorporate uncertainty through quantitative methods as well as qualitatively informing the nature of the model as imperfect but necessary and adequate. A case study is presented of the manufacture and deployment of utility-scale wind turbines evaluated for a proposed change in blade manufacturing. It provides the first life cycle assessment (LCA) evaluating impact of carbon nanofibers, an emerging material, proposed for integration to wind power generation systems as blade reinforcement. Few LCAs of nanoproducts are available in scientific literature due to research and development (R&D) for applications that continues to outpace R&D for environmental, health, and safety (EHS) and life cycle impacts. LCAs of emerging technologies are crucial for informing developers of potential impacts, especially where market growth is swift and dissipative. A second case study is presented that evaluates consumer choice between disposable and reusable beverage cups. While there are a few studies that attempt to make the comparison using LCA, none adequately address uncertainty, nor are they representative for the typical American consumer. By disaggregating U.S. power generation into 26 subregional grid production mixes and evaluating

  12. Clarifying assumptions to enhance our understanding and assessment of clinical reasoning.

    Science.gov (United States)

    Durning, Steven J; Artino, Anthony R; Schuwirth, Lambert; van der Vleuten, Cees

    2013-04-01

    Deciding on a diagnosis and treatment is essential to the practice of medicine. Developing competence in these clinical reasoning processes, commonly referred to as diagnostic and therapeutic reasoning, respectively, is required for physician success. Clinical reasoning has been a topic of research for several decades, and much has been learned. However, there still exists no clear consensus regarding what clinical reasoning entails, let alone how it might best be taught, how it should be assessed, and the research and practice implications therein.In this article, the authors first discuss two contrasting epistemological views of clinical reasoning and related conceptual frameworks. They then outline four different theoretical frameworks held by medical educators that the authors believe guide educators' views on the topic, knowingly or not. Within each theoretical framework, the authors begin with a definition of clinical reasoning (from that viewpoint) and then discuss learning, assessment, and research implications. The authors believe these epistemologies and four theoretical frameworks also apply to other concepts (or "competencies") in medical education.The authors also maintain that clinical reasoning encompasses the mental processes and behaviors that are shared (or evolve) between the patient, physician, and the environment (i.e., practice setting). Clinical reasoning thus incorporates components of all three factors (patient, physician, environment). The authors conclude by outlining practical implications and potential future areas for research. PMID:23425980

  13. Plasmodium falciparum: assessment of in vitro growth by (/sup 3/H)hypoxanthine incorporation

    Energy Technology Data Exchange (ETDEWEB)

    Chulay, J.D.; Haynes, J.D.; Diggs, C.L.

    1983-02-01

    To evaluate rapidly Plasmodium falciparum growth in Vitro, (/sup 3/H)hypoxanthine was added to parasite microcultures and radioisotope incorporation was measured. When culture parameters were carefully controlled, (/sup 3/H)hypoxanthine incorporation was proportional to the number of parasitized erythrocytes present. Factors affecting (/sup 3/H)hypoxanthine incorporation included initial parasitemia, duration of culture, duration of radioisotope pulse, parasite stage, concentration of uninfected erythrocytes, the use of serum or plasma to supplement growth, and the concentration of a variety of purines in the culture medium. The method described can be used to measure inhibition of P. falciparum growth by immune serum and has previously been used to study antimalarial drug activity in vitro.

  14. What Clinical Instructors Want: Perspectives on a New Assessment Tool for Students in the Clinical Environment

    OpenAIRE

    Anderson, Charlotte; Cosgrove, Meaghan; Lees, Dalyce; Chan, Gigi; Gibson, Barbara E; Hall, Mark; Mori, Brenda

    2014-01-01

    Purpose: Many Canadian physical therapy education programs use the 1997 version of the Physical Therapist Clinical Performance Instrument (PT-CPI) to evaluate students in their clinical placements. Recent evidence that clinical instructors (CIs) are unsatisfied with the PT-CPI, however, suggests a need to develop a new assessment tool. The purpose of this study was to gather Canadian CIs' perspectives on rating scales, preferred training methods, and format for future tool development. Method...

  15. Clinical assessment of suspected child physical abuse

    International Nuclear Information System (INIS)

    Violence against children has many faces. Child physical abuse, neglect, sexual abuse and interparental violence can cause acute and permanent damage and affect children's development and their life plans in the long term. In industrialized nations almost 1 child in 10 is affected. Up to 10% of child physical abuse cases involve the central nervous system with 80% of these cases occurring during the first year of life. Worldwide more than 50,000 children die as a result of violence, abuse and neglect every year, according to the United Nations Children's Fund UNICEF. In Germany, there are about 120 cases of non-accidental head injury per year. In addition to the officially known cases there is a large grey area for all forms of violence. Recognition of these cases and the provision of help for the victims require an appropriate suspicion and understanding of the pertinent pathophysiology. Suspicion must be based on a well-documented medical history and multidisciplinary diagnostic assessment. Medical confidentiality prevents the disclosure of such information making early detection networks and guidelines for collaboration absolutely indispensable. (orig.)

  16. A proposed new clinical assessment framework for diagnostic medical ultrasound students.

    Science.gov (United States)

    Gibbs, Vivien

    2014-05-01

    Current financial pressures within higher education institutions (HEIs) are driving new ways of delivering education and assessment. New technological developments are facilitating opportunities to rethink traditional educational methods and explore more innovative, effective approaches. Set against a background of increasing pressures to integrate technology to enhance learning, both in higher education and the NHS, education is moving towards greater integration of technology. Ultrasound education is an area which is currently being reviewed in many HEIs, as these programmes are expensive to administer for the relatively low numbers of students involved. Within ultrasound education, rigorous assessment of clinical competence is an area which is particularly expensive to undertake, and methods used in many training programmes are potentially unsustainable for HEIs in the current economic climate. In addition, clinical assessment methods used are often criticised for the difficulties encountered in trying to exclude subjectivity from the process, and ensure equity across all assessments. A new framework is therefore proposed, which has recently been accredited within a HEI ultrasound training programme by the Consortium for the Accreditation of Sonographic Education (CASE), and has been piloted during 2013. One of the components of this approach is the incorporation of an ultrasound simulator, which will help to standardise assessments and ensure students are assessed over a range of pathologies, rather than only those randomly presenting on the day of assessment. This paper discusses details of the newly accredited assessment process. PMID:27433204

  17. Clinical assessment of newborn with indirect hyperbilirubinemia

    Directory of Open Access Journals (Sweden)

    Özgül Yiğit

    2006-01-01

    Full Text Available Objective: Hyperbilirubinemia is a common and, in most cases, benign problem in newborns. Nonetheless, untreated, severe indirect hyperbilirubinemia is potentially neurotoxic. The aim of this study is to evaluate the etiological factors and clinical characteristics of newborns with indirect hyperbilirubinemia. Material and Methods: In this study, 319 newborns with indirect hyperbilirubinemia were investigated prospectively at Vakıf Gureba Education and Research Hospital. Blood groups, infection criteria, hemotocrits, direct Coombs tests, reticulocyte values, glucose-6-phosphatase (G6PD levels, thyroid-stimulating hormone and thyroxin levels were determined. In newborns with indirect hyperbilirubinemia, phototherapy was initiated according to the guidelines proposed by the American Academy of Pediatrics. Results: The gender and gestational age of the infants were 202 (%63.3 male, 117 (%36.7 female; 266 (%83.4 term, 53 (%16.6 preterm. When etiological factors were considered, 109 cases (%34.1 were idiopatic, 67 cases (%21 were ABO incompatibility, 15 cases (%4.7 were Rh incompatibility, 7 case (%2.3 were ABO and Rh incompatibility, 43 cases (%13.5 were prematurity, 25 cases (% 7.8 were polycythemia, 30 cases (%9.4 were infection, 9 cases (%2.8 were cephalohematoma, 4 cases (%1.2 were G6PD deficiency, 5 cases (%1.5 were infant of a diabetic mother, 2 cases (%0.7 were trisomy 21, 3 cases (%1 were hypothyroidism. Bilirubin levels higher than 25 mg/dl were detected in 7 (% 2.3 cases. The highest bilirubin level was 28 mg/dl, and this case had the urinary infection. In only one of the cases exchance transfusion was applied there was a fast rise in the bilirubin levels in the first 24 hours and as there was no respons to phototherapy. Conclusion: Hyperbilirubinemia frequently encountered problem in the newborn is not only the result of blood group incompatibility, but may also be due to sepsis, urinary tract infection, hypothyroidism, polycythemia and

  18. Assessment of internal dose from incorporated plutonium-239 by means of biological dosimetry

    International Nuclear Information System (INIS)

    Intra- and inter-chromosomal aberration frequency in Mayak P.A. nuclear workers was studied by mFISH and mBAND techniques. Intra-chromosomal aberrations in lymphocytes from the peripheral blood were found to be a bio marker of densely-ionizing radiation (alpha-particles) in workers exposed to radiation many years ago. A dependence of the frequency of intra-chromosomal aberrations in plutonium workers on absorbed dose to the red bone marrow from internal exposure to incorporated plutonium-239 was found. A preliminary 'bio dosimetry system' was developed. Its capability to estimate internal doses from incorporated plutonium-239 in plutonium production workers based on the frequency of intra-chromosomal aberrations detected in these workers was tested. Estimates of internal doses from incorporated plutonium - 239 obtained using the preliminary 'bio dosimetry system' were compared with doses calculated by a model based on measurements of plutonium excretion in urine ('Mayak Doses-2000'). Estimates of internal doses from incorporated plutonium-239 obtained using both independent techniques demonstrated a highly significant correlation (correlation coefficient, R2 = 74%). At the current research phase, the developed 'bio dosimetry system' is to be adjusted, which will allow to estimate plutonium-239 body burden with an uncertainty less than 30%. (authors)

  19. Application of fuzzy sets and cognitive maps to incorporate social science scenarios in integrated assessment models

    NARCIS (Netherlands)

    Kok, de Jean-Luc; Titus, Milan; Wind, Herman G.

    2000-01-01

    Decision-support systems in the field of integrated water management could benefit considerably from social science knowledge, as many environmental changes are human-induced. Unfortunately the adequate incorporation of qualitative social science concepts in a quantitative modeling framework is not

  20. Using systematically observed clinical encounters (SOCEs to assess medical students’ skills in clinical settings

    Directory of Open Access Journals (Sweden)

    George R Bergus

    2010-11-01

    Full Text Available George R Bergus1–3, Jerold C Woodhead4, Clarence D Kreiter2,51Performance Based Assessment Program, Office of Student Affairs and Curriculum, 2Department of Family Medicine, 3Department of Psychiatry, 4Department of Pediatrics, 5Office of Consultation and Research in Medical Education, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA, USAIntroduction: The Objective Structured Clinical Examination (OSCE is widely used to assess the clinical performance of medical students. However, concerns related to cost, availability, and validity, have led educators to investigate alternatives to the OSCE. Some alternatives involve assessing students while they provide care to patients – the mini-CEX (mini-Clinical Evaluation Exercise and the Long Case are examples. We investigated the psychometrics of systematically observed clinical encounters (SOCEs, in which physicians are supplemented by lay trained observers, as a means of assessing the clinical performances of medical students.Methods: During the pediatrics clerkship at the University of Iowa, trained lay observers assessed the communication skills of third-year medical students using a communication checklist while the students interviewed and examined pediatric patients. Students then verbally presented their findings to faculty, who assessed students’ clinical skills using a standardized form. The reliability of the combined communication and clinical skills scores was calculated using generalizability theory.Results: Fifty-one medical students completed 199 observed patient encounters. The mean combined clinical and communication skills score (out of a maximum 45 points was 40.8 (standard deviation 3.3. The calculated reliability of the SOCE scores, using generalizability theory, from 10 observed patient encounters was 0.81. Students reported receiving helpful feedback from faculty after 97% of their observed clinical encounters.Conclusion: The SOCE can

  1. Cognitive Assessment of Elderly Inpatients: A Clinical Audit

    Directory of Open Access Journals (Sweden)

    Elizabeth Shermon

    2015-01-01

    Full Text Available Background: Comprehensive geriatric assessment including cognitive assessment results in better outcomes and quality of life through facilitating access to support and further care. The National Audit of Dementia Care revealed too few patients were being assessed for cognition and therefore failing to receive adequate care. Methods: This was a retrospective clinical audit in a district general hospital with systematic sampling of the clinical records of 50 inpatients on an elderly care ward. A descriptive analysis of the results was performed. Results: Despite guidance that cognitive assessment should be performed on admission, this was only documented in 22% of the medical notes. However, this rate improved to 56% by discharge. The most commonly used tool was the Abbreviated Mental Test (AMT 10. Assessment completion was independent of gender or social support, but only patients aged over 75 years were assessed. Of those, 75% had some level of cognitive impairment and 36.8% received a new or suspected diagnosis of dementia. Discussion: Cognitive assessment rates continue to be low. Our findings support the need for increased education regarding the importance and benefits of assessment as well as how to complete and document the assessment correctly. Conclusion: Cognitive assessment rates need to be further improved to promote better outcomes for patients with dementia.

  2. Workgroup Report: Incorporating In Vitro Alternative Methods for Developmental Neurotoxicity into International Hazard and Risk Assessment Strategies

    OpenAIRE

    Coecke S.; Goldberg A.M.; Allen S; Buzanska L.; Calamandrei G.; Crofton K.; Hareng L.; Hartung T.; Knaut H.; Honegger P.; Jacobs M.; Lein P.; Li A.; Mundy W.; Owen D.

    2007-01-01

    This is the report of the first workshop on Incorporating In Vitro Alternative Methods for Developmental Neurotoxicity (DNT) Testing into International Hazard and Risk Assessment Strategies, held in Ispra, Italy, on 19-21 April 2005. The workshop was hosted by the European Centre for the Validation of Alternative Methods (ECVAM) and jointly organized by ECVAM, the European Chemical Industry Council, and the Johns Hopkins University Center for Alternatives to Animal Testing. The primary aim of...

  3. Consensus clinical guidelines for the assessment of cognitive and behavioural problems in Tuberous Sclerosis.

    Science.gov (United States)

    de Vries, Petrus; Humphrey, Ayla; McCartney, Deborah; Prather, Penny; Bolton, Patrick; Hunt, Ann

    2005-07-01

    Tuberous Sclerosis (TSC) is a genetic disorder characterised by abnormal growths in a wide range of organs. In the brain, abnormalities of differentiation, proliferation and migration can produce a range of neuropsychiatric features such as mental retardation, autism and ADHD. Although these manifestations are not diagnostic of the disorder, cognitive and behavioural features are often of greatest concern to families yet limited clinical assessment and interventions are currently offered. A consensus panel at a TSC Brain/Behaviour workshop recommended that the cognitive and behavioural profiles of individuals with TSC should be assessed at regular intervals in a planned fashion in accordance with the difficulties associated with the disorder. Evaluations should include the use of standardised neuropsychological and behavioural tools as appropriate to the age and developmental level of the individual assessed. These cognitive and behavioural profiles should be incorporated in the overall formulation of the needs of the person with TSC to plan educational, social and clinical management strategies. Assessments should be documented so that individual longitudinal progress can be monitored. The paper outlines the problems associated with TSC, the purpose of recommended assessments, developmentally appropriate stages for assessment, and identifies specific areas that should be targeted for assessment. PMID:15981129

  4. Clinically assessed mediolateral knee motion: impact on gait

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Creaby, Mark W; Simic, Milena;

    2011-01-01

    Mediolateral knee movement can be assessed visually with clinical tests. A knee-medial-to-foot position is associated with an increased risk of knee injuries and pathologies. However, the implications of such findings on daily tasks are not well understood. The aim of this study was to investigate...... if a knee-medial-to-foot position assessed during a clinical test was associated with altered hip and knee joint kinematics and knee joint kinetics during gait compared with those with a knee-over-foot position....

  5. Incorporation of Socio-Cultural Values in Damage Assessment Valuations of Contaminated Lands in the Niger Delta

    Directory of Open Access Journals (Sweden)

    Victor A. Akujuru

    2014-07-01

    Full Text Available Damages on contaminated land have been mostly assessed for developments subsisting on the land, neglecting the goods and services derived from the land which possess only socio-cultural values. This paper aims to ascertain the importance of socio-cultural values in the total economic value of contaminated land, drawing from the experience of a coastal community oil spillage in the Niger Delta. The paper examines what constitutes a valuable interest on contaminated land and how socio-cultural factors are valued in the damage assessment process. After reviewing the literature and decided cases, a questionnaire survey was conducted and a sample valuation report was analysed. It is concluded that there exists a socio-cultural interest on contaminated land which professional valuers do not reflect in damage assessment claims. It is recommended that any comprehensive damage assessment requires the incorporation of socio-cultural values in the valuations.

  6. Clinical application of Assessment of Parenting Competencies (APC)

    DEFF Research Database (Denmark)

    Jacobsen, Stine Lindahl

    This paper is part of a symposium on music therapy with families with Kirsi Tuomi as Chair. It revolves around the clinical application of a new music therapy assessment model on parent-child interaction and parenting competencies. APC was developed for emotional neglected children and their......, child somatic hospitals, centers for refuges and other populations where it would be clinical relevant to assess the parent-child interaction. APC is an observational and improvisational based assessment model evaluating dyads of parent and child (child age range is 5-12). It produces information...... (numbers, graphs, and descriptions) of parent-child interaction and parenting competencies including nonverbal communication, level of attunement in the dyad, and level of emotional support from the parent. It is based on video analysis and a fixed assessment protocol. It was developed through a completed...

  7. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  8. How should training of graduates in clinical pharmacology and therapeutics be delivered and assessed?

    Science.gov (United States)

    Jackson, Peter

    2012-06-01

    The UK postgraduate curriculum in clinical pharmacology and therapeutics (CPT) incorporates the common competencies required of all physicians and shows how trainees from other specialties, including primary care, can train in CPT. Various models of training and assessment are possible. Evolution of the current system to meet new challenges would maintain an established tradition, with a ready source of training funds. However, this would require greater input from all consultants in CPT, including the training and assessment of trainees. A joint venture with the Faculty of Pharmaceutical Medicine would have the advantage, if the Faculty agreed, of introducing ready-made curriculum modules and assessment tools that have been accepted by the General Medical Council. However, extra modules relevant to CPT would have to be constructed to complement the common areas already in the pharmaceutical medicine curriculum, and there would be a perceived loss of the independence that clinical pharmacologists currently enjoy when making decisions about manufacturers' products. Abandoning externally approved training in CPT would allow the specialty to devise its own training and assessment in the necessary skills. Critically, however, this would impair the status of the specialty and would incur loss of financial support from postgraduate Deaneries. To attract high-calibre trainees, we must completely define CPT training and assessment structures. Most clinical pharmacologists seem to prefer to allow the current structures to evolve under external guidance. However, this will not succeed unless all trained clinical pharmacologists contribute to development of both the curriculum and specific assessment tools, and open their teaching and assessment skills to scrutiny. PMID:22360893

  9. Implementing Standards-Based Assessment Effectively: Incorporating Discussion of Exemplars into Classroom Teaching

    Science.gov (United States)

    Hendry, Graham D.; Armstrong, Susan; Bromberger, Nikki

    2012-01-01

    Many universities are moving to greater use of standards-based assessment to support effective student learning. Implementing a standards-based approach includes involving academic staff in writing descriptions of standards for assessment tasks both to guide the marking process and clarify staff expectations for students. However, recent research…

  10. Incorporating virtual reality graphics with brain imaging for assessment of sport-related concussions.

    Science.gov (United States)

    Slobounov, Semyon; Sebastianelli, Wayne; Newell, Karl M

    2011-01-01

    There is a growing concern that traditional neuropsychological (NP) testing tools are not sensitive to detecting residual brain dysfunctions in subjects suffering from mild traumatic brain injuries (MTBI). Moreover, most MTBI patients are asymptomatic based on anatomical brain imaging (CT, MRI), neurological examinations and patients' subjective reports within 10 days post-injury. Our ongoing research has documented that residual balance and visual-kinesthetic dysfunctions along with its underlying alterations of neural substrates may be detected in "asymptomatic subjects" by means of Virtual Reality (VR) graphics incorporated with brain imaging (EEG) techniques. PMID:22254575

  11. Clinical assessment of transthoracic echocardiography skills: a generalizability study

    DEFF Research Database (Denmark)

    Nielsen, Dorte Guldbrand; O'Neill, Lotte; Jensen, Signe

    2015-01-01

    objective assessment instrument for TTE technical proficiency including a global rating score and a checklist score has previously been shown reliability and validity in a standardised setting. Objectives: As clinical test situations typically have several sources of error giving rise to variance in scores...

  12. Upper Limb Assessment in Tetraplegia: Clinical, Functional and Kinematic Correlations

    Science.gov (United States)

    Cacho, Enio Walker Azevedo; de Oliveira, Roberta; Ortolan, Rodrigo L.; Varoto, Renato; Cliquet, Alberto

    2011-01-01

    The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak…

  13. Mentors’ implication in clinical learning and assessment of nursing students

    OpenAIRE

    González Chordá, Víctor; Mena Tudela, Desirée; Cervera Gasch, Águeda; Salas Medina, Pablo; Folch Ayora, Ana; Orts Cortés, María Isabel; Maciá Soler, Loreto

    2014-01-01

    Nursing Education in Europe is regulated by law from 2005. Clinical learning comprises at least 50% of the total degree program in nursing. It is necessary rely on professionals nurses involved in the learning process and skills development assessment. The level of implication in learning processes of these professional nurses is very important to ensure good results.

  14. Normal Personality Assessment in Clinical Practice: The NEO Personality Inventory.

    Science.gov (United States)

    Costa, Paul T.; McCrae, Robert R.

    1992-01-01

    The NEO Personality Inventory (NEO-PI) is described as a measure of five factors of personality and its use in clinical assessment and treatment practice is reviewed. Data from 17 adult men and women show links between NEO-PI scales and other measures of psychopathology. (SLD)

  15. Completing Northeast Regional Vulnerability Assessment Incorporating the NatureServe Climate Change Vulnerability Index

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — NatureServe and Heritage Program collaborators have developed a Climate Change Vulnerability Index (CCVI) to provide a rapid, scientifically defensible assessment...

  16. Caries assessment: establishing mathematical link of clinical and benchtop method

    Science.gov (United States)

    Amaechi, Bennett T.

    2009-02-01

    It is well established that the development of new technologies for early detection and quantitative monitoring of dental caries at its early stage could provide health and economic benefits ranging from timely preventive interventions to reduction of the time required for clinical trials of anti-caries agents. However, the new technologies currently used in clinical setting cannot assess and monitor caries using the actual mineral concentration within the lesion, while a laboratory-based microcomputed tomography (MCT) has been shown to possess this capability. Thus we envision the establishment of mathematical equations relating the measurements of each of the clinical technologies to that of MCT will enable the mineral concentration of lesions detected and assessed in clinical practice to be extrapolated from the equation, and this will facilitate preventitive care in dentistry to lower treatment cost. We utilize MCT and the two prominent clinical caries assessment devices (Quantitative Light-induced Fluorescence [QLF] and Diagnodent) to longitudinally monitor the development of caries in a continuous flow mixed-organisms biofilm model (artificial mouth), and then used the collected data to establish mathematical equation relating the measurements of each of the clinical technologies to that of MCT. A linear correlation was observed between the measurements of MicroCT and that of QLF and Diagnodent. Thus mineral density in a carious lesion detected and measured using QLF or Diagnodent can be extrapolated using the developed equation. This highlights the usefulness of MCT for monitoring the progress of an early caries being treated with therapeutic agents in clinical practice or trials.

  17. A durability model incorporating safe life methodology and damage tolerance approach to assess first inspection and maintenance period for structures

    International Nuclear Information System (INIS)

    This paper outlines a new durability model to assess the first inspection and maintenance period for structures. Practical scatter factor formulae are presented to determine the safe fatigue crack initiation and propagation lives from the results of a single full-scale test of a complete structure. New theoretical solutions are proposed to determine the sa-sm-N surfaces of fatigue crack initiation and propagation. Prediction techniques are then developed to establish the relationship equation between safe fatigue crack initiation and propagation lives with a specific reliability level using a two-stage fatigue damage cumulative rule. A new durability model incorporating safe life and damage tolerance design approaches is derived to assess the first inspection and maintenance period. Finally, the proposed models are applied to assess the first inspection and maintenance period of a fastening structure at the root of helicopter blade.

  18. COPD management: role of symptom assessment in routine clinical practice

    Science.gov (United States)

    van der Molen, Thys; Miravitlles, Marc; Kocks, Janwillem WH

    2013-01-01

    Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms that significantly impair health-related quality of life. Despite this, COPD treatment and its management are mainly based on lung function assessments. There is increasing evidence that conventional lung function measures alone do not correlate well with COPD symptoms and their associated impact on patients’ everyday lives. Instead, symptoms should be assessed routinely, preferably by using patient-centered questionnaires that provide a more accurate guide to the actual burden of COPD. Numerous questionnaires have been developed in an attempt to find a simple and reliable tool to use in everyday clinical practice. In this paper, we review three such patient-reported questionnaires recommended by the latest Global Initiative for Chronic Obstructive Lung Disease guidelines, ie, the modified Medical Research Council questionnaire, the clinical COPD questionnaire, and the COPD Assessment Test, as well as other symptom-specific questionnaires that are currently being developed. PMID:24143085

  19. Incorporating ecological risk assessment into remedial investigation/feasibility study work plans

    International Nuclear Information System (INIS)

    This guidance document (1) provides instructions on preparing the components of an ecological work plan to complement the overall site remedial investigation/feasibility study (RI/FS) work plan and (2) directs the user on how to implement ecological tasks identified in the plan. Under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA), as amended by the Superfund Amendments and Reauthorization Act of 1986 (SARA), and RI/FS work plan will have to be developed as part of the site-remediation scoping process. Specific guidance on the RI/FS process and the preparation of work plans has been developed by the US Environmental Protection Agency (EPA 1988a). This document provides guidance to US Department of Energy (DOE) staff and contractor personnel for incorporation of ecological information into environmental remediation planning and decision making at CERCLA sites

  20. Objective Structured Clinical Examinations Provide Valid Clinical Skills Assessment in Emergency Medicine Education

    OpenAIRE

    Wallenstein, Joshua; Ander, Douglas

    2015-01-01

    Introduction: Evaluation of emergency medicine (EM) learners based on observed performance in the emergency department (ED) is limited by factors such as reproducibility and patient safety. EM educators depend on standardized and reproducible assessments such as the objective structured clinical examination (OSCE). The validity of the OSCE as an evaluation tool in EM education has not been previously studied. The objective was to assess the validity of a novel management-focused OSCE as an ev...

  1. Incorporating climate-system and carbon-cycle uncertainties in integrated assessments of climate change. (Invited)

    Science.gov (United States)

    Rogelj, J.; McCollum, D. L.; Reisinger, A.; Knutti, R.; Riahi, K.; Meinshausen, M.

    2013-12-01

    The field of integrated assessment draws from a large body of knowledge across a range of disciplines to gain robust insights about possible interactions, trade-offs, and synergies. Integrated assessment of climate change, for example, uses knowledge from the fields of energy system science, economics, geophysics, demography, climate change impacts, and many others. Each of these fields comes with its associated caveats and uncertainties, which should be taken into account when assessing any results. The geophysical system and its associated uncertainties are often represented by models of reduced complexity in integrated assessment modelling frameworks. Such models include simple representations of the carbon-cycle and climate system, and are often based on the global energy balance equation. A prominent example of such model is the 'Model for the Assessment of Greenhouse Gas Induced Climate Change', MAGICC. Here we show how a model like MAGICC can be used for the representation of geophysical uncertainties. Its strengths, weaknesses, and limitations are discussed and illustrated by means of an analysis which attempts to integrate socio-economic and geophysical uncertainties. These uncertainties in the geophysical response of the Earth system to greenhouse gases remains key for estimating the cost of greenhouse gas emission mitigation scenarios. We look at uncertainties in four dimensions: geophysical, technological, social and political. Our results indicate that while geophysical uncertainties are an important factor influencing projections of mitigation costs, political choices that delay mitigation by one or two decades a much more pronounced effect.

  2. Comparative Assessment of Antimicrobial Efficiency of Ionic Silver, Silver Monoxide, and Metallic Silver Incorporated onto an Aluminum Oxide Nanopowder Carrier

    OpenAIRE

    Agnieszka Maria Jastrzębska; Ewa Karwowska; Andrzej R. Olszyna; Antoni R. Kunicki

    2013-01-01

    The present paper provides comparative assessment of antimicrobial efficiency of ionic silver (Ag+), silver monoxide (Ag2O), and metallic silver (Ag) incorporated onto an aluminum oxide nanopowder carrier (Al2O3). The deposition of Ag+ ions, Ag2O nanoparticles, and Ag nanoparticles on an different phases of aluminum oxide nanopowder carrier was realized using consecutive stages of dry sol-gel method. The Al2O3-Ag+, Al2O3-Ag2O, and Al2O3-Ag nanopowders were widely characterized qualitatively a...

  3. Clinical assessment tools identify functional deficits in fragility fracture patients

    Science.gov (United States)

    Ames, Tyler D; Wee, Corinne E; Le, Khoi M; Wang, Tiffany L; Bishop, Julie Y; Phieffer, Laura S; Quatman, Carmen E

    2016-01-01

    Purpose To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control. Patients and methods Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt) that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB), handgrip strength (handheld dynamometer), and lumbopelvic control (iPod Touch Level Belt), which were compared between fragility fracture patients and healthy controls. Results Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042) and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026) when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020) and total components (P=0.010) of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003). Conclusion The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls.

  4. Incorporating Risk Assessment and Inherently Safer Design Practices into Chemical Engineering Education

    Science.gov (United States)

    Seay, Jeffrey R.; Eden, Mario R.

    2008-01-01

    This paper introduces, via case study example, the benefit of including risk assessment methodology and inherently safer design practices into the curriculum for chemical engineering students. This work illustrates how these tools can be applied during the earliest stages of conceptual process design. The impacts of decisions made during…

  5. Incorporating Access to More Effective Teachers into Assessments of Educational Resource Equity

    Science.gov (United States)

    Bastian, Kevin C.; Henry, Gary T.; Thompson, Charles L.

    2013-01-01

    To address gaps in achievement between more- and less-affluent students, states and districts need to ensure that high-poverty students and schools have equitable access to educational resources. Traditionally, assessments of resource equity have focused on per-pupil expenditures and more proximal inputs, such as teacher credentials and class…

  6. Formative Assessment and the Intuitive Incorporation of Research-Based Instruction Techniques

    Science.gov (United States)

    Kuiper, Paula; VanOeffelen, Rachel; Veldkamp, Simon; Bokma, Isaac; Breems, Luke; Fynewever, Herb

    2015-01-01

    Using Max Weber's theory of ideal types, the authors classify the formative assessment techniques used by 12 college instructors. Their data reveal two pairs of opposing preferences: (1) highly preplanned vs. highly emergent and (2) focused on individual students vs. focused on the class as a whole. Using interview data, they illustrate how each…

  7. Fundamentals of Clinical Outcomes Assessment for Spinal Disorders: Clinical Outcome Instruments and Applications.

    Science.gov (United States)

    Vavken, Patrick; Ganal-Antonio, Anne Kathleen B; Quidde, Julia; Shen, Francis H; Chapman, Jens R; Samartzis, Dino

    2015-08-01

    Study Design A broad narrative review. Objectives Outcome assessment in spinal disorders is imperative to help monitor the safety and efficacy of the treatment in an effort to change the clinical practice and improve patient outcomes. The following article, part two of a two-part series, discusses the various outcome tools and instruments utilized to address spinal disorders and their management. Methods A thorough review of the peer-reviewed literature was performed, irrespective of language, addressing outcome research, instruments and tools, and applications. Results Numerous articles addressing the development and implementation of health-related quality-of-life, neck and low back pain, overall pain, spinal deformity, and other condition-specific outcome instruments have been reported. Their applications in the context of the clinical trial studies, the economic analyses, and overall evidence-based orthopedics have been noted. Additional issues regarding the problems and potential sources of bias utilizing outcomes scales and the concept of minimally clinically important difference were discussed. Conclusion Continuing research needs to assess the outcome instruments and tools used in the clinical outcome assessment for spinal disorders. Understanding the fundamental principles in spinal outcome assessment may also advance the field of "personalized spine care." PMID:26225283

  8. Incorporating biomarkers in ecological risk assessment of chemical contaminants of soils

    Directory of Open Access Journals (Sweden)

    A. J. Reinecke

    2007-09-01

    Full Text Available Soil is an important but complex natural resource which is increasingly used as sink for chemicals. The monitoring of soil quality and the assessment of risks posed by contaminants have become crucial. This study deals with the potential use of biomarkers in the monitoring of soils and the assessment of risk resulting from contamination. Apart from an overview of the existing literature on biomarkers, the results of various of our field experiments in South African soils are discussed. Biomarkers may have potential in the assessment of risk because they can indicate at an early stage that exposure has taken place and that a toxic response has been initiated. It is therefore expected that early biomarkers will play an increasing role as diagnostic tools for determining exposure to chemicals and the resulting effects. They may have predictive value that can assist in the prevention or minimising of risks. The aim of this study was to investigate the possibilities of using our results on biomarker responses of soil dwelling organisms to predict changes at higher organisational levels (which may have ecological implications. Our recent experimental results on the evaluation of various biomarkers in both the laboratory and the field are interpreted and placed in perspective within the broader framework of response biology. The aim was further to contribute to the development and application of biomarkers in regulatory risk assessment schemes of soils. This critical review of our own and recent literature on biomarkers in ecotoxicology leads to the conclusion that biomarkers can, under certain conditions, be useful tools in risk assessment. Clear relationships between contamination loads in soil organisms and certain biomarker responses were determined in woodlice, earthworms and terrestrial snails. Clear correlations were also established in field experiments between biomarker responses and changes at the population level. This indicated that, in

  9. Incorporating group coursework as an assessment component into online and traditional university programmes

    OpenAIRE

    Bace, Edward

    2016-01-01

    Despite the many advantages of online learning programmes in university curricula, such programmes can present challenges, particularly in terms of assessment of group coursework and participation in discussion fora. The author’s experiences suggest ways to mitigate the “free rider” problem often accompanying group coursework, in which a few motivated students perform the bulk of the work. Mitigation of this problem can be achieved by requiring a shorter, individual submission separately fr...

  10. In vitro and in vivo assessment of piroxicam incorporated Aloe vera transgel

    OpenAIRE

    Velam, Vinesha; Yalavarthi, Prasanna Raju; Sundaresan, CR; Vandana, KR; Dudala, Thushara Bindu; Kodavatikanti, Haritha; Vadlamudi, Harini Chowdary

    2013-01-01

    Background: The aim of the study was to develop piroxicam-Aloe vera gel (PAG) formulation and make a pharmacodynamic evaluation of the formulation. Materials and Methods: The gel was prepared by using carbopol 934 as gelling agent and methyl paraben as a preservative in an Aloe vera gel base. The formulated gel was also evaluated for physicochemical parameters like pH, viscosity, drug content, and in vitro diffusion assessment. Pharmacodynamic activity of the formulation was evaluated in Wist...

  11. A hybrid approach to incorporating climate change and variability into climate scenario for impact assessments

    OpenAIRE

    Gebretsadik, Yohannes; Strzepek, Kenneth; Schlosser, C. Adam

    2014-01-01

    Traditional 'delta-change' approach of scenario generation for climate change impact assessment to water resources strongly depends on the selected base-case observed historical climate conditions that the climate shocks are to be super-imposed. This method disregards the combined effect of climate change and the inherent hydro-climatological variability in the system. Here we demonstrated a hybrid uncertainty approach in which uncertainties in historical climate variability are combined with...

  12. Incorporating cumulative effects into environmental assessments of mariculture: Limitations and failures of current siting methods

    International Nuclear Information System (INIS)

    Assessing and evaluating the cumulative impacts of multiple marine aquaculture facilities has proved difficult in environmental assessment. A retrospective review of 23 existing mariculture farms in southwestern New Brunswick was conducted to determine whether cumulative interactions would have justified site approvals. Based on current scientific evidence of cumulative effects, six new criteria were added to a set of far-field impacts and other existing criteria were expanded to include regional and cumulative environmental impacts in Hargrave's [Hargrave BT. A traffic light decision system for marine finfish aquaculture siting. Ocean Coast Manag 2002; 45:215-35.] Traffic Light Decision Support System (DSS) presently used in Canadian aquaculture environmental assessments. Before mitigation, 19 of the 23 sites failed the amended set of criteria and after considering mitigation, 8 sites failed. Site and ecosystem indices yielded varying site acceptability scores; however, many sites would not have been approved if siting decisions had been made within a regional management framework and cumulative impact criteria were considered in the site evaluation process

  13. Forensic neuropsychological assessment: clinical case of depression and working incapacity

    Directory of Open Access Journals (Sweden)

    Camila Monti

    2015-03-01

    Full Text Available Issues related to mental health in relation to court matters have increasingly required the participation of the psychologist. We present the use of forensic neuropsychological assessment in a case of retirement reversal. Incapacity was attested due to disability resulting from depression of a 35-year-old attorney, and the case was forwarded from the courts to the Forensic Psychiatry and Psychology Unit at the USP Clinical Hospital. A clinical interview and application of cognitive tests was conducted. Despite the depression, significant cognitive losses that would prevent return to his professional assignments were not detected. The neuropsychological assessment has been shown to be an important tool in the forensic context, as it assists with diagnostic value for clarification of functional aspects in the various psychopathological areas in terms of disabilities or potentialities.

  14. [External quality assessment for clinical microbiology and good laboratory management].

    Science.gov (United States)

    Kumasaka, K

    1998-02-01

    The Tokyo Metropolitan external quality assessment (EQA) program has revealed some serious problems in private independent microbiology laboratories in Tokyo since 1982. The poor performance in the EQA surveys closely related to poor laboratory managements, the type of training, experience of the medical technologists or technicians, and supervisory ability of the consultant physicians in independent laboratories. Social factors impede the reform of the quality assurance of clinical microbiology. Such factors include poor infrastructure of continuing education for small private laboratories, closure of the central clinical laboratories in the hospitals and outsourcing of laboratory tests due to restructuring in response to economic problems, and limited numbers of certified clinical pathologists of the Japan Society of Clinical Pathology (JSCP). Therefore, the Tokyo Metropolitan EQA Scheme is still confidential and its main role is educational. Good two way communication between participants and the organizers' clinical pathologists is essential, if the quality of laboratory tests is to be improved. The new JSCP edition of the postgraduate training requirement in clinical pathology includes "Laboratory Administration and Management". Good laboratory management(GLM) is an increasingly important component of good laboratory practice. The practice activities of clinical pathologists must include general management in addition to exercising there specialized knowledge in medicine and technology. Whereas leadership of a good clinical pathologist provides the direction of where a good laboratory is going, good management provides the steps of how to get there. And I believe quality system models from business and industry may provide us with strong guidance to build a quality system for the good laboratory that will endure into the next century. PMID:9528335

  15. Combining multiple serum biomarkers in tumor diagnosis: A clinical assessment

    OpenAIRE

    Li, Xin; LU, JUN; Ren, Hui; CHEN, TIANJUN; Gao, Lin; DI, LIGAI; SONG, ZHUCUI; Zhang, Ying; Yang, Tian; THAKUR, ASMITANANDA; Zhou, Shu-Feng; Yin, Yanhai; Chen, Mingwei

    2012-01-01

    The present study aimed to assess the diagnostic/prognostic value of various clinical tumor markers, including carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 (CYFRA21-1), α-fetoprotein (AFP), carbohydrate antigen-125 (CA-125), carbohydrate antigen-19.9 (CA-19.9) and ferritin, individually or in combination. The electro-chemiluminescence immunization method was performed to detect the levels of seven tumor markers in 560 cancer patients and 103 healthy subjects f...

  16. Ultrasonic elastography in clinical quantitative assessment of fatty liver

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To investigate the clinical application of ultrasonic elastography in quantitative assessment of fatty liver grading. METHODS: A total of 105 patients with fatty liver were divided into mild group (n = 46), moderate group (n = 39), and severe group (n = 20). Forty-five healthy individuals served as a normal control group. All patients who underwent routine ultrasound scan and further ultrasonic elastography were evaluated accordingly to the evaluation standards for ultrasonic elastography. The ratio of...

  17. Clinical significance of computed tomography assessment for third molar surgery

    OpenAIRE

    Nakamori, Kenji; Tomihara, Kei; Noguchi, Makoto

    2014-01-01

    Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed ...

  18. Incorporating HIV/AIDS Considerations into Vulnerability Assessments for Disaster Risk Reduction

    Directory of Open Access Journals (Sweden)

    Gideon van Riet

    2006-04-01

    Full Text Available The paper briefly highlights the link between HIV/AIDS and vulnerability, the latter being a focus point of DRR. In particular it investigates in which ways HIV/AIDS contributes to the vulnerability (for the purposes of this discussion defined as the susceptibility of households to the negative effects of certain natural hazards, brought on by the interplay between various political, economic, social and environmental factors of households. Secondly, the paper investigates the possible measurement of HIV/AIDS in general vulnerability assessments used for the purposes of DRR, by evaluating the merit of certain indicators often used to target humanitarian aid.

  19. Clinical assessment of social cognitive function in neurological disorders.

    Science.gov (United States)

    Henry, Julie D; von Hippel, William; Molenberghs, Pascal; Lee, Teresa; Sachdev, Perminder S

    2016-01-01

    Social cognition broadly refers to the processing of social information in the brain that underlies abilities such as the detection of others' emotions and responding appropriately to these emotions. Social cognitive skills are critical for successful communication and, consequently, mental health and wellbeing. Disturbances of social cognition are early and salient features of many neuropsychiatric, neurodevelopmental and neurodegenerative disorders, and often occur after acute brain injury. Its assessment in the clinic is, therefore, of paramount importance. Indeed, the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduced social cognition as one of six core components of neurocognitive function, alongside memory and executive control. Failures of social cognition most often present as poor theory of mind, reduced affective empathy, impaired social perception or abnormal social behaviour. Standard neuropsychological assessments lack the precision and sensitivity needed to adequately inform treatment of these failures. In this Review, we present appropriate methods of assessment for each of the four domains, using an example disorder to illustrate the value of these approaches. We discuss the clinical applications of testing for social cognitive function, and finally suggest a five-step algorithm for the evaluation and treatment of impairments, providing quantitative evidence to guide the selection of social cognitive measures in clinical practice. PMID:26670297

  20. SYVAC - a computer program for assessment of nuclear fuel waste management systems, incorporating parameter variability

    International Nuclear Information System (INIS)

    This is a users' manual describing SYVAC, a computer program designed for use in post-closure assessment of risk associated with a nuclear fuel waste disposal system, taking into account variability and uncertainty in parameters defining the state of the disposal vault and its surroundings. Transport of radionuclides through a component of the system, such as a rock mass, is represented by a submodel that depends on system parameters. Several submodels are executed in sequence under the control of SYVAC to provide an estimate of the consequence associated with a given set of parameter values. Many such estimates are made, each time using a set of parameter values obtained by random sampling from distributions of specified type and range. The end result is a probability density function of consequence estimates together with detailed time-dependent information on all runs

  1. Incorporation of formal safety assessment and Bayesian network in navigational risk estimation of the Yangtze River

    International Nuclear Information System (INIS)

    Formal safety assessment (FSA), as a structured and systematic risk evaluation methodology, has been increasingly and broadly used in the shipping industry around the world. Concerns have been raised as to navigational safety of the Yangtze River, China's largest and the world's busiest inland waterway. Over the last few decades, the throughput of ships in the Yangtze River has increased rapidly due to the national development of the Middle and Western parts of China. Accidents such as collisions, groundings, contacts, oil-spills and fires occur repeatedly, often causing serious consequences. In order to improve the navigational safety in the Yangtze River, this paper estimates the navigational risk of the Yangtze River using the FSA concept and a Bayesian network (BN) technique. The navigational risk model is established by considering both probability and consequences of accidents with respect to a risk matrix method, followed by a scenario analysis to demonstrate the application of the proposed model

  2. Clinical significance of computed tomography assessment for third molar surgery.

    Science.gov (United States)

    Nakamori, Kenji; Tomihara, Kei; Noguchi, Makoto

    2014-07-28

    Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed tomography (CT) now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery. Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation, whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve. Multiple factors, including demographic, anatomic, and treatment-related factors, influence the incidence of nerve injury during or following removal of the third molar. CT assessment of the third molar prior to surgery can identify some of these risk factors, such as the absence of cortication between the mandibular third molar and the inferior alveolar canal, prior to surgery to reduce the risk for nerve damage. This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery. PMID:25071882

  3. Clinical significance of computed tomography assessment for third molar surgery

    Institute of Scientific and Technical Information of China (English)

    Kenji; Nakamori; Kei; Tomihara; Makoto; Noguchi

    2014-01-01

    Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery.Third molar surgery is warranted when there is inadequate space for eruption,malpositioning,or risk for cyst or odontogenic tumor formation.Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues.Due to developments in medical engineering technology,computed tomography(CT)now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery.Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation,whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve.Multiple factors,including demographic,anatomic,and treatment-related factors,influence the incidence of nerve injury during or following removal of the third molar.CT assessment of the third molar prior to surgery can identify some of these risk factors,such as the absence of cortication between themandibular third molar and the inferior alveolar canal,prior to surgery to reduce the risk for nerve damage.This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery.

  4. CLINICAL PSYCHOLOGICAL ASSESSMENT IN LITHUANIAN HEALTH CARE INSTITUTIONS: OPINION ANALYSIS OF PROFESSIONALS

    OpenAIRE

    Augustinas Rotomskis

    2015-01-01

    Purpose – to investigate the state of clinical psychological assessment in the Lithuanian health care system: 1) what kind of tests are used in clinical practice and what are clinicians opinions about them; 2) what kind of psychological functions are assessed in clinical practice and what is the opinion of clinicians about the assessment of these psychological functions; 3) what kind of issues are the most pressing in clinical assessment. Design/methodology/approach – 101 clinical psychol...

  5. Incorporating covariates into fisheries stock assessment models with application to Pacific herring.

    Science.gov (United States)

    Deriso, Richard B; Maunder, Mark N; Pearson, Walter H

    2008-07-01

    We present a framework for evaluating the cause of fishery declines by integrating covariates into a fisheries stock assessment model. This allows the evaluation of fisheries' effects vs. natural and other human impacts. The analyses presented are based on integrating ecological science and statistics and form the basis for environmental decision-making advice. Hypothesis tests are described to rank hypotheses and determine the size of a multiple covariate model. We extend recent developments in integrated analysis and use novel methods to produce effect size estimates that are relevant to policy makers and include estimates of uncertainty. Results can be directly applied to evaluate trade-offs among alternative management decisions. The methods and results are also broadly applicable outside fisheries stock assessment. We show that multiple factors influence populations and that analysis of factors in isolation can be misleading. We illustrate the framework by applying it to Pacific herring of Prince William Sound, Alaska (USA). The Pacific herring stock that spawns in Prince William Sound is a stock that has collapsed, but there are several competing or alternative hypotheses to account for the initial collapse and subsequent lack of recovery. Factors failing the initial screening tests for statistical significance included indicators of the 1989 Exxon Valdez oil spill, coho salmon predation, sea lion predation, Pacific Decadal Oscillation, Northern Oscillation Index, and effects of containment in the herring egg-on-kelp pound fishery. The overall results indicate that the most statistically significant factors related to the lack of recovery of the herring stock involve competition or predation by juvenile hatchery pink salmon on herring juveniles. Secondary factors identified in the analysis were poor nutrition in the winter, ocean (Gulf of Alaska) temperature in the winter, the viral hemorrhagic septicemia virus, and the pathogen Ichthyophonus hoferi. The

  6. Development of a human eye model incorporated with intraocular scattering for visual performance assessment

    Science.gov (United States)

    Chen, Yi-Chun; Jiang, Chong-Jhih; Yang, Tsung-Hsun; Sun, Ching-Cherng

    2012-07-01

    A biometry-based human eye model was developed by using the empirical anatomic and optical data of ocular parameters. The gradient refractive index of the crystalline lens was modeled by concentric conicoid isoindical surfaces and was adaptive to accommodation and age. The chromatic dispersion of ocular media was described by Cauchy equations. The intraocular scattering model was composed of volumetric Mie scattering in the cornea and the crystalline lens, and a diffusive-surface model at the retina fundus. The retina was regarded as a Lambertian surface and was assigned its corresponding reflectance at each wavelength. The optical performance of the eye model was evaluated in CodeV and ASAP and presented by the modulation transfer functions at single and multiple wavelengths. The chromatic optical powers obtained from this model resembled that of the average physiological eyes. The scattering property was assessed by means of glare veiling luminance and compared with the CIE general disability glare equation. By replacing the transparent lens with a cataractous lens, the disability glare curve of cataracts was generated to compare with the normal disability glare curve. This model has high potential for investigating visual performance in ordinary lighting and display conditions and under the influence of glare sources.

  7. An International Assessment of Mangrove Management: Incorporation in Integrated Coastal Zone Management

    Directory of Open Access Journals (Sweden)

    Haille N. Carter

    2015-04-01

    Full Text Available Due to increasing recognition of the benefits provided by mangrove ecosystems, protection policies have emerged under both wetland and forestry programs. However, little consistency remains among these programs and inadequate coordination exists among sectors of government. With approximately 123 countries containing mangroves, the need for global management of these ecosystems is crucial to sustain the industries (i.e., fisheries, timber, and tourism and coastal communities that mangroves support and protect. To determine the most effective form of mangrove management, this review examines management guidelines, particularly those associated with Integrated Coastal Zone Management (ICZM. Five case studies were reviewed to further explore the fundamentals of mangrove management. The management methodologies of two developed nations as well as three developing nations were assessed to encompass comprehensive influences on mangrove management, such as socioeconomics, politics, and land-use regulations. Based on this review, successful mangrove management will require a blend of forestry, wetland, and ICZM programs in addition to the cooperation of all levels of government. Legally binding policies, particularly at the international level, will be essential to successful mangrove management, which must include the preservation of existing mangrove habitat and restoration of damaged mangroves.

  8. Truck shipment risks for assessing hazardous materials - a new paradigm incorporating safety and security

    International Nuclear Information System (INIS)

    Recent terrorist events, most notably September 11, 2001, have taught us that transportation risk management must be performed with a different lens to accommodate terrorism scenarios that would have previously been considered unlikely to warrant serious attention. Given these circumstances, a new paradigm is needed for managing the risks associated with highway transport of hazardous materials. In particular, this paradigm must: 1) more explicitly consider security threat and vulnerability, and 2) integrate security considerations into an overall framework for addressing natural and man-made disasters, be they accidental or planned. This paper summarizes the results of a study sponsored by the U.S. Department of Transportation, Federal Motor Carrier Safety Administration for the purpose of exploring how a paradigm might evolve in which both safety and security risks can be evaluated as a systematic, integrated process. The work was directed at developing a methodology for assessing the impacts of hazardous materials safety and security incident consequences when transported by highway. This included consideration of the manner in which these materials could be involved in initiating events as well as potential outcomes under a variety of release conditions. The methodology is subsequently applied to various classes of hazardous materials to establish an economic profile of the impacts that might be expected if a major release were to occur. The paper concludes with a discussion of the findings and implications associated with this effort

  9. Clinical assessment tools identify functional deficits in fragility fracture patients

    Directory of Open Access Journals (Sweden)

    Ames TD

    2016-05-01

    Full Text Available Tyler D Ames,1 Corinne E Wee,1 Khoi M Le,1 Tiffany L Wang,1 Julie Y Bishop,2 Laura S Phieffer,2 Carmen E Quatman2 1The Ohio State University College of Medicine, 2Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA Purpose: To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.Patients and methods: Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB, handgrip strength (handheld dynamometer, and lumbopelvic control (iPod Touch Level Belt, which were compared between fragility fracture patients and healthy controls.Results: Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042 and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026 when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020 and total components (P=0.010 of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003.Conclusion: The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls. Keywords: fall risk, geriatric fracture, Nintendo Wii Balance Board, Level Belt, fragility fracture

  10. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial

    OpenAIRE

    Lam, Carly Siu Yin; Tang, Wing Chun; Tse, Dennis Yan-Yin; Tang, Ying Yung; To, Chi Ho

    2013-01-01

    Aims To determine if ‘Defocus Incorporated Soft Contact’ (DISC) lens wear slows childhood myopia progression. Methods A 2-year double-blind randomised controlled trial was carried out in 221 children aged 8–13 years, with myopia between −1.00 and −5.00 Dioptres (D) and astigmatism ≤1.00 D. Subjects were randomly assigned to the DISC (n=111) or single vision (SV; n=110) contact lens group. DISC lenses incorporated concentric rings, which provided an addition of +2.50 D, alternating with the no...

  11. Assessment of clinical depression comorbid with posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Simonović Maja

    2008-01-01

    Full Text Available Background/Aim. Comorbidity of the posttraumatic stress disorder (PTSD and depression is often recognized in the clinical practice. The aim of the paper was to determine the severity of depression and the group of symptoms which are the most prominent in clinical depression comorbid with PTSD. Methods. Totally 60 patients were assessed and divided into the experimental and control group using the Structured Clinical Interview for DSM-IV Axis I Disorders, Investigator Version (SCID-I, modified (SCID for DSM-IV and ICD-10 diagnostic criteria. The presence and the severity of the disorders were assessed by means of the following instruments: Clinician-Administrated PTSD Scale for DSM-IV (CAPS-DX, Montgomery-Asberg Depression Rating Scale (MADRS and 17-item Hamilton Rating Scale for Depression (HAMD. The differences between groups were evaluated using Student t test and by means of the correlation analysis of the data with p < 0.05. Results. The obtained results showed that depression witch was comorbid with PTSD was of significant clinical severity with 31.20 score on HAMD and 30.43 score on MADRS in PTSD-D group. The group of the symptoms: lassitude, inability to feel, suicidal thoughts and inner tension contributed mostly to the global severity of the comorbid clinical depression on MADRS. The group of the symptoms: suicide and somatic symptoms, gastrointestinal, guilt, hypochondriasis, work and activity, anxiety psychic, agitation, and weight loss, genital symptoms and anxiety somatic contributed mostly to the global severity of comorbid clinical depression on HAMD. The average score was 16.03 and 16.97 on HAMD and MADRS, respectively in PTSD group. Conclusion. Depression which is comorbid with posttraumatic stress disorder represents significant clinical entity with domination of the different groups of symptoms between the groups PTSD and PTSD-D on HAMD. Identification of aforementioned severity of illness and delineated group of symptoms lead

  12. Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA).

    Science.gov (United States)

    Tricarico, Pierfrancesco; Tardivo, Stefano; Sotgiu, Giovanni; Moretti, Francesca; Poletti, Piera; Fiore, Alberto; Monturano, Massimo; Mura, Ida; Privitera, Gaetano; Brusaferro, Silvio

    2016-08-01

    Purpose - The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach - A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings - The self-assessment tool - Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications - This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value - The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries. PMID:27477931

  13. Clinical Evaluation of a Novel and Mobile Autism Risk Assessment.

    Science.gov (United States)

    Duda, Marlena; Daniels, Jena; Wall, Dennis P

    2016-06-01

    The Mobile Autism Risk Assessment (MARA) is a new, electronically administered, 7-question autism spectrum disorder (ASD) screen to triage those at highest risk for ASD. Children 16 months-17 years (N = 222) were screened during their first visit in a developmental-behavioral pediatric clinic. MARA scores were compared to diagnosis from the clinical encounter. Participant median age was 5.8 years, 76.1 % were male, and most participants had an intelligence/developmental quotient score >85; 69 of the participants (31 %) received a clinical diagnosis of ASD. The sensitivity of the MARA in detecting ASD was 89.9 % [95 % CI = 82.7-97]; the specificity was 79.7 % [95 % CI = 73.4-86.1]. In a high-risk clinical setting, the MARA shows promise as a screen to distinguish ASD from other developmental/behavioral disorders. PMID:26873142

  14. Health assessment for Koppers Company Incorporated, Florence, South Carolina, Region 4. CERCLIS No. SCD003353026. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1989-05-01

    Koppers Company, Incorporated-Florence (KCI-F) is located in northeastern South Carolina near the city of Florence. KCI-F is on the U.S. Environmental Protection Agency's National Priorities List; KCI-F is also listed as a Resource Conservation Recovery Act facility. Available data identify pentachlorophenol (PCP), polycyclic aromatic hydrocarbons (PAHs), naphthalene, and phenols among the contaminants present in on-site and off-site groundwater. In addition to PCP, analyses of on-site soil borings demonstrated high levels of oil and grease. No surface soil assays were conducted. Known exposure pathways include ingestion, inhalation and dermal contact with contaminated groundwater and soil. Adverse health effects have been associated with some of the identified contaminants in the quantities reported in the preliminary data. However, more current and extensive sampling data of pertinent environmental media are needed to fully assess the public health implications of the site.

  15. How does the medical graduates' self-assessment of their clinical competency differ from experts' assessment?

    OpenAIRE

    Abadel Fatima Taleb; Hattab Abdulla Saeed

    2013-01-01

    Abstract Background The assessment of the performance of medical school graduates during their first postgraduate years provides an early indicator of the quality of the undergraduate curriculum and educational process. The objective of this study was to assess the clinical competency of medical graduates, as perceived by the graduates themselves and by the experts. Methods This is a hospital based cross-sectional study. It covered 105 medical graduates and 63 experts selected by convenient s...

  16. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project

    OpenAIRE

    Kaleta Anna; Walczak Jacek; Suter Katja; Kunz Regina; Zanrei Gianni; Horvath Andrea R; Arvanitis Theodoros N; Meyerrose Berit; Weinbrenner Susanne; Barnfield Gemma; Thangaratinam Shakila; Rengerink Katrien; Gee Harry; Mol Ben WJ; Khan Khalid S

    2009-01-01

    Abstract Background Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional deve...

  17. MR imaging assessment of clinical problems in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, Jose A.; Roca, Yolanda; Aguilera, Carlos [Department of CT and MR Imaging, Hospital Duran i Reynals, Universitaria de Bellvitge, Barcelona (Spain); Narvaez, Javier [Department of Medicine, Delfos Medical Center, Barcelona (Spain)

    2002-07-01

    Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, ''rice-bodies'' bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis. (orig.)

  18. Clinical and psychometric validation of the psychotic depression assessment scale

    DEFF Research Database (Denmark)

    Østergaard, Søren Dinesen; Pedersen, Christina Horsager; Uggerby, Peter;

    2015-01-01

    BACKGROUND: Recent studies have indicated that the 11-item Psychotic Depression Assessment Scale (PDAS), consisting of the 6-item melancholia subscale (HAM-D6) of the Hamilton Depression Rating Scale and 5 psychosis items from the Brief Psychiatric Rating Scale (BPRS), is a valid measure for the...... severity of psychotic depression. The aim of this study was to subject the PDAS, and its depression (HAM-D6) and psychosis (BPRS5) subscales to further validation. METHODS: Patients diagnosed with psychotic depression at Danish psychiatric hospitals participated in semi-structured interviews. Video...... recordings of these interviews were assessed by two experienced psychiatrists (global severity rating of psychotic depression, depressive symptoms and psychotic symptoms) and by two young physicians (rating on 27 symptom items, including the 11 PDAS items). The clinical validity and responsiveness of the...

  19. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management.

    Science.gov (United States)

    Goom, Thomas S H; Malliaras, Peter; Reiman, Michael P; Purdam, Craig R

    2016-06-01

    Synopsis Proximal hamstring tendinopathy (PHT) typically manifests as deep buttock pain at the hamstring common origin. Both athletic and nonathletic populations are affected by PHT. Pain and dysfunction are often long-standing and limit sporting and daily functions. There is limited evidence regarding diagnosis, assessment, and management; for example, there are no randomized controlled trials investigating rehabilitation of PHT. Some of the principles of management established in, for example, Achilles and patellar tendinopathy would appear to apply to PHT but are not as well documented. This narrative review and commentary will highlight clinical aspects of assessment and management of PHT, drawing on the available evidence and current principles of managing painful tendinopathy. The management outline presented aims to guide clinicians as well as future research. J Orthop Sports Phys Ther 2016;46(6):483-493. Epub 15 Apr 2016. doi:10.2519/jospt.2016.5986. PMID:27084841

  20. Implementing an Assessment Clinic in a Residential PTSD Program

    Directory of Open Access Journals (Sweden)

    Joan McDowell

    2014-08-01

    Full Text Available Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included.

  1. A Range-Based Vehicle Life Cycle Assessment Incorporating Variability in the Environmental Assessment of Different Vehicle Technologies and Fuels

    Directory of Open Access Journals (Sweden)

    Maarten Messagie

    2014-03-01

    Full Text Available How to compare the environmental performance of different vehicle technologies? Vehicles with lower tailpipe emissions are perceived as cleaner. However, does it make sense to look only to tailpipe emissions? Limiting the comparison only to these emissions denies the fact that there are emissions involved during the production of a fuel and this approach gives too much advantage to zero-tailpipe vehicles like battery electric vehicles (BEV and fuel cell electric vehicle (FCEV. Would it be enough to combine fuel production and tailpipe emissions? Especially when comparing the environmental performance of alternative vehicle technologies, the emissions during production of the specific components and their appropriate end-of-life treatment processes should also be taken into account. Therefore, the complete life cycle of the vehicle should be included in order to avoid problem shifting from one life stage to another. In this article, a full life cycle assessment (LCA of petrol, diesel, fuel cell electric (FCEV, compressed natural gas (CNG, liquefied petroleum gas (LPG, hybrid electric, battery electric (BEV, bio-diesel and bio-ethanol vehicles has been performed. The aim of the manuscript is to investigate the impact of the different vehicle technologies on the environment and to develop a range-based modeling system that enables a more robust interpretation of the LCA results for a group of vehicles. Results are shown for climate change, respiratory effects, acidification and mineral extraction damage of the different vehicle technologies. A broad range of results is obtained due to the variability within the car market. It is concluded that it is essential to take into account the influence of all the vehicle parameters on the LCA results.

  2. Effect of a Smartphone Application Incorporating Personalized Health-Related Imagery on Adherence to Antiretroviral Therapy: A Randomized Clinical Trial

    OpenAIRE

    Perera, Anna I.; Thomas, Mark G.; Moore, John O.; Faasse, Kate; Petrie, Keith J

    2014-01-01

    Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained ...

  3. Clinical competency assessment in intravenous therapy and vascular access: part 2.

    Science.gov (United States)

    Louise Hulse, Anna

    This article explores and critically evaluates clinical practice competencies as a form of assessment within post-registration nurse education, specifically relating to competence assessment of intravenous (IV) therapy. In the first article in this two-part series, 'Competency assessment in intravenous therapy and vascular access: part 1' (BJN, 22(16)), an in-depth literature review was carried out and applied to current competency assessment design. Clinical staff opinion was sought to evaluate users' opinions of this assessment method against recommended literature. The aim of both articles is to describe critically and analyse existing practice using this form of assessment, and relate other forms of assessment to IV therapy and vascular access clinical competence. A small-scale study was performed to evaluate whether clinical competency assessment is the most appropriate form of assessment of IV therapy and vascular access skills. A questionnaire was designed to assess nurse opinion in relation to advantages (positives) and disadvantages (negatives) of clinical practice competency assessment; 35 randomly selected post-registered nurses were included in the sample. Findings illustrated that clinical competency assessment is the most appropriate form for the assessment of clinical skills in IV therapy. However, recommendations were made for the possible use of Objective Structured Clinical Examination (OSCE) assessment. Furthermore, this report recommends the assessment of theory and knowledge through written exams or multiple-choice questions (MCQs) as an addition to clinical practice competence assessment for IV therapy. PMID:24067310

  4. Clinical and economic outcomes assessment in nuclear cardiology

    International Nuclear Information System (INIS)

    The future of nuclear medicine procedures, as understood within our current economic climate, depends upon its ability to provide relevant clinical information at similar or lower comparative costs. With an ever-increasing emphasis on cost containment, outcome assessment forms the basis of preserving the quality of patient care. Today, outcomes assessment encompasses a wide array of subjects including clinical, economic, and humanistic (i.e., quality of life) outcomes. For nuclear cardiology, evidence-based medicine would require a threshold level of evidence in order to justify the added cost of any test in a patient's work-up. This evidence would include large multicenter, observational series as well as randomized trial data in sufficiently large and diverse patient populations. The new movement in evidence-based medicine is also being applied to the introduction of new technologies, in particular when comparative modalities exist. In the past 5 years, it has seen a dramatic shift in the quality of outcomes data published in nuclear cardiology. This includes the use of statistically rigorous risk-adjusted techniques as well as large populations (i.e., >500 patients) representing multiple diverse medical care settings. This has been the direct result of the development of multiple outcomes databases that have now amassed thousands of patients worth of data. One of the benefits of examining outcomes in large patient datasets is the ability to assess individual endpoints (e.g., cardiac death) as compared with smaller datasets that often assess combined endpoints (e.g., death, myocardial infarction, or unstable angina). New technologies for the diagnosis of coronary artery disease have contributed to the rising costs of care. In the United States and in Europe, costs of care have risen dramatically, consuming an ever-increasing amount of available resources. The overuse of diagnostic angiography often leads to unnecessary revascularization that does not lead to

  5. Using Experience Sampling Methods/Ecological Momentary Assessment (ESM/EMA) in Clinical Assessment and Clinical Research: Introduction to the Special Section

    OpenAIRE

    Trull, Timothy J.; Ebner-Priemer, Ulrich W.

    2009-01-01

    This article introduces the special section on experience sampling methods and ecological momentary assessment in clinical assessment. We review the conceptual basis for experience sampling methods (ESM; Csikszentmihalyi & Larson, 1987) and ecological momentary assessment (EMA; Stone & Shiffman, 1994). Next, we highlight several advantageous features of ESM/EMA as applied to psychological assessment and clinical research. We provide a brief overview of the articles in this special section, ea...

  6. Assessing Clinical Research Capacity in Vietnam: A Framework for Strengthening Capability for Clinical Trials in Developing Countries.

    Science.gov (United States)

    Kagan, Jonathan; Giang, Dao Duc; Iademarco, Michael F; Phung, Van Tt; Lau, Chuen-Yen; Quang, Nguyen Ngo

    2016-01-01

    Although improving health systems promises important benefits, most developing nations lack the resources to support nationally driven clinical research. Strengthened clinical research capacity can advance national health goals by supporting greater autonomy in aligning research with national priorities. From March through June 2010, we assessed six elements of clinical research capacity in Vietnam: research agenda; clinical investigators and biostatisticians; donors and sponsors; community involvement; scientific, ethical, safety, and quality oversight; and clinical research institutions. Assessments were drawn from interviews with investigators, Ministry of Health staff members, nongovernment organizations, and U.S. Mission staff members, and document review. Observations and recommendations were shared with collaborators. Reassessment in 2015 found growth in the number of clinical trials, improved regulation in human subjects protection and community engagement, and modest advances in research agenda setting. Training and investment in institutions remain challenging. A framework for assessing clinical research capacity can affirm strengths and weaknesses and guide the coordination of capacity-building efforts. PMID:27252559

  7. Assessing cognitive function in clinical trials of schizophrenia.

    Science.gov (United States)

    Barnett, Jennifer H; Robbins, Trevor W; Leeson, Verity C; Sahakian, Barbara J; Joyce, Eileen M; Blackwell, Andrew D

    2010-07-01

    Cognitive dysfunction in schizophrenia is an important target for novel therapies. Effectively measuring the cognitive effects of compounds in clinical trials of schizophrenia could be a major barrier to drug development. The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) programme produced a consensus cognitive battery which is now widely used, however alternative assessments have advantages and disadvantages when compared with MATRICS. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerised assessment developed from animal behaviour paradigms and human neuropsychology. We review the utility of CANTAB according to MATRICS and CNTRICS recommendations. CANTAB tests have been used in more than 60 studies of psychotic disorders. Their neural bases are well understood through patient and neuroimaging studies and directly equivalent tests in rodents and non-human primates. The tests' sensitivity to pharmacological manipulation is well established. Future studies should collect more data regarding psychometric properties in patients over short time periods, and should continue to study the tests' relationships to functional outcomes. Computerised cognitive assessment may optimise the statistical power of cognitive trials by reducing measurement error and between-site variability and decreasing patient attrition through increased tolerability. PMID:20105440

  8. Physiologically based pharmacokinetic modeling for assessing the clinical drug-drug interaction of alisporivir.

    Science.gov (United States)

    Xia, Binfeng; Barve, Avantika; Heimbach, Tycho; Zhang, Tao; Gu, Helen; Wang, Lai; Einolf, Heidi; Alexander, Natalya; Hanna, Imad; Ke, June; Mangold, James B; He, Handan; Sunkara, Gangadhar

    2014-10-15

    Alisporivir is a novel cyclophilin-binding molecule with potent anti-hepatitis C virus (HCV) activity. In vitro data from human liver microsomes suggest that alisporivir is a substrate and a time-dependent inhibitor (TDI) of CYP3A4. The aim of the current work was to develop a novel physiologically based pharmacokinetic (PBPK) model to quantitatively assess the magnitude of CYP3A4 mediated drug-drug interactions with alisporivir as the substrate or victim drug. Towards that, a Simcyp PBPK model was developed by integrating in vitro data with in vivo clinical findings to characterize the clinical pharmacokinetics of alisporivir and further assess the magnitude of drug-drug interactions. Incorporated with absorption, distribution, elimination, and TDI data, the model accurately predicted AUC, Cmax, and tmax values after single or multiple doses of alisporivir with a prediction deviation within ± 32%. The model predicted an alisporivir AUC increase by 9.4-fold and a decrease by 86% when alisporivir was co-administrated with ketoconazole (CYP3A4 inhibitor) or rifampin (CYP3A4 inducer), respectively. Predictions were within ± 20% of the observed changes. In conclusion, the PBPK model successfully predicted the alisporivir PK and the magnitude of drug-drug interactions. PMID:25008118

  9. Radiation Therapy Oncology Group Translational Research Program Stem Cell Symposium: Incorporating Stem Cell Hypotheses into Clinical Trials

    International Nuclear Information System (INIS)

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease sites. This report summarizes the major topics discussed and the future directions that research should take. Major conclusions of the symposium were that the flow cytometry of multiple markers in fresh tissue would remain the standard technique of evaluating cancer-initiating cells and that surrogates need to be developed for both experimental and clinical use.

  10. From Clinical-Developmental Theory to Assessment: The Holistic Student Assessment Tool

    Directory of Open Access Journals (Sweden)

    Gil Noam

    2012-12-01

    Full Text Available A description and test of the Holistic Student Assessment Tool (HSA, an assessment tool to measure children’s and adolescents’ resiliencies in relation to externalizing and internalizing problem behaviors. The HSA is based on the authors’ research-based clinical-developmental Clover Leaf Model of resilience and psychopathology, and is one of the first attempts at closing the gap between risk and resilience approaches in developmental assessment. The HSA was tested in a cross-sectional sample of 423 children and adolescents.The results lend support to the HSA as a valid measure of children’s and adolescents’ resiliencies. Furthermore, the resilience scales mostly exhibited the theoretically expected convergent and divergent relationships with the psychopathology scales. In addition, we show how the resilience scales predict adolescents’ externalizing and internalizing symptoms. We contend that evidence-based intervention to address youth aggression needs to be based on sounddevelopmental assessment.

  11. Incorporating change information into sexual offender risk assessments using the violence risk scale-sexual offender version.

    Science.gov (United States)

    Olver, Mark E; Christofferson, Sarah M Beggs; Grace, Randolph C; Wong, Stephen C P

    2014-10-01

    We examined the use of risk-change information in sexual offender risk assessments featuring the Violence Risk Scale-Sexual Offender version (VRS-SO), a sex offender risk assessment and treatment planning tool. The study featured a combined international sample of 539 sex offenders followed up an average of 15.5 years post-release. Pre- and posttreatment VRS-SO ratings were amalgamated from two treated samples of sex offenders from Canada and New Zealand. Analyses focused on examinations and applications of change data and its relationship to sexual and violent recidivism. VRS-SO change scores were significantly associated with decreases in these outcome criteria with, and without, controlling for indicators of pretreatment risk (e.g., Static-99R score) and individual differences in follow-up time. Applications of logistic regression using fixed 5-year follow-ups generated estimated rates of sexual and violent recidivism at different VRS-SO score thresholds. The use of logistic regression demonstrated a clinically useful and systematic means of combining risk and change information into posttreatment risk appraisals. Implications for the use of change information in the assessment and management of sexual offender risk are discussed. PMID:24088814

  12. Establishing a family risk assessment clinic for breast cancer.

    LENUS (Irish Health Repository)

    Mulsow, Jurgen

    2012-02-01

    Breast cancer is the most common cancer affecting European women and the leading cause of cancer-related death. A total of 15-20% of women who develop breast cancer have a family history and 5-10% a true genetic predisposition. The identification and screening of women at increased risk may allow early detection of breast cancer and improve prognosis. We established a family risk assessment clinic in May 2005 to assess and counsel women with a family history of breast cancer, to initiate surveillance, and to offer risk-reducing strategies for selected high-risk patients. Patients at medium or high risk of developing breast cancer according to NICE guidelines were accepted. Family history was determined by structured questionnaire and interview. Lifetime risk of developing breast cancer was calculated using Claus and Tyrer-Cuzick scoring. Risk of carrying a breast cancer-related gene mutation was calculated using the Manchester system. One thousand two hundred and forty-three patients have been referred. Ninety-two percent were at medium or high risk of developing breast cancer. Formal assessment of risk has been performed in 368 patients, 73% have a high lifetime risk of developing breast cancer, and 72% a Manchester score >or=16. BRCA1\\/2 mutations have been identified in 14 patients and breast cancer diagnosed in two. Our initial experience of family risk assessment has shown there to be a significant demand for this service. Identification of patients at increased risk of developing breast cancer allows us to provide individuals with accurate risk profiles, and enables patients to make informed choices regarding their follow-up and management.

  13. RADIATION THERAPY ONCOLOGY GROUP TRANSLATIONAL RESEARCH PROGRAM STEM CELL SYMPOSIUM : INCORPORATING STEM CELL HYPOTHESES INTO CLINICAL TRIALS

    NARCIS (Netherlands)

    Woodward, Wendy A.; Bristow, Robert G.; Clarke, Michael F.; Coppes, Robert P.; Cristofanilli, Massimo; Duda, Dan G.; Fike, John R.; Hambardzumyan, Dolores; Hill, Richard P.; Jordan, Craig T.; Milas, Luka; Pajonk, Frank; Curran, Walter J.; Dicker, Adam P.; Chen, Yuhchyau

    2009-01-01

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease si

  14. Adopting a Clinical Assessment Framework in Older Adult Mental Health.

    Science.gov (United States)

    Hung, Lillian; Lee, Patience Anne; Au-Yeung, Andy T; Kucherova, Irina; Harrigan, MaryLou

    2016-07-01

    Obtaining new knowledge accepted and used by practitioners remains a slow process. A dearth of knowledge translation research exists that explores how to effectively move knowledge to practice in the field of older adult mental health. The current article reports findings of a knowledge translation study that examined what factors enabled the adoption of a new clinical assessment framework, P.I.E.C.E.S.™, into practice in an older adult tertiary mental health unit. Theoretical insights of appreciative inquiry were used to guide the study. Qualitative methods were used, including focus groups with 20 staff and individual interviews with three leaders. The appreciative inquiry approach helped researchers successfully facilitate knowledge translation. Enabling factors included: (a) fostering positive energy to make continuous improvement, (b) working with team members across disciplines at all levels, and (c) using knowledge translation tools to enable and sustain the new practice. [Journal of Psychosocial Nursing and Mental Health Services, 54 (7), 26-31.]. PMID:27362382

  15. Ways of incorporating photographic images in learning and assessing high school biology: A study of visual perception and visual cognition

    Science.gov (United States)

    Nixon, Brenda Chaumont

    This study evaluated the cognitive benefits and costs of incorporating biology-textbook and student-generated photographic images into the learning and assessment processes within a 10th grade biology classroom. The study implemented Wandersee's (2000) 20-Q Model of Image-Based Biology Test-Item Design (20-Q Model) to explore the use of photographic images to assess students' understanding of complex biological processes. A thorough review of the students' textbook using ScaleMaster R with PC Interface was also conducted. The photographs, diagrams, and other representations found in the textbook were measured to determine the percentage of each graphic depicted in the book and comparisons were made to the text. The theoretical framework that guided the research included Human Constructivist tenets espoused by Mintzes, Wandersee and Novak (2000). Physiological and cognitive factors of images and image-based learning as described by Robin (1992), Solso (1997) and Wandersee (2000) were examined. Qualitative case study design presented by Yin (1994), Denzin and Lincoln (1994) was applied and data were collected through interviews, observations, student activities, student and school artifacts and Scale Master IIRTM measurements. The results of the study indicate that although 24% of the high school biology textbook is devoted to photographic images which contribute significantly to textbook cost, the teacher and students paid little attention to photographic images other than as aesthetic elements for creating biological ambiance, wasting valuable opportunities for learning. The analysis of the photographs corroborated findings published by the Association American Association for the Advancement of Science that indicated "While most of the books are lavishly illustrated, these representations are rarely helpful, because they are too abstract, needlessly complicated, or inadequately explained" (Roseman, 2000, p. 2). The findings also indicate that applying the 20-Q

  16. Clinical specialization programs for dietitians: a needs assessment.

    Science.gov (United States)

    Bellman, J C; Nestor, L M

    1995-01-01

    This needs assessment was conducted to identify the perceived need for advancement and specialization through practicum programs in clinical dietetics. A questionnaire was developed and validated through a pilot study. It was mailed to a randomized sample of 950 dietitians (52%) registered with the ODA. Fifty two per cent responded, representing 27% of ODA members. Of those surveyed 89% were currently employed. The most current area of practice was clinical nutrition (55%) followed by foodservice (22%) and community nutrition (14%). Seventy two per cent of the respondents identified that they would consider enrolling in a specialized practicum. Most cited reasons for enrolling were increased knowledge/expertise (44%) and increased professional profile (25%). Areas of greatest interest were: nutrition assessment (9%), critical care/nutrition support (8%) and gerontology (7.5%). Sixty two per cent preferred the program to be offered part-time, 27% full-time and 9% were impartial. The most frequently cited length and cost per week for the program within specified part or full-time categories was: two weeks full-time (36.5%) at S200-299.00 (33%), four weeks full-time (25%) at S100-199.00 (31%) and two weeks part or full-time (23.5%) at S200-299.00 (57%). Desired ODA regions for program availability were: Toronto (34%), Kitchener/Waterloo/Hamilton (17.5%) and London (14%). Lastly, 92% of the respondents felt the program should be CDA and ODA approved and continuing education points be provided. These results indicate that dietitians are interested in pursuing professional self-development through specialized practicums. PMID:10153678

  17. Feedback and assessment for clinical placements: achieving the right balance

    Directory of Open Access Journals (Sweden)

    Burgess A

    2015-05-01

    Full Text Available Annette Burgess, Craig Mellis Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Abstract: During clinical placements, the provision of feedback forms an integral part of the learning process and enriches students' learning experiences. The purpose of feedback is to improve the learner's knowledge, skills, or behavior. Receipt of accurate feedback can help to narrow the gap between actual and desired performance. Effective and regular feedback has the potential to reinforce good practice and motivate the learner toward the desired outcome. Despite the obvious role of feedback in effective teaching and learning, a common complaint from students is that they do not receive adequate feedback. Unfortunately, skills in giving and receiving feedback are rarely taught to students or clinicians. This study aims to provide an understanding of the role of feedback within the learning process, consider consequences of inadequate or poorly given feedback, consider the barriers to the feedback process, provide practical guidelines for providing feedback, and consider the need for student and faculty development in feedback skills. Keywords: medical students, formative, summative, assessment

  18. Quality assurance of radiotherapy and its clinical assessment

    International Nuclear Information System (INIS)

    We investigated the clinical quality assurance (QA) of radiotherapy in Japan since 1981. The aim of this study was to establish the QA of a radiotherapy system and its clinical assessment in Japan. We introduced the Patterns of Care Study (PCS) into Japan to perform this study in 1996. The PCS is a retrospective study designed to establish the national practice for cancer patients during a specific period and should be a complementary study to a prospective randomized controlled study. We collected precise data for 4399 patients with carcinomas of the breast, cervix, esophagus, lung and prostate by means of external audits for 96 institutes from 1998 through 2001. Patients were randomly sampled with two-stage cluster sampling. We stratified 556 institutes into four categories according to the academic condition and annual number of radiotherapy patients. National and regional averages of various factors of radiotherapy could be calculated and were used to measure QA of radiotherapy. Using a standard score, we could compare the process of individual institutions with national averages and feed back the evaluation score to each institution. With a PCS process survey, we could observe the dissemination of the treatment method under evidence-based medicine from the prospective randomized controlled study. We proposed future prediction of the number of radiotherapy patients and a counter plan for equipment and personnel. The first US-Japan PCS Workshop was held at San Francisco in 2001. We could establish QA of a radiotherapy system using PCS 1995-97 in Japan. (author)

  19. Assessing hospitals' clinical risk management: Development of a monitoring instrument

    Directory of Open Access Journals (Sweden)

    Pfeiffer Yvonne

    2010-12-01

    Full Text Available Abstract Background Clinical risk management (CRM plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals. Methods The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes. Results The monitoring instrument consists of 28 main questions organized in three sections: 1 Implementation and organizational integration of CRM, 2 Strategic objectives and operational implementation of CRM at hospital level, and 3 Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian. It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement. Conclusions We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety.

  20. ASSESSMENT OF SURGICAL OUTCOMES OF RHINOPLASTY – A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Tanthry Deepalakshmi

    2015-12-01

    Full Text Available Rhinoplasty is one of the most common cosmetic surgery performed by the otorhinolaryngologists. The main indication for rhinoplasty is cosmetic or functional or both. In regard to paucity of research regarding patient satisfaction after surgery, we have done this prospective clinical study in our hospital. 40 patients were included in the study from January 2012 to December 2012. Rhinoplasty Outcomes Evaluation (ROE Questionnaire was applied to all the patients and evaluation of the satisfaction pre op and post operatively was assessed and the results were statistically analysed. The age of the study group ranged from 20 yrs to 39 yrs with the mean age of 24.85 +/- 3.43 years. The average satisfaction mark of patients undergoing rhinoplasty in pre-operative state was 28.05 & post-operative it improved and reached to 67.91.The average satisfaction of female were 26.75 preoperatively reached to 63.68 postoperatively. The average satisfaction of male were 31.2 preoperatively reached upto 67.91 post operatively. The degree of the satisfaction pre and post operatively was compared using student t test and paired t test. It was 67.91 in males and 36.53 among females which was statistically significant (p < 0.05. Patient satisfaction is as important as technical aspects of rhinoplasty. Hence a novel attempt is made in this direction to assess and understand patient expectations to achieve realistic goals in rhinoplasty.

  1. [How to Understand "Clinical Ethics" and "Research Ethics" in Clinical Settings--Incorporation of IRB, REC, and CEC in Hospital Organizations].

    Science.gov (United States)

    Ita, Koichiro

    2016-02-01

    As the traditional definition of "medical ethics" has recently changed markedly with advances in medical knowledge and technology, medical doctors and researchers in Japan are required to understand and apply both research and clinical ethics. Quite frequently, ethical problems in clinical settings cannot be addressed by the simple application of good will, hard work, and perseverance by medical personnel. The Ministry of Health, Labour and Welfare (MHLW) and the Ministry of Education, Culture, Sports, Science and Technology (MEXT) have jointly published "Ethical Guidelines for Clinical Studies;" however, clear guidelines (legal, ministerial, or governmental) outlining the expectations regarding clinical ethics do not exist. All medical personnel face deep ethical dilemmas. In these instances, if the fulfillment of 'ethics' relies solely on the capacity of personnel to apply their own individual moral efforts, the result will be burn-out among these workers who have a strong sense of responsibility. In order to avoid this, a system which comprises multiple physicians, nurses, and other personnel must be established, allowing collaboration when an appropriate response is required. A major factor supporting this approach is the offering of Clinical Ethics Consultations. PMID:27311285

  2. Re-thinking clinical assessment: What can we learn from the medical literature?

    International Nuclear Information System (INIS)

    This article explores the literature available in the field of medical education on the topic of clinical assessment, in order to suggest different ways of assessing clinical experience that may not have been considered within undergraduate radiography programmes. The medical literature is contrasted with the clinical assessment currently being used in a medical imaging programme in New Zealand, with the aim of offering suggestions that may benefit the assessment of the clinical and professional elements of radiography programmes more generally. The authors conclude that ideally students need to be assessed in the clinical domain by multiple assessors, with varied assessment methods used repeatedly over a period of time and with the provision of frequent and constructive feedback. Various methods of clinical assessment are suggested and it is emphasised that the methods selected need to be valid, reliable and psychometrically supported. This encourages an evidence-based practice approach that is supportive of on-going programme development and change.

  3. CLINICAL PSYCHOLOGICAL ASSESSMENT IN LITHUANIAN HEALTH CARE INSTITUTIONS: OPINION ANALYSIS OF PROFESSIONALS

    Directory of Open Access Journals (Sweden)

    Augustinas Rotomskis

    2015-07-01

    Full Text Available Purpose – to investigate the state of clinical psychological assessment in the Lithuanian health care system: 1 what kind of tests are used in clinical practice and what are clinicians opinions about them; 2 what kind of psychological functions are assessed in clinical practice and what is the opinion of clinicians about the assessment of these psychological functions; 3 what kind of issues are the most pressing in clinical assessment. Design/methodology/approach – 101 clinical psychologists, who work in Lithuanian health care institutions, completed a questionnaire about their opinion on clinical psychological assessment. Findings – Attention, memory, executive functions, intelligence and emotions are the most important and frequently assessed psychological functions in clinical practice. Neuropsychogical assessment of attention, memory, executive functions, are viewed as the most problematic fields of assessment. The adaptation, standartization and revision of the various neuropsychological tests is suggested. The most pressing issues in clinical practice are: 1 the assessment of specific psychological functions (neuropsychological and psychosocial functioning; 2 the assessment of specific disorders (schizophrenia spectrum disorders and autism spectrum disorders; 3 the asessment of specific stages of development (children and teenagers. Research limitations/implications – 32 percent of health care institutions (30 out of 95 identified institutions, which provide mental health care, did not participate in the study. The majority of these institutions are from the provinces. Practical implications – psychological assessment plays a key role in the practice of a clinical psychologist. This study investigated and pinpointed the most pressing issues and needs of psychologists in clinical practice. According to the study results, recommendations ascertaining to the adaptation and revision of tests and preparation of clinical psychologists

  4. Predictive validity of measurements of clinical competence using the team objective structured bedside assessment (TOSBA): assessing the clinical competence of final year medical students.

    LENUS (Irish Health Repository)

    Meagher, Frances M

    2009-11-01

    The importance of valid and reliable assessment of student competence and performance is gaining increased recognition. Provision of valid patient-based formative assessment is an increasing challenge for clinical teachers in a busy hospital setting. A formative assessment tool that reliably predicts performance in the summative setting would be of value to both students and teachers.

  5. Drug delivery system innovation and Health Technology Assessment: Upgrading from Clinical to Technological Assessment.

    Science.gov (United States)

    Panzitta, Michele; Bruno, Giorgio; Giovagnoli, Stefano; Mendicino, Francesca R; Ricci, Maurizio

    2015-11-30

    Health Technology Assessment (HTA) is a multidisciplinary health political instrument that evaluates the consequences, mainly clinical and economical, of a health care technology; the HTA aim is to produce and spread information on scientific and technological innovation for health political decision making process. Drug delivery systems (DDS), such as nanocarriers, are technologically complex but they have pivotal relevance in therapeutic innovation. The HTA process, as commonly applied to conventional drug evaluation, should upgrade to a full pharmaceutical assessment, considering the DDS complexity. This is useful to study more in depth the clinical outcome and to broaden its critical assessment toward pharmaceutical issues affecting the patient and not measured by the current clinical evidence approach. We draw out the expertise necessary to perform the pharmaceutical assessment and we propose a format to evaluate the DDS technological topics such as formulation and mechanism of action, physicochemical characteristics, manufacturing process. We integrated the above-mentioned three points in the Evidence Based Medicine approach, which is data source for any HTA process. In this regard, the introduction of a Pharmaceutics Expert figure in the HTA could be fundamental to grant a more detailed evaluation of medicine product characteristics and performances and to help optimizing DDS features to overcome R&D drawbacks. Some aspects of product development, such as manufacturing processes, should be part of the HTA as innovative manufacturing processes allow new products to reach more effectively patient bedside. HTA so upgraded may encourage resource allocating payers to invest in innovative technologies and providers to focus on innovative material properties and manufacturing processes, thus contributing to bring more medicines in therapy in a sustainable manner. PMID:26399633

  6. Development of a clinically applicable tool for bone density assessment

    International Nuclear Information System (INIS)

    To assess the accuracy and reliability of new software for radiodensitometric evaluations. A densitometric tool developed by MevisLab registered was used in conjunction with intraoral radiographs of the premolar region in both in vivo and laboratory settings. An aluminum step wedge was utilized for comparison of grey values. After computer-aided segmentation, the interproximal bone between the premolars was assessed in order to determine the mean grey value intensity of this region and convert it to a thickness in aluminum. Evaluation of the tool was determined using bone mineral density (BMD) values derived from decalcified human bone specimens as a reference standard. In vivo BMD data was collected from 35 patients as determined with dual X-ray absorptiometry (DXA). The intra and interobserver reliability of this method was assessed by Bland and Altman Plots to determine the precision of this tool. In the laboratory study, the threshold value for detection of bone loss was 6.5%. The densitometric data (mm Al eq.) was highly correlated with the jaw bone BMD, as determined using dual X-ray absorptiometry (r=0.96). For the in vivo study, the correlations between the mm Al equivalent of the average upper and lower jaw with the lumbar spine BMD, total hip BMD and femoral neck BMD were 0.489, 0.537 and 0.467, respectively (P<0.05). For the intraobserver reliability, a Bland and Altman plot showed that the mean difference ±1.96 SD were within ±0.15 mm Al eq. with the mean difference value small than 0.003 mm Al eq. For the interobserver reliability, the mean difference ±1.96 SD were within ±0.11 mm Al eq. with the mean difference of 0.008 mm Al eq. A densitometric software tool has been developed, that is reliable for bone density assessment. It now requires further investigation to evaluate its accuracy and clinical applicability in large scale studies. (orig.)

  7. Lymphoplasmacytic sclerosing cholangitis: assessment of clinical, CT, and pathological findings

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, S., E-mail: shigekimiyo@luck.ocn.ne.j [Department of Technical Radiology, Nagoya University School of Health Sciences, Nagoya (Japan); Nagasaka, T. [Department of Pathology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Suzuki, K.; Satake, H.; Ota, T.; Naganawa, S. [Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2009-11-15

    Aim: To assess the clinical, computed tomography (CT), and pathological findings in patients with lymphoplasmacytic sclerosing cholangitis. Materials and methods: Fifteen consecutive patients (four women and 11 men, mean age 71 years) with lymphoplasmacytic sclerosing cholangitis and without the characteristic features of underlying disorders causing benign biliary strictures were retrospectively recruited. Two radiologists evaluated multiphase contrast-enhanced CT images acquired with 0.5 or 1-mm collimation. One pathologist performed all histological examinations, including IgG4 immunostaining. Results: The intrahepatic biliary ducts showed dilatation in all 15 patients, but only seven presented with jaundice. Although laboratory data were not available in all patients, serum gammaglobulin and IgG levels were elevated in five of six patients and six of eight patients, respectively. Anti-nuclear antibody was detected in three of six patients. The involved biliary ducts showed the following CT findings: involvement of the hilar biliary duct (14/15), a mean wall thickness of 4.9 mm, a smooth margin (10/15), a narrow but visible lumen (6/15), hyper-attenuation during the late arterial phase (9/15), homogeneous hyper-attenuation during the delayed phase (11/11), and no vascular invasion (14/15). Abnormal findings in the pancreas and urinary tract were detected in eight of 15 patients. In 13 patients with adequate specimens, moderate to severe lymphoplasmacytic infiltration associated with dense fibrosis was observed. Infiltration of IgG4-positive plasma cells was moderate or severe in nine patients and minimal or absent in four patients. Conclusion: Lymphoplasmacytic sclerosing cholangitis exhibits relatively characteristic clinical and CT findings, although they are not sufficiently specific for differentiation from other biliary diseases.

  8. Lymphoplasmacytic sclerosing cholangitis: assessment of clinical, CT, and pathological findings

    International Nuclear Information System (INIS)

    Aim: To assess the clinical, computed tomography (CT), and pathological findings in patients with lymphoplasmacytic sclerosing cholangitis. Materials and methods: Fifteen consecutive patients (four women and 11 men, mean age 71 years) with lymphoplasmacytic sclerosing cholangitis and without the characteristic features of underlying disorders causing benign biliary strictures were retrospectively recruited. Two radiologists evaluated multiphase contrast-enhanced CT images acquired with 0.5 or 1-mm collimation. One pathologist performed all histological examinations, including IgG4 immunostaining. Results: The intrahepatic biliary ducts showed dilatation in all 15 patients, but only seven presented with jaundice. Although laboratory data were not available in all patients, serum gammaglobulin and IgG levels were elevated in five of six patients and six of eight patients, respectively. Anti-nuclear antibody was detected in three of six patients. The involved biliary ducts showed the following CT findings: involvement of the hilar biliary duct (14/15), a mean wall thickness of 4.9 mm, a smooth margin (10/15), a narrow but visible lumen (6/15), hyper-attenuation during the late arterial phase (9/15), homogeneous hyper-attenuation during the delayed phase (11/11), and no vascular invasion (14/15). Abnormal findings in the pancreas and urinary tract were detected in eight of 15 patients. In 13 patients with adequate specimens, moderate to severe lymphoplasmacytic infiltration associated with dense fibrosis was observed. Infiltration of IgG4-positive plasma cells was moderate or severe in nine patients and minimal or absent in four patients. Conclusion: Lymphoplasmacytic sclerosing cholangitis exhibits relatively characteristic clinical and CT findings, although they are not sufficiently specific for differentiation from other biliary diseases.

  9. Clinical Assessment of a New Stereoscopic Digital Angiography System

    International Nuclear Information System (INIS)

    Purpose: To assess the clinical feasibility of an experimental modified angiographic system capable of real-time digital stereofluoroscopy and stereography in X-ray angiography, using a twin-focus tube and a stereoscopic monitor. Methods: We report the experience obtained in 37 patients with a well-documented examination. The patients were examined for coronary angiography (11 cases), aortography (7 cases), pulmonary angiography (6 cases), inferior vena cava filter placement (2 cases), and cerebral angiography (11 cases). Six radiologists were asked to use stereoscopic features for fluoroscopy and angiography. A questionnaire was designed to record their subjective evaluation of stereoscopic image quality, ergonomics of the system, and its medical interest. Results: Stereofluoroscopy was successfully used in 25 of 37 cases; diplopia and/or ghost images were reported in 6 cases. It was helpful for aortic catheterization in 10 cases and for selective catheterization in 5 cases. In stereoangiography, depth was easily and accurately perceived in 27 of 37 cases; diplopia and/or ghost images were reported in 4 cases. A certain gain in the three-dimensional evaluation of the anatomy and relation between vessels and lesions was noted. As regards ergonomic considerations, polarized spectacles were not considered cumbersome. Visual fatigue and additional work were variously reported. Stereoshift tuning before X-ray acquisition was not judged to be a limiting factor. Conclusion: A twin-focus X-ray tube and a polarized shutter for stereoscopic display allowed effective real-time three-dimensional perception of angiographic images. Our clinical study suggests no clear medical interest for diagnostic examinations, but the field of interventional radiology needs to be investigated

  10. Comparative Assessment of Antimicrobial Efficiency of Ionic Silver, Silver Monoxide, and Metallic Silver Incorporated onto an Aluminum Oxide Nanopowder Carrier

    International Nuclear Information System (INIS)

    The present paper provides comparative assessment of antimicrobial efficiency of ionic silver (Ag+), silver monoxide (Ag2O), and metallic silver (Ag) incorporated onto an aluminum oxide nanopowder carrier (Al2O3). The deposition of Ag+ ions, Ag2O nanoparticles, and Ag nanoparticles on an different phases of aluminum oxide nanopowder carrier was realized using consecutive stages of dry sol-gel method. The Al2O3-Ag+, Al2O3-Ag2O, and Al2O3-Ag nanopowders were widely characterized qualitatively and quantitatively by SEM, physical nitrogen sorption and XRD analyses. Results indicate that the Al2O3 nanopowders added with Ag+, Ag2O, and Ag, apart from phase composition, were not differing considerably from one another in terms of their morphology and physical properties. However, nanopowders of Al2O3-Ag were more agglomerated than Al2O3-Ag2O and Al2O3-Ag+ nanopowders. The antibacterial activity of the nanopowders was examined by the spread plate method using bacterial strains such as Escherichia coli, Sarcina lutea, and Bacillus subtilis. The best antibacterial properties against Sarcina lutea strain were achieved in the amorphous-Al2O3-Ag+ and Al2O3-Ag2O nanopowders, whereas the worst antimicrobial activity against Bacillus subtilis and Escherichia coli was shown by the Al2O3-Ag+ and Al2O3-Ag nanopowders. The observed increase of the antibacterial activity as the silver content was not however significant for Al2O3-Ag nanopowders. The results obtained in the present experiments show that the Al2O3-Ag+, Al2O3-Ag2O, and Al2O3-Ag nanopowders, possessing good bactericidal properties, can be produced by using consecutive stages of dry sol-gel method, and Al2O3 nanopowder added with Ag2O is considered as the best raw material in the production of antiseptic materials.

  11. The Clinical Potential of Circulating Tumor Cells; The Need to Incorporate a Modern “Immunological Cocktail” in the Assay

    Directory of Open Access Journals (Sweden)

    Jonathan W. Uhr

    2013-12-01

    Full Text Available The accepted clinical assay, CellSearch®, and lab-on-a-chip tests for capturing circulating tumor cells are antibody-mediated. Attempts to improve their sensitivity have relied upon physical changes in the instruments. There have been no significant advances in improving the antibody-mediated portion of the capture. Modern immunologic engineering offers major possibilities for improving the sensitivity and other features of the assay. These include obtaining univalent antibody fragments such as scFvs with picomolar binding affinity and sufficient specificity; altering them to enhance their range of potential contact with target antigens; using antibodies directed against different epitopes on epithelial, mesenchymal or organ-specific cell surface markers to allow simultaneous binding and investigating non-antibody binding molecules as substitutes for antibody. These maneuvers could markedly improve the ability of current assays to improve patient care and might result in an acceptable test for detecting cancer earlier in high risk patients.

  12. The Clinical Potential of Circulating Tumor Cells; The Need to Incorporate a Modern “Immunological Cocktail” in the Assay

    International Nuclear Information System (INIS)

    The accepted clinical assay, CellSearch®, and lab-on-a-chip tests for capturing circulating tumor cells are antibody-mediated. Attempts to improve their sensitivity have relied upon physical changes in the instruments. There have been no significant advances in improving the antibody-mediated portion of the capture. Modern immunologic engineering offers major possibilities for improving the sensitivity and other features of the assay. These include obtaining univalent antibody fragments such as scFvs with picomolar binding affinity and sufficient specificity; altering them to enhance their range of potential contact with target antigens; using antibodies directed against different epitopes on epithelial, mesenchymal or organ-specific cell surface markers to allow simultaneous binding and investigating non-antibody binding molecules as substitutes for antibody. These maneuvers could markedly improve the ability of current assays to improve patient care and might result in an acceptable test for detecting cancer earlier in high risk patients

  13. Clinical Assessment of Stereoacuity and 3-D Stereoscopic Entertainment

    Science.gov (United States)

    Tidbury, Laurence P.; Black, Robert H.; O’Connor, Anna R.

    2015-01-01

    Abstract Background/Aims: The perception of compelling depth is often reported in individuals where no clinically measurable stereoacuity is apparent. We aim to investigate the potential cause of this finding by varying the amount of stereopsis available to the subject, and assessing their perception of depth viewing 3-D video clips and a Nintendo 3DS. Methods: Monocular blur was used to vary interocular VA difference, consequently creating 4 levels of measurable binocular deficit from normal stereoacuity to suppression. Stereoacuity was assessed at each level using the TNO, Preschool Randot®, Frisby, the FD2, and Distance Randot®. Subjects also completed an object depth identification task using the Nintendo 3DS, a static 3DTV stereoacuity test, and a 3-D perception rating task of 6 video clips. Results: As intraocular VA differences increased, stereoacuity of the 57 subjects (aged 16–62 years) decreased (eg, 110”, 280”, 340”, and suppression). The ability to correctly identify depth on the Nintendo 3DS remained at 100% until suppression of one eye occurred. The perception of a compelling 3-D effect when viewing the video clips was rated high until suppression of one eye occurred, where the 3-D effect was still reported as fairly evident. Conclusion: If an individual has any level of measurable stereoacuity, the perception of 3-D when viewing stereoscopic entertainment is present. The presence of motion in stereoscopic video appears to provide cues to depth, where static cues are not sufficient. This suggests there is a need for a dynamic test of stereoacuity to be developed, to allow fully informed patient management decisions to be made. PMID:26669421

  14. [Economic assessment, a field between clinical research and observational studies].

    Science.gov (United States)

    Launois, Robert

    2003-01-01

    Health technology assessments propose to study the differential impact of health interventions in a complex care system which is characterised by the multitude of individual behaviours and the diverse nature of the institutions involved. Current systems for data collection lend themselves poorly to this rigorous analysis of efficacy of treatments in the actual situations where they are used. Randomised trials endeavour to neutralise any parasitic interference which could compromise testing for a causal relationship between the treatment administered and the result obtained. Their methodology which establishes the term ceteris paribus in the principle of good practice lends itself poorly to an analysis of individual behaviour. Observational studies are start from actual treatment situations to describe them as reliably as possible. By definition, however, these assume that the natural course of events is not deviated by any intervention. The absence of an experimental plan increases the likelihood of bias and makes it more difficult to test for causal relationships. They lend themselves poorly to testing for incremental efficacy. The two instruments to be preferred are decisional analysis and quasi-experimental studies. Decisional analysis help to avoid the problems of external validity associated with randomised clinical trials by associating parameters which are extracted from data obtained from everyday practice. Quasi-experimental studies or pragmatic trials are based on the reality of behaviour of the prescriber and his/her patients; their impact on efficacy, quality of life social costs of the disease and of treatments may be identified under normal conditions of use. PMID:12609811

  15. Objective Structured Clinical Examinations Provide Valid Clinical Skills Assessment in Emergency Medicine Education

    Directory of Open Access Journals (Sweden)

    Wallenstein, Joshua

    2014-12-01

    Full Text Available Introduction: Evaluation of emergency medicine (EM learners based on observed performance in the emergency department (ED is limited by factors such as reproducibility and patient safety. EM educators depend on standardized and reproducible assessments such as the objective structured clinical examination (OSCE. The validity of the OSCE as an evaluation tool in EM education has not been previously studied. The objective was to assess the validity of a novel management-focused OSCE as an evaluation instrument in EM education through demonstration of performance correlation with established assessment methods and case item analysis. Methods: We conducted a prospective cohort study of fourth-year medical students enrolled in a required EM clerkship. Students enrolled in the clerkship completed a five-station EM OSCE. We used Pearson’s coefficient to correlate OSCE performance with performance in the ED based on completed faculty evaluations. Indices of difficulty and discrimination were computed for each scoring item. Results: We found a moderate and statistically-significant correlation between OSCE score and ED performance score [r(239 =0.40, p<0.001]. Of the 34 OSCE testing items the mean index of difficulty was 63.0 (SD =23.0 and the mean index of discrimination was 0.52 (SD =0.21. Conclusion: Student performance on the OSCE correlated with their observed performance in the ED, and indices of difficulty and differentiation demonstrated alignment with published best-practice testing standards. This evidence, along with other attributes of the OSCE, attest to its validity. Our OSCE can be further improved by modifying testing items that performed poorly and by examining and maximizing the inter-rater reliability of our evaluation instrument. [West J Emerg Med. 2015;16(1:121–126.

  16. Predictive validity of measurements of clinical competence using the team objective structured bedside assessment (TOSBA): assessing the clinical competence of final year medical students.

    OpenAIRE

    Meagher, Frances M; Butler, Marcus W.; Miller, Stanley DW; Costello, Richard; Conroy, Ronán; McElvaney, Noel G.

    2009-01-01

    BACKGROUND: The importance of valid and reliable assessment of student competence and performance is gaining increased recognition. Provision of valid patient-based formative assessment is an increasing challenge for clinical teachers in a busy hospital setting. A formative assessment tool that reliably predicts performance in the summative setting would be of value to both students and teachers. AIM: This study explores the utility of the team objective structured bedside assessment (TOSBA),...

  17. Use of radioactive ethanolamine incorporation into phospholipids to assess in vitro antimalarial activity by the semiautomated microdilution technique.

    OpenAIRE

    Elabbadi, N; Ancelin, M.L.; Vial, H J

    1992-01-01

    Phospholipid biosynthetic activity is intense in the erythrocytic stage of Plasmodium falciparum because of the parasite's own enzymatic machinery. The incorporation of various labeled phospholipid precursors in comparison with the incorporation of nucleic acid and protein precursors was tested to evaluate P. falciparum growth in vitro. These precursors, namely, [3H]ethanolamine, [3H]hypoxanthine, [3H]palmitate, [14C]serine, [3H]choline, [3H]inositol, and [3H]isoleucine, were all accurate ind...

  18. Clinical Validity of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62): Further Evaluation and Clinical Applications

    Science.gov (United States)

    McAleavey, Andrew A.; Nordberg, Samuel S.; Hayes, Jeffrey A.; Castonguay, Louis G.; Locke, Benjamin D.; Lockard, Allison J.

    2012-01-01

    Self-report instruments of psychological symptoms are increasingly used in counseling centers but rely on rigorous evaluation of their clinical validity. Three studies reported here (total N = 26,886) investigated the validity of the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62; Locke et al., 2011) as an assessment and…

  19. Assessing the impacts of climate change on agricultural production in the Columbia River basin: incorporating water management

    Science.gov (United States)

    Adam, J. C.; Rajagopalan, K.; Stockle, C. O.; Yorgey, G.; Kruger, C. E.; Chinnayakanahalli, K.; Nelson, R.

    2014-12-01

    moving through growth stages earlier in the season with wetter and warmer spring conditions. Incorporating regulations into integrated modeling framework results in a more realistic assessment of climate change impacts.

  20. The experience of qualified nurses in assessing student nurses' clinical skills

    OpenAIRE

    Kelly, Mary

    2002-01-01

    The purpose of this study was to explore the experience of qualified nurses in assessing student nurses’ clinical skills. The writer’s interest in this area arose from the findings of reports in the UK and Ireland. These reports suggested that nurses do not feel adequately prepared for their roles in clinical assessment. The literature reviewed for this study highlights some of the difficulties surrounding assessment. Two areas identified are: lack of preparation for a role in assessment an...

  1. Clinical research training of Peruvian neurologists: a baseline assessment

    Directory of Open Access Journals (Sweden)

    Gian Carlos Navarro-Chumbes

    2010-05-01

    Full Text Available In Peru, despite a strong clinical research infrastructure in Lima, and Masters degree programs in epidemiology at three universities, few neurologists participate in clinical research. It was our objective to identify perceived needs and opportunities for increasing clinical research capacity and training opportunities for Peruvian neurologists. We conducted a descriptive, cross-sectional survey of Peruvian neurologists in Lima and Arequipa, Peru. Forty-eight neurologists completed written surveys and oral interviews. All neurologists reported interest in clinical research, but noted that lack of time and financial resources limited their ability to participate. Although most neurologists had received some training in epidemiology and research design as medical students or residents, the majority felt these topics were not adequately covered. Neurologists in Arequipa noted international funding for clinical research was uncommon outside the capital city of Lima. We concluded that clinical research is important to Peruvian neurologists. The three main barriers to increased participation in clinical research identified by neurologists were insufficient training in clinical research methodology, meager funding opportunities, and lack of dedicated time to participate in clinical research. Distance learning holds promise as a method for providing additional training in clinical research methodology, especially for neurologists who may have difficulty traveling to larger cities for additional training.

  2. Assessing the quality of clinical teachers: a systematic review of content and quality of questionnaires for assessing clinical teachers.

    NARCIS (Netherlands)

    Fluit, C.R.M.G.; Bolhuis, S.; Grol, R.P.T.M.; Laan, R.F.J.M.; Wensing, M.J.P.

    2010-01-01

    BACKGROUND: Learning in a clinical environment differs from formal educational settings and provides specific challenges for clinicians who are teachers. Instruments that reflect these challenges are needed to identify the strengths and weaknesses of clinical teachers. OBJECTIVE: To systematically r

  3. A clinical assessment tool for ultrasound-guided axillary brachial plexus block.

    LENUS (Irish Health Repository)

    Sultan, S F

    2012-05-01

    Competency in anesthesia traditionally has been determined subjectively in practice. Optimal training in procedural skills requires valid and reliable forms of assessment. The objective was to examine a procedure-specific clinical assessment tool for ultrasound-guided axillary brachial plexus block for inter-rater reliability and construct validity in a clinical setting.

  4. Assessment of Genetics Knowledge and Skills in Medical Students: Insight for a Clinical Neurogenetics Curriculum

    Science.gov (United States)

    Pearl, Phillip L.; Pettiford, Jennifer M.; Combs, Susan E.; Heffron, Ari; Healton, Sean; Hovaguimian, Alexandra; Macri, Charles J.

    2011-01-01

    The pace of discovery in biochemistry and genetics and its effect on clinical medicine places new curricular challenges in medical school education. We sought to evaluate students' understanding of neurogenetics and its clinical applications to design a pilot curriculum into the clinical neurology clerkship. We utilized a needs assessment and a…

  5. The Identification and Assessment of Late-Life ADHD in Memory Clinics

    Science.gov (United States)

    Fischer, Barbara L.; Gunter-Hunt, Gail; Steinhafel, Courtney Holm; Howell, Timothy

    2012-01-01

    Objective: Little data exist about ADHD in late life. While evaluating patients' memory problems, the memory clinic staff has periodically identified ADHD in previously undiagnosed older adults. The authors conducted a survey to assess the extent to which other memory clinics view ADHD as a relevant clinical issue. Method: The authors developed…

  6. Annual summary of Immobilized Low-Activity Waste (ILAW) Performance Assessment for 2003 Incorporating the Integrated Disposal Facility Concept

    Energy Technology Data Exchange (ETDEWEB)

    MANN, F M

    2003-09-01

    To Erik Olds 09/30/03 - An annual summary of the adequacy of the Hanford Immobilized Low-Activity Tank Waste Performance Assessment (ILAW PA) is necessary in each year in which a full performance assessment is not issued.

  7. The safety and efficacy of bacterial nanocellulose wound dressing incorporating sericin and polyhexamethylene biguanide: in vitro, in vivo and clinical studies.

    Science.gov (United States)

    Napavichayanun, Supamas; Yamdech, Rungnapha; Aramwit, Pornanong

    2016-03-01

    In our previous work, we have attempted to develop a novel bacterial nanocellulose wound dressing which composed of both polyhexamethylene biguanide (PHMB) as an antimicrobial agent and sericin as an accelerative wound healing component. The loading sequence and concentration of PHMB and sericin were optimized to provide the wound dressing with the most effective antimicrobial activity and enhanced collagen production. In this study, further in vitro, in vivo, and clinical studies of this novel wound dressing were performed to evaluate its safety, efficacy, and applicability. For the in vitro cytotoxic test with L929 mouse fibroblast cells, our novel dressing was not toxic to the cells and also promoted cell migration as good as the commercially available dressing, possibly due to the component of sericin released. When implanted subcutaneously in rats, the lower inflammation response was observed for the novel dressing implanted, comparing to the commercially available dressing. This might be that the antimicrobial PHMB component of the novel dressing played a role to reduce infection and inflammation reaction. The clinical trial patch test was performed on the normal skin of healthy volunteers to evaluate the irritation effect of the dressing. Our novel dressing did not irritate the skin of any volunteers, as characterized by the normal levels of erythema and melanin and the absence of edema, papule, vesicle, and bullae. Then, the novel dressing was applied for the treatment of full-thickness wounds in rats. The wounds treated with our novel dressing showed significantly lower percentage of wound size and higher extent of collagen formation mainly due to the activity of sericin. We concluded that our novel bacterial nanocellulose incorporating PHMB and sericin was a safe and efficient wound dressing material for further investigation in the wound healing efficacy in clinic. PMID:26796543

  8. Evaluation of the environmental implications of the incorporation of feed-use amino acids in the manufacturing of pig and broiler feeds using Life Cycle Assessment.

    Science.gov (United States)

    Mosnier, E; van der Werf, H M G; Boissy, J; Dourmad, J-Y

    2011-12-01

    The incorporation of feed-use (FU) amino acids (AAs) in diets results in a reduced use of protein-rich ingredients such as soybean meal, recognized to have elevated contributions to environmental impacts. This study investigated whether the incorporation of L-lysine.HCl, L-threonine and FU-methionine reduces the environmental impacts of pig and broiler feeds using Life Cycle Assessment. The following impact categories were considered: climate change, eutrophication, acidification, terrestrial ecotoxicity, cumulative energy demand and land occupation. Several feeds were formulated either to minimize the cost of the formulation (with or without AA utilization), to maximize AA incorporation (i.e. the cost of AA was considered to be similar to that of soybean meal), or to minimize greenhouse gas emissions. For both pig and broiler feeds, calculations were made first using only cereals and soybean meal as main ingredients and then using cereals and several protein-rich ingredients (soybean meal, rapeseed meal and peas). In addition, these calculations were performed using two types of soybean meal (from Brazil, associated with recent deforestation or not). For broiler feeds, two types of maize (from France, irrigated, with mineral fertilization v. not irrigated, with animal manure fertilization) were also tested. Regarding the feeds formulated to minimize cost, incorporation of AA decreased the values for eutrophication, terrestrial ecotoxicity and cumulative energy demand of both pig and broiler feeds, regardless of the base ingredients. Reduction in climate change and acidification due to the incorporation of AA depended on the nature of the feed ingredients, with the effect of AA incorporation being greater when combined with ingredients with high impacts such as soybean meal associated with deforestation. Feeds formulated to maximize AA incorporation generally had a similar composition to those formulated to minimize cost, suggesting that the costs of AA were not

  9. Veterinary students' attitudes toward the assessment of clinical reasoning using extended matching questions.

    Science.gov (United States)

    Tomlin, Jane L; Pead, Matthew J; May, Stephen A

    2008-01-01

    For the purposes of assessment, clinical expertise has been broken down into three broad components: scientific and clinical knowledge, clinical reasoning, and practical or technical skills. This structure can be used to define the tools used for assessment of clinical students. Knowledge can be assessed through a variety of written formats, and skills through various practical assessments, including the objective structured clinical examination. The assessment of clinical reasoning is more of a challenge, and, partly in order to address this challenge, the Royal Veterinary College recently introduced veterinary clinical-scenario-based extended matching questions. A questionnaire was used to collect students' perceptions of the new format. Surprisingly, this questionnaire also delivered important insights into the students' understanding of the process of clinical reasoning itself that could be crucial in future curriculum design. Despite a theory course that introduced students to the nature of expertise and the importance of pattern recognition to experienced clinicians, some final-year students could not recognize this approach as relevant to them and objected to the way in which some of the questions were driving them to think. This may relate to the variety of methods of case management that students observe during their practical experience and the different attitudes of clinicians to the way students work up cases. Overall, the students perceived this question type as an appropriate way to test clinical reasoning and as relevant to the experience they had gained during their clinical rotations, both within the college and in veterinary practices outside it. PMID:19228917

  10. Feedback and assessment for clinical placements: achieving the right balance

    OpenAIRE

    Burgess, Annette

    2015-01-01

    Annette Burgess, Craig Mellis Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Abstract: During clinical placements, the provision of feedback forms an integral part of the learning process and enriches students' learning experiences. The purpose of feedback is to improve the learner's knowledge, skills, or behavior. Receipt of accurate feedback can help to narrow the gap between actual and desired performance. Effective and reg...

  11. Feedback and assessment for clinical placements: achieving the right balance

    OpenAIRE

    Burgess A; Mellis C

    2015-01-01

    Annette Burgess, Craig Mellis Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Abstract: During clinical placements, the provision of feedback forms an integral part of the learning process and enriches students' learning experiences. The purpose of feedback is to improve the learner's knowledge, skills, or behavior. Receipt of accurate feedback can help to narrow the gap between actual and desired performance. Effective and regular fee...

  12. Innovative Clinical Assessment Technologies : Challenges and Opportunities in Neuroimaging

    OpenAIRE

    Miller, Gregory A.; Elbert, Thomas; Bradley P. Sutton; Heller, Wendy

    2010-01-01

    The authors review the reasons for the contrast between the remarkable advances that hemodynamic and electromagnetic imaging of the human brain appear capable of delivering in clinical practice in psychology and their very limited penetration into practice to date. Both the heritages of the relevant technologies and the historical orientation of clinical psychology away from biological phenomena are factors. Discussion of some technical aspects and prospects of these methods and recommendatio...

  13. Effects of resource availability and bacterivory on leucine incorporation in different groups of freshwater bacterioplankton, assessed using microautoradiography

    Czech Academy of Sciences Publication Activity Database

    Horňák, Karel; Jezbera, Jan; Nedoma, Jiří; Gasol, J.M.; Šimek, Karel

    2006-01-01

    Roč. 45, č. 3 (2006), s. 277-289. ISSN 0948-3055 R&D Projects: GA ČR GA206/05/0007 Grant ostatní: FRVŠ(CZ) 1062/2004 Institutional research plan: CEZ:AV0Z60170517 Keywords : leucine incorporation * bacterial structure * bacterial function Subject RIV: EH - Ecology, Behaviour Impact factor: 2.209, year: 2006

  14. Clinical application of 3D imaging for assessment of treatment outcomes

    OpenAIRE

    Cevidanes, Lucia H.C.; Oliveira, Ana Emilia Figueiredo; Grauer, Dan; Styner, Martin; Proffit, William R.

    2011-01-01

    This paper outlines the clinical application of CBCT for assessment of treatment outcomes, and discusses current work to superimpose digital dental models and 3D photographs. Superimposition of CBCTs on stable structures of reference now allow assessment of 3D dental, skeletal and soft tissue changes for both growing and non-growing patients. Additionally, we describe clinical findings from CBCT superimpositions in assessment of surgery and skeletal anchorage treatment.

  15. Critical Assessment of Clinical Prognostic Tools in Melanoma.

    Science.gov (United States)

    Mahar, Alyson L; Compton, Carolyn; Halabi, Susan; Hess, Kenneth R; Gershenwald, Jeffrey E; Scolyer, Richard A; Groome, Patti A

    2016-09-01

    The 7th edition American Joint Committee on Cancer (AJCC) melanoma staging system classifies patients according to prognosis. Significant within-stage heterogeneity remains and the inclusion of additional clinicopathologic and other host- and tumor-based prognostic factors have been proposed. Clinical prognostic tools have been developed for use in clinical practice to refine survival estimates. Little is known about the comparative features of tools in melanoma. We performed a systematic search of the scientific published literature for clinical prognostic tools in melanoma and web-based resources. A priori criteria were used to evaluate their quality and clinical relevance, and included intended clinical use, model development approaches, validation strategies, and performance metrics. We identified 17 clinical prognostic tools for primary cutaneous melanoma. Patients with stages I-III and T1 or thin melanoma were the most frequently considered populations. Seventy-five percent of tools were developed using data collected from patients diagnosed in 2006 or earlier, and the well-established factors of tumor thickness, ulceration, and age were included in 70 % of tools. Internal validity using cross-validation or bootstrapping techniques was performed for two tools only. Fewer than half were evaluated for external validity; however, when done, the appropriate statistical methodology was applied and results indicated good generalizability. Several clinical prognostic tools have the potential to refine survival estimates for individual melanoma patients; however, there is a great opportunity to improve these tools and to foster the development of new, validated tools by the inclusion of contemporary clinicopathological covariates and by using improved statistical and methodological approaches. PMID:27052645

  16. Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice

    Directory of Open Access Journals (Sweden)

    Yuzawa M

    2013-07-01

    Full Text Available Mitsuko Yuzawa,1 Kyoko Fujita,1 Erika Tanaka,2 Edward C Y Wang21Department of Ophthalmology, Nihon University School of Medicine, Surugadai, Kanda, Chiyoda-ku, Tokyo, Japan; 2Health Economics and Outcomes Research, Bayer Yakuhin Ltd, Marunouchi, Chiyoda-ku, Tokyo, JapanBackground: The importance of incorporating quality-of-life (QoL assessments into medical practice is growing as health care practice shifts from a “disease-based” to a “patient-centered” model. The prevalence of age-related macular degeneration (AMD is increasing in today’s aging population. The purpose of this paper is: (1 to discuss, by reviewing the current literature, the impact of AMD on patients’ QoL and the utility of QoL assessments in evaluating the impact of AMD and its treatment; and (2 to make a recommendation for incorporating QoL into clinical practice.Methods: We conducted a PubMed and an open Internet search to identify publications on the measurement of QoL in AMD, as well as the impact of AMD and the effect of treatment on QoL. A total of 28 articles were selected.Results: AMD has been found to cause a severity-dependent decrement in QoL that is comparable to systemic diseases such as cancer, ischemic heart disease, and stroke. QoL impairment manifests as greater social dependence, difficulty with daily living, higher rates of clinical depression, increased risk of falls, premature admission to nursing homes, and suicide. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25 is the most widely used eye disease-specific QoL instrument in AMD. It has been shown to correlate significantly with visual acuity (VA. QoL reflects aspects of AMD including psychological well-being, functional capacity, and the ability to perform patients’ valued activities, which are not captured by a single, numerical VA score.Conclusion: The literature shows that the adverse impact of AMD on QoL is comparable to serious systemic disease. Eye disease

  17. [Clinical and technical assessment of the cervical spine].

    Science.gov (United States)

    Dvorak, J

    1996-11-01

    In analysis of the cervical and cervicobrachial syndrome with or without signs of compression of the nerve root or spinal cord, functional assessment of the cervical spine is of great importance. Comparisons between actively performed and passively induced motion can be verified by using standardized computer-assisted assessment allowing precise documentation of the range of motion and coupled motion. The age-related normal values should be considered. The neurological assessment includes not only the cranial nerves and upper extremities but also lower extremities to avoid overlooking the signs of cervical myelopathy. In patients with compression of nerve roots or the spinal cord neurophysiology might be helpful in identifying or verifying compression. In patients with suspected myelopathy sensory evoked potentials will allow assessment of the function of the ascending spinal pathways and motor evoked potentials, assessment of the function of the descending cortical spinal pathways. PMID:8999404

  18. Test Review: Bracken, B. A., & Keith, L. K. (2004). "Clinical Assessment of Behavior." Lutz, FL: Psychological Assessment Resources

    Science.gov (United States)

    Beran, Tanya N.

    2006-01-01

    The Clinical Assessment of Behavior (CAB) is designed to assess both adaptive and problematic behaviors of children and adolescents from age 2 to 18 years. It can be individually or group administered, measures behaviors in different contexts, and includes both parent and teacher forms. The test was developed to be consistent with current…

  19. Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie

    2014-01-01

    voluntary arm movement task and 2) selective activation tasks during sessions with and without on-line biofeedback, in a general population consisting of 16 SIS patients and 15 controls (No-SIS). Furthermore, 3) a systematic review was conducted of all available clinical scapular assessment methods and......Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics Larsen CM1, Juul-Kristensen B1,2 Holtermann A3, Lund H1,2, Søgaard K1 1University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, DK 2Institute of...... patient sample with SIS, and to assess the clinimetric properties of clinical assessment methods of scapular kinematics as important aspects for optimising effect measures of treatment in order to improve clinical guidelines in this area. METHODS: Scapular muscle activity was examined, 1) during a...

  20. Platelet function testing: methods of assessment and clinical utility.

    LENUS (Irish Health Repository)

    Mylotte, Darren

    2012-02-01

    Platelets play a central role in the regulation of both thrombosis and haemostasis yet tests of platelet function have, until recently, been exclusively used in the diagnosis and management of bleeding disorders. Recent advances have demonstrated the clinical utility of platelet function testing in patients with cardiovascular disease. The ex vivo measurement of response to antiplatelet therapies (aspirin and clopidogrel), by an ever-increasing array of platelet function tests, is with some assays, predictive of adverse clinical events and thus, represents an emerging area of interest for both the clinician and basic scientist. This review article will describe the advantages and disadvantages of the currently available methods of measuring platelet function and discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice.

  1. Platelet function testing: methods of assessment and clinical utility.

    LENUS (Irish Health Repository)

    Mylotte, Darren

    2011-01-01

    Platelets play a central role in the regulation of both thrombosis and haemostasis yet tests of platelet function have, until recently, been exclusively used in the diagnosis and management of bleeding disorders. Recent advances have demonstrated the clinical utility of platelet function testing in patients with cardiovascular disease. The ex vivo measurement of response to antiplatelet therapies (aspirin and clopidogrel), by an ever-increasing array of platelet function tests, is with some assays, predictive of adverse clinical events and thus, represents an emerging area of interest for both the clinician and basic scientist. This review article will describe the advantages and disadvantages of the currently available methods of measuring platelet function and discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice.

  2. European clinical network: autism spectrum disorder assessments and patient characterisation.

    Science.gov (United States)

    Ashwood, Karen L; Buitelaar, Jan; Murphy, Declan; Spooren, Will; Charman, Tony

    2015-08-01

    The United Nations and World Health Organisation have identified autism spectrum disorder (ASD) as an important public health issue across global mental health services. Although a range of tools exist to identify and quantify ASD symptoms, there is a lack of information about which ASD measures are used in different services worldwide. This paper presents data from a large survey of measures used for patient characterisation in major ASD research and clinical centres across Europe collected between June 2013 and January 2014. The objective was to map the use of different instruments used to characterise ASD, comorbid psychopathology and cognitive and adaptive ability for patient diagnostic and characterisation purposes across Europe. Sixty-six clinical research sites diagnosing 14,844 patients per year contributed data. The majority of sites use the well-established Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI) instruments, though the proportion of sites in Western Europe using the ADI was almost double the rate in Eastern Europe. Approximately half the sites also used the Social Communication Questionnaire (SCQ) and Social Responsiveness Scale (SRS), although use of the SRS was over three times higher in Western Europe compared with Eastern Europe. The use of free/open access measures was lower than commercially available tools across all regions. There are clinical and scientific benefits in encouraging further convergence of clinical characterisation measures across ASD research and clinical centres in Europe to facilitate large-scale data sharing and collaboration, including clinical trials of novel medications and psychological interventions. PMID:25471824

  3. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis

    DEFF Research Database (Denmark)

    Rocca, Maria A; Amato, Maria P; De Stefano, Nicola; Enzinger, Christian; Geurts, Jeroen J; Penner, Iris-K; Rovira, Alex; Sumowski, James F; Valsasina, Paola; Filippi, Massimo; Frederiksen, Jette Lautrup Battistini

    2015-01-01

    In patients with multiple sclerosis (MS), grey matter damage is widespread and might underlie many of the clinical symptoms, especially cognitive impairment. This relation between grey matter damage and cognitive impairment has been lent support by findings from clinical and MRI studies. However......, many aspects of cognitive impairment in patients with MS still need to be characterised. Standardised neuropsychological tests that are easy to administer and sensitive to disease-related abnormalities are needed to gain a better understanding of the factors affecting cognitive performance in patients...

  4. Study of the Reliability and Validity of Objective Structured Clinical Examination (OSCE) in the Assessment of Clinical Skills of Audiology Students

    OpenAIRE

    Nickbakht, Mansoureh; Amiri, Marzieh; Latifi, Seyed Mahmoud

    2013-01-01

    Introduction: Audiology students should possess clinical competence and skills. To achieve this, their clinical skills must be properly assessed. The Objective Structured Clinical Examination (OSCE) is a standard and fair examination of clinical competence. The goal of this study is to devise a checklist of OSCE examination criteria and study their validity and reliability for assessing the clinical competence of Audiology students. Methods: Among the various procedures in which audiology stu...

  5. Instructor and Dental Student Perceptions of Clinical Communication Skills via Structured Assessments.

    Science.gov (United States)

    McKenzie, Carly T

    2016-05-01

    The aim of this study was to use structured assessments to assess dental students' clinical communication skills exhibited during patient appointments. Fourth-year dental students (n=55) at the University of Alabama at Birmingham evaluated their own interpersonal skills in a clinical setting utilizing the Four Habits Coding Scheme. An instructor also assessed student-patient clinical communication. These assessments were used to identify perceived strengths and weaknesses in students' clinical communication. Both instructor assessments and student self-assessments pinpointed the following clinical communication skills as effective the most often: patient greeting, avoidance of jargon, and non-verbal behavior. There was also relative agreement between instructor assessments and student self-assessments regarding clinical communication skills that were rated as not effective most frequently: ensuring patient comprehension, identification of patient feelings, and exploration of barriers to treatment. These resulted pointed to strengths and weaknesses in the portion of the curriculum designed to prepare students for effective provider-patient communication. These results may suggest a need for the school's current behavioral science curriculum to better address discussion of potential treatment barriers and patient feelings as well as techniques to ensure patient comprehension. PMID:27139207

  6. Evaluation of a new clinical performance assessment tool : A reliability study

    Directory of Open Access Journals (Sweden)

    C. Joseph

    2012-12-01

    Full Text Available Clinical practice is an essential requirement of any graduatephysiotherapy programme. For this purpose, valid and reliable assessment toolsare paramount for the measurement of key competencies in the real-worldsetting. This study aims to determine the internal consistency and inter-raterreliability of a newly developed and validated clinical performance assessmentform. A cross-sectional quantitative research design was used, which includedpaired evaluations of 32 (17 treatment and 15 assessment student examinationsperformed by two independent clinical educators. Chronbachs alpha was computedto assess internal consistency and intraclass correlation coefficient (ICC’s withconfidence intervals of 95% were computed to determine the percentage agreement between paired examiners. Thedegree of internal consistency was substantial for all key performance areas of both examinations, except for timeand organisational management (0.21 and professionalism (0.42 in the treatment and evaluation examinationsrespectively. The overall internal consistency was 0.89 and 0.73 for both treatment and assessment examinations,indicating substantial agreement. With regard to agreement between raters, the ICC’s for the overall marks were0.90 and 0.97 for both treatment and assessment examinations. Clinical educators demonstrated a high level ofreliability in the assessment of students’ competence using the newly developed clinical performance assessment form.These findings greatly underscore the reliability of results obtained through observation of student examinations, andadd another tool to the basket of ensuring quality assurance in physiotherapy clinical practice assessment.

  7. Skills in clinical communication: Are we correctly assessing them at undergraduate level?

    Directory of Open Access Journals (Sweden)

    Alberto Zamora Cervantes

    2014-07-01

    Full Text Available Communicating with the patient in clinical practice refers to the way in which the doctor and the patient interact both verbally and nonverbally, in order to achieve a shared understanding of problems and solutions. Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of professional practice. Problem Based Learning (PBL has been put forward as an alternative to the mere reproduction of knowledge and pre-established patterns, enabling students to develop their own learning strategies to overcome problems in their future professional practice. The challenge is to determine how to assess the acquisition of clinical communication skills. The authors have recommended a summative assessment of clinical communication skills based on the combination of different methods. It highlights the importance of feedback-based formative assessment. This raises the need to develop and validate assessment scales in clinical communication at an undergraduate level. Based on this work, the authors put forward a "fanned out" assessment in terms of clinical communication skills in Medicine degrees, with the use of different instruments in a "spiraled" manner, where the greater the contact with clinical practice in the various degree and integral courses, the greater difficulty experienced, with the participation of all the stakeholders involved (self, hetero and peer assessment without precluding the involvement of patients (real or simulated in the design of assessment instruments.

  8. Towards A Clinical Tool For Automatic Intelligibility Assessment.

    Science.gov (United States)

    Berisha, Visar; Utianski, Rene; Liss, Julie

    2013-01-01

    An important, yet under-explored, problem in speech processing is the automatic assessment of intelligibility for pathological speech. In practice, intelligibility assessment is often done through subjective tests administered by speech pathologists; however research has shown that these tests are inconsistent, costly, and exhibit poor reliability. Although some automatic methods for intelligibility assessment for telecommunications exist, research specific to pathological speech has been limited. Here, we propose an algorithm that captures important multi-scale perceptual cues shown to correlate well with intelligibility. Nonlinear classifiers are trained at each time scale and a final intelligibility decision is made using ensemble learning methods from machine learning. Preliminary results indicate a marked improvement in intelligibility assessment over published baseline results. PMID:25004985

  9. CT assessment of the correlation between clinical examination and bone involvement in oral malignant tumors

    Energy Technology Data Exchange (ETDEWEB)

    Albuquerque, Marco Antonio Portela; Oliveira, Ilka Regina Souza; Cavalcanti, Marcelo Gusmao Paraiso [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Odontologia. Dept. de Radiologia], e-mail: mgpcaval@usp.br; Kuruoshi, Marcia Etsuko [Universidade de Sao Paulo (USP), SP (Brazil). Hospital Universitario. Dept. de Radiologia

    2009-07-01

    Oral cancers have a tendency to invade the surrounding bone structures, and this has a direct influence on the treatment management and on outcomes. The objective of this study was to correlate the clinical parameters (location, clinical presentation and TNM staging) of oral malignant tumors that can be associated with a potential of bone invasion and determine the accuracy of clinical examination to predict bone involvement, using computed tomography (CT). Twenty five patients, with oral malignant tumors were submitted to clinical and CT examinations. CT was considered the standard parameter to evaluate the presence of bone involvement. Clinical assessment of location, presentation form and TNM staging of the tumors were then compared to the CT findings in predicting bone involvement. Bone involvement was observed in 68% of the cases. It was predicted that tumors located in the retromolar trigone and hard palate, with a clinical aspect of infiltrative ulcer or nodule and classified in stage IV had a high potential to cause bone involvement. The clinical examination assessment of these tumors showed to be a valuable tool to predict bone invasion, with high sensitivity (82%) and specificity (87.5%), based on the results found in the CT images. No statistical significance was found between the CT and clinical examinations regarding bone involvement. The identification of some clinical parameters such as location, clinical presentation, and TNM stage, associated with a detailed clinical examination, was considered a valuable tool for the assessment of bone destruction by oral malignant tumors. (author)

  10. Do pressure ulcer risk assessment scales improve clinical practice?

    OpenAIRE

    Jan Kottner; Katrin Balzer

    2010-01-01

    Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulne...

  11. Assessment of technical documentation of medical devices for clinical investigation

    NARCIS (Netherlands)

    Roszek B; Bruijn ACP de; Drongelen AW van; Geertsma RE; BMT

    2007-01-01

    The technical documentation on non-market approved medical devices intended for clinical investigation contains major shortcomings. This could imply increased risks which could affect patient safety. The investigation described here focused on the availability and quality of the technical documentat

  12. Innovative Clinical Assessment Technologies: Challenges and Opportunities in Neuroimaging

    Science.gov (United States)

    Miller, Gregory A.; Elbert, Thomas; Sutton, Bradley P.; Heller, Wendy

    2007-01-01

    The authors review the reasons for the contrast between the remarkable advances that hemodynamic and electromagnetic imaging of the human brain appear capable of delivering in clinical practice in psychology and their very limited penetration into practice to date. Both the heritages of the relevant technologies and the historical orientation of…

  13. A moving target—incorporating knowledge of the spatial ecology of fish into the assessment and management of freshwater fish populations

    Science.gov (United States)

    Cooke, Steven J.; Martins, Eduardo G; Struthers, Daniel P; Gutowsky, Lee F G; Powers, Michael H.; Doka, Susan E; Dettmers, John M.; Crook, David A; Lucas, Martyn C.; Holbrook, Christopher; Krueger, Charles C.

    2016-01-01

    Freshwater fish move vertically and horizontally through the aquatic landscape for a variety of reasons, such as to find and exploit patchy resources or to locate essential habitats (e.g., for spawning). Inherent challenges exist with the assessment of fish populations because they are moving targets. We submit that quantifying and describing the spatial ecology of fish and their habitat is an important component of freshwater fishery assessment and management. With a growing number of tools available for studying the spatial ecology of fishes (e.g., telemetry, population genetics, hydroacoustics, otolith microchemistry, stable isotope analysis), new knowledge can now be generated and incorporated into biological assessment and fishery management. For example, knowing when, where, and how to deploy assessment gears is essential to inform, refine, or calibrate assessment protocols. Such information is also useful for quantifying or avoiding bycatch of imperiled species. Knowledge of habitat connectivity and usage can identify critically important migration corridors and habitats and can be used to improve our understanding of variables that influence spatial structuring of fish populations. Similarly, demographic processes are partly driven by the behavior of fish and mediated by environmental drivers. Information on these processes is critical to the development and application of realistic population dynamics models. Collectively, biological assessment, when informed by knowledge of spatial ecology, can provide managers with the ability to understand how and when fish and their habitats may be exposed to different threats. Naturally, this knowledge helps to better evaluate or develop strategies to protect the long-term viability of fishery production. Failure to understand the spatial ecology of fishes and to incorporate spatiotemporal data can bias population assessments and forecasts and potentially lead to ineffective or counterproductive management actions.

  14. A moving target--incorporating knowledge of the spatial ecology of fish into the assessment and management of freshwater fish populations.

    Science.gov (United States)

    Cooke, Steven J; Martins, Eduardo G; Struthers, Daniel P; Gutowsky, Lee F G; Power, Michael; Doka, Susan E; Dettmers, John M; Crook, David A; Lucas, Martyn C; Holbrook, Christopher M; Krueger, Charles C

    2016-04-01

    Freshwater fish move vertically and horizontally through the aquatic landscape for a variety of reasons, such as to find and exploit patchy resources or to locate essential habitats (e.g., for spawning). Inherent challenges exist with the assessment of fish populations because they are moving targets. We submit that quantifying and describing the spatial ecology of fish and their habitat is an important component of freshwater fishery assessment and management. With a growing number of tools available for studying the spatial ecology of fishes (e.g., telemetry, population genetics, hydroacoustics, otolith microchemistry, stable isotope analysis), new knowledge can now be generated and incorporated into biological assessment and fishery management. For example, knowing when, where, and how to deploy assessment gears is essential to inform, refine, or calibrate assessment protocols. Such information is also useful for quantifying or avoiding bycatch of imperiled species. Knowledge of habitat connectivity and usage can identify critically important migration corridors and habitats and can be used to improve our understanding of variables that influence spatial structuring of fish populations. Similarly, demographic processes are partly driven by the behavior of fish and mediated by environmental drivers. Information on these processes is critical to the development and application of realistic population dynamics models. Collectively, biological assessment, when informed by knowledge of spatial ecology, can provide managers with the ability to understand how and when fish and their habitats may be exposed to different threats. Naturally, this knowledge helps to better evaluate or develop strategies to protect the long-term viability of fishery production. Failure to understand the spatial ecology of fishes and to incorporate spatiotemporal data can bias population assessments and forecasts and potentially lead to ineffective or counterproductive management actions

  15. Incorporating mesh-insensitive structural stress into the fatigue assessment procedure of common structural rules for bulk carriers

    Directory of Open Access Journals (Sweden)

    Kim Seong-Min

    2015-01-01

    Full Text Available This study introduces a fatigue assessment procedure using mesh-insensitive structural stress method based on the Common Structural Rules for Bulk Carriers by considering important factors, such as mean stress and thickness effects. The fatigue assessment result of mesh-insensitive structural stress method have been compared with CSR procedure based on equivalent notch stress at major hot spot points in the area near the ballast hold for a 180 K bulk carrier. The possibility of implementing mesh-insensitive structural stress method in the fatigue assessment procedure for ship structures is discussed.

  16. Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force.

    Science.gov (United States)

    Walton, Marc K; Powers, John H; Hobart, Jeremy; Patrick, Donald; Marquis, Patrick; Vamvakas, Spiros; Isaac, Maria; Molsen, Elizabeth; Cano, Stefan; Burke, Laurie B

    2015-09-01

    An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to

  17. Radiology education. The evaluation and assessment of clinical competence

    Energy Technology Data Exchange (ETDEWEB)

    Hibbert, Kathryn M.; Van Deven, Teresa [The Univ. of Western Ontario, London, ON (Canada). Dept. of Medical Imaging; Chhem, Rethy K. [Medical Univ. of Vienna (Austria). Dept. of Radiology; Nagasaki Univ. (Japan). Atomic Bomb Disease Inst.; Wang, Shih-chang (eds.) [Univ. of Sydney Westmead Hospital (Australia). Dept. of Radiology; Royal Australian and New Zealand College of Radiologists, Sydney (Australia). Faculty of Radiodiagnosis

    2012-11-01

    Third volume of a trilogy devoted to radiology education and improvement of medical imaging students' learning, teaching, and scholarship. Reviews the philosophies, theories, and principles that underpin assessment and evaluation in radiology education. Includes a series of rich case studies. Written by an international group of experienced educators and medical professionals. This book reviews the philosophies, theories, and principles that underpin assessment and evaluation in radiology education, highlighting emerging practices and work done in the field. The sometimes conflicting assessment and evaluation needs of accreditation bodies, academic programs, trainees, and patients are carefully considered. The final section of the book examines assessment and evaluation in practice, through the development of rich case studies reflecting the implementation of a variety of approaches. This is the third book in a trilogy devoted to the scholarship of radiology education and is the culmination of an important initiative to improve medical imaging students' learning, teaching, and scholarship by bringing together experienced educators and medical professionals. The previous two books focused on the culture and the learning organizations in which our future radiologists are educated and on the application of educational principles in the education of radiologists. Here, the trilogy comes full circle: attending to the assessment and evaluation of the education of its members has much to offer back to the learning of the organization.

  18. Radiology education. The evaluation and assessment of clinical competence

    International Nuclear Information System (INIS)

    Third volume of a trilogy devoted to radiology education and improvement of medical imaging students' learning, teaching, and scholarship. Reviews the philosophies, theories, and principles that underpin assessment and evaluation in radiology education. Includes a series of rich case studies. Written by an international group of experienced educators and medical professionals. This book reviews the philosophies, theories, and principles that underpin assessment and evaluation in radiology education, highlighting emerging practices and work done in the field. The sometimes conflicting assessment and evaluation needs of accreditation bodies, academic programs, trainees, and patients are carefully considered. The final section of the book examines assessment and evaluation in practice, through the development of rich case studies reflecting the implementation of a variety of approaches. This is the third book in a trilogy devoted to the scholarship of radiology education and is the culmination of an important initiative to improve medical imaging students' learning, teaching, and scholarship by bringing together experienced educators and medical professionals. The previous two books focused on the culture and the learning organizations in which our future radiologists are educated and on the application of educational principles in the education of radiologists. Here, the trilogy comes full circle: attending to the assessment and evaluation of the education of its members has much to offer back to the learning of the organization.

  19. Challenges in the clinical assessment of novel tuberculosis drugs.

    Science.gov (United States)

    Dooley, Kelly E; Phillips, Patrick P J; Nahid, Payam; Hoelscher, Michael

    2016-07-01

    To tackle the global TB epidemic effectively, novel treatment strategies are critically needed to shorten the duration of TB therapy and treat drug-resistant TB. Drug development for TB, stymied for decades, has enjoyed a renaissance over the past several years. However, the development of new TB regimens is hindered by the limitations in our understanding and use of preclinical models; the paucity of accurate, early surrogate markers of cure, and challenges in untangling the individual contributions of drugs to multidrug regimens in a complex, multi-compartment disease. Lack of profit motive, advocacy, and imagination has contributed mightily to the dearth of drugs we have on the shelf to treat this ancient disease. Areas that will speed the development of new regimens for TB include novel murine and in vitro pharmacodynamics models, clinical endpoints that are not culture-based, innovative clinical trial designs, and an infusion of much-needed funding. PMID:26827911

  20. Assessing progression of clinical reasoning through virtual patients: An exploratory study.

    Science.gov (United States)

    Forsberg, Elenita; Ziegert, Kristina; Hult, Håkan; Fors, Uno

    2016-01-01

    To avoid test-driven learning, there have been discussions regarding the use of more formative assessments in health care education to promote students' deep learning. Feedback is important in formative assessment, but many students ignore it; therefore, interventions should be introduced which stimulate them to reflect on the new knowledge. The aim for this study was to explore if Virtual Patient (VP)-based formative assessments, in connection with self-evaluations, had an impact on postgraduate pediatric nursing students' development of clinical reasoning abilities. Students' self-evaluations served as the basis for measuring progress. Data was analysed using deductive content analysis. The findings showed a clear progression of the clinical reasoning ability of the students. After the first assessment, the students described feelings of uncertainty and that their knowledge gaps were exposed. At the mid-course assessment the awareness of improved clinical reasoning was obvious and the students were more certain of knowing how to solve the VP cases. In the final assessment, self-efficacy was expressed. VP-based assessments, in connection with self-evaluations, early in the education resulted in a gain of students' own identification of the concept of clinical reasoning, awareness of what to focus on during clinical practice and visualised expected clinical competence. PMID:26482401

  1. Test of Integrated Professional Skills: Objective Structured Clinical Examination/Simulation Hybrid Assessment of Obstetrics-Gynecology Residents' Skill Integration

    Science.gov (United States)

    Winkel, Abigail Ford; Gillespie, Colleen; Hiruma, Marissa T.; Goepfert, Alice R.; Zabar, Sondra; Szyld, Demian

    2014-01-01

    Background Assessment of obstetrics-gynecology residents' ability to integrate clinical judgment, interpersonal skills, and technical ability in a uniform fashion is required to document achievement of benchmarks of competency. An observed structured clinical examination that incorporates simulation and bench models uses direct observation of performance to generate formative feedback and standardized evaluation. Methods The Test of Integrated Professional Skills (TIPS) is a 5-station performance-based assessment that uses standardized patients and complex scenarios involving ultrasonography, procedural skills, and evidence-based medicine. Standardized patients and faculty rated residents by using behaviorally anchored checklists. Mean scores reflecting performance in TIPS were compared across competency domains and by developmental level (using analysis of variance) and then compared to standard faculty clinical evaluations (using Spearman ρ). Participating faculty and residents were also asked to evaluate the usefulness of the TIPS. Results Twenty-four residents participated in the TIPS. Checklist items used to assess competency were sufficiently reliable, with Cronbach α estimates from 0.69 to 0.82. Performance improved with level of training, with wide variation in performance. Standard faculty evaluations did not correlate with TIPS performance. Several residents who were rated as average or above average by faculty performed poorly on the TIPS (> 1 SD below the mean). Both faculty and residents found the TIPS format useful, providing meaningful evaluation and opportunity for feedback. Conclusions A simulation-based observed structured clinical examination facilitates observation of a range of skills, including competencies that are difficult to observe and measure in a standardized way. Debriefing with faculty provides an important interface for identification of performance gaps and individualization of learning plans. PMID:24701321

  2. The relevance of clinical balance assessment tools to differentiate balance deficits

    OpenAIRE

    Mancini, Martina; Horak, Fay B.

    2010-01-01

    Control of balance is complex and involves maintaining postures, facilitating movement, and recovering equilibrium. Balance control consists of controlling the body center of mass over its limits of stability. Clinical balance assessment can help assess fall risk and/or determine the underlying reasons for balance disorders. Most functional balance assessment scales assess fall risk and the need for balance rehabilitation but do not differentiate types of balance deficits. A system approach t...

  3. Reliable and Valid Assessment of Clinical Bronchoscopy Performance

    DEFF Research Database (Denmark)

    Konge, Lars; Larsen, Klaus Richter; Clementsen, Paul;

    2012-01-01

    interrater reliability was high, with Cronbach's a = 0.86. Assessment of 3 bronchoscopies by a single rater had a generalizability coefficient of 0.84. The correlation between experience and performance was good (Pearson correlation = 0.76). There were significant differences between the groups for all...

  4. Clinical Assessment of Psychopathology in Violent and Nonviolent Juvenile Offenders.

    Science.gov (United States)

    Richardson, Linda M.; And Others

    The Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach test are frequently used in juvenile justice settings to assess current psychological functioning and to predict future behavior. The Exner Comprehensive System, which standardized the Rorschach, made possible a comparison of the Rorschach and the MMPI in an investigation of…

  5. Comprehensive geriatric assessment and its clinical impact in oncology.

    NARCIS (Netherlands)

    Maas, H.A.; Janssen-Heijnen, M.L.; Olde Rikkert, M.G.M.; Wymenga, A.N.

    2007-01-01

    Comprehensive geriatric assessment (CGA) is a process that consists of a multidimensional data-search and a process of analyzing and linking patient characteristics creating an individualized intervention-plan, carried out by a multidisciplinary team. In general, the positive health care effects of

  6. Use of clinical simulation for assessment in EHR-procurement

    DEFF Research Database (Denmark)

    Jensen, Sanne; Rasmussen, Stine L.; Lyng, Karen M.

    2013-01-01

    . While design methods are widely described, there are very limited descriptions of how to assess and compare different EHR-platforms and their support in work processes upon its procurement. This paper describes the method we have developed to undertake this task. It is discussed how the method differs...

  7. The clinical assessment of intraductal ultrasonography in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis.

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To assess and compare the clinical value of intraductal ultrasonography (IDUS) in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis with conventional imaging methods. Methods: IDUS was carried out in eighteen patients with pancreatic carcinoma and chronic pancreatitis

  8. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment

    DEFF Research Database (Denmark)

    Cath, Danielle C; Hedderly, Tammy; Ludolph, Andrea G;

    2011-01-01

    members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities...

  9. Students’ performance in the different clinical skills assessed in OSCE: what does it reveal?

    Directory of Open Access Journals (Sweden)

    Joong Hiong Sim

    2015-02-01

    Full Text Available Introduction: The purpose of this study was to compare students’ performance in the different clinical skills (CSs assessed in the objective structured clinical examination. Methods: Data for this study were obtained from final year medical students’ exit examination (n=185. Retrospective analysis of data was conducted using SPSS. Means for the six CSs assessed across the 16 stations were computed and compared. Results: Means for history taking, physical examination, communication skills, clinical reasoning skills (CRSs, procedural skills (PSs, and professionalism were 6.25±1.29, 6.39±1.36, 6.34±0.98, 5.86±0.99, 6.59±1.08, and 6.28±1.02, respectively. Repeated measures ANOVA showed there was a significant difference in the means of the six CSs assessed [F(2.980, 548.332=20.253, p<0.001]. Pairwise multiple comparisons revealed significant differences between the means of the eight pairs of CSs assessed, at p<0.05. Conclusions: CRSs appeared to be the weakest while PSs were the strongest, among the six CSs assessed. Students’ unsatisfactory performance in CRS needs to be addressed as CRS is one of the core competencies in medical education and a critical skill to be acquired by medical students before entering the workplace. Despite its challenges, students must learn the skills of clinical reasoning, while clinical teachers should facilitate the clinical reasoning process and guide students’ clinical reasoning development.

  10. The MMPI-2 Restructured Clinical Scales in the Assessment of Posttraumatic Stress Disorder and Comorbid Disorders

    OpenAIRE

    Wolf, Erika J.; Miller, Mark W.; Orazem, Robert J.; Weierich, Mariann R.; Castillo, Diane T.; Milford, Jaime; Kaloupek, Danny G.; Keane, Terence M.

    2008-01-01

    This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Cli...

  11. Using functional magnetic resonance imaging to improve how we understand, teach, and assess clinical reasoning

    NARCIS (Netherlands)

    Durning, S.J.; Costanzo, M.; Artino, A.R.; Vleuten, C.P.M. van der; Beckman, T.J.; Holmboe, E.; Roy, M.J.; Schuwirth, L.

    2014-01-01

    Clinical reasoning is essential to the practice of medicine. There have been many advances in the understanding of clinical reasoning and its assessment, yet current approaches have a number of important limitations. Functional magnetic resonance imaging (fMRI) is promising because it permits invest

  12. Cognitive Set and Clinical Inference: Referral Information May Not (Always) Affect Psychosocial Assessment.

    Science.gov (United States)

    Abraham, Ivo L.

    1986-01-01

    Studied the effects of general referral information about a client on subsequent clinical inferences. Nursing students (N=54) were randomly assigned to "referral information" or "no referral information" conditions before being presented with additional data. Clinical inferential tasks included the assessment of maladjustment, client stress,…

  13. Quality assessment in in vivo NMR spectroscopy: III. Clinical test objects: design, construction, and solutions

    DEFF Research Database (Denmark)

    Leach, M.O.; Collins, D.J.; Keevil, S;

    1995-01-01

    Based on the requirements of test protocols developed to evaluate clinical MRS single slice and volume localisation sequences, two clinical test objects, STO1 and STO2 have been developed. The properties of a range of potential construction materials have been assessed, demonstrating that the water...

  14. Clinical evaluation of concussion: the evolving role of oculomotor assessments.

    Science.gov (United States)

    Sussman, Eric S; Ho, Allen L; Pendharkar, Arjun V; Ghajar, Jamshid

    2016-04-01

    Sports-related concussion is a change in brain function following a direct or an indirect force to the head, identified in awake individuals and accounting for a considerable proportion of mild traumatic brain injury. Although the neurological signs and symptoms of concussion can be subtle and transient, there can be persistent sequelae, such as impaired attention and balance, that make affected patients particularly vulnerable to further injury. Currently, there is no accepted definition or diagnostic criteria for concussion, and there is no single assessment that is accepted as capable of identifying all patients with concussion. In this paper, the authors review the available screening tools for concussion, with particular emphasis on the role of visual function testing. In particular, they discuss the oculomotor assessment tools that are being investigated in the setting of concussion screening. PMID:27032924

  15. Assessing monoclonal antibody product quality attribute criticality through clinical studies

    OpenAIRE

    Goetze, Andrew M; Schenauer, Matthew R; Flynn, Gregory C.

    2010-01-01

    Recombinant therapeutic proteins, including antibodies, contain a variety of chemical and physical modifications. Great effort is expended during process and formulation development in controlling and minimizing this heterogeneity, which may not affect safety or efficacy and, therefore, may not need to be controlled. Many of the chemical conversions also occur in vivo and knowledge about the alterations can be applied to assessment of the potential impact on characteristics and the biological...

  16. Regulation of the cerebral circulation: bedside assessment and clinical implications.

    Science.gov (United States)

    Donnelly, Joseph; Budohoski, Karol P; Smielewski, Peter; Czosnyka, Marek

    2016-01-01

    Regulation of the cerebral circulation relies on the complex interplay between cardiovascular, respiratory, and neural physiology. In health, these physiologic systems act to maintain an adequate cerebral blood flow (CBF) through modulation of hydrodynamic parameters; the resistance of cerebral vessels, and the arterial, intracranial, and venous pressures. In critical illness, however, one or more of these parameters can be compromised, raising the possibility of disturbed CBF regulation and its pathophysiologic sequelae. Rigorous assessment of the cerebral circulation requires not only measuring CBF and its hydrodynamic determinants but also assessing the stability of CBF in response to changes in arterial pressure (cerebral autoregulation), the reactivity of CBF to a vasodilator (carbon dioxide reactivity, for example), and the dynamic regulation of arterial pressure (baroreceptor sensitivity). Ideally, cerebral circulation monitors in critical care should be continuous, physically robust, allow for both regional and global CBF assessment, and be conducive to application at the bedside. Regulation of the cerebral circulation is impaired not only in primary neurologic conditions that affect the vasculature such as subarachnoid haemorrhage and stroke, but also in conditions that affect the regulation of intracranial pressure (such as traumatic brain injury and hydrocephalus) or arterial blood pressure (sepsis or cardiac dysfunction). Importantly, this impairment is often associated with poor patient outcome. At present, assessment of the cerebral circulation is primarily used as a research tool to elucidate pathophysiology or prognosis. However, when combined with other physiologic signals and online analytical techniques, cerebral circulation monitoring has the appealing potential to not only prognosticate patients, but also direct critical care management. PMID:27145751

  17. An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information (Final Report)

    Science.gov (United States)

    This report, prepared by the Global Change Research Program (GCRP) in the National Center for Environmental Assessment (NCEA) of the Office of Research and Development (ORD) at the U.S. Environmental Protection Agency (EPA), is a review of decision-making processes of selected la...

  18. Towards a Global Water Scarcity Risk Assessment Framework: Incorporation of Probability Distributions and Hydro-Climatic Variability

    Science.gov (United States)

    Veldkamp, T. I. E.; Wada, Y.; Aerts, J. C. J. H.; Ward, P. J.

    2016-01-01

    Changing hydro-climatic and socioeconomic conditions increasingly put pressure on fresh water resources and are expected to aggravate water scarcity conditions towards the future. Despite numerous calls for risk-based water scarcity assessments, a global-scale framework that includes UNISDR's definition of risk does not yet exist. This study provides a first step towards such a risk based assessment, applying a Gamma distribution to estimate water scarcity conditions at the global scale under historic and future conditions, using multiple climate change and population growth scenarios. Our study highlights that water scarcity risk, expressed in terms of expected annual exposed population, increases given all future scenarios, up to greater than 56.2% of the global population in 2080. Looking at the drivers of risk, we find that population growth outweigh the impacts of climate change at global and regional scales. Using a risk-based method to assess water scarcity, we show the results to be less sensitive than traditional water scarcity assessments to the use of fixed threshold to represent different levels of water scarcity. This becomes especially important when moving from global to local scales, whereby deviations increase up to 50% of estimated risk levels.

  19. Towards a global water scarcity risk assessment framework: incorporation of probability distributions and hydro-climatic variability

    Science.gov (United States)

    Veldkamp, T. I. E.; Wada, Y.; Aerts, J. C. J. H.; Ward, P. J.

    2016-02-01

    Changing hydro-climatic and socioeconomic conditions increasingly put pressure on fresh water resources and are expected to aggravate water scarcity conditions towards the future. Despite numerous calls for risk-based water scarcity assessments, a global-scale framework that includes UNISDR’s definition of risk does not yet exist. This study provides a first step towards such a risk-based assessment, applying a Gamma distribution to estimate water scarcity conditions at the global scale under historic and future conditions, using multiple climate change and population growth scenarios. Our study highlights that water scarcity risk, expressed in terms of expected annual exposed population, increases given all future scenarios, up to >56.2% of the global population in 2080. Looking at the drivers of risk, we find that population growth outweigh the impacts of climate change at global and regional scales. Using a risk-based method to assess water scarcity, we show the results to be less sensitive than traditional water scarcity assessments to the use of fixed threshold to represent different levels of water scarcity. This becomes especially important when moving from global to local scales, whereby deviations increase up to 50% of estimated risk levels.

  20. Health-care technology assessment: a clinical perspective.

    Science.gov (United States)

    Chantler, Cyril

    2004-01-01

    Health technology assessment needs to relate to contemporary questions which concern public health-care systems: how to keep people healthy, how to focus on the needs of those with chronic disabilities and integrate care between the hospital and the community, how to encourage and audit effective teamwork, and how to establish a consensus about what is effective and affordable. Clinicians have an ethical responsibility to practice efficiently and economically, for profligacy in the care of one patient may mean that another is treated inadequately. For similar reasons, clinicians need to play a full role in the management of services. Advice from health technology assessment is vital and needs to be accurate, relevant, timely, clear, and accessible. As well as being concerned about what works, we need also to eliminate from practice what does not. Regular audit and appraisal of practice against the evidence base should be useful in this respect. Alternative approaches to management, such as the provision of care as opposed to aggressive treatments, need to be evaluated, and health technology assessment needs to consider how services are delivered, not just specific treatments. PMID:15176183

  1. Untreated periodontal disease in Indonesian adolescents : Longitudinal clinical data and prospective clinical and microbiological risk assessment

    NARCIS (Netherlands)

    Timmerman, MF; Van der Weijden, GA; Abbas, F; Arief, EM; Armand, S; Winkel, EG; Van Winkelhoff, AJ; Van der Velden, U

    2000-01-01

    Background, aims: In order to investigate the role of various putative clinical and microbiological risk markers, a longitudinal study was initiated in a young population deprived of regular dental care. In 1987 all inhabitants in the age range 15-25 years living in a village with approximately 2000

  2. Clinical assessment of enamel wear caused by monolithic zirconia crowns.

    Science.gov (United States)

    Stober, T; Bermejo, J L; Schwindling, F S; Schmitter, M

    2016-08-01

    The purpose of this study was to measure enamel wear caused by antagonistic monolithic zirconia crowns and to compare this with enamel wear caused by contralateral natural antagonists. Twenty monolithic zirconia full molar crowns were placed in 20 patients. Patients with high activity of the masseter muscle at night (bruxism) were excluded. For analysis of wear, vinylpolysiloxane impressions were prepared after crown incorporation and at 6-, 12-, and 24-month follow-up. Wear of the occlusal contact areas of the crowns, of their natural antagonists, and of two contralateral natural antagonists (control teeth) was measured by use of plaster replicas and a 3D laser-scanning device. Differences of wear between the zirconia crown antagonists and the control teeth were investigated by means of two-sided paired Student's t-tests and linear regression analysis. After 2 years, mean vertical loss was 46 μm for enamel opposed to zirconia, 19-26 μm for contralateral control teeth and 14 μm for zirconia crowns. Maximum vertical loss was 151 μm for enamel opposed to zirconia, 75-115 μm for control teeth and 60 μm for zirconia crowns. Statistical analysis revealed significant differences between wear of enamel by zirconia-opposed teeth and by control teeth. Gender, which significantly affected wear, was identified as a possible confounder. Monolithic zirconia crowns generated more wear of opposed enamel than did natural teeth. Because of the greater wear caused by other dental ceramics, the use of monolithic zirconia crowns may be justified. PMID:27198539

  3. Incorporating availability/bioavailability in risk assessment and decision making of polluted sites, using Germany as an example.

    Science.gov (United States)

    Kördel, Werner; Bernhardt, Cornelia; Derz, Kerstin; Hund-Rinke, Kerstin; Harmsen, Joop; Peijnenburg, Willie; Comans, Rob; Terytze, Konstantin

    2013-10-15

    Nearly all publications dealing with availability or bioavailability of soil pollutants start with the following statement: the determination of total pollutant content will lead to an over-estimation of risk. However, an assessment of contaminated sites should be based on the determination of mobile fractions of pollutants, and the fractions with potential for mobilisation that threaten groundwater and surface water, and the actual and potential fractions available for uptake by plants, soil microflora and soil organisms. After reviewing the literature for method proposals concerning the determination of available/bioavailable fractions of contaminants with respect to leaching, plants, microorganisms (biodegradation) and soil organisms, we propose a testing and assessment scheme for contaminated sites. The proposal includes (i) already accepted and used methods, (ii) methods which are under standardisation, and (iii) methods for which development has just started in order to promote urgently needed research. PMID:23746963

  4. Incorporation of Socio-Cultural Values in Damage Assessment Valuations of Contaminated Lands in the Niger Delta

    OpenAIRE

    Victor A. Akujuru; Les Ruddock

    2014-01-01

    Damages on contaminated land have been mostly assessed for developments subsisting on the land, neglecting the goods and services derived from the land which possess only socio-cultural values. This paper aims to ascertain the importance of socio-cultural values in the total economic value of contaminated land, drawing from the experience of a coastal community oil spillage in the Niger Delta. The paper examines what constitutes a valuable interest on contaminated land and how socio-cultural...

  5. Incorporating the productivity benefits into the assessment of cost effective energy savings potential using conservation supply curves

    OpenAIRE

    Laitner, John A.; Ruth, Michael; Worrell, Ernst

    2001-01-01

    We review the relationship between energy efficiency improvement measures and productivity in industry. We propose a method to include productivity benefits in the economic assessment of the potential for energy efficiency improvement. The paper explores the implications of how this change in perspective might affect the evaluation of energy-efficient technologies for a study of the iron and steel industry in the U.S. It is found that including productivity benefits explicitly in the mo...

  6. Validity of the youth assessment and screening instrument: A juvenile justice tool incorporating risks, needs, and strengths.

    Science.gov (United States)

    Jones, Natalie J; Brown, Shelley L; Robinson, David; Frey, Deanna

    2016-04-01

    The primary purpose of this study is to introduce the Youth Assessment and Screening Instrument (YASI; Orbis Partners, 2000), which is a comprehensive assessment protocol gauging a range of risks, needs, and strengths associated with criminal conduct in juvenile populations. Applied to a sample of 464 juvenile offenders bound by community supervision in Alberta, Canada, the Pre-Screen version of the instrument achieved a high level of accuracy in predicting both general and violent offenses over an 18-month follow-up period (Area Under the Curve [AUC] = .79). No significant differences in overall predictive validity were found across demographic groups, save for the relatively lower level of accuracy achieved in predicting general reoffending across the subsample of girls (AUC = .68). With regard to strengths, a buffering effect was identified whereby high-risk cases with higher levels of strength had superior outcomes compared to their lower strength counterparts. Results suggest that it is advisable to consider the quantitative inclusion of strength-based items in the assessment of juvenile risk. (PsycINFO Database Record PMID:26752015

  7. Clinical assessment of chest pain and guidelines for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, J., E-mail: joachim.gruettner@umm.de [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Henzler, T. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Sueselbeck, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Borggrefe, M.; Walter, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany)

    2012-12-15

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  8. Clinical assessment of chest pain and guidelines for imaging

    International Nuclear Information System (INIS)

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  9. Assessment Experiences in the Workplace: A Comparative Study between Clinical Educators' and Their Students' Perceptions

    Science.gov (United States)

    Trede, Franziska; Mischo-Kelling, Maria; Gasser, Eva Maria; Pulcini, Stefania

    2015-01-01

    With this paper, we contribute to the complex field of assessment of student learning in work placements. The complexity includes the dual role of clinical educators as mentors and assessors, students as pre-accredited practitioners and the diverse purposes of assessment. A philosophical hermeneutic approach was adopted to explore the perceptions…

  10. Cross-Linguistic Expression of Contrastive Accent: Clinical Assessment in Spanish and English

    Science.gov (United States)

    Martinez-Castilla, Pastora; Peppe, Sue

    2010-01-01

    Well-documented Romance-Germanic differences in the use of accent in speech to convey information-structure and focus cause problems for the assessment of prosodic skills in populations with clinical disorders. The strategies for assessing the ability to use lexical and contrastive accent in English and Spanish are reviewed, and studies in the…

  11. Scale Development of a Measure to Assess Community-Based and Clinical Intervention Group Environments

    Science.gov (United States)

    Wilson, Patrick A.; Hansen, Nathan B.; Tarakeshwar, Nalini; Neufeld, Sharon; Kochman, Arlene; Sikkema, Kathleen J.

    2008-01-01

    Though group interventions are widely used in community-based and clinical settings, there are few brief instruments for assessing the group environment. Two studies on the development of a brief measure to assess intervention group environments are described, and psychometric properties of the new scale are presented. The new measure is based on…

  12. Clinical assessment of hip strength using a hand-held dynamometer is reliable

    DEFF Research Database (Denmark)

    Thorborg, K; Petersen, J; Magnusson, S P;

    2010-01-01

    Hip strength assessment plays an important role in the clinical examination of the hip and groin region. The primary aim of this study was to examine the absolute test-retest measurement variation concerning standardized strength assessments of hip abduction (ABD), adduction (ADD), external rotat...

  13. Structured clinical assessment of the ear, nose and throat in patients with granulomatosis with polyangiitis (Wegener's)

    DEFF Research Database (Denmark)

    Martinez Del Pero, Marcos; Rasmussen, Niels; Chaudhry, Afzal;

    2013-01-01

    a detailed clinical assessment by an ENT surgeon of their ear, nose and head and neck complaints. An evaluation of whether there was disease activity and/or infection in each ENT area was made using the European Vasculitis Study Group guidelines. The number of patients assessed was 144. The...

  14. Incorporation of lithium lead eutectic as a working fluid in RELAP5 and preliminary safety assessment of LLCS

    Energy Technology Data Exchange (ETDEWEB)

    Trivedi, A.K., E-mail: trivedi@iitk.ac.in [Nuclear Engineering and Technology Programme, Indian Institute of Technology, Kanpur 208016 (India); Sandeep, K.T. [Institute for Plasma Research, Gandhinagar 382428 (India); Allison, C. [Innovative Systems Software, Idaho Falls, ID 83406 (United States); Khanna, A., E-mail: akhanna@iitk.ac.in [Nuclear Engineering and Technology Programme, Indian Institute of Technology, Kanpur 208016 (India); Chaudhari, V.; Kumar, E.R. [Institute for Plasma Research, Gandhinagar 382428 (India); Munshi, P. [Nuclear Engineering and Technology Programme, Indian Institute of Technology, Kanpur 208016 (India)

    2014-12-15

    Highlights: • The current work involves thermal hydraulic calculation of Lithium Lead Cooling System (LLCS) for the Indian test blanket module (TBM) for testing in ITER. • It uses the RELAP portion of RELAP/SCDAPSIM/MOD4.0. • RELAP steady state results closely match with the operating conditions of LLCS. • Results from transient calculations show that a maximum temperature of 875 K is attained 300 s after the loss of LLE flow. - Abstract: The current work involves thermal hydraulic calculation of Lithium Lead Cooling System (LLCS) for the Indian test blanket module (TBM) for testing in International Thermonuclear Experimental reactor (ITER). It uses the RELAP portion of RELAP/SCDAPSIM/MOD4.0. Lithium-lead eutectic (LLE) has been used as multiplier, breeder and coolant in TBM. Thermodynamic and transport properties of the LLE have been incorporated into the code. The main focus of this study is to check the heat transfer capability of LLE as coolant for TBM system for steady state and the considered anticipated operational occurrences (AOO's), namely, loss of heat source, loss of primary flow and loss of secondary flow. The six heat transfer correlation (reported for liquid metals in the literature) has been tested for steady state analysis of LLCS loop and results are roughly same for all of them. A good agreement has been observed between the operating conditions of LLCS with those of RELAP5 calculations. Results from transient calculations show that a maximum temperature of 875 K is attained during a 300 s loss of primary flow (LLE)

  15. Refined Assessment of Human PM2.5 Exposure in Chinese city by Incorporating Time-activity Data

    Science.gov (United States)

    Zhu, W.; Wang, H.

    2015-12-01

    Since urban residents tend to spend a majority of time indoors throughout a day, it has been widely discussed in recent years, whether fixed-site monitoring PM2.5 ambient concentration is feasible as a surrogate of human PM2.5 exposure. Comprehensive understanding of residents' daily time-activity patterns (TAP) and possible indoor behavior are urgently needed to perform a more accurate estimate of human PM2.5exposure, especially in China, where is experiencing rapid urbanization.Field surveys of TAP were carried out in a Chinese city of Suzhou from 2014 to 2015 to evaluate PM2.5 exposure in various micro-environments (ME, e.g., residence, outdoors and in-transit). We gathered and analyzed urban residents' seasonal time-activity data using 24h retrospective time-location diaries, as well as diversified exposure-related indoor information (e.g. ventilation, environment tobacco smoke and cooking). PM2.5exposure is calculated through the incorporation of ambient concentration data, modified indoor/outdoor empirical functions and TAP. The spatial distributions of TAP-based exposure and static-population based exposure are also compared.Residents in Suzhou urban area spend over 65% of time at home and 90% indoors. There are significant temporal (season, day type) and socioeconomic differences (gender, age, education, living alone, having children at home, employment status, etc.) of time-activity distributions, which makes the sum of PM2.5 ME exposure differs notably from static-population based ambient exposure. People prefer to spend more time at home both in winter (Peducation and living alone are negative associated with time spent home, while age, children at home and employment status are positively related. On the other hand, due to lack of monitoring stations in unban Suzhou, the inverse distance squared weighting method is not ideally performed and may be less representative of the ambient PM2.5characteristics than satellite data.

  16. Using plant clinic registers to assess the quality of diagnoses and advice given to farmers

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses;

    2012-01-01

    clinic registers have been used to systematically assess quality of plant clinic services. Apart from being a valuable tool for quality assessment of extension, the plant clinic registers constitute a novel source of regular information about pests, diseases and farmer demand that can help improve...... validated diagnoses. The majority of recommendations (82%) were assessed ‘partially effective’. ‘Best practice’ was recommended for 10% and ineffective advice was given in 8% of the cases with considerable variation between diseases. Practical implications: Plant doctors need more training in symptom...... recognition, pest management and record keeping as well as better technical backstopping to solve unknown problems. Common standards and procedures for clinic data collection and analysis should be established, and roles and responsibilities clearly defined. Originality/value: This is the first time plant...

  17. Multisource feedback: 360-degree assessment of professional skills of clinical directors.

    Science.gov (United States)

    Palmer, Robert; Rayner, Hugh; Wall, David

    2007-08-01

    For measuring behaviour of National Health Service (NHS) staff, 360-degree assessment is a valuable tool. The important role of a clinical director as a medical leader is increasingly recognized, and attributes of a good clinical director can be defined. Set against these attributes, a 360-degree assessment tool has been designed. The job description for clinical directors has been used to develop a questionnaire sent to senior hospital staff. The views of staff within the hospital are similar irrespective of gender, post held or length of time in post. Analysis has shown that three independent factors can be distilled, namely operational management, interpersonal skills and creative/strategic thinking. A simple validated questionnaire has been developed and successfully introduced for the 360-degree assessment of clinical directors. PMID:17683657

  18. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Mazur, Lukasz M., E-mail: lukasz_mazur@ncsu.edu [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Biomedical Engineering, North Carolina State University, Raleigh, North Carolina (United States); Mosaly, Prithima R. [Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Jackson, Marianne; Chang, Sha X.; Burkhardt, Katharin Deschesne; Adams, Robert D.; Jones, Ellen L.; Hoyle, Lesley [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Xu, Jing [Industrial Extension Service, North Carolina State University, Raleigh, North Carolina (United States); Rockwell, John; Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

    2012-08-01

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  19. Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology

    International Nuclear Information System (INIS)

    Purpose: Workload level and sources of stressors have been implicated as sources of error in multiple settings. We assessed workload levels and sources of stressors among radiation oncology professionals. Furthermore, we explored the potential association between workload and the frequency of reported radiotherapy incidents by the World Health Organization (WHO). Methods and Materials: Data collection was aimed at various tasks performed by 21 study participants from different radiation oncology professional subgroups (simulation therapists, radiation therapists, physicists, dosimetrists, and physicians). Workload was assessed using National Aeronautics and Space Administration Task-Load Index (NASA TLX). Sources of stressors were quantified using observational methods and segregated using a standard taxonomy. Comparisons between professional subgroups and tasks were made using analysis of variance ANOVA, multivariate ANOVA, and Duncan test. An association between workload levels (NASA TLX) and the frequency of radiotherapy incidents (WHO incidents) was explored (Pearson correlation test). Results: A total of 173 workload assessments were obtained. Overall, simulation therapists had relatively low workloads (NASA TLX range, 30-36), and physicists had relatively high workloads (NASA TLX range, 51-63). NASA TLX scores for physicians, radiation therapists, and dosimetrists ranged from 40-52. There was marked intertask/professional subgroup variation (P<.0001). Mental demand (P<.001), physical demand (P=.001), and effort (P=.006) significantly differed among professional subgroups. Typically, there were 3-5 stressors per cycle of analyzed tasks with the following distribution: interruptions (41.4%), time factors (17%), technical factors (13.6%), teamwork issues (11.6%), patient factors (9.0%), and environmental factors (7.4%). A positive association between workload and frequency of reported radiotherapy incidents by the WHO was found (r = 0.87, P value=.045

  20. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications

    Directory of Open Access Journals (Sweden)

    Stefano ePallanti

    2011-12-01

    Full Text Available Obsessive-compulsive disorder (OCD is a neuropsychiatric disorder affecting approximately 1-3% of the population. OCD is probably an etiologically heterogeneous condition. Individuals with OCD frequently have additional psychiatric disorders concomitantly or at some time during their lifetime. Recently, some authors proposed an OCD sub-classification based on co-morbidity. An important issue in assessing comorbidity is the fact that the non-response to treatment often involves the presence of comorbid conditions. Non-responsive patients are more likely to meet criteria for comorbid axis I or axis II disorders and the presence of a specific comorbid condition could be a distinguishing feature in OCD, with influence on the treatment adequacy and outcome.

  1. Internet addiction: definition, assessment, epidemiology and clinical management.

    Science.gov (United States)

    Shaw, Martha; Black, Donald W

    2008-01-01

    Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and internet access that lead to impairment or distress. The condition has attracted increasing attention in the popular media and among researchers, and this attention has paralleled the growth in computer (and Internet) access. Prevalence estimates vary widely, although a recent random telephone survey of the general US population reported an estimate of 0.3-0.7%. The disorder occurs worldwide, but mainly in countries where computer access and technology are widespread. Clinical samples and a majority of relevant surveys report a male preponderance. Onset is reported to occur in the late 20s or early 30s age group, and there is often a lag of a decade or more from initial to problematic computer usage. Internet addiction has been associated with dimensionally measured depression and indicators of social isolation. Psychiatric co-morbidity is common, particularly mood, anxiety, impulse control and substance use disorders. Aetiology is unknown, but probably involves psychological, neurobiological and cultural factors. There are no evidence-based treatments for internet addiction. Cognitive behavioural approaches may be helpful. There is no proven role for psychotropic medication. Marital and family therapy may help in selected cases, and online self-help books and tapes are available. Lastly, a self-imposed ban on computer use and Internet access may be necessary in some cases. PMID:18399706

  2. Clinical assessment of 15 cases of pediatric neck abscess

    International Nuclear Information System (INIS)

    Pediatric neck-abscess incidence has decreased thanks to early treatment using antibiotics, but diagnosis remains difficult due to varied clinical symptoms and a lack of subjective complaints. It must be diagnosed and treated early, due to being potentially life-threatening. We studied 15 such cases- 12 boys and 3 girls, 0 to 11 years old (mean; 3.5)- treated from January 2005 to January 2010. Their chief complaints were 5 high fevers, 4 neck swellings, and 6 neck and throat pain. Neck computed tomography (CT) with contrast medium was useful in diagnosis. Neck abscesses were found in 4 patients in the retropharyngeal space and parapharyngeal space, 2 patients in the submandibular space, retrocervical space, thyroid glands, and peritonsillar space, plus 3 miscellaneous. Antibiotics were used to treat all cases. Eleven required surgery and one puncture. Bacteria detected in 10 cases were 4 of Streptococcus pyogenes (Group A), 3 of Staphylococcus aureus, and 1 each of Group F Streptococcus, Peptostreptococcus sp. and Actinomyces. Hospitalization ranged from 7 to 44 days (mean; 17.2). All cases recovered satisfactorily. (author)

  3. Worldwide clinical safety assessment of gadoteridol injection: an update

    International Nuclear Information System (INIS)

    Gadoteridol injection is a low molecular weight chelate complex of gadolinium (III) which is useful as a contrast agent for magnetic resonance imaging. A total of 2481 adult and pediatric subjects were studied with gadoteridol at doses from 0.025 to 0.3 mmol/kg in phase I-IIIb clinical trials in Europe and the United States. The study population had a mean age of 49 years, and included 119 patients under 18 years of age and 747 patients over 60 years of age. After 2656 administered injections of gadoteridol a total of 233 adverse events were recorded in 176 exposures, an incidence rate of 6.6 % irrespective of relationship to drug administration. The most frequently reported adverse events were nausea (1.5 %), taste perversion (0.9 %), and headache (0.6 %). All other adverse events occurred with an incidence of 0.5 % or less. This report confirms the excellent safety profile of gadoteridol in healthy subjects and patients with a variety of known or suspected pathologies. (orig.)

  4. Incorporating the productivity benefits into the assessment of cost effective energy savings potential using conservation supply curves

    International Nuclear Information System (INIS)

    We review the relationship between energy efficiency improvement measures and productivity in industry. We propose a method to include productivity benefits in the economic assessment of the potential for energy efficiency improvement. The paper explores the implications of how this change in perspective might affect the evaluation of energy-efficient technologies for a study of the iron and steel industry in the U.S. It is found that including productivity benefits explicitly in the modeling parameters would double the cost-effective potential for energy efficiency improvement, compared to an analysis excluding those benefits. We provide suggestions for future research for this important area

  5. Implementing video cases in clinical paediatric teaching increases medical students' self-assessed confidence

    DEFF Research Database (Denmark)

    Malon, Michelle; Cortes, Dina; Andersen, Jesper;

    2014-01-01

    INTRODUCTION: Use of video cases in clinical education is rarely used systematically. MATERIAL AND METHODS: Medical students (n = 127) reported by questionnaire whether they had or had not seen a bedside case of each of 22 specific clinical conditions during their five-week clinical course in...... having seen a child with asthma in the daily clinic. In contrast, respiratory syncytial virus infection was only seen by 20%. Students' self-reported confidence in the assessment of paediatric patients increased after the video case library was made available: Before the intervention, 41% (57/138) of the...

  6. Development and Implementation of an Electronic Clinical Formative Assessment: Dental Faculty and Student Perspectives.

    Science.gov (United States)

    Kirkup, Michele L; Adams, Brooke N; Meadows, Melinda L; Jackson, Richard

    2016-06-01

    A traditional summative grading structure, used at Indiana University School of Dentistry (IUSD) for more than 30 years, was identified by faculty as outdated for assessing students' clinical performance. In an effort to change the status quo, a feedback-driven assessment was implemented in 2012 to provide a constructive assessment tool acceptable to both faculty and students. Building on the successful non-graded clinical evaluation employed at Baylor College of Dentistry, IUSD implemented a streamlined electronic formative feedback model (FFM) to assess students' daily clinical performance. An important addition to this evaluation tool was the inclusion of routine student self-assessment opportunities. The aim of this study was to determine faculty and student response to the new assessment instrument. Following training sessions, anonymous satisfaction surveys were examined for the three user groups: clinical faculty (60% response rate), third-year (D3) students (72% response rate), and fourth-year (D4) students (57% response rate). In the results, 70% of the responding faculty members preferred the FFM over the summative model; however, 61.8% of the D4 respondents preferred the summative model, reporting insufficient assessment time and low faculty participation. The two groups of students had different responses to the self-assessment component: 70.2% of the D4 respondents appreciated clinical self-assessment compared to 46% of the D3 respondents. Overall, while some components of the FFM assessment were well received, a phased approach to implementation may have facilitated a transition more acceptable to both faculty and students. Improvements are being made in an attempt to increase overall satisfaction. PMID:27251346

  7. Utility of clinical examination and CT scan in assessment of penetrating neck trauma

    International Nuclear Information System (INIS)

    Managing penetrating injuries adequately and effectively depends a great deal on proper assessment of the injury. This study carried out was done at The Aga Khan University Hospital to assess the role of clinical examination and CT scan imaging in evaluation of penetrating neck injuries. A total of 68 students were included, with ages ranging from 3 to 74 years. The involved zones and the injured structures were noted. Results showed a high sensitivity of clinical examination in assessing vascular (81%) and airway trauma (77%), with a low sensitivity for esophageal trauma (34%). For CT scan the sensitivity was 90% for vascular trauma, 83% for airway trauma and 53% for esophageal injuries. Clinical findings and CT scan imaging are important assessment tools for evaluation of penetrating neck traumas, with a high sensitivity for vascular and airway injuries. (author)

  8. Measurement properties of exsisting clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, B; Lund, H;

    2014-01-01

    MEASUREMENT PROPERTIES OF EXISTING CLINICAL ASSESSMENT METHODS EVALUATING SCAPULAR POSITIONING AND FUNCTION. A SYSTEMATIC REVIEW1,2Camilla Marie Larsen, 1,3Birgit Juul-Kristensen, 1,3Hans Lund, 1Karen Søgaard1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark2...... of the available clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. METHODS A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in...... groups: Static positioning assessment (n=19), Semi-dynamic (n=13), and Dynamic functional assessment (n=22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health...

  9. Incorporating organizational factors into Probabilistic Risk Assessment (PRA) of complex socio-technical systems: A hybrid technique formalization

    International Nuclear Information System (INIS)

    This paper is a result of a research with the primary purpose of extending Probabilistic Risk Assessment (PRA) modeling frameworks to include the effects of organizational factors as the deeper, more fundamental causes of accidents and incidents. There have been significant improvements in the sophistication of quantitative methods of safety and risk assessment, but the progress on techniques most suitable for organizational safety risk frameworks has been limited. The focus of this paper is on the choice of 'representational schemes' and 'techniques.' A methodology for selecting appropriate candidate techniques and their integration in the form of a 'hybrid' approach is proposed. Then an example is given through an integration of System Dynamics (SD), Bayesian Belief Network (BBN), Event Sequence Diagram (ESD), and Fault Tree (FT) in order to demonstrate the feasibility and value of hybrid techniques. The proposed hybrid approach integrates deterministic and probabilistic modeling perspectives, and provides a flexible risk management tool for complex socio-technical systems. An application of the hybrid technique is provided in the aviation safety domain, focusing on airline maintenance systems. The example demonstrates how the hybrid method can be used to analyze the dynamic effects of organizational factors on system risk

  10. Refined Assessment of Human PM2.5 Exposure in Chinese city by Incorporating Time-activity Data

    Science.gov (United States)

    Zhu, W.; Wang, H.

    2015-12-01

    Since urban residents tend to spend a majority of time indoors throughout a day, it has been widely discussed in recent years, whether fixed-site monitoring PM2.5 ambient concentration is feasible as a surrogate of human PM2.5 exposure. Comprehensive understanding of residents' daily time-activity patterns (TAP) and possible indoor behavior are urgently needed to perform a more accurate estimate of human PM2.5exposure, especially in China, where is experiencing rapid urbanization.Field surveys of TAP were carried out in a Chinese city of Suzhou from 2014 to 2015 to evaluate PM2.5 exposure in various micro-environments (ME, e.g., residence, outdoors and in-transit). We gathered and analyzed urban residents' seasonal time-activity data using 24h retrospective time-location diaries, as well as diversified exposure-related indoor information (e.g. ventilation, environment tobacco smoke and cooking). PM2.5exposure is calculated through the incorporation of ambient concentration data, modified indoor/outdoor empirical functions and TAP. The spatial distributions of TAP-based exposure and static-population based exposure are also compared.Residents in Suzhou urban area spend over 65% of time at home and 90% indoors. There are significant temporal (season, day type) and socioeconomic differences (gender, age, education, living alone, having children at home, employment status, etc.) of time-activity distributions, which makes the sum of PM2.5 ME exposure differs notably from static-population based ambient exposure. People prefer to spend more time at home both in winter (PGender, education and living alone are negative associated with time spent home, while age, children at home and employment status are positively related. On the other hand, due to lack of monitoring stations in unban Suzhou, the inverse distance squared weighting method is not ideally performed and may be less representative of the ambient PM2.5characteristics than satellite data.

  11. Test Reviews: Bracken, B. A., & Howell, K. (2004). "Clinical Assessment of Depression." Odessa, FL: Psychological Assessment Resources

    Science.gov (United States)

    Aghakhani, Anoosha; Chan, Eric K.

    2007-01-01

    In this article, the authors review the Clinical Assessment of Depression (CAD), a 50-item self-report measure of depressive symptoms designed for children, adolescents, adults, and elderly adults from 8 to 79 years of age. Purporting to be sensitive to depressive symptomatology across the lifespan, the test items were written to reflect the…

  12. Human tibial torsion - Morphometric assessment and clinical relevance

    Directory of Open Access Journals (Sweden)

    Swati Gandhi

    2014-02-01

    Full Text Available Background: Tibial torsion is an important anatomical parameter in clinical practice and displays variability among individuals. These variations are extremely significant in view of alignment guides such as those related to rotational landmarks of tibia in total knee arthroplasty. Further, precise knowledge and information pertaining to angle of tibial torsion also helps in correction of traumatic malunion or congenital maltorsion of tibia. Methods: The present study was carried out to determine the angle of tibial torsion in 100 adult dry tibia bones in the Department of Anatomy, Government Medical College, Amritsar. The study group comprised 50 males and 50 females with equal number of right- and left-sided bones. The measurements were meticulously recorded and the data were subjected to statistical analysis. The results were analyzed and discussed in the light of existing literature. Results: On the right side, it was found to be 29.84° ± 4.86°° (range = 22.00° -38.00° in males and 28.92° ± 5.10°° (range = 15.00°-38.00° in females. On the left side, it was found to be 28.00° ± 4.94°° (range = 20.00°-40.00°° in males and 28.12° ± 4.28°° (range = 20.00°-37.00°° in females. Conclusion: The present study is an endeavor to provide baseline data with reference to the angle of tibial torsion in the Indian population. The results of the study assume special importance in view of the technical advancements in reconstructive surgical procedures in orthopedic practice.

  13. MRI assessment program. Consensus statement on clinical efficacy of MRI

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-05-01

    This consensus statement is largely based on the experience gained at the MRI units at the four hospitals which have operated scanners in the MRI program. It reflects the considered opinion of the radiologists responsible for the MRI services at those hospitals. Account has also been taken of relevant overseas data. This collection of opinion relates particularly to comparison with other imaging modalities. The specific comments will require further consideration as technical developments with MRI become available, additional experience is gained with gadolinium contrast material and additional data are obtained on the influence of MRI on patient management. MRI, at present, is used either to improve diagnostic accuracy when other tests are negative or equivocal, when there is strong clinical suspicion of disease, or to improve surgical or other management planning when the diagnosis known. In some situations (eg syringomyelia, congenital spinal disease, posterior fossa/cerebello-pontine angle tumours) it may entirely replace other tests (eg myelography, air contrast, CT) which are substantially less accurate and/or more invasive. In other situations (eg hemispheric brain tumours, lumbar disc protrusions) when other tests, such as CT, can be as accurate, MRI is not usually or initially indicated because it is currently more expensive and of limited availability. However, balanced against this is the fact that it does not expose the patient to potentially harmful ionising radiation. It is also stressed that MRI images depend on complex, widely variable and, as yet, incompletely understood parameters. There is concern that this may result in false positive diagnoses, especially where MRI is used alone as a screening test, or used as the initial test. For several reasons (availability, cost, medical and diagnostic efficacy), the specific comments on indications for MRI presented are based upon the assumption that MRI is a tertiary and complementary imaging examination

  14. MRI assessment program. Consensus statement on clinical efficacy of MRI

    International Nuclear Information System (INIS)

    This consensus statement is largely based on the experience gained at the MRI units at the four hospitals which have operated scanners in the MRI program. It reflects the considered opinion of the radiologists responsible for the MRI services at those hospitals. Account has also been taken of relevant overseas data. This collection of opinion relates particularly to comparison with other imaging modalities. The specific comments will require further consideration as technical developments with MRI become available, additional experience is gained with gadolinium contrast material and additional data are obtained on the influence of MRI on patient management. MRI, at present, is used either to improve diagnostic accuracy when other tests are negative or equivocal, when there is strong clinical suspicion of disease, or to improve surgical or other management planning when the diagnosis known. In some situations (eg syringomyelia, congenital spinal disease, posterior fossa/cerebello-pontine angle tumours) it may entirely replace other tests (eg myelography, air contrast, CT) which are substantially less accurate and/or more invasive. In other situations (eg hemispheric brain tumours, lumbar disc protrusions) when other tests, such as CT, can be as accurate, MRI is not usually or initially indicated because it is currently more expensive and of limited availability. However, balanced against this is the fact that it does not expose the patient to potentially harmful ionising radiation. It is also stressed that MRI images depend on complex, widely variable and, as yet, incompletely understood parameters. There is concern that this may result in false positive diagnoses, especially where MRI is used alone as a screening test, or used as the initial test. For several reasons (availability, cost, medical and diagnostic efficacy), the specific comments on indications for MRI presented are based upon the assumption that MRI is a tertiary and complementary imaging examination

  15. Clinical frailty syndrome assessment using inertial sensors embedded in smartphones.

    Science.gov (United States)

    Galán-Mercant, A; Cuesta-Vargas, A I

    2015-09-01

    The aim of this study was to identify the series of kinematic variables demonstrating the greatest precision in discriminating between the function of two groups of elderly persons (frail and non-frail) in the 10 m expanded timed up and go (ETUG) test using inertial sensors embedded in the iPhone 4(®). A cross-sectional study was conducted to identify the kinematic variables with the highest degree of precision in discriminating between the two groups. The predicted capability of the kinematic variables was evaluated using receiver operating characteristic curves. The sample comprised 30 participants over 65 years old, 14 frail and 16 non-frail, assessed for frailty syndrome using the Fried criteria. Acceleration variables discriminated between the participant groups in the study; specifically these were the peak negative acceleration variables for motion axes x, y and z. In terms of sensitivity, the values were greater than or equal to those for the variable traditionally used to discriminate in the ETUG test, namely time. The kinematic parameters obtained from the internal inertial sensors in the iPhone 4(®) are promising additions to the ETUG analysis. There are encouraging signs that the analyses of these parameters in the separate phases of the ETUG procedure offer the potential for improved discrimination between frail and non-frail individuals. However, further in-depth study is required to verify the findings. PMID:26245213

  16. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality.

    Directory of Open Access Journals (Sweden)

    Carmel Jacobs

    Full Text Available BACKGROUND: Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS: Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS: Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice

  17. Biological Assessment of a Calcium Silicate Incorporated Hydroxyapatite-Gelatin Nanocomposite: A Comparison to Decellularized Bone Matrix

    Directory of Open Access Journals (Sweden)

    Dong Joon Lee

    2014-01-01

    Full Text Available Our laboratory utilized biomimicry to develop a synthetic bone scaffold based on hydroxyapatite-gelatin-calcium silicate (HGCS. Here, we evaluated the potential of HGCS scaffold in bone formation in vivo using the rat calvarial critical-sized defect (CSD. Twelve Sprague-Dawley rats were randomized to four groups: control (defect only, decellularized bone matrix (DECBM, and HGCS with and without multipotent adult progenitor cells (MAPCs. DECBM was prepared by removing all the cells using SDS and NH4OH. After 12 weeks, the CSD specimens were harvested to evaluate radiographical, histological, and histomorphometrical outcomes. The in vitro osteogenic effects of the materials were studied by focal adhesion, MTS, and alizarin red. Micro-CT analysis indicated that the DECBM and the HGCS scaffold groups developed greater radiopaque areas than the other groups. Bone regeneration, assessed using histological analysis and fluorochrome labeling, was the highest in the HGCS scaffold seeded with MAPCs. The DECBM group showed limited osteoinductivity, causing a gap between the implant and host tissue. The group grafted with HGCS+MAPCs resulting in twice as much new bone formation seems to indicate a role for effective bone regeneration. In conclusion, the novel HGCS scaffold could improve bone regeneration and is a promising carrier for stem cell-mediated bone regeneration.

  18. Biological assessment of a calcium silicate incorporated hydroxyapatite-gelatin nanocomposite: a comparison to decellularized bone matrix.

    Science.gov (United States)

    Lee, Dong Joon; Padilla, Ricardo; Zhang, He; Hu, Wei-Shou; Ko, Ching-Chang

    2014-01-01

    Our laboratory utilized biomimicry to develop a synthetic bone scaffold based on hydroxyapatite-gelatin-calcium silicate (HGCS). Here, we evaluated the potential of HGCS scaffold in bone formation in vivo using the rat calvarial critical-sized defect (CSD). Twelve Sprague-Dawley rats were randomized to four groups: control (defect only), decellularized bone matrix (DECBM), and HGCS with and without multipotent adult progenitor cells (MAPCs). DECBM was prepared by removing all the cells using SDS and NH4OH. After 12 weeks, the CSD specimens were harvested to evaluate radiographical, histological, and histomorphometrical outcomes. The in vitro osteogenic effects of the materials were studied by focal adhesion, MTS, and alizarin red. Micro-CT analysis indicated that the DECBM and the HGCS scaffold groups developed greater radiopaque areas than the other groups. Bone regeneration, assessed using histological analysis and fluorochrome labeling, was the highest in the HGCS scaffold seeded with MAPCs. The DECBM group showed limited osteoinductivity, causing a gap between the implant and host tissue. The group grafted with HGCS+MAPCs resulting in twice as much new bone formation seems to indicate a role for effective bone regeneration. In conclusion, the novel HGCS scaffold could improve bone regeneration and is a promising carrier for stem cell-mediated bone regeneration. PMID:25054149

  19. Neurocognitive clinical outcome assessments for inborn errors of metabolism and other rare conditions.

    Science.gov (United States)

    Shapiro, Elsa; Bernstein, Jessica; Adams, Heather R; Barbier, Ann J; Buracchio, Teresa; Como, Peter; Delaney, Kathleen A; Eichler, Florian; Goldsmith, Jonathan C; Hogan, Melissa; Kovacs, Sarrit; Mink, Jonathan W; Odenkirchen, Joanne; Parisi, Melissa A; Skrinar, Alison; Waisbren, Susan E; Mulberg, Andrew E

    2016-06-01

    Well-defined and reliable clinical outcome assessments are essential for determining whether a drug provides clinically meaningful treatment benefit for patients. In 2015, FDA convened a workshop, "Assessing Neurocognitive Outcomes in Inborn Errors of Metabolism." Topics covered included special challenges of clinical studies of inborn errors of metabolism (IEMs) and other rare diseases; complexities of identifying treatment effects in the context of the dynamic processes of child development and disease progression; and the importance of natural history studies. Clinicians, parents/caregivers, and participants from industry, academia, and government discussed factors to consider when developing measures to assess treatment outcomes, as well as tools and methods that may contribute to standardizing measures. Many issues examined are relevant to the broader field of rare diseases in addition to specifics of IEMs. PMID:27132782

  20. A Dynamic Imaging Database for 3-D Morphologic Analysis and Clinical Assessment in Diagnostic Radiology

    OpenAIRE

    Niculescu, Gabriela; Toni, Louay; Foran, David J.; Nosher, John L.; DeMarco, J. Kevin

    2002-01-01

    Modern imaging techniques such as MRI and CT have become invaluable clinical and research tools for visualizing internal organs and anatomic structures, non-invasively. We present a dynamic imaging database for performing comparative morphologic studies in diagnostic radiology to facilitate clinical assessment. The prototype system utilizes a double elliptic Fourier transform to characterize shape in three dimensions. A prototype system was used to evaluate neuroanatomy from MR brain scans of...

  1. Neuromuscular function in patients with Subacromial Impingement Syndrome and clinical assessment of scapular kinematics

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Lund, Hans; Juul-Kristensen, Birgit;

    Occupational Therapy, Bergen University College, Bergen, Norway 3National Research Centre for the Working Environment, Copenhagen, DK E-mail: cmlarsen@health.sdu.dk AIMS: The aims were to understand potential mechanisms for impairment in the neuromuscular function of the scapular stabilisers in a general...... with SIS, however, SIS patients may benefit from biofeedback training. Lastly, these results indicate that very few clinical assessment methods have sufficient clinimetric properties that can be recommended for clinical use....

  2. ASSESSMENT OF UTI IN POSTMENOPAUSAL WOMEN ATTENDING OPD CLINIC OF CHITWAN MEDICAL COLLEGE, BHARATPUR, CHITWAN, NEPAL

    OpenAIRE

    Mamata Sharma Neupane; Kalpana Dhakal Sharma; Sangharshila Basnet; Pratik Adhikary; Harish Chandra Neupane; Bijay Aryal

    2013-01-01

    Urinary tract infection (UTI) is the most common bacterial infection in young and elderly women. Despite the higher incidence of bacteriuria in elderly women, most UTI research has been conducted in young women. Hence, the present paper investigates the assessment of UTI in postmenopausal women attending OPD Clinic of Chitwan Medical College, Bharatpur, Chitwan, Nepal. A cross-sectional study was conducted in OPD clinic of Chitwan Medical College Teaching Hospital from December, 2012 to April...

  3. Improving the clinical assessment of consciousness with advances in electrophysiological and neuroimaging techniques

    OpenAIRE

    D'Arcy Ryan CN; Gawryluk Jodie R; Connolly John F; Weaver Donald F

    2010-01-01

    Abstract In clinical neurology, a comprehensive understanding of consciousness has been regarded as an abstract concept - best left to philosophers. However, times are changing and the need to clinically assess consciousness is increasingly becoming a real-world, practical challenge. Current methods for evaluating altered levels of consciousness are highly reliant on either behavioural measures or anatomical imaging. While these methods have some utility, estimates of misdiagnosis are worriso...

  4. Development of Standardized Clinical Assessment and Management Plans (SCAMPs) in Plastic and Reconstructive Surgery

    OpenAIRE

    Caterson, Stephanie A.; Singh, Mansher; Orgill, Dennis; Ghazinouri, Roya; Ciociolo, George; Laskowski, Karl; Greenberg, Jeffery O.

    2015-01-01

    Background: With rising cost of healthcare, there is an urgent need for developing effective and economical streamlined care. In clinical situations with limited data or conflicting evidence-based data, there is significant institutional and individual practice variation. Quality improvement with the use of Standardized Clinical Assessment and Management Plans (SCAMPs) might be beneficial in such scenarios. The SCAMPs method has never before been reported to be utilized in plastic surgery. Me...

  5. The modification of the thrombin generation test for the clinical assessment of dabigatran etexilate efficiency

    OpenAIRE

    Gribkova, Irina V.; Lipets, Elena N; Rekhtina, Irina G.; Alex I. Bernakevich; Ayusheev, Dorzho B.; Ruzanna A. Ovsepyan; Ataullakhanov, Fazoil I.; Elena I Sinauridze

    2016-01-01

    A new oral anticoagulant, dabigatran etexilate (DE, a prodrug of direct thrombin inhibitor (DTI) dabigatran), has been used clinically to prevent thrombosis. The assessment of dabigatran efficiency is necessary in some clinical cases, such as renal insufficiency, risk of bleeding, and drug interactions. However, a specific thrombin generation test (TGT) that is one of the most informative and sensitive to anticoagulant therapy (calibrated automated thrombinography (САТ)) shows a paradoxical i...

  6. Assessing depression in youth at clinical high risk for psychosis: a comparison of three measures

    OpenAIRE

    DeVylder, Jordan; Yang, Lawrence; Harkavy-Friedman, Jill; Azimov, Neyra; Walder, Deborah; Corcoran, Cheryl

    2013-01-01

    Depressive symptoms are prevalent among individuals at clinical high-risk (CHR) for psychosis. Prior studies have used the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), and the “dysphoric mood” item of the Scale of Prodromal Symptoms (SOPS) to assess depressive symptoms in CHR samples. We compared the psychometric properties of these instruments in a CHR cohort, to support the selection of appropriate depressive symptoms measures in future studies and in clinical s...

  7. Incorporating socio-environmental considerations into project assessment models using multi-criteria analysis: A case study of Sri Lankan hydropower projects

    International Nuclear Information System (INIS)

    Before commissioning any energy projects, conducting robust assessments of different options in terms of their economic and socio-environmental impacts is important for successful project implementation. Yet, there is currently a lack of tools that simultaneously assess sustainability impacts; instead, they are often investigated separately, which gives decision makers somehow disintegrated information. Thus the main objective of this study is to examine how to incorporate socio-environmental considerations into project assessment models. The multi-criteria analysis is applied to the case study of Sri Lankan hydropower projects as an illustrative example. The estimated quantitative relationship between economic, environmental and social impacts of hydropower development is presented in this study. Such estimation, using sustainability indicators of hydropower projects, enables us to understand marginal trade-offs among economic, environmental and social objectives of hydropower development. Hence, this would provide an overview of potential impacts of different scenarios that are designed to be implemented and indicate an optimum mix of hydropower generation. - Highlights: • This study provides an effective hydropower project evaluation method using the MCA. • The proposed tool shows the quantitative relationship explicitly. • Marginal trade-offs between sustainability objectives are presented

  8. In vivo dopamine receptor assessment for clinical studies using positron emission tomography

    International Nuclear Information System (INIS)

    A discussion is presented of techniques to determine cerebral DA-receptor function in vivo and possible (future) applications of such techniques in clinical studies. A brief summary is given on existing approaches that are of particular clinical interest. The emphasis is laid on the in vivo receptor binding techniques, which have become of clinical interest with the advent of positron emission tomography. Both possibilities and limitations of the present methods to assess DA receptors and possible relationships to pathological or behavioral manifestations are described. (author)

  9. Using the script concordance test to assess clinical reasoning skills in undergraduate and postgraduate medicine.

    Science.gov (United States)

    Wan, S H

    2015-10-01

    The script concordance test is a relatively new format of written assessment that is used to assess higher-order clinical reasoning and data interpretation skills in medicine. Candidates are presented with a clinical scenario, followed by the reveal of a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability or likelihood of a particular diagnostic, investigative, or management decision. To score these questions, the candidate's decision in each question is compared with that of a reference panel of expert clinicians. This review focuses on the development of quality script concordance questions, using expert panellists to score the items and set the passing score standard, and the challenges in the practical implementation (including pitfalls to avoid) of the written assessment. PMID:26314569

  10. Training needs assessment for clinicians at antiretroviral therapy clinics: evidence from a national survey in Uganda

    Directory of Open Access Journals (Sweden)

    Namagala Elizabeth

    2009-08-01

    Full Text Available Abstract Background To increase access to antiretroviral therapy in resource-limited settings, several experts recommend "task shifting" from doctors to clinical officers, nurses and midwives. This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy training needs among clinicians to whom tasks have shifted. Methods The Infectious Diseases Institute, in collaboration with the Ugandan Ministry of Health, surveyed health professionals and heads of antiretroviral therapy clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed, previous human immunodeficiency virus training, and self-assessment of knowledge of human immunodeficiency virus and antiretroviral therapy. Heads of the antiretroviral therapy clinics reported on clinic characteristics. Results Thirty of 33 doctors (91%, 24 of 40 clinical officers (60%, 16 of 114 nurses (14% and 13 of 54 midwives (24% who worked in accredited antiretroviral therapy clinics reported that they prescribed this therapy (p Conclusion Training initiatives should be an integral part of the support for task shifting and ensure that antiretroviral therapy is used correctly and that toxicity or drug resistance do not reverse accomplishments to date.

  11. Methods Used in Internal Industry Clinical Trials to Assess Tobacco Risk Reduction

    Science.gov (United States)

    Rees, Vaughan W.; Kreslake, Jennifer M.; O’Connor, Richard J.; Cummings, K. Michael; Parascandola, Mark; Hatsukami, Dorothy; Shields, Peter G.; Connolly, Gregory N.

    2009-01-01

    Objective Methods to assess reduced exposure products should include those which aid in determining likely patterns of human use and exposure. Tobacco industry clinical trial methods may provide insight into strategies to assess potential reduced exposure products (PREPs) for public health purposes. Internal tobacco industry documents detailing human clinical research with PREPs were examined to document major research strategies used and identify potentially fruitful methods not currently used in the mainstream arena. Methods Primary data were obtained from records of research conducted internally by tobacco companies and affiliated researchers, and included manuscript drafts, presentations, protocols, and instruments relating to internal clinical trials of human tobacco use and exposure. Results Tobacco industry clinical research has focused on reduced exposure products, most notably Premier, Accord and Eclipse. The most widely used strategy observed was switching studies, and details of study designs and protocols favored by the industry are described. Key measures include biomarkers of exposure (e.g. cotinine, CO and specific carcinogens), and acute health effects such as physical health and fitness. Conclusions Tobacco industry clinical research has used relatively standard switching study methods, but with a broad set of measures. Clinical switching studies have been conducted by the industry primarily to support existing claims or to develop new claims. Knowledge of prior industry activity can guide and inform future public health research efforts. While industry clinical trial methods are comparable to current mainstream methods, limited information about the validity of outcome measures used limit their viability for immediate adoption in mainstream science. PMID:19959673

  12. Official position of the American Academy of Clinical Neuropsychology on serial neuropsychological assessments: the utility and challenges of repeat test administrations in clinical and forensic contexts.

    Science.gov (United States)

    Heilbronner, Robert L; Sweet, Jerry J; Attix, Deborah K; Krull, Kevin R; Henry, George K; Hart, Robert P

    2010-11-01

    Serial assessments are now common in neuropsychological practice, and have a recognized value in numerous clinical and forensic settings. These assessments can aid in differential diagnosis, tracking neuropsychological strengths and weaknesses over time, and managing various neurologic and psychiatric conditions. This document provides a discussion of the benefits and challenges of serial neuropsychological testing in the context of clinical and forensic assessments. Recommendations regarding the use of repeated testing in neuropsychological practice are provided. PMID:21108148

  13. Motor problems in children with ADHD and clinical effects of Methylphenidate as assessed with the MFNU

    OpenAIRE

    Stray, Liv Larsen

    2009-01-01

    The Motor Function Neurological Assessment (MFNU) has been developed over a 25 year period based on clinical observations and assessments of children referred for evaluation of possible Attention Deficit Hyperactivity Disorder (ADHD)/Hyperkinetic disorder (HKD). The sub-tests of the MFNU were constructed to demonstrate these motor problems to parents and teachers of these children, and to make changes in motor performance observable when the child was medicated with Methylphenidate (...

  14. Improvement of interpretation in cystic fibrosis clinical laboratory reports: longitudinal analysis of external quality assessment data

    OpenAIRE

    Berwouts, Sarah; Girodon, Emmanuelle; Schwarz, Martin; Stuhrmann, Manfred; Morris, Michael A.; Dequeker, Elisabeth

    2012-01-01

    Participation in external quality assessment (EQA) is a key element of quality assurance in medical laboratories. In genetics EQA, both genotyping and interpretation are assessed. We aimed to analyse changes in the completeness of interpretation in clinical laboratory reports of the European cystic fibrosis EQA scheme and to investigate the effect of the number of previous participations, laboratory accreditation/certification status, setting and test volume. We distributed similar versions o...

  15. Development of Detailed Clinical Models for Nursing Assessments and Nursing Interventions

    OpenAIRE

    Park, Hyeoun-Ae; Min, Yul Ha; Kim, Younglan; Lee, Myung Kyung; Lee, Youngji

    2011-01-01

    Objectives The aim of this study was to develop and validate Detailed Clinical Models (DCMs) for nursing assessments and interventions. Methods First, we identified the nursing assessment and nursing intervention entities. Second, we identified the attributes and the attribute values in order to describe the entities in more detail. The data type and optionality of the attributes were then defined. Third, the entities, attributes and value sets in the DCMs were mapped to the International Cla...

  16. Preschool Anxiety Disorders: Comprehensive Assessment of Clinical, Demographic, Temperamental, Familial, and Life Stress Correlates

    OpenAIRE

    Dougherty, Lea R.; Tolep, Marissa R.; Bufferd, Sara J.; Olino, Thomas M.; Dyson, Margaret; Traditi, Jennifer; Rose, Suzanne; Carlson, Gabrielle A.; Klein, Daniel N.

    2013-01-01

    This study examined correlates of preschoolers’ anxiety disorders using a comprehensive, multi-method design. Participants included a community sample of 541 three-year-old children, of whom 106 (19.6%) met criteria for at least one anxiety disorder. Child and parental psychopathology and life stress were assessed with clinical interviews. Child temperament and parenting behavior were assessed with laboratory observations. Mothers and fathers reported on their parenting styles. Compared to pr...

  17. Developing a viva exam to assess clinical reasoning in pre-registration osteopathy students

    OpenAIRE

    Orrock, Paul; Grace, Sandra; Vaughan, Brett; Coutts, Rosanne

    2014-01-01

    Background Clinical reasoning (CR) is a core capability for health practitioners. Assessing CR requires a suite of tools to encompass a wide scope of contexts and cognitive abilities. The aim of this project was to develop an oral examination and grading rubric for the assessment of CR in osteopathy, trial it with senior students in three accredited university programs in Australia and New Zealand, and to evaluate its content and face validity. Methods Experienced osteopathic academics develo...

  18. Entrustability Scales: Outlining Their Usefulness for Competency-Based Clinical Assessment.

    Science.gov (United States)

    Rekman, Janelle; Gofton, Wade; Dudek, Nancy; Gofton, Tyson; Hamstra, Stanley J

    2016-02-01

    Meaningful residency education occurs at the bedside, along with opportunities for situated in-training assessment. A necessary component of workplace-based assessment (WBA) is the clinical supervisor, whose subjective judgments of residents' performance can yield rich and nuanced ratings but may also occasionally reflect bias. How to improve the validity of WBA instruments while simultaneously capturing meaningful subjective judgment is currently not clear. This Perspective outlines how "entrustability scales" may help bridge the gap between the assessment judgments of clinical supervisors and WBA instruments. Entrustment-based assessment evaluates trainees against what they will actually do when independent; thus, "entrustability scales"-defined as behaviorally anchored ordinal scales based on progression to competence-reflect a judgment that has clinical meaning for assessors. Rather than asking raters to assess trainees against abstract scales, entrustability scales provide raters with an assessment measure structured around the way evaluators already make day-to-day clinical entrustment decisions, which results in increased reliability. Entrustability scales help raters make assessments based on narrative descriptors that reflect real-world judgments, drawing attention to a trainee's readiness for independent practice rather than his/her deficiencies. These scales fit into milestone measurement both by allowing an individual resident to strive for independence in entrustable professional activities across the entire training period and by allowing residency directors to identify residents experiencing difficulty. Some WBA tools that have begun to use variations of entrustability scales show potential for allowing raters to produce valid judgments. This type of anchor scale should be brought into wider circulation. PMID:26630609

  19. Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research.

    Science.gov (United States)

    Land, Stephanie R; Toll, Benjamin A; Moinpour, Carol M; Mitchell, Sandra A; Ostroff, Jamie S; Hatsukami, Dorothy K; Duffy, Sonia A; Gritz, Ellen R; Rigotti, Nancy A; Brandon, Thomas H; Prindiville, Sheila A; Sarna, Linda P; Schnoll, Robert A; Herbst, Roy S; Cinciripini, Paul M; Leischow, Scott J; Dresler, Carolyn M; Fiore, Michael C; Warren, Graham W

    2016-04-15

    There is strong evidence that cigarette smoking causes adverse outcomes in people with cancer. However, more research is needed regarding those effects and the effects of alternative tobacco products and of secondhand smoke, the effects of cessation (before diagnosis, during treatment, or during survivorship), the biologic mechanisms, and optimal strategies for tobacco dependence treatment in oncology. Fundamentally, tobacco is an important source of variation in clinical treatment trials. Nevertheless, tobacco use assessment has not been uniform in clinical trials. Progress has been impeded by a lack of consensus regarding tobacco use assessment suitable for cancer patients. The NCI-AACR Cancer Patient Tobacco Use Assessment Task Force identified priority research areas and developed recommendations for assessment items and timing of assessment in cancer research. A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve the measurement items. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes "Core" items for minimal assessment of tobacco use at initial and follow-up time points, and an "Extension" set. Domains include the following: cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption of the recommended measures and timing protocol, and pursuit of the recommended research priorities, will help us to achieve a clearer understanding of the significance of tobacco use and cessation for cancer patients.Clin Cancer Res; 22(8); 1907-13. ©2016 AACR. PMID:26888828

  20. Caries Risk Assessment for Determination of Focus and Intensity of Prevention in a Dental School Clinic.

    Science.gov (United States)

    Dodds, Michael W. J.; Suddick, Richard P.

    1995-01-01

    A study at the University of Texas, San Antonio's dental school resulted in development of a system of caries risk assessment, applied to all undergraduate clinic patients. The rationale, structure, elements, and application of the system are outlined, and course content supporting the system is noted. Need for validation and other improvements is…

  1. Clinical assessment of spasticity in children with cerebral palsy: A critical review of available instruments

    NARCIS (Netherlands)

    V.A.B. Scholtes; J.G. Becher; A. Beelen; G.J. Lankhorst

    2006-01-01

    This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase, an

  2. An Objective Structured Clinical Examination to Assess Problem-Based Learning

    OpenAIRE

    Salinitri, Francine D.; O'Connell, Mary Beth; Garwood, Candice L.; Lehr, Victoria Tutag; Abdallah, Karina

    2012-01-01

    Objectives. To compare pharmacy students’ performance on an objective structured clinical examination (OSCE) to their performance on a written examination for the assessment of problem-based learning (PBL); and to determine students’ and faculty members’ perceptions of OSCEs for PBL evaluations.

  3. The Value of Item Response Theory in Clinical Assessment: A Review

    Science.gov (United States)

    Thomas, Michael L.

    2011-01-01

    Item response theory (IRT) and related latent variable models represent modern psychometric theory, the successor to classical test theory in psychological assessment. Although IRT has become prevalent in the measurement of ability and achievement, its contributions to clinical domains have been less extensive. Applications of IRT to clinical…

  4. Early Identification of High-Ability Students: Clinical Assessment of Behavior

    Science.gov (United States)

    Bracken, Bruce A.; Brown, Elissa F.

    2008-01-01

    This study investigated the ability of teachers to accurately rate the cognitive and academic functioning of 1,375 students in kindergarten through the third grade on the Clinical Assessment of Behavior (CAB), as compared to two objective cognitive ability tests. CAB teacher ratings were compared for high-ability students who were currently…

  5. [Supporting the clinical assessment: from a printed handbook to its digital version].

    Science.gov (United States)

    Jouy, Isabelle; Pagadoy, Nathalie

    2016-03-01

    Nurses from a palliative care network questioned the methods of the global clinical assessment performed in patients' homes. Going back to the very foundations of the profession, they drew up a handbook on this subject aimed at home care professionals. An embedded digital version has been developed enabling caregivers to consult it at any time on their mobile telephone. PMID:26944646

  6. Clinical examination and physical assessment of hip joint-related pain in athletes

    DEFF Research Database (Denmark)

    Reiman, Michael P; Thorborg, Kristian

    2014-01-01

    UNLABELLED: Evidence-based clinical examination and assessment of the athlete with hip joint related pain is complex. It requires a systematic approach to properly differentially diagnose competing potential causes of athletic pain generation. An approach with an initial broad focus (and hence us...

  7. Handbook of Cross-Cultural and Multicultural Personality Assessment. Personality and Clinical Psychology Series.

    Science.gov (United States)

    Dana, Richard H., Ed.

    This collection of papers includes: (1) "An Assessment-Intervention Model for Research and Practice with Multicultural Populations" (Richard H. Dana); (2) "An Africentric Perspective for Clinical Research and Practice" (Edward F. Morris); (3) "Myths about the Null Hypothesis and the Path to Reform" (Robert G. Malgady); (4) "A Construct-Based…

  8. Improving the clinical assessment of consciousness with advances in electrophysiological and neuroimaging techniques

    Directory of Open Access Journals (Sweden)

    D'Arcy Ryan CN

    2010-01-01

    Full Text Available Abstract In clinical neurology, a comprehensive understanding of consciousness has been regarded as an abstract concept - best left to philosophers. However, times are changing and the need to clinically assess consciousness is increasingly becoming a real-world, practical challenge. Current methods for evaluating altered levels of consciousness are highly reliant on either behavioural measures or anatomical imaging. While these methods have some utility, estimates of misdiagnosis are worrisome (as high as 43% - clearly this is a major clinical problem. The solution must involve objective, physiologically based measures that do not rely on behaviour. This paper reviews recent advances in physiologically based measures that enable better evaluation of consciousness states (coma, vegetative state, minimally conscious state, and locked in syndrome. Based on the evidence to-date, electroencephalographic and neuroimaging based assessments of consciousness provide valuable information for evaluation of residual function, formation of differential diagnoses, and estimation of prognosis.

  9. Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework.

    Science.gov (United States)

    Pearson, David G; Deeprose, Catherine; Wallace-Hadrill, Sophie M A; Burnett Heyes, Stephanie; Holmes, Emily A

    2013-02-01

    Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of studies across experimental psychology and clinical psychology in order to highlight the key domains and measures most likely to be of relevance. This includes a consideration of methods for experimentally assessing the generation, maintenance, inspection and transformation of mental images; as well as subjective measures of characteristics such as image vividness and clarity. We present a guiding framework in which we propose that cognitive, subjective and clinical aspects of imagery should be explored in future research. The guiding framework aims to assist researchers in the selection of measures for assessing those aspects of mental imagery that are of most relevance to clinical psychology. We propose that a greater understanding of the role of mental imagery in clinical disorders will help drive forward advances in both theory and treatment. PMID:23123567

  10. Features of assessment learners use to make informed self-assessments of clinical performance.

    NARCIS (Netherlands)

    Sargeant, J.; Eva, K.W.; Armson, H.; Chesluk, B.; Dornan, T.; Holmboe, E.; Lockyer, J.M.; Loney, E.; Mann, K.V.; Vleuten, C.P.M. van der

    2011-01-01

    CONTEXT: Conceptualisations of self-assessment are changing as its role in professional development comes to be viewed more broadly as needing to be both externally and internally informed through activities that enable access to and the interpretation and integration of data from external sources.

  11. Students’ perceptions regarding the objective, structured, clinical evaluation as an assessment approach

    Directory of Open Access Journals (Sweden)

    Louis Frederick Small

    2013-04-01

    Full Text Available The nursing profession is characterised by the fact that a significant amount of time is spent on competency-related activities. The assessment of clinical competence is therefore an important issue in nursing education and the utilisation of objective structured clinical evaluation for that purpose was considered to be very important in this study. The objective of this research was to explore and describe the perceptions of first- and third-year student nurses with regard to the objective structured clinical evaluation assessment approach. A quantitative, cross-sectional, analytical research design was used. The instrument was a questionnaire (ordinal. This questionnaire focused on the perceptions of student nurses with regard to the objective structured clinical evaluation approach in particular, and with regard to aspects such as reality, execution, time allocation and student and assessor variables. The findings indicated that, as an assessment tool, the objective structured clinical evaluation approach was perceived as not being totally realistic, especially by the more senior nursing students (third-year as compared with the first-year nursing students. Varying degrees of stress were experienced by the nursing students in their first and third years but, in general, the overall perception appeared to be that the approach was well organised and that the respective students would be able to perform equally well in the clinical field. It may be concluded that the majority of students appreciate the format of the objective structured clinical evaluation approach. However, the study further highlighted the fact that more extensive training of students on time management and the relief of emotional stress is necessary during the implementation of this approach.

  12. A contemporary perspective on techniques for the clinical assessment of alveolar bone

    Energy Technology Data Exchange (ETDEWEB)

    Hausmann, E. (State Univ. of New York, Buffalo (USA))

    1990-03-01

    Radiographic techniques, traditional ones as well as newer ones under development, for clinically assessing alveolar bone are critically assessed. Traditional intraoral radiography is reexamined, in particular with regard to the accuracy with which the alveolar crest is seen. Evidence is presented for a more accurate representation of the alveolar crest on bitewings rather than periapical films. Application in periodontics of newer radiographic techniques, subtraction radiography, and single and dual photon aborptiometry presently under clinical development are discussed in regard to their potential and limitations. Similarly, radiopharmaceuticals to evaluate the metabolic status of alveolar bone are discussed as well as the potential for using analyses of gingival crevice fluid as a window for assessment of alveolar crest metabolism. 46 references.

  13. Atlas-based liver segmentation and hepatic fat-fraction assessment for clinical trials.

    Science.gov (United States)

    Yan, Zhennan; Zhang, Shaoting; Tan, Chaowei; Qin, Hongxing; Belaroussi, Boubakeur; Yu, Hui Jing; Miller, Colin; Metaxas, Dimitris N

    2015-04-01

    Automated assessment of hepatic fat-fraction is clinically important. A robust and precise segmentation would enable accurate, objective and consistent measurement of hepatic fat-fraction for disease quantification, therapy monitoring and drug development. However, segmenting the liver in clinical trials is a challenging task due to the variability of liver anatomy as well as the diverse sources the images were acquired from. In this paper, we propose an automated and robust framework for liver segmentation and assessment. It uses single statistical atlas registration to initialize a robust deformable model to obtain fine segmentation. Fat-fraction map is computed by using chemical shift based method in the delineated region of liver. This proposed method is validated on 14 abdominal magnetic resonance (MR) volumetric scans. The qualitative and quantitative comparisons show that our proposed method can achieve better segmentation accuracy with less variance comparing with two other atlas-based methods. Experimental results demonstrate the promises of our assessment framework. PMID:24962337

  14. Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation

    Directory of Open Access Journals (Sweden)

    Elizabeth C. Ward

    2013-01-01

    employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management.

  15. Professional Development Needs of Novice Nursing Clinical Teachers: A Rapid Evidence Assessment.

    Science.gov (United States)

    Jetha, Farah; Boschma, Geertje; Clauson, Marion

    2016-01-01

    The current nursing profession is challenged with a decreasing supply of competent clinical teachers due to several factors consequently impacting the quality of nursing education. To meet this demand, academic nursing programs are resorting to hiring expert nurses who may have little or no teaching experience. They need support during their transition from practice to teaching. Using the systematic approach of a Rapid Evidence Assessment (REA), scholarly literature was reviewed to identify existing professional development needs for novice clinical teachers as well as supportive strategies to aid the transition of experienced nurses into teaching practice. The REA included 29 relevant studies. Findings revealed three main professional development needs for novice clinical teachers and key supportive strategies. Based on these findings recommendations for best practices to support and prepare novice clinical teachers are presented. PMID:26918271

  16. Sharing clinical information across care settings: the birth of an integrated assessment system

    Directory of Open Access Journals (Sweden)

    Henrard Jean-Claude

    2009-04-01

    Full Text Available Abstract Background Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.

  17. Magnetic resonance lung function – a breakthrough for lung imaging and functional assessment? A phantom study and clinical trial

    Directory of Open Access Journals (Sweden)

    Rauh Manfred

    2006-08-01

    Full Text Available Abstract Background Chronic lung diseases are a major issue in public health. A serial pulmonary assessment using imaging techniques free of ionizing radiation and which provides early information on local function impairment would therefore be a considerably important development. Magnetic resonance imaging (MRI is a powerful tool for the static and dynamic imaging of many organs. Its application in lung imaging however, has been limited due to the low water content of the lung and the artefacts evident at air-tissue interfaces. Many attempts have been made to visualize local ventilation using the inhalation of hyperpolarized gases or gadolinium aerosol responding to MRI. None of these methods are applicable for broad clinical use as they require specific equipment. Methods We have shown previously that low-field MRI can be used for static imaging of the lung. Here we show that mathematical processing of data derived from serial MRI scans during the respiratory cycle produces good quality images of local ventilation without any contrast agent. A phantom study and investigations in 85 patients were performed. Results The phantom study proved our theoretical considerations. In 99 patient investigations good correlation (r = 0.8; p ≤ 0.001 was seen for pulmonary function tests and MR ventilation measurements. Small ventilation defects were visualized. Conclusion With this method, ventilation defects can be diagnosed long before any imaging or pulmonary function test will indicate disease. This surprisingly simple approach could easily be incorporated in clinical routine and may be a breakthrough for lung imaging and functional assessment.

  18. Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial.

    Science.gov (United States)

    Hashem, D; Mannocci, F; Patel, S; Manoharan, A; Brown, J E; Watson, T F; Banerjee, A

    2015-04-01

    The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is

  19. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

    Directory of Open Access Journals (Sweden)

    Erik E. Langenau

    2012-07-01

    Full Text Available Background: High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods: Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC were conducted to determine consistency across different specialties. Results: Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%, advanced cardiovascular life support (ACLS (91.1%, basic life support (BLS (90.0%, interpretation of electrocardiogram (89.4% and blood gas (88.7%. Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%, sterile technique (67.2%, BLS (68.9%, ACLS (65.9% and phlebotomy (63.5%. Discussion: Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the

  20. BENCHPAR PROJECT. How to Incorporate ThermaI-Hydro-Mechanical Coupled Processes into Performance Assessments and Design Studies for Radioactive Waste Disposal in Geological Formations. Guidance Document

    Energy Technology Data Exchange (ETDEWEB)

    Stephansson, O. [Royal Inst. of Technology, Stockholm (Sweden). Engineering Geology; Hudson, J.A. [Rock Engineering Consultants, Welwyn Garden City (United Kingdom); Andersson, Johan [JA Streamflow AB, Aelvsjoe (Sweden)

    2005-02-15

    The objective of this Guidance Document is to provide advice on how to incorporate thermo-hydro-mechanical (THM) coupled processes into Performance Assessments (PAS) and design studies for radioactive waste disposal in geological formations to be experienced in a European context. The document has been generated by the EU research project BENCHPAR: Benchmark Tests and Guidance on Coupled Processes for Performance Assessment of Nuclear Waste Repositories. The document starts in Section 1 with an explanation of why numerical analyses incorporating THM mechanisms are required for radioactive waste studies and provides background material on the subject. Then, the THM processes and their interactions are explained in Section 2. Three case examples of THM numerical analysis are presented in Section 3 to illustrate the type of work that can be conducted to study the near-field, upscaling, and the far-field. For the three cases, there is discussion on the main findings, the relevance to a safety case, the relative importance of the different couplings, and the uncertainties involved. The importance and priority of the THM couplings are then summarized in Section 4. It is especially important to be able to technically audit the numerical analyses in order to establish that all the relevant variables, parameters and mechanisms have been included in the modelling and hence that the numerical model adequately represents the rock and engineering reality. Accordingly, recommended soft and hard auditing procedures are presented in Section 5. In this Guidance Document, we emphasize especially that the most important step in numerical modelling is not executing the calculations per se, but the earlier conceptualization of the problem regarding the dominant processes, the material properties and parameters, the engineering perturbations, and their mathematical presentations. The associated modelling component of addressing the uncertainties and estimating their influence on the

  1. BENCHPAR PROJECT. How to Incorporate ThermaI-Hydro-Mechanical Coupled Processes into Performance Assessments and Design Studies for Radioactive Waste Disposal in Geological Formations. Guidance Document

    International Nuclear Information System (INIS)

    The objective of this Guidance Document is to provide advice on how to incorporate thermo-hydro-mechanical (THM) coupled processes into Performance Assessments (PAS) and design studies for radioactive waste disposal in geological formations to be experienced in a European context. The document has been generated by the EU research project BENCHPAR: Benchmark Tests and Guidance on Coupled Processes for Performance Assessment of Nuclear Waste Repositories. The document starts in Section 1 with an explanation of why numerical analyses incorporating THM mechanisms are required for radioactive waste studies and provides background material on the subject. Then, the THM processes and their interactions are explained in Section 2. Three case examples of THM numerical analysis are presented in Section 3 to illustrate the type of work that can be conducted to study the near-field, upscaling, and the far-field. For the three cases, there is discussion on the main findings, the relevance to a safety case, the relative importance of the different couplings, and the uncertainties involved. The importance and priority of the THM couplings are then summarized in Section 4. It is especially important to be able to technically audit the numerical analyses in order to establish that all the relevant variables, parameters and mechanisms have been included in the modelling and hence that the numerical model adequately represents the rock and engineering reality. Accordingly, recommended soft and hard auditing procedures are presented in Section 5. In this Guidance Document, we emphasize especially that the most important step in numerical modelling is not executing the calculations per se, but the earlier conceptualization of the problem regarding the dominant processes, the material properties and parameters, the engineering perturbations, and their mathematical presentations. The associated modelling component of addressing the uncertainties and estimating their influence on the

  2. Welfare assessment: correlations and integration between a Qualitative Behavioural Assessment and a clinical/ health protocol applied in veal calves farms

    Directory of Open Access Journals (Sweden)

    Cornelis G. Van Reenen

    2010-01-01

    Full Text Available This study is aimed at finding correlations and possible integration among Qualitative Behavioural Assessment (QBA and a specific protocol of clinical/health evaluation. Both welfare assessment methods were based on direct animal observation and were applied in 24 Italian veal calves farms at 3 weeks (wks of rearing. Principal component analysis (PCA summarized 20 QBA descriptors on two main components (PC1 and PC2 with eigenvalues above 4 and explaining 29.6 and 20.3% of the variation respectively. PCA on residuals obtained after correcting for housing condition yielded highly similar results, indicating that the rearing environment of the calves was not an important determinant of the observer reliability of QBA. A relationship was found between QBA PC2 and the presence of signs of cross-sucking recorded during the clinical visit (presence PC2=1.11 vs. absence PC2=-1.55, P<0.001. There were no other relations between the quantitative clinical measures and QBA PC’s. The frequency of farmer, veterinarian, or industry technician visits to the veal unit significantly affected QBA PC1 and PC2 scores. These results suggest that the 2 methods provide complementary types of information and can each make valid a contribution to an integrated animal welfare monitoring scheme.

  3. Rapid full-field OCT assessment of clinical tissue specimens (Conference Presentation)

    Science.gov (United States)

    Dalimier, Eugénie; Harms, Fabrice; Brossollet, Charles; Benoit, Emilie; Martins, Franck; Boccara, Claude A.

    2016-03-01

    FFOCT (Full Field Optical Coherence Tomography) is a novel optical technology that gives access to very high resolution tomography images of biological tissues within minutes, non-invasively. This makes it an attractive tool to bridge the gap between medical imaging modalities (MRI, ultrasound, CT) used for cancer lesion identification or targeting and histological diagnosis. Clinical tissue specimens, such as surgical cancer margins or biopsies, can potentially be assessed rapidly, by the clinician, in the aim to help him decide on the course of action. A fast FFOCT prototype was built, that provides 1cm2 images with 1 µm resolution in 1 minute, and can accommodate samples up to 50mm diameter. Specific work was carried out to implement a large sample holder, high-speed image acquisition system, optimized scanning, and accelerated GPU tiles stitching. Results obtained on breast, urology, and digestive tissues show the efficiency of the technique for the detection of cancer on clinical tissue specimens, and reinforce the clinical relevance of the technique. The technical and clinical results show that the fast FFOCT system can successfully be used for a fast assessment of cancer excision margins or biopsies providing a very valuable tool in the clinical environment.

  4. Assessing Competencies in a Master of Science in Clinical Research Program: The Comprehensive Competency Review.

    Science.gov (United States)

    Robinson, Georgeanna F W B; Moore, Charity G; McTigue, Kathleen M; Rubio, Doris M; Kapoor, Wishwa N

    2015-12-01

    Competencies in Master of Science Clinical Research programs are becoming increasingly common. However, students and programs can only benefit fully from competency-based education if students' competence is formally assessed. Prior to a summative assessment, students must have at least one formative, formal assessment to be sure they are developing competence appropriate for their stage of training. This paper describes the comprehensive competency review (CCR), a milestone for MS students in Clinical Research at the University of Pittsburgh's Institute for Clinical Research Education. The CCR involves metacognitive reflection of the student's learning as a whole, written evidence of each competency, a narrative explaining the choice of evidence for demonstrating competencies, and a meeting in which two faculty members review the evidence and solicit further oral evidence of competence. CCRs allow for individualized feedback at the midpoint in degree programs, providing students with confidence that they will have the means and strategies to develop competence in all areas by the summative assessment of competence at their thesis defense. CCRs have also provided programmatic insight on the need for curricular revisions and additions. These benefits outweigh the time cost on the part of students and faculty in the CCR process. PMID:26332763

  5. Validation of the Rowland universal dementia assessment scale for multicultural screening in Danish memory clinics

    DEFF Research Database (Denmark)

    Nielsen, T Rune; Andersen, Birgitte Bo; Gottrup, Hanne; Lützhøft, Jan; Høgh, Peter; Waldemar, Gunhild

    Background/Aims: The Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive screening test that was developed to detect dementia in multicultural populations. The RUDAS has not previously been validated in multicultural populations outside of Australia. The aim of this study was...... to evaluate the diagnostic accuracy of the RUDAS in a multicultural sample of patients referred to Danish memory clinics. Methods: Data were collected from 137 consecutive patients (34 with an immigrant background) in three Danish memory clinics. All patients were given the RUDAS as a supplement to...

  6. Incorporation of Personal Single Nucleotide Polymorphism (SNP) Data into a National Level Electronic Health Record for Disease Risk Assessment, Part 2: The Incorporation of SNP into the National Health Information System of Turkey

    OpenAIRE

    Beyan, Timur; Aydın Son, Yeşim

    2014-01-01

    Background A personalized medicine approach provides opportunities for predictive and preventive medicine. Using genomic, clinical, environmental, and behavioral data, the tracking and management of individual wellness is possible. A prolific way to carry this personalized approach into routine practices can be accomplished by integrating clinical interpretations of genomic variations into electronic medical record (EMR)s/electronic health record (EHR)s systems. Today, various central EHR inf...

  7. Using Physiologically-Based Pharmacokinetic Models to Incorporate Chemical and Non-Chemical Stressors into Cumulative Risk Assessment: A Case Study of Pesticide Exposures

    Directory of Open Access Journals (Sweden)

    Jonathan I. Levy

    2012-05-01

    Full Text Available Cumulative risk assessment has been proposed as an approach to evaluate the health risks associated with simultaneous exposure to multiple chemical and non-chemical stressors. Physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD models can allow for the inclusion and evaluation of multiple stressors, including non-chemical stressors, but studies have not leveraged PBPK/PD models to jointly consider these disparate exposures in a cumulative risk context. In this study, we focused on exposures to organophosphate (OP pesticides for children in urban low-income environments, where these children would be simultaneously exposed to other pesticides (including pyrethroids and non-chemical stressors that may modify the effects of these exposures (including diet. We developed a methodological framework to evaluate chemical and non-chemical stressor impacts on OPs, utilizing an existing PBPK/PD model for chlorpyrifos. We evaluated population-specific stressors that would influence OP doses or acetylcholinesterase (AChE inhibition, the relevant PD outcome. We incorporated the impact of simultaneous exposure to pyrethroids and dietary factors on OP dose through the compartments of metabolism and PD outcome within the PBPK model, and simulated combinations of stressors across multiple exposure ranges and potential body weights. Our analyses demonstrated that both chemical and non-chemical stressors can influence the health implications of OP exposures, with up to 5-fold variability in AChE inhibition across combinations of stressor values for a given OP dose. We demonstrate an approach for modeling OP risks in the presence of other population-specific environmental stressors, providing insight about co-exposures and variability factors that most impact OP health risks and contribute to children’s cumulative health risk from pesticides. More generally, this framework can be used to inform cumulative risk assessment for any compound impacted by

  8. Portfolio assessment and evaluation: Implications and guidelines for clinical nursing education

    Directory of Open Access Journals (Sweden)

    M.M. Chabeli

    2002-09-01

    Full Text Available With the advent of Outcomes-Based Education in South Africa, the quality of nursing education is debatable, especially with regard to the assessment and evaluation of clinical nursing education, which is complex and renders the validity and reliability of the methods used questionable. This paper seeks to explore and describe the use of portfolio assessment and evaluation, its implications and guidelines for its effective use in nursing education. Firstly, the concepts of assessment, evaluation, portfolio and alternative methods of evaluation are defined. Secondly, a comparison of the characteristics of the old (traditional methods and the new alternative methods of evaluation is made. Thirdly, through deductive analysis, synthesis and inference, implications and guidelines for the effective use of portfolio assessment and evaluation are described.

  9. [Clinical research evolution. In parallel with the current changes in welfare expectations and information technology incorporation, study designs and data collection and analysis are quickly changing as well].

    Science.gov (United States)

    Tavazzi, Luigi

    2015-10-01

    The development of both technology, biological, and clinical knowledge leads to remarkable changes of scientific research methodology, including the clinical research. Major changes deal with the pragmatic approach of trial designs, an explosive diffusion of observational research which is becoming a usual component of clinical practice, and an active modelling of new research design. Moreover, a new healthcare landscape could be generated from the information technology routinely used to collect clinical data in huge databases, the management and the analytic methodology of big data, and the development of biological sensors compatible with the daily life delivering signals remotely forwardable to central databases. Precision medicine and individualized medicine seem to be the big novelties of the coming years, guiding to a shared pattern of patient/physician relationship. In healthcare, a huge business related mainly, but not exclusively, to the implementation of information technology is growing. This development will favor radical changes in the health systems, also reshaping the clinical activity. A new governance of the research strategies is needed and the application of the results should be based on shared ethical foundations. This new evolving profile of medical research and practice is discussed in this paper. PMID:26442975

  10. Beyond the Basics of Clinical Outcomes Assessment: Selecting Appropriate Patient-Rated Outcomes Instruments for Patient Care

    Science.gov (United States)

    Valier, Alison R.; Lam, Kenneth C.

    2015-01-01

    The fifth edition of the "Athletic Training Education Competencies" emphasizes the concepts of clinical outcomes assessment. In athletic training, clinical outcomes assessment, especially as it relates to patient-rated outcomes (PRO) instruments, is new, which produces uncertainty with regard to how to integrate PROs into athletic…

  11. Clinical assessment of hip strength using a hand-held dynamometer is reliable

    DEFF Research Database (Denmark)

    Thorborg, K; Petersen, J; Magnusson, S P;

    2010-01-01

    Hip strength assessment plays an important role in the clinical examination of the hip and groin region. The primary aim of this study was to examine the absolute test-retest measurement variation concerning standardized strength assessments of hip abduction (ABD), adduction (ADD), external...... by the same examiner. The test order was randomized to avoid systematic bias. Measurement variation between sessions was 3-12%. When the maximum value of four measurements was used, test-retest measurement variation was below 10% in 11 of the 12 individual hip strength tests and below 5% in five of...

  12. Clinical application of music therapy assessment within the field of child protection

    DEFF Research Database (Denmark)

    Jacobsen, Stine Lindahl; Killén, Kari

    2015-01-01

    and challenges of a nonverbal and emotional interactional medium such as music in assessing parent–child interaction and parental capacity are presented and discussed. The assessment model relates to theories of attunement, autonomy, and attachment, and clinical relevance for practice within the field of child......-service professions within the field of child protection, including level of mutual attunement, nonverbal communication skills, emotional parental response, and possibly indications of attachment behavior in the child. APC can thereby help indicate the severity of the situation and the possible therapeutic direction...

  13. Clinical utility of Standardised Assessment of Personality - Abbreviated Scale (SAPAS) among patients with first episode depression

    DEFF Research Database (Denmark)

    Bukh, Jens Drachmann; Bock, Camilla; Vinberg, Maj; Gether, Ulrik; Kessing, Lars Vedel

    Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: We found, that a cut-off of 3 on the screen correctly identified the presence of comorbid personality disorder in 73.1% of the patients. The sensitivity and specificity were 0.80 and 0.70, respectively. LIMITATIONS: The findings cannot......BACKGROUND: Personality disorder frequently co-occurs with depression and seems to be associated with a poorer outcome of treatment and increased risk for recurrences. However, the diagnosing of personality disorder can be lengthy and requires some training. Therefore, a brief screening interview...... for comorbid personality disorder among patients suffering from depression would be of clinical use. METHOD: The present study aimed to assess the utility of the Standardised Assessment of Personality - Abbreviated Scale (SAPAS) as a screen for personality disorder in a population of patients recently...

  14. The Counseling Center Assessment of Psychological Symptoms (CCAPS): Merging clinical practice, training, and research.

    Science.gov (United States)

    Youn, Soo Jeong; Castonguay, Louis G; Xiao, Henry; Janis, Rebecca; McAleavey, Andrew A; Lockard, Allison J; Locke, Benjamin D; Hayes, Jeffrey A

    2015-12-01

    The goal of this article is to present information about a standardized multidimensional measure of psychological symptoms, the Counseling Center Assessment of Psychological Symptoms (CCAPS; Locke et al., 2011; Locke, McAleavey, et al., 2012; McAleavey, Nordberg, Hayes, et al., 2012), developed to assess difficulties specific to college students' mental health. We provide (a) a brief review and summary of the psychometric and research support for the CCAPS; (b) examples of the use of the CCAPS for various purposes, including clinical, training, policy, and counseling center advocacy; and (c) implications of the integration of routine outcome monitoring and feedback for the future of training, research, and clinical practice. In particular, the article emphasizes how the assimilation of and symbiotic relationship between research and practice can address the scientist-practitioner gap. PMID:26641373

  15. Validation of a computer based objective structured clinical examination in the assessment of undergraduate dermatology courses

    Directory of Open Access Journals (Sweden)

    Feroze Kaliyadan

    2014-01-01

    Full Text Available Many teaching centers have now adopted objective structured clinical examination (OSCE as an assessment method for undergraduate dermatology courses. A modification of the standard OSCE in dermatology is computer based or electronic OSCE (eOSCE. We attempted to validate the use of a computer-based OSCE in dermatology in a group of fifth year medical students. The scores of the students in the computer-based OSCE showed a strong positive correlation with the scores on the clinical presentation (Pearson′s co-efficient - 0.923, P value <0.000, significant at the 0.01 level and a good correlation with overall scores of the student (Pearson′s co-efficient - 0.728, P value <0.000, significant at the 0.01 level, indicating that this is a reliable method for assessment in dermatology. Generally, the students′ feedback regarding the methods was positive.

  16. Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, Birgit; Lund, Hans;

    2014-01-01

    The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computerassisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October...... excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was ‘‘fair’’ (57%) to......) reliability; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase...

  17. Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, Birgit; Lund, Hans;

    2014-01-01

    Abstract The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to...... excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was "fair" (57%) to......; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase...

  18. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

    Science.gov (United States)

    Schnakers, Caroline; Vanhaudenhuyse, Audrey; Giacino, Joseph; Ventura, Manfredi; Boly, Melanie; Majerus, Steve; Moonen, Gustave; Laureys, Steven

    2009-01-01

    Background Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R). Methods We prospectively followed 103 patients (55 ± 19 years) with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.' Results Of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10%) had emerged from MCS, according to the CRS-R. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89%) were in MCS based on CRS-R findings. Conclusion Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus. PMID:19622138

  19. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

    Directory of Open Access Journals (Sweden)

    Majerus Steve

    2009-07-01

    Full Text Available Abstract Background Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS. However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R. Methods We prospectively followed 103 patients (55 ± 19 years with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.' Results Of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41% were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10% had emerged from MCS, according to the CRS-R. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89% were in MCS based on CRS-R findings. Conclusion Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.

  20. Ultrasound Image Quality Assessment: A framework for evaluation of clinical image quality

    DEFF Research Database (Denmark)

    Hemmsen, Martin Christian; Pedersen, Mads Møller; Nikolov, Svetoslav Ivanov;

    2010-01-01

    Improvement of ultrasound images should be guided by their diagnostic value. Evaluation of clinical image quality is generally performed subjectively, because objective criteria have not yet been fully developed and accepted for the evaluation of clinical image quality. Based on recommendation 500...... from the International Telecommunication Union - Radiocommunication (ITU-R) for such subjective quality assessment, this work presents equipment and a methodology for clinical image quality evaluation for guiding the development of new and improved imaging. The system is based on a BK-Medical 2202 Pro......Focus scanner equipped with a UA2227 research interface, connected to a PC through X64-CL Express camera link. Data acquisition features subject data recording, loading/saving of exact scanner settings (for later experiment reproducibility), free access to all system parameters for beamformation and is...

  1. Research progress of motor function assessments and their clinical applications in Duchenne muscular dystrophy

    OpenAIRE

    Shi, Wei

    2015-01-01

    Duchenne muscular dystrophy (DMD), clinically featured as progressive skeletal muscle atrophy with gradual loss of muscle strength and activity abilities, is the most common genetic muscular disease in children throughout the world. The core and continuous characteristic of DMD is motor dysfunction. Motor function assessments of DMD are now focusing on muscle strength, walking ability, range of motion and ability of activities, still without unified standards. Confirming the comprehensive, sc...

  2. Combined student ratings and self-assessment provide useful feedback for clinical teachers

    OpenAIRE

    Stalmeijer, Renée E.; Dolmans, Diana H. J. M.; Wolfhagen, Ineke H. A. P.; Peters, Wim G.; van Coppenolle, Lieve; Scherpbier, Albert J J A

    2009-01-01

    Many evaluation instruments have been developed to provide feedback to physicians on their clinical teaching but written feedback alone is not always effective. We explored whether feedback effectiveness improved when teachers’ self-assessment was added to written feedback based on student ratings. 37 physicians (10 residents, 27 attending physicians) from different specialties (Internal Medicine, Surgery, Obstetrics/Gynecology, Pediatrics, Neurology, Dermatology, Ophthalmology, ENT, and Psyc...

  3. Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

    OpenAIRE

    Nicole Bijlsma; Marc M. Cohen

    2016-01-01

    A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, i...

  4. Italian translation and cultural adaptation of the communication assessment tool in an outpatient surgical clinic

    OpenAIRE

    Scala, Daniela; Menditto, Enrica; Armellino, Mariano Fortunato; Manguso, Francesco; Monetti, Valeria Marina; Orlando, Valentina; Antonino, Antonio; Makoul, Gregory; De Palma, Maurizio

    2016-01-01

    Background The aim of the study is to translate and cross-culturally adapt, for use in the Italian context, the Communication Assessment Tool (CAT) developed by Makoul and colleagues. Methods The study was performed in the out-patient clinic of the Surgical Department of Cardarelli Hospital in Naples, Italy. It involved a systematic, standardized, multi-step process adhering to internationally accepted and recommended guidelines. Corrections and adjustments to the translation addressed both l...

  5. Assessment of quality in psychiatric nursing documentation-a clinical audit

    OpenAIRE

    2014-01-01

    Background: Quality in nursing documentation facilitates continuity of care and patient safety. Lack of communication between healthcare providers is associated with errors and adverse events. Shortcomings are identified in nursing documentation in several clinical specialties, but very little is known about the quality of how nurses document in the field of psychiatry. Therefore, the aim of this study was to assess the quality of the written nursing documentation in a psychiatric...

  6. Clinical assessment of standing and gait in ataxic patients using a triaxial accelerometer

    OpenAIRE

    Matsushima, Akira; Yoshida, Kunihiro; Genno, Hirokazu; Murata, Asuka; Matsuzawa, Setsuko; Nakamura, Katsuya; Nakamura, Akinori; Ikeda, Shu-ichi

    2015-01-01

    Background The aim of this study was to investigate the usefulness of a triaxial accelerometer for the clinical assessment of standing and gait impairment in ataxic patients quantitatively. Fifty-one patients with spinocerebellar ataxia (SCA) or multiple system atrophy with predominant cerebellar ataxia (MSA-C) and 56 healthy control subjects were enrolled. The subjects, with a triaxial accelerometer on their back, were indicated to stand for 30 s in four different conditions (eyes opened or ...

  7. Assessing decentering: Validation, psychometric properties and clinical usefulness of the Experiences Questionnaire in a Spanish sample

    OpenAIRE

    Soler Ribaudi, Joaquim; Franquesa, Alba; Feliu-Soler, Albert; Cebolla i Martí, Ausiàs Josep; García Campayo, Javier; Tejedor, Rosa; Demarzo, Marcelo; Baños Rivera, Rosa María; Pascual, Juan Carlos; Portella, María J.

    2014-01-01

    Decentering is defined as the ability to observe one’s thoughts and feelings in a detached manner. The Experiences Questionnaire (EQ) is a self-report instrument that originally assessed decentering and rumination. The purpose of this study was to evaluate the psychometric properties of the Spanish version of EQ-Decentering and to explore its clinical usefulness. The 11-item EQ-Decentering subscale was translated into Spanish and psychometric properties were examined in a sample of 921 adult ...

  8. Necrotizing Enterocolitis in the Premature Infant: Neonatal Nursing Assessment, Disease Pathogenesis, and Clinical Presentation

    OpenAIRE

    Gregory, Katherine E.; DeForge, Christine E.; Natale, Kristan M.; Phillips, Michele; Van Marter, Linda J

    2011-01-01

    Necrotizing enterocolitis (NEC) remains one of the most catastrophic comorbidities associated with prematurity. In spite of extensive research, the disease remains unsolved. The aims of this paper are to present the current state of the science on the pathogenesis of NEC, summarize the clinical presentation and severity staging of the disease, and highlight the nursing assessments required for early identification of NEC and ongoing care for infants diagnosed with this gastrointestinal diseas...

  9. Pedographic and clinical assessment of total contact cast immobilization in diabetic foot syndrome

    OpenAIRE

    Sergey Valentinovich Gorokhov; Oleg Viktorovich Udovichenko; Irina Nikolaevna Ul'yanova; Evgeniya Aleksandrovna Berseneva; Gagik Radikovich Galstyan

    2012-01-01

    Aims: to estimate offloading efficiency of total contact cast (TCC) and determine factors, affecting trophic ulcer response to treatment with TCC, as well as ways of their compensation. Methods: 30 patients, receiving an outpatient treatment with TCC for diabetic foot syndrome, underwent routine clinical examination, pedography and walking activity monitoring. We assessed degree of pressure reduction on the planta and the lesion area in particular, in its correlation with treatmen...

  10. Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification

    OpenAIRE

    Shrivastava, Amresh; Bureau, Yves; Rewari, Nitika; Johnston, Megan

    2013-01-01

    Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be one of the greatest barriers to regaining a normal lifestyle and health. Research advances have defined stigma and assessed its implications and have even examined intervention strategies for dealing with stigma. We are of the opinion that stigma is a potential clinical risk factor. It delays treatment seeking, worsens course and outcome, reduces...

  11. Assessment of biofilm formation in device-associated clinical bacterial isolates in a tertiary level hospital

    OpenAIRE

    Summaiya A Mulla; Sangita Revdiwala

    2011-01-01

    Background: Biofilm formation is a developmental process with intercellular signals that regulate growth. Biofilms contaminate catheters, ventilators, and medical implants; they act as a source of disease for humans, animals, and plants. Aim: In this study we have done quantitative assessment of biofilm formation in device-associated clinical bacterial isolates in response to various concentrations of glucose in tryptic soya broth and with different incubation time. Materials and Methods: The...

  12. Development and assessment of a clinically viable system for breast ultrasound computer-aided diagnosis

    Science.gov (United States)

    Gruszauskas, Nicholas Peter

    The chances of surviving a breast cancer diagnosis as well as the effectiveness of any potential treatments increase significantly with early detection of the disease. As such, a considerable amount of research is being conducted to augment the breast cancer detection and diagnosis process. One such area of research involves the investigation and application of sophisticated computer algorithms to assist clinicians in detecting and diagnosing breast cancer on medical images (termed generally as "computer-aided diagnosis" or CAD). This study investigated a previously-developed breast ultrasound CAD system with the intent of translating it into a clinically-viable system. While past studies have demonstrated that breast ultrasound CAD may be a beneficial aid during the diagnosis of breast cancer on ultrasound, there are no investigations concerning its potential clinical translation and there are currently no commercially-available implementations of such systems. This study "bridges the gap" between the laboratory-developed system and the steps necessary for clinical implementation. A novel observer study was conducted that mimicked the clinical use of the breast ultrasound CAD system in order to assess the impact it had on the diagnostic performance of the user. Several robustness studies were also performed: the sonographic features used by the system were evaluated and the databases used for calibration and testing were characterized, the effect of the user's input was assessed by evaluating the performance of the system with variations in lesion identification and image selection, and the performance of the system on different patient populations was investigated by evaluating its performance on a database consisting solely of patients with Asian ethnicity. The analyses performed here indicate that the breast ultrasound CAD system under investigation is robust and demonstrates only minor variability when subjected to "real-world" use. All of these results are

  13. Diagnostic outcome following routine genetics clinic referral for the assessment of global developmental delay.

    LENUS (Irish Health Repository)

    Shahdadpuri, R

    2012-02-01

    The aim of this study was to ascertain the diagnostic yield following a routine genetics clinic referral for the assessment of global developmental delay. Detailed retrospective review of 119 complete consecutive case notes of patients referred to one single clinical geneticist over a 14 month time period was undertaken (n = 119; 54 males, 65 females). The age at initial review ranged from 2 months to 37 years 3 months (mean 8 y 3 mo [SD 7 y 10 mo]). We made a diagnosis in 36\\/119 (30%); 21\\/36 were new diagnoses and 15\\/36 were confirmations of diagnoses. We removed a wrong diagnostic label in 8\\/119 (7%). In 3\\/8 we were able to achieve a diagnosis but in 5\\/8 no alternative diagnosis was reached. We had a better diagnostic rate where the patients were dysmorphic (odds ratio [OR] 1.825; 95% confidence interval [CI] 1.065 to 3.128, p = 0.044). In the majority, the diagnosis was made by clinical examination only. Molecular diagnosis was reached in seven cases. Five cases were confirmed by cytogenetic analysis. Brain magnetic resonance imaging (MRI) revealed a diagnosis in three cases. This study confirms the importance of a clinical genetics assessment in the investigation of global developmental delay.

  14. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal

    Directory of Open Access Journals (Sweden)

    Kent David M

    2010-08-01

    Full Text Available Abstract Mounting evidence suggests that there is frequently considerable variation in the risk of the outcome of interest in clinical trial populations. These differences in risk will often cause clinically important heterogeneity in treatment effects (HTE across the trial population, such that the balance between treatment risks and benefits may differ substantially between large identifiable patient subgroups; the "average" benefit observed in the summary result may even be non-representative of the treatment effect for a typical patient in the trial. Conventional subgroup analyses, which examine whether specific patient characteristics modify the effects of treatment, are usually unable to detect even large variations in treatment benefit (and harm across risk groups because they do not account for the fact that patients have multiple characteristics simultaneously that affect the likelihood of treatment benefit. Based upon recent evidence on optimal statistical approaches to assessing HTE, we propose a framework that prioritizes the analysis and reporting of multivariate risk-based HTE and suggests that other subgroup analyses should be explicitly labeled either as primary subgroup analyses (well-motivated by prior evidence and intended to produce clinically actionable results or secondary (exploratory subgroup analyses (performed to inform future research. A standardized and transparent approach to HTE assessment and reporting could substantially improve clinical trial utility and interpretability.

  15. Ultrafast CT scoring system for assessing bronchopulmonary dysplasia. Reproducibility and clinical correlation

    International Nuclear Information System (INIS)

    To evaluate the reproducibility of the Ultrafast CT (UFCT) scoring system and assess its usefulness in monitoring clinical severity in infants with bronchopulmonary dysplasia (BPD). UFCT scoring was done in 22 infants (15 boys and 7 girls aged 1 to 37 months) with BPD. A total of 258 lung fields were evaluated for the presence of hyperaeration, linear opacities, triangular subpleural opacities, and bronchovascular bundle distortion or thickening, and UFCT scores were given. Intraobserver and interobserver agreement and reproducibility of UFCT scores were statistically analyzed. In 12 patients, UFCT scores were linearly correlated with clinical severity scores based on respiratory dysfunction and complexity of care. 'Hyperaeration,' which was the most frequent (18 of 22, 81.8%) finding, showed high concordance (κ=0.73, p<0.001, κ=0.59, p<0.001), and its UFCT scores significantly correlated with intraobserver and interobserver analyses (r=0.94, p<0.001, r=0.82, p<0.001, respectively). UFCT scores for hyperaeration significantly correlated with clinical scores (r=0.75, p<0.01), whereas those for the others did not. UFCT is useful for assessing BPD. Hyperaeration was the most common and reproducible finding, and its extent significantly correlated with clinical severity. (author)

  16. The pre-clinical assessment of rapamycin-eluting, durable polymer-free stent coating concepts.

    Science.gov (United States)

    Steigerwald, Kristin; Merl, Sabine; Kastrati, Adnan; Wieczorek, Anna; Vorpahl, Marc; Mannhold, Raimund; Vogeser, Michael; Hausleiter, Jörg; Joner, Michael; Schömig, Albert; Wessely, Rainer

    2009-02-01

    All four currently FDA-approved drug-eluting stents (DESs) contain a durable polymeric coating which can negatively impact vascular healing processes and eventually lead to adverse cardiac events. Aim of this study was the pre-clinical assessment of two novel rapamycin-eluting stent (RES) coating technologies that abstain from use of a durable polymer. Two distinctive RES coating technologies were evaluated in vitro and in the porcine coronary artery stent model. The R-poly(S) stent platform elutes rapamycin from a biodegradable polymer that is top coated with the resin shellac to minimize the amount of polymer. The R-pro(S) stent platform allows dual drug release of rapamycin and probucol, blended by shellac. HPLC-based determination of pharmacokinetics indicated drug release for more than 28 days. At 30 days, neointimal formation was found to be significantly decreased for both DESs compared to bare-metal stents. Assessment of vascular healing revealed absence of increased inflammation in both DESs, which is commonly observed in DES with non-erodible polymeric coating. In conclusion, the pre-clinical assessment of RESs with resin-based or dual drug coating indicated an adequate efficacy profile as well as a beneficial effect for vascular healing processes. These results encourage the transfer of these technologies to clinical evaluation. PMID:18990438

  17. Link between cognitive neuroscience and education: the case of clinical assessment of developmental dyscalculia.

    Science.gov (United States)

    Rubinsten, Orly

    2015-01-01

    In recent years, cognitive neuroscience research has identified several biological and cognitive features of number processing deficits that may now make it possible to diagnose mental or educational impairments in arithmetic, even earlier and more precisely than is possible using traditional assessment tools. We provide two sets of recommendations for improving cognitive assessment tools, using the important case of mathematics as an example. (1) neurocognitive tests would benefit substantially from incorporating assessments (based on findings from cognitive neuroscience) that entail systematic manipulation of fundamental aspects of number processing. Tests that focus on evaluating networks of core neurocognitive deficits have considerable potential to lead to more precise diagnosis and to provide the basis for designing specific intervention programs tailored to the deficits exhibited by the individual child. (2) implicit knowledge, derived from inspection of variables that are irrelevant to the task at hand, can also provide a useful assessment tool. Implicit knowledge is powerful and plays an important role in human development, especially in cases of psychiatric or neurological deficiencies (such as math learning disabilities or math anxiety). PMID:26074805

  18. Link between cognitive neuroscience and education: The case of clinical assessment of developmental dyscalculia

    Directory of Open Access Journals (Sweden)

    Orly eRubinsten

    2015-05-01

    Full Text Available In recent years, cognitive neuroscience research has identified several biological and cognitive features of number processing deficits that may now make it possible to diagnose mental or educational impairments in arithmetic, even earlier and more precisely than is possible using traditional assessment tools. We provide two sets of recommendations for improving cognitive assessment tools, using the important case of mathematics as an example. (1 neurocognitive tests would benefit substantially from incorporating assessments (based on findings from cognitive neuroscience that entail systematic manipulation of fundamental aspects of number processing. Tests that focus on evaluating networks of core neurocognitive deficits have considerable potential to lead to more precise diagnosis and to provide the basis for designing specific intervention programs tailored to the deficits exhibited by the individual child. (2 implicit knowledge, derived from inspection of variables that are irrelevant to the task at hand, can also provide a useful assessment tool. Implicit knowledge is powerful and plays an important role in human development, especially in cases of psychiatric or neurological deficiencies (such as math learning disabilities

  19. Exploring the Clinical Utility of the Development and Well-Being Assessment (DAWBA) in the Detection of Hyperkinetic Disorders and Associated Diagnoses in Clinical Practice

    Science.gov (United States)

    Foreman, David; Morton, Stephanie; Ford, Tamsin

    2009-01-01

    Background: The clinical diagnosis of ADHD is time-consuming and error-prone. Secondary care referral results in long waiting times, but primary care staff may not provide reliable diagnoses. The Development And Well-Being Assessment (DAWBA) is a standardised assessment for common child mental health problems, including attention…

  20. Value of CT and clinical criteria in assessment of patients with acute pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Ju Shenghong [Department of Radiology, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing 210009 (China); Chen Feng [Department of Radiology, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing 210009 (China)]. E-mail: chenfengbe@yahoo.com.cn; Liu Shengli [Department of Radiology, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing 210009 (China); Zheng Kaier [Department of Radiology, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing 210009 (China); Teng Gaojun [Department of Radiology, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing 210009 (China)

    2006-01-15

    Objective: To re-assess the value of CT and clinical criteria as prognostic and severity indicators in acute pancreatitis and the correlation between them. Methods: Sixty-five cases with acute pancreatitis (AP) were included in the study. The hospitalization days, fevering days and overall complications were regarded as clinical endpoints for the patient group. CT criteria used for AP evaluation included Balthazar's plain CT scan score, CT severity index (CTSI) and London's pancreatic size index (PSI) score. Clinical criteria was Ranson score. The correlations between each criterion and the clinical endpoints, and the relation between CT and clinical criteria were analyzed. The power of each criterion and combination of CT and clinical criteria in predicting overall complications of AP were assessed and compared by using a receiver operative characteristic curve (ROC) analysis. Results: The mean scores of PSI, Ranson among the three groups classified according to overall complications were significantly different. Except Balthazar's plain CT scan criterion, each criterion's mean score in-groups with local complications was significantly higher than that in-group without. The overall complications were significantly more in severe group than that in mild group classified according to each criterion except plain CT scan criterion. Mean days of hospital stay and fevering were significantly longer in severe group with Ranson score than that in mild group. PSI and Ranson score had a linear correlation with fevering days, and Ranson score had a linear correlation with hospitalization days. In CT criteria, only PSI had a linear correlation with Ranson score. The findings of plain CT scan was found to be some laggard compared with that of clinic. ROC analysis showed the largest A {sub Z} of Ranson score, and there was no A {sub Z} increase when CT criteria were added to clinical criteria. Conclusion: The predictive values of Ranson and PSI score in AP

  1. Assessment set for evaluation of clinical outcomes in multiple sclerosis: psychometric properties

    Directory of Open Access Journals (Sweden)

    Rasova K

    2012-10-01

    Full Text Available Kamila Rasova,1 Patricia Martinkova,2 Jana Vyskotova,3 Michaela Sedova21Department of Rehabilitation, 3rd Faculty of Medicine, Charles University in Prague and Faculty Hospital Královské Vinohrady, Prague, Czech Republic; 2Center of Biomedical Informatics and Department of Medical Informatics and Biostatistics, Institute of Computer Science, AS CR, Prague, Czech Republic; 3Faculty of Medicine, Ostrava University, Ostrava, Czech RepublicPurpose: Multiple sclerosis (MS manifests itself in a wide range of symptoms. Physiotherapy plays an important role in the treatment of those symptoms connected with mobility. For this therapy to be at its most effective it should be based on a systematic examination that is able to describe and classify damaged clinical functions meaningfully. The purpose of this study was to develop and validate a battery of tests and composite tests that can be used to systematically evaluate clinical features of MS treatable by physiotherapy.Methods: The authors assembled a proposed battery of tests comprising known, standard, and validated assessments (low-contrast letter acuity testing; the Motricity Index; the Modified Ashworth Scale; the Berg Balance Scale; scales of postural reactions, tremor, dysdiadochokinesia, and dysmetria; the Nine-Hole Peg Test; the Timed 25-Foot Walk; and the 3-minute version of the Paced Auditory Serial Addition Test and one test (knee hyperextension of the authors’ own. Normalization was calculated and six composite assessments were measured. Seventeen ambulatory subjects with MS were tested twice with the assessment set before undergoing physiotherapy, and 12 were also tested with the assessment set after the physiotherapy. The test–retest reliability, stability, internal consistency of composite measurements, sensitivity to changes after therapy, and correlation between measurements and the Kurtzke Expanded Disability Status Scale score were evaluated for all tests in the assessment set

  2. Evaluation of a clinical needs assessment and exploration of the associated supports for students with a disability in clinical practice: part 2.

    Science.gov (United States)

    Howlin, Frances; Halligan, Phil; O'Toole, Sinead

    2014-09-01

    Engagement and successful completion of nursing and midwifery programmes may be predicated on the identification and implementation of reasonable accommodations to facilitate clinical learning for students with a disability. This qualitative study aims to evaluate a clinical needs assessment for students with a disability and explore their experiences of support in clinical practice. A purposive sample of year one undergraduate students was used. Four students consented to participate and undertook an individual interview. Their disabilities were categorised as specific learning disability (dyslexia) (n = 3) and mental health (n = 1). Data analysis revealed two main themes 'students' experiences of disclosure' and 'receiving support'. Findings revealed that all students disclosed on placement, however, the extent of disclosure was influenced by personal and environmental factors. Students used the clinical needs assessment to highlight accommodations to clinical staff on placement. Issues of concern that arose, included communication between all key stakeholders, negative staff attitudes and the need to improve the provision of accommodations. This preliminary evaluation indicates that the Clinical Needs Assessment bridges the gap in provision of student support between higher education and healthcare institutions. Findings suggest that competence based needs assessments can identify individualised reasonable accommodations for students undertaking clinical placements. PMID:25052770

  3. Research progress of motor function assessments and their clinical applications in Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Wei SHI

    2015-07-01

    Full Text Available Duchenne muscular dystrophy (DMD, clinically featured as progressive skeletal muscle atrophy with gradual loss of muscle strength and activity abilities, is the most common genetic muscular disease in children throughout the world. The core and continuous characteristic of DMD is motor dysfunction. Motor function assessments of DMD are now focusing on muscle strength, walking ability, range of motion and ability of activities, still without unified standards. Confirming the comprehensive, scientific, reasonable and accurate evaluation tools for DMD assessment is the premise of research in motor developmental rules of DMD, which will help to better understand the motor progress of DMD and to supply evidences for choosing treatment methods, confirming timing of intervention, assessing effect of treatments and designing rehabilitation plans. DOI: 10.3969/j.issn.1672-6731.2015.06.002

  4. Integrating Interactive Web-Based Technology to Assess Adherence and Clinical Outcomes in Pediatric Sickle Cell Disease

    Directory of Open Access Journals (Sweden)

    Lori E. Crosby

    2012-01-01

    Full Text Available Research indicates that the quality of the adherence assessment is one of the best predictors for improving clinical outcomes. Newer technologies represent an opportunity for developing high quality standardized assessments to assess clinical outcomes such as patient experience of care but have not been tested systematically in pediatric sickle cell disease (SCD. The goal of the current study was to pilot an interactive web-based tool, the Take-Charge Program, to assess adherence to clinic visits and hydroxyurea (HU, barriers to adherence, solutions to overcome these barriers, and clinical outcomes in 43 patients with SCD age 6–21 years. Results indicate that the web-based tool was successfully integrated into the clinical setting while maintaining high patient satisfaction (>90%. The tool provided data consistent with the medical record, staff report, and/or clinical lab data. Participants reported that forgetting and transportation were major barriers for adherence to both clinic attendance and HU. A greater number of self-reported barriers (P<.01 and older age (P<.05 were associated with poorer clinic attendance and HU adherence. In summary, the tool represents an innovative approach to integrate newer technology to assess adherence and clinical outcomes for pediatric patients with SCD.

  5. A Systematic Review of the Use of Self-Assessment in Preclinical and Clinical Dental Education.

    Science.gov (United States)

    Mays, Keith A; Branch-Mays, Grishondra L

    2016-08-01

    A desired outcome of dental and dental hygiene programs is the development of students' self-assessment skills. To that end, the Commission on Dental Accreditation states that "graduates must demonstrate the ability to self-assess." However, it is unclear that merely providing opportunity for self-assessment actually leads to the desired outcome. The aim of this study was to systematically review the literature on self-assessment in dental education. A search of English-language articles for the past 25 years (January 1, 1990, to June 30, 2015) was performed using MEDLINE Medical Subject Heading terms. Each abstract and/or article was validated for inclusion. The data collected included student classification, self-assessment environment, faculty assessment, training, faculty calibration, predictive value, and student perceptions. A qualitative analysis was also performed. From an initial list of 258 articles, 19 were selected for inclusion; exclusion criteria included studies that evaluated a non-preclinical or non-clinical exercise or whose subjects were not predoctoral dental or dental hygiene students. The results showed limited information regarding any kind of systematic training of students on how to perform a self-assessment. The majority of the studies also did not specify the impact of self-assessment on student performance. Self-assessment was primarily performed in the second year and in the preclinical environment. Students received feedback through a correlated faculty assessment in 73% of the studies, but 64% did not provide information regarding students' perceptions of self-assessment. There was a trend for students to be better self-assessors in studies in which a grade was connected to the process. In addition, there was a trend for better performing students to underrate themselves and for poorer performing students to overrate themselves and, overall, for students to score themselves higher than did their faculty evaluators. These findings

  6. 临床药学纳入医院“质控”体系的实践与体会%Practice and Experience of Incorporating Clinical Pharmacy into Hospital Quality Control System

    Institute of Scientific and Technical Information of China (English)

    丁建强; 朱军; 祁小乐; 程晶晶

    2013-01-01

    目的:探索将临床药学纳入医院综合质量目标责任管理(简称“质控”)体系的工作模式.方法:介绍我院的“质控”体系及将临床药学纳入“质控”体系的方法,并分析从2012年初起实践半年后的效果,总结体会.结果:我院“质控”体系包括组织机构及管理制度、考评结果汇总分析及奖惩三部分;我院将临床药师合理化建议评价管理、临床药师参与科室会诊及意见、医院药品不良反应监测和报告制度、抗菌药物合理应用情况纳入“质控”体系.经过半年实践,全院会诊病例临床药师参与率已达100%,临床药师用药合理化建议被采纳率达90%,5名临床药师2012年撰写药学专业论文20篇.结论:临床药师自身综合素质的提高是临床药学开展的基础,恰当合理的行政干预方式是临床药学发展的保障,将临床药学纳入医院“质控”体系可有力推动临床药学规范、快速地发展.%OBJECTIVE:To explore a new work mode of incorporating clinical pharmacy into hospital comprehensive quality objective responsibility management (called quality control in short) system. METHODS: The quality control system of our hospital was introduced, as well as the method of incorporating clinical pharmacy into quality control system. Experience and practice effect of the system were analyzed and summarized after half year of practice since early 2012. RESULTS: The quality control system of our hospital included 3 parts: i.e. organization and institution, summary and analysis of evaluation results, encouragements and penalties. Quality control system of our hospital included reasonable suggestion and evaluation management, participation of clinical pharmacist in consultation of department, ADR monitoring and reporting system and rational use of antibiotics. After half year, the ratio of clinical pharmacists attending consultations reached 100%. The ratio of clinical pharmacists' reasonable

  7. Outcomes assessment of case-based writing exercises in a veterinary clinical pathology course.

    Science.gov (United States)

    Sharkey, Leslie; Michael, Helen; LeBeau, Brandon; Center, Bruce; Wingert, Deb

    2012-01-01

    Our second-year core clinical pathology course uses free-response case-based learning exercises in an otherwise traditional lecture or laboratory course format to augment the development of skills in application of knowledge and critical thinking and clinical reasoning. We previously reported increased learner confidence accompanied by perceived improvements in understanding and ability to apply information, along with enhanced feelings of preparedness for examinations that students attributed to the case-based exercises. The current study prospectively follows a cohort of students to determine the ability of traditional multiple-choice versus free-response case-based assessments to predict future academic performance and to determine if the perceived value of the case-based exercises persists through the curriculum. Our data show that after holding multiple-choice scores constant, better performance on case-based free-response exercises led to higher GPA and better class rank in the second and third years and better class rank in the fourth year. Students in clinical rotations reported that the case-based approach was superior to traditional lecture or multiple-choice exam format for learning clinical reasoning, retaining factual information, organizing information, communicating medical information clearly to colleagues in clinical situations, and preparing high quality medical records. In summary, this longitudinal study shows that case-based free-response writing assignments are efficacious above and beyond standard measures in determining students' GPAs and class rank and in students' acquisition of knowledge, skills, and clinical reasoning. Students value these assignments and overwhelmingly find them an efficient use of their time, and these opinions are maintained even two years following the course. PMID:23187033

  8. Assessing Readiness to Lose Weight among Obese Women Attending the Nutrition Clinic

    Directory of Open Access Journals (Sweden)

    Fatemeh Ghannadiasl

    2014-07-01

    Full Text Available Background: Assessing individual’s readiness to change and targeting the intervention to the level of readiness may improve successful weight loss rates. This study aimed to assess readiness for weight loss in obese women using the trans theoretical model. Methods: A cross-sectional study was conducted on 90 volunteer apparently healthy obese women, in Ardabil, Iran. Participants completed the translated and validated University of Rhode Island Change Assessment questionnaire in their first visit. Subjects were categorized into one of the stages of change based on the highest of four z-transformed scale scores. The readiness to change score was calculated. Results: More than half of the participants were in early stages of weight loss and 24.5% were in the action stage. The readiness score in the precontemplation stage was significantly lower than the other stages, but no significant difference was observed among the contemplation, action and maintenance stages. The significant correlation was observed between the stages of change and waist-to-hip ratio (r=0.33, P<0.05. Conclusion: Obese women attending the nutrition clinic are in different stages to change for weight loss. Understanding person specific stages of change orientates the dietitian to use the most appropriate counseling strategies. Hence the stages and readiness to change should be considered before implementing any intervention in clinical settings for optimal outcomes.

  9. Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room.

    Science.gov (United States)

    Bijlsma, Nicole; Cohen, Marc M

    2016-02-01

    A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, innovative breakthroughs in biomedical research encompassing the "-omics" fields, and advances in mobile sensing, peer-to-peer networks and big data, provide tools that future clinicians can use to assess environmental chemical exposures in their patients. There is also a need for concerted action at all levels, including actions by individual patients, clinicians, medical educators, regulators, government and non-government organisations, corporations and the wider civil society, to understand the "exposome" and minimise the extent of toxic exposures on current and future generations. Clinical environmental chemical risk assessment may provide a bridge between multiple disciplines that uses new technologies to herald in a new era in personalised medicine that unites clinicians, patients and civil society in the quest to understand and master the links between the environment and human health. PMID:26848668

  10. Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

    Directory of Open Access Journals (Sweden)

    Nicole Bijlsma

    2016-02-01

    Full Text Available A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, innovative breakthroughs in biomedical research encompassing the “-omics” fields, and advances in mobile sensing, peer-to-peer networks and big data, provide tools that future clinicians can use to assess environmental chemical exposures in their patients. There is also a need for concerted action at all levels, including actions by individual patients, clinicians, medical educators, regulators, government and non-government organisations, corporations and the wider civil society, to understand the “exposome” and minimise the extent of toxic exposures on current and future generations. Clinical environmental chemical risk assessment may provide a bridge between multiple disciplines that uses new technologies to herald in a new era in personalised medicine that unites clinicians, patients and civil society in the quest to understand and master the links between the environment and human health.

  11. Nutritional condition of school age children. Clinic, anthropo-medical and alimentary assessment

    Directory of Open Access Journals (Sweden)

    Alina Esther González Hermida

    2011-04-01

    Full Text Available Background: the study of children´s growth in an appropriate indicator of children health condition and should be used as one of the basis in the practice of preventive medicine. Objective: to determine the nutritional al condition of children of third and sixth grade of elementary schools of Health Area V of Cienfuegos Municipality. Methods: descriptive, observational, cross-sectional and relational study of 445 school age children from 4 elementary schools. A clinic assessment was carried out along with an anthropo-medical evaluation. A qualitative survey was developed to assess the frequency of consumption of different alimentary groups. Results: the relation weight/height in the two genders presents a prevalence of normal weight; undernourishment is more common among females, overweight is more usual among boys and obesity can be found in both genders. The variable weight/age showed one bad-nutrition (for defect among females, there was a prevalence of bad-nutrition for excess in both genders. There were no children with height under the third percentile, with prevalence of boys and girls tall and very tall. Bronchial asthma was the most common disease. Conclusions: Food consumption in general, taking into account frequency and kind of food, is not the appropriate. There is a relation between positive clinical findings and the anthropometric assessment of weight/height.

  12. Genetic Stratification in Myeloid Diseases: From Risk Assessment to Clinical Decision Support Tool

    Directory of Open Access Journals (Sweden)

    Yishai Ofran

    2014-10-01

    Full Text Available Genetic aberrations have become a dominant factor in the stratification of myeloid malignancies. Cytogenetic and a few mutation studies are the backbone of risk assessment models of myeloid malignancies which are a major consideration in clinical decisions, especially patient assignment for allogeneic stem cell transplantation. Progress in our understanding of the genetic basis of the pathogenesis of myeloid malignancies and the growing capabilities of mass sequencing may add new roles for the clinical usage of genetic data. A few recently identified mutations recognized to be associated with specific diseases or clinical scenarios may soon become part of the diagnostic criteria of such conditions. Mutational studies may also advance our capabilities for a more efficient patient selection process, assigning the most effective therapy at the best timing for each patient. The clinical utility of genetic data is anticipated to advance further with the adoption of deep sequencing and next-generation sequencing techniques. We herein suggest some future potential applications of sequential genetic data to identify pending deteriorations at time points which are the best for aggressive interventions such as allogeneic stem cell transplantation. Genetics is moving from being mostly a prognostic factor to becoming a multitasking decision support tool for hematologists. Physicians must pay attention to advances in molecular hematology as it will soon be accessible and influential for most of our patients.

  13. Fast full-field OCT assessment of clinical tissue specimens (Conference Presentation)

    Science.gov (United States)

    Dalimier, Eugénie; Harms, Fabrice; Brossolet, Charles; Benoit, Emilie; Martins, Franck; Boccara, Claude

    2016-03-01

    Full-field optical coherence tomography (FFOCT) offers a non-invasive method of obtaining images of biological tissues at ultrahigh resolution (1µm in all 3 directions) approaching traditional histological sections. Previous clinical studies have shown the high efficiency of this imaging technique for the detection of cancer on various organs. This promises great potential of the technique for an ex-vivo quick analysis of surgical resections or biopsy specimens, in the aim to help the surgeon/radiologist decide on the course of action. Here we will present some of the latest technical developments on a FFOCT system which can produce 1cm2 images with 1 µm resolution in 1 minute. Larger samples, up to 50mm diameter, can also be imaged. Details on the large sample handling, high-speed image acquisition, optimized scanning, and accelerated GPU tiles stitching will be given. Results on the clinical applications for breast, urology, and digestive tissues will also be given. They highlight the relevance of the system characteristics for the detection of cancer on ex-vivo specimens. FFOCT now appears clearly as a very fast and non-destructive imaging technique that provides a quick assessment of the tissue morphology. With the benefit of both new technical developments and clinical validation, it turned into a mature technique to be implemented in the clinical environment. In particular, the technique holds potential for the fast ex-vivo analysis of excision margins or biopsies in the operating room.

  14. Harnessing Clinical Psychiatric Data with an Electronic Assessment Tool (OPCRIT+): The Utility of Symptom Dimensions

    Science.gov (United States)

    Brittain, Philip James; Lobo, Sarah Elizabeth Margaret; Rucker, James; Amarasinghe, Myanthi; Anilkumar, Anantha Padmanabha Pillai; Baggaley, Martin; Banerjee, Pallavi; Bearn, Jenny; Broadbent, Matthew; Butler, Matthew; Campbell, Colin Donald; Cleare, Anthony James; Dratcu, Luiz; Frangou, Sophia; Gaughran, Fiona; Goldin, Matthew; Henke, Annika; Kern, Nikola; Krayem, Abdallah; Mufti, Faiza; McIvor, Ronan; Needham-Bennett, Humphrey; Newman, Stuart; Olajide, Dele; O’Flynn, David; Rao, Ranga; Rehman, Ijaz Ur; Seneviratne, Gertrude; Stahl, Daniel; Suleman, Sajid; Treasure, Janet; Tully, John; Veale, David; Stewart, Robert; McGuffin, Peter; Lovestone, Simon; Hotopf, Matthew; Schumann, Gunter

    2013-01-01

    Progress in personalised psychiatry is dependent on researchers having access to systematic and accurately acquired symptom data across clinical diagnoses. We have developed a structured psychiatric assessment tool, OPCRIT+, that is being introduced into the electronic medical records system of the South London and Maudsley NHS Foundation Trust which can help to achieve this. In this report we examine the utility of the symptom data being collected with the tool. Cross-sectional mental state data from a mixed-diagnostic cohort of 876 inpatients was subjected to a principal components analysis (PCA). Six components, explaining 46% of the variance in recorded symptoms, were extracted. The components represented dimensions of mania, depression, positive symptoms, anxiety, negative symptoms and disorganization. As indicated by component scores, different clinical diagnoses demonstrated distinct symptom profiles characterized by wide-ranging levels of severity. When comparing the predictive value of symptoms against diagnosis for a variety of clinical outcome measures (e.g. ‘Overactive, aggressive behaviour’), symptoms proved superior in five instances (R2 range: 0.06–0.28) whereas diagnosis was best just once (R2∶0.25). This report demonstrates that symptom data being routinely gathered in an NHS trust, when documented on the appropriate tool, have considerable potential for onward use in a variety of clinical and research applications via representation as dimensions of psychopathology. PMID:23520532

  15. Wii Balance Board: Reliability and Clinical Use in Assessment of Balance in Healthy Elderly Women.

    Science.gov (United States)

    Monteiro-Junior, Renato Sobral; Ferreira, Arthur Sá; Puell, Vivian Neiva; Lattari, Eduardo; Machado, Sérgio; Otero Vaghetti, César Augusto; da Silva, Elirez Bezerra

    2015-01-01

    Force plate is considered gold standard tool to assess body balance. However the Wii Balance Board (WBB) platform is a trustworthy equipment to assess stabilometric components in young people. Thus, we aim to examine the reliability of measures of center of pressure with WBB in healthy elderly women. Twenty one healthy and physically active women were enrolled in the study (age: 64 ± 7 years; body mass index: 29 ± 5 kg/m2. The WBB was used to assess the center of pressure measures in the individuals. Pressure was linearly applied to different points to test the platform precision. Three assessments were performed, with two of them being held on the same day at a 5- to 10-minute interval, and the third one was performed 48 h later. A linear regression analysis was used to find out linearity, while the intraclass correlation coefficient was used to assess reliability. The platform precision was adequate (R2 = 0.997, P = 0.01). Center of pressure measures showed an excellent reliability (all intraclass correlation coefficient values were > 0.90; p < 0.01). The WBB is a precise and reliable tool of body stability quantitative measure in healthy active elderly women and its use should be encouraged in clinical settings. PMID:26556091

  16. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Hans-Christoph, E-mail: christoph.becker@med.uni-muenchen.de [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany); Johnson, Thorsten [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany)

    2012-12-15

    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

  17. New approaches to the Doppler echocardiographic assessment of diastolic function: from research laboratory to clinical practice

    Science.gov (United States)

    Pasquet, A.; Garcia, M. J.; Thomas, J. D.

    1999-01-01

    Over the past decade, Doppler echocardiography has become a well-established tool for the diagnosis of left ventricular diastolic dysfunction. Unfortunately, in many clinical situations traditional Doppler indices of transmittal and pulmonary venous flow are inconclusive, primarily due to their dependence on left atrial pressure. Recently, new Doppler indices that are much less dependent on preload have been developed, based on intraventricular flow propagation and intrinsic myocardial velocity. These methodologies provide direct assessment of ventricular relaxation and the small intraventricular pressure gradients essential to efficient filling of the ventricle. We review in this article the theoretical and experiment background of these new echo techniques as well as how they can be implemented in routine clinical practice.

  18. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    International Nuclear Information System (INIS)

    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

  19. Practice Guidelines for the Assessment of Clinically Significant Treatment Outcomes in the Children's Mental Health System.

    Science.gov (United States)

    Chomycz, Suzanne; Schmidt, Fred

    2016-01-01

    The use of program evaluation to monitor client change and improve intervention effectiveness is gaining increasing importance in the mental health field. However, there is a lack of literature available in community-based clinics for those who desire to evaluate the effectiveness of services. Through this article the authors review the literature on the best methods to assess clinically significant treatment outcomes in community-based children's mental health services. The strengths and weaknesses of commonly recommended methods of evaluating change are discussed (i.e., reliable change index, percentage of improvement, normative comparisons, and effect size) using a dataset from a community-based parenting program (N = 308). PMID:26086975

  20. Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, B; Lund, H;

    2014-01-01

    Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review Larsen CM1, Juul-Kristensen B1,2 Lund H1,2, Søgaard K1 1University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics 2Institute of Occupational....... Methods A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. The overall method used in this review can be divided into four steps: 1) Compile an...... evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was ‘fair’ (57%) to ‘poor’ (43%), with...

  1. Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, Birgit; Lund, Hans;

    ABSTRACT OARSI Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review Larsen CM1, Juul-Kristensen B1,2 Lund H1,2, Søgaard K11University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics2Institute of...... studies.MethodsA systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. The overall method used in this review can be divided into four steps: 1) Compile an...... evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was ‘fair’ (57%) to ‘poor’ (43%), with...

  2. Robust statistical approaches to assess the degree of agreement of clinical data

    Science.gov (United States)

    Grilo, Luís M.; Grilo, Helena L.

    2016-06-01

    To analyze the blood of patients who took vitamin B12 for a period of time, two different medicine measurement methods were used (one is the established method, with more human intervention, and the other method uses essentially machines). Given the non-normality of the differences between both measurement methods, the limits of agreement are estimated using also a non-parametric approach to assess the degree of agreement of the clinical data. The bootstrap resampling method is applied in order to obtain robust confidence intervals for mean and median of differences. The approaches used are easy to apply, running a friendly software, and their outputs are also easy to interpret. In this case study the results obtained with (non)parametric approaches lead us to different statistical conclusions, but the decision whether agreement is acceptable or not is always a clinical judgment.

  3. Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire

    DEFF Research Database (Denmark)

    Hederos, C.A.; Hasselgren, M.; Hedlin, G.;

    2007-01-01

    corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient...... medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2-6 yr of age, although only half of the individual patients......Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the...

  4. Incorporating longitudinal pediatric patient-centered outcome measurement into the clinical workflow using a commercial electronic health record: a step toward increasing value for the patient.

    Science.gov (United States)

    Carberry, Kathleen; Landman, Zachary; Xie, Michelle; Feeley, Thomas; Henderson, John; Fraser, Charles

    2016-01-01

    Patient-centered outcomes measurement provides healthcare organizations with crucial information for increasing value for patients; however, organizations have struggled to obtain outcomes data from electronic health record (EHR) systems. This study describes how Texas Children's Hospital customized a commercial EHR system and assembled a cross-functional team to capture outcomes data using existing functionality. Prior to its installation and customization, no surgical subspecialties besides the congenital heart and transplant surgery groups conducted prospective, patient outcomes measurement, but by 2015, the outcomes of over 1300 unique patients with supracondylar fractures, cleft lip and/or palate, or voiding dysfunction had been tracked. Key factors for integrating outcomes measurement into the clinical workflow include ongoing communication between cross-functional teams composed of clinicians and technical professionals, an iterative design process, organizational commitment, and prioritizing measurement as early as possible during EHR optimization. PMID:26377989

  5. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology

    International Nuclear Information System (INIS)

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  6. Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran

    Science.gov (United States)

    Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

    2015-01-01

    Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094

  7. Cancer pain assessment in clinical trials. A review of the literature (1999-2002).

    Science.gov (United States)

    Caraceni, Augusto; Brunelli, Cinzia; Martini, Cinzia; Zecca, Ernesto; De Conno, Franco

    2005-05-01

    The aim of this review was to evaluate the methods of pain measurement in controlled clinical trials in oncology published between 1999 and 2002. An electronic literature search strategy was used according to established criteria applied to the Medline database and PubMed search engine. Articles were selected to include only studies that had chronic cancer pain as the primary or secondary objective of a controlled clinical trial. A specific evaluation scheme was used to examine how pain measurement methods were chosen and implemented in the study procedures. The search strategy identified 613 articles, and 68 were selected for evaluation. Most articles (69%) chose unidimensional pain measurement tools, such as visual analogue scales, numerical rating scales and verbal rating scales, whereas others used questionnaires. The implementation of the pain assessment method was problematic in many studies, especially as far as time frame of pain assessment (70%), administration modalities (46%), and use of non-validated measurement methods (10%). Design of study and data analysis were often unclear about the definition of pain outcome measure (40%), patient compliance with pain assessment (98%), and impact of missing data (56%). Statistical techniques were seldom appropriate to the type of data collected and often inadequate to describe the pain variable under study. It is clear from this review that most authors were aware of the need of valid pain measurement tools to be used in clinical trials. However, too often these tools were not appropriately used in the trial, or at least their use was not described with sufficient accuracy in the trial methods. PMID:15904753

  8. Assessment of noise levels in clinical and laboratory areas of dental teaching institution, Ahmedabad

    OpenAIRE

    Parkar, Sujal M; Sagar H Parekh; Lopa M Shah; Abhishek S Sharma

    2014-01-01

    Aim: To measure and assess the noise levels produced by different dental equipments. Materials and Methods: Measurement of the noise level was performed in preclinics, clinics, and dental laboratory of different departments of Ahmedabad Dental College and Hospital. The noise levels were determined using a Mini sound meter (CEM USA), which was placed at the dentist′s and laboratory technician′s ear level and at a distance of 1 m from a main noise source. The level of noise was measured in deci...

  9. A group-mediated psychotherapy with children: Clinical observation and assessment

    Directory of Open Access Journals (Sweden)

    Sara Cuticchio

    2014-09-01

    Full Text Available The study is based on clinical evaluation of a psychotherapy group for children, employing Sicilian puppets, objects as mediators, to reflect on significant moments and the dynamic processes of change during the therapy. TCM (Therapeutic Cycle Model, 1996, designed by Mergenthaler, is used to identify whether and how the assessment corresponds to the changes detected by observation of each subject and the group. During the 8 sessions of therapy, verbal productions of children and therapists were analyzed and compared. Keywords:Evaluation; Group therapy; Mediating object; Children 

  10. Doppler string phantom for assessment of clinical doppler ultrasound velocity measurement

    OpenAIRE

    Yi Zhang; Ted Lynch; Hangiandreou, Nicholas J.

    2014-01-01

    Purpose: The Doppler string phantom provides accurate velocity of the string motion; it can be used to calibrate Doppler ultrasound (US) velocity measurements and to evaluate variations due to intrinsic spectral broadening. We developed a semi‐automated method to estimate the mode velocity (Vmode) and peak velocity (Vmax) based on duplex US images from a string phantom, and use them to assess clinical Doppler US velocity measurement.Methods: Steady motion of a rubber O‐ring (20 – 110 cm/s) in...

  11. Music Therapy for children with special needs - clinical practice and assessment in the light of developmental psychology and communicative musicality

    DEFF Research Database (Denmark)

    Holck, Ulla

    assessment, the focus is on clinical use of an assessment approach in everyday work, followed by ways of using video recordings in assessing music therapy processes. The way you ask musically, the way the child can answer you! Therefore, it is the therapist’s responsibility to ask in many ways...... for patterns in clinical work, e.g. analyzing the way members act in the group or towards the therapist. The practices will continuously be connected with a focus on how the music therapy research as well as developmental psychology can inform the assessment. Literature for further reading: Holck, U. (2007...

  12. The Influence of Clinical Experience and Photographic Presentation on Age Assessment of Women

    DEFF Research Database (Denmark)

    Nielsen, Barbara Rubek; Linneberg, Allan; Christensen, Kaare;

    2016-01-01

    BACKGROUND: Epidemiological studies have reported that a higher perceived age is associated with poor health and higher mortality. However, the method used for the assessment of perceived age differs between studies with regard to age, gender, the number and occupation of assessors as well as the...... presentation of participants. OBJECTIVE: It is not known whether the clinical experience of the assessor or photographic presentation have an influence on the assessment of perceived age, which the present study aimed to investigate. METHODS: In a cross-sectional study of 460 women aged 25-93 years, 10...... inter-class correlation coefficient within each assessor group and photographic presentation varied from 0.66 to 0.75. Limits of agreement were in a broad range but were similar in the two assessor groups. The best inter-assessor agreement was obtained from photographs of both the face and the whole...

  13. Automatic Speech Signal Analysis for Clinical Diagnosis and Assessment of Speech Disorders

    CERN Document Server

    Baghai-Ravary, Ladan

    2013-01-01

    Automatic Speech Signal Analysis for Clinical Diagnosis and Assessment of Speech Disorders provides a survey of methods designed to aid clinicians in the diagnosis and monitoring of speech disorders such as dysarthria and dyspraxia, with an emphasis on the signal processing techniques, statistical validity of the results presented in the literature, and the appropriateness of methods that do not require specialized equipment, rigorously controlled recording procedures or highly skilled personnel to interpret results. Such techniques offer the promise of a simple and cost-effective, yet objective, assessment of a range of medical conditions, which would be of great value to clinicians. The ideal scenario would begin with the collection of examples of the clients’ speech, either over the phone or using portable recording devices operated by non-specialist nursing staff. The recordings could then be analyzed initially to aid diagnosis of conditions, and subsequently to monitor the clients’ progress and res...

  14. Sperm DNA damage and its clinical relevance in assessing reproductive outcome

    Institute of Scientific and Technical Information of China (English)

    R.K.Sharma; T.Said; A.Agarwal

    2004-01-01

    The routine examination of semen, which assesses sperm concentration, percentage motility and morphology,does not identify subtle defects in sperm chromatin architecture. The focus on the genomic integrity of the male gamete has intensified recently due to the growing concern that genetic diseases may be transmitted via assisted reproductive techniques (ART). Accordingly, the intent of this review is to describe the details of the informationpertaining to mitochondfial/nuclear sperm DNA damage with an emphasis on its clinical significance and its relationship with male infertility. Assessment of sperm DNA damage appears to be a potential tool for evaluating semen samples prior to their use in ART. Testing DNA integrity may help select spermatozoa with intact DNA or with the least amount of DNA damage for use in assisted conception. In turn, this may alleviate the financial, social and emotional problems associated with failed ART attempts.

  15. CLINICAL ASPECTS OF ACUTE POST-OPERATIVE PAIN MANAGEMENT & ITS ASSESSMENT

    Directory of Open Access Journals (Sweden)

    R.S.R Murthy

    2010-06-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  16. Clinical aspects of acute post-operative pain management & its assessment

    Directory of Open Access Journals (Sweden)

    Anuj Gupta

    2010-01-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  17. Incorporation of Therapeutic Interventions in Physiologically Based Pharmacokinetic Modeling of Human Clinical Case Reports of Accidental or Intentional Overdosing with Ethylene Glycol

    Energy Technology Data Exchange (ETDEWEB)

    Corley, Rick A.; McMartin, K. E.

    2005-05-16

    Ethylene glycol is a high production volume chemical used in the manufacture of resins and fibers, antifreeze, deicing fluids, heat transfer and hydraulic fluids. Although occupational uses of ethylene glycol have not been associated with adverse effects, there are case reports where humans have either intentionally or accidentally ingested large quantities of ethylene glycol, primarily from antifreeze. The acute toxicity of ethylene glycol in humans and animals and can proceed through three stages, each associated with a different metabolite: central nervous system depression (ethylene glycol), cardiopulmonary effects associated with metabolic acidosis (glycolic acid) and ultimately renal toxicity (oxalic acid), depending upon the total amounts consumed and effectiveness of therapeutic interventions. A physiologically based pharmacokinetic (PBPK) model developed in a companion paper (Corley et al., 2004) was refined in this study to include clinically relevant treatment regimens for ethylene glycol poisoning such as hemodialysis or metabolic inhibition with either ethanol or fomepizole. Such modifications enabled the model to describe several human case reports which included analysis of ethylene glycol and/or glycolic acid. Such data and model simulations provide important confirmation that the PBPK model developed previously can adequately describe the pharmacokinetics of ethylene glycol in humans following low, occupational or environmentally relevant inhalation exposures, as well as massive oral doses even under conditions where treatments have been employed that markedly affect the disposition of ethylene glycol and glycolic acid. By integrating the case report data sets with controlled studies in this PBPK model, it was demonstrated that fomepizole, if administered early enough in a clinical situation, can be more effective than ethanol or hemodialysis in preventing the metabolism of ethylene glycol to more toxic metabolites. Hemodialysis remains an

  18. Clinical reasoning in nursing, a think-aloud study using virtual patients - a base for an innovative assessment.

    Science.gov (United States)

    Forsberg, Elenita; Ziegert, Kristina; Hult, Håkan; Fors, Uno

    2014-04-01

    In health-care education, it is important to assess the competencies that are essential for the professional role. To develop clinical reasoning skills is crucial for nursing practice and therefore an important learning outcome in nursing education programmes. Virtual patients (VPs) are interactive computer simulations of real-life clinical scenarios and have been suggested for use not only for learning, but also for assessment of clinical reasoning. The aim of this study was to investigate how experienced paediatric nurses reason regarding complex VP cases and how they make clinical decisions. The study was also aimed to give information about possible issues that should be assessed in clinical reasoning exams for post-graduate students in diploma specialist paediatric nursing education. The information from this study is believed to be of high value when developing scoring and grading models for a VP-based examination for the specialist diploma in paediatric nursing education. Using the think-aloud method, data were collected from 30 RNs working in Swedish paediatric departments, and child or school health-care centres. Content analysis was used to analyse the data. The results indicate that experienced nurses try to consolidate their hypotheses by seeing a pattern and judging the value of signs, symptoms, physical examinations, laboratory tests and radiology. They show high specific competence but earlier experience of similar cases was also of importance for the decision making. The nurses thought it was an innovative assessment focusing on clinical reasoning and clinical decision making. They thought it was an enjoyable way to be assessed and that all three main issues could be assessed using VPs. In conclusion, VPs seem to be a possible model for assessing the clinical reasoning process and clinical decision making, but how to score and grade such exams needs further research. PMID:23938093

  19. Digital photography for assessment of shoulder range of motion: A novel clinical and research tool

    Science.gov (United States)

    O’Neill, Barry J.; O’Briain, David; Hirpara, Kieran M.; Shaughnesy, Michelle; Yeatman, Elizabeth A.; Kaar, T. Kenneth

    2013-01-01

    Purpose: Maintenance of a pain-free functional range of motion is the aim of surgery for shoulder trauma. The aim of this study was to show that the range of motion can be accurately assessed using digital photographs. Materials and Methods: We reviewed 17 patients who had undergone surgery for shoulder trauma. Each patient's range of motion was assessed by two physicians and two physiotherapists. Digital photographs were taken of each patient at their functional limit. Photographs were assessed by two physicians and two physiotherapists, and by an external physician who had no previous contact with the patients. Results: Inter-observer and intra-observer reliability trials showed excellent correlation of results. There was no significant difference between observer's results, or between results of physical examination and photographic examination. Conclusions: Digital photography is a viable adjunct to assessment of range of motion of the shoulder. This has positive implications both clinically, and for shoulder research. Level of Evidence: Level 3. PMID:23858292

  20. Digital photography for assessment of shoulder range of motion: A novel clinical and research tool

    Directory of Open Access Journals (Sweden)

    Barry J O′Neill

    2013-01-01

    Full Text Available Purpose: Maintenance of a pain-free functional range of motion is the aim of surgery for shoulder trauma. The aim of this study was to show that the range of motion can be accurately assessed using digital photographs. Materials and Methods: We reviewed 17 patients who had undergone surgery for shoulder trauma. Each patient′s range of motion was assessed by two physicians and two physiotherapists. Digital photographs were taken of each patient at their functional limit. Photographs were assessed by two physicians and two physiotherapists, and by an external physician who had no previous contact with the patients. Results: Inter-observer and intra-observer reliability trials showed excellent correlation of results. There was no significant difference between observer′s results, or between results of physical examination and photographic examination. Conclusions: Digital photography is a viable adjunct to assessment of range of motion of the shoulder. This has positive implications both clinically, and for shoulder research. Level of Evidence: Level 3.

  1. Assessing the need for hospital admission by the Cape Triage discriminator presentations and the simple clinical score.

    LENUS (Irish Health Repository)

    Emmanuel, Andrew

    2010-11-01

    There is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.

  2. Evaluation of clinical skills for first-year surgical residents using orientation programme and objective structured clinical evaluation as a tool of assessment

    Directory of Open Access Journals (Sweden)

    Pandya J

    2010-01-01

    Full Text Available Background: Postgraduate specialities require a combination of knowledge and clinical skills. The internship year is less structured. Clinical and practical skills that are picked up during training are not well regulated and the impact is not assessed. In this study, we assessed knowledge and skills using objective structured clinical examination (OSCE. Aim: To evaluate the clinical skills of new first-year surgical residents using orientation programme and OSCE as a tool for assessment. Settings and Design: Observational study. Materials and Methods: Twenty new first-year surgical residents (10 each in 2008 and 2009 participated in a detailed structured orientation programme conducted over a period of 7 days. Clinically important topics and skills expected at this level (e.g., suturing, wound care etc. were covered. The programme was preceded by an OSCE to test pre-programme knowledge (the "pre-test". The questions were validated by senior department staff. A post-programme OSCE (the "post-test" helped to evaluate the change in clinical skill level brought about by the orientation programme. Statistical Analysis: Wilcoxson matched-pairs signed-ranks test. Results: Passing performance was achieved by all participants in both pre- and post-tests. Following the orientation programme, significant improvement was seen in tasks testing the psychomotor and cognitive domains. (P = 0.0001 and P = 0.0401, respectively. Overall reliability of the OSCE was found to be 0.7026 (Cronbach′s coefficient alpha. Conclusions: This study highlighted the lacunae in current internship training, especially for skill-based tasks. There is a need for universal inclusion of structured orientation programmes in the training of first-year residents. OSCE is a reliable, valid and effective method for the assessment of clinical skills.

  3. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making.

    Science.gov (United States)

    Thouvenot, Pierre; Ben Yamin, Barbara; Fourrière, Lou; Lescure, Aurianne; Boudier, Thomas; Del Nery, Elaine; Chauchereau, Anne; Goldgar, David E; Houdayer, Claude; Stoppa-Lyonnet, Dominique; Nicolas, Alain; Millot, Gaël A

    2016-06-01

    Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening. PMID:27272900

  4. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making.

    Directory of Open Access Journals (Sweden)

    Pierre Thouvenot

    2016-06-01

    Full Text Available Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening.

  5. Predicting reoffense in pedophilic child molesters by clinical diagnoses and risk assessment.

    Science.gov (United States)

    Eher, Reinhard; Olver, Mark E; Heurix, Isabelle; Schilling, Frank; Rettenberger, Martin

    2015-12-01

    A Diagnostic and Statistical Manual of Mental Disorders (DSM)-based diagnosis of pedophilia has so far failed to predict sexual reoffense in convicted child molesters, probably because of its broad and unspecific conceptualization. In this study, therefore, we investigated the prognostic value of the subtype exclusive pedophilia and a series of customary risk assessment instruments (SSPI, Static-99, Stable-2007, VRS:SO) and the PCL-R in a sample of prison released pedophilic sexual offenders. First, we examined the convergent validity of risk assessment instruments (N = 261). Then, we calculated the predictive accuracy of the measures and diagnosis for sexual recidivism by ROC analyses and subsequent Cox regression (N = 189). Also, predictive values with more clinical immediacy were calculated (sensitivity, specificity, PPV and NPV). The VRS:SO, the SSPI, and the Static-99 significantly predicted sexual recidivism, as did a diagnosis of exclusive pedophilia. Also, the VRS:SO predicted sexual reoffense significantly better than the Stable-2007, the Static-99/Stable-2007 combined score, and the PCL-R. When used combined, only the VRS:SO and a diagnosis of exclusive pedophilia added incremental validity to each other. Our findings support that the clinical diagnosis of an exclusive pedophilia based on DSM criteria and VRS:SO defined risk factors can reliably discriminate higher from lower risk offenders, even within the select subgroup of pedophilic child molesters. PMID:26146817

  6. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making

    Science.gov (United States)

    Thouvenot, Pierre; Ben Yamin, Barbara; Fourrière, Lou; Lescure, Aurianne; Boudier, Thomas; Del Nery, Elaine; Chauchereau, Anne; Goldgar, David E.; Stoppa-Lyonnet, Dominique; Nicolas, Alain; Millot, Gaël A.

    2016-01-01

    Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening. PMID:27272900

  7. Imaging photoplethysmography for clinical assessment of cutaneous microcirculation at two different depths

    Science.gov (United States)

    Marcinkevics, Zbignevs; Rubins, Uldis; Zaharans, Janis; Miscuks, Aleksejs; Urtane, Evelina; Ozolina-Moll, Liga

    2016-03-01

    The feasibility of bispectral imaging photoplethysmography (iPPG) system for clinical assessment of cutaneous microcirculation at two different depths is proposed. The iPPG system has been developed and evaluated for in vivo conditions during various tests: (1) topical application of vasodilatory liniment on the skin, (2) skin local heating, (3) arterial occlusion, and (4) regional anesthesia. The device has been validated by the measurements of a laser Doppler imager (LDI) as a reference. The hardware comprises four bispectral light sources (530 and 810 nm) for uniform illumination of skin, video camera, and the control unit for triggering of the system. The PPG signals were calculated and the changes of perfusion index (PI) were obtained during the tests. The results showed convincing correlations for PI obtained by iPPG and LDI at (1) topical liniment (r=0.98) and (2) heating (r=0.98) tests. The topical liniment and local heating tests revealed good selectivity of the system for superficial microcirculation monitoring. It is confirmed that the iPPG system could be used for assessment of cutaneous perfusion at two different depths, morphologically and functionally different vascular networks, and thus utilized in clinics as a cost-effective alternative to the LDI.

  8. Joint Estimation of Treatment and Placebo Effects in Clinical Trials with Longitudinal Blinding Assessments

    Science.gov (United States)

    Liu, Wei; Zhang, Zhiwei; Schroeder, R. Jason; Ho, Martin; Zhang, Bo; Long, Cynthia; Zhang, Hui; Irony, Telba Z.

    2016-01-01

    In some therapeutic areas, treatment evaluation is frequently complicated by a possible placebo effect (i.e., the psychobiological effect of a patient’s knowledge or belief of being treated). When a substantial placebo effect is likely to exist, it is important to distinguish the treatment and placebo effects in quantifying the clinical benefit of a new treatment. These causal effects can be formally defined in a joint causal model that includes treatment (e.g., new versus placebo) and treatmentality (i.e., a patient’s belief or mentality about which treatment she or he has received) as separate exposures. Information about the treatmentality exposure can be obtained from blinding assessments, which are increasingly common in clinical trials where blinding success is in question. Assuming that treatmentality has a lagged effect and is measured at multiple time points, this article is concerned with joint evaluation of treatment and placebo effects in clinical trials with longitudinal follow-up, possibly with monotone missing data. We describe and discuss several methods adapted from the longitudinal causal inference literature, apply them to a weight loss study, and compare them in simulation experiments that mimic the weight loss study. PMID:27110045

  9. Multicenter external quality assessment program for PCR detection of Mycobacterium ulcerans in clinical and environmental specimens.

    Directory of Open Access Journals (Sweden)

    Miriam Eddyani

    Full Text Available BACKGROUND: Mycobacterium ulcerans is the causative agent of Buruli ulcer (BU, a necrotizing disease of the skin, soft tissue and bone. PCR is increasingly used in the diagnosis of BU and in research on the mode of transmission and environmental reservoir of M. ulcerans. METHODOLOGY/PRINCIPAL FINDINGS: The aim of this study was to evaluate the performance of laboratories in detecting M. ulcerans using molecular tests in clinical and environmental samples by implementing sequential multicenter external quality assessment (EQA programs. The second round of the clinical EQA program revealed somewhat improved performance. CONCLUSIONS/SIGNIFICANCE: Ongoing EQA programs remain essential and continued participation in future EQA programs by laboratories involved in the molecular testing of clinical and environmental samples for M. ulcerans for diagnostic and research purposes is strongly encouraged. Broad participation in such EQA programs also benefits the harmonization of quality in the BU research community and enhances the credibility of advances made in solving the transmission enigma of M. ulcerans.

  10. Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Macri, Marina Rodrigues Bueno

    2014-01-01

    Full Text Available Introduction: Chronic obstructive pulmonary disease is characterized by progressive and partially reversible obstruction of pulmonary airflow. Aim: To characterize swallowing in patients with chronic obstructive pulmonary disease and correlate the findings with the degree chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, and smoking. Method: We conducted a prospective cohort study of 19 patients (12 men and 7 women; age range, 50–85 years with confirmed medical diagnosis of chronic obstructive pulmonary disease. This study was performed in 2 stages (clinical evaluation and functional assessment using nasolaryngofibroscopy on the same day. During both stages, vital signs were checked by medical personnel. Results: Clinical evaluation of swallowing in all patients showed the clinical signs of cough. The findings of nasolaryngofibroscopy highlighted subsequent intraoral escape in 5 patients (26.5%. No patient had tracheal aspiration. There was no association of subsequent intraoral escape with degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking. Conclusion: In patients with chronic obstructive pulmonary disease, there was a prevalence of oral dysphagia upon swallowing and nasolaryngofibroscopy highlighted the finding of subsequent intraoral escape. There was no correlation between intraoral escape and the degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking.

  11. Effect of amifostine on patient assessed clinical benefit in irradiated head and neck cancer

    International Nuclear Information System (INIS)

    Purpose: To determine if head and neck (H/N) cancer patients receiving daily amifostine during radiation therapy (RT) experienced clinical benefit (improvement in their ability to carry out normal functions with reduced discomfort) compared to nonamifostine treated patients. Methods and Materials: This was an open-label, multi-institutional randomized trial in 303 H/N cancer patients treated with RT +amifostine. Clinical benefit was measured using an 8-item validated Patient Benefit Questionnaire (PBQ) during and up to 11 months after RT. Results: 301 patients completed one or more PBQ assessments. Amifostine patients had significantly better PBQ scores (p < 0.05) than controls. The improvement in PBQ scores was most significant during chronic xerostomia. Conclusions: Amifostine use results in improved Patient Benefit Questionnaire (PBQ) scores, which is indicative of improved oral toxicity related outcomes and improved clinical benefit. Less oral toxicity should lead to preservation of late dental and oral health, and improvements in activities such as diet, nutrition, and sleep

  12. Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

    DEFF Research Database (Denmark)

    Evron, L.; Schultz-Larsen, K.; Fristrup, T.

    2009-01-01

    Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...

  13. Development and Analysis of an Instrument to Assess Student Understanding of GOB Chemistry Knowledge Relevant to Clinical Nursing Practice

    Science.gov (United States)

    Brown, Corina E.; Hyslop, Richard M.; Barbera, Jack

    2015-01-01

    The General, Organic, and Biological Chemistry Knowledge Assessment (GOB-CKA) is a multiple-choice instrument designed to assess students' understanding of the chemistry topics deemed important to clinical nursing practice. This manuscript describes the development process of the individual items along with a psychometric evaluation of the…

  14. Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey

    Science.gov (United States)

    Yaşar, Ilknur; Kahveci, Rabia; Baydar Artantaş, Aylin; Ayhan Başer, Duygu; Gökşin Cihan, Fatma; Şencan, Irfan; Koç, Esra Meltem; Özkara, Adem

    2016-01-01

    Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. Aim This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Methodology Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the “Statistical Yearbook of Turkey 2012” were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. Findings 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; Scope and purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. Conclusion This is the first

  15. Assessment of Mandibular Distraction Regenerate Using Ultrasonography and Cone Beam Computed Tomography: A Clinical Study.

    Science.gov (United States)

    Dabas, Jitender; Mohanty, Sujata; Chaudhary, Zainab; Rani, Amita

    2016-03-01

    Distraction osteogenesis (DO) is becoming a popular method of reconstruction for maxillofacial bony deformities or defects secondary to trauma or surgical tumor ablation. However, the technique is very sensitive in terms of the rate and rhythm of distraction. Because of this, there is a need for monitoring of the distraction regenerate during the distraction as well as the consolidation period. The present study was conducted to assess the regenerate using two imaging modalities, namely, ultrasonography (USG) and cone beam computed tomography (CBCT) to determine their relative efficacies and to weigh their clinical usefulness in assessment of DO regenerate. The study was conducted on 12 patients (18 sites) who underwent mandibular distraction for correction of facial deformities. The results showed that overall USG correlated better with the condition of regenerate (r = 0.606) as compared with CBCT (r = 0.476). However, USG was less effective as compared with CBCT in assessing the regenerate once corticomedullary differentiation occurred in the bone. PMID:26889351

  16. IRMA for assessment of soluble platelet glycocalicin and its clinical application in coronary heart disease

    International Nuclear Information System (INIS)

    Objective: To establish the immunoradiometric assay (IRMA) method for assessment of soluble platelet glycocalicin (sGC) and its clinical use. Methods: The labeling of 125I-2D4 was by chloramine T method. IRMA method was established for assessment of sGC. The plasma sGC levels of 50 healthy mine T method. IRMA method was established for assessment of sGC. The plasma sGC levels of 50 healthy people, 15 unstable angina (UA) and 37 acute myocardial infraction (AMI) were measured by IRMA. Results: The assaying range was 31.25-2000 μg/L. The sensitivity was 15 μg/L. The intra assay coefficients of variation (CV) were 6.25%, 4.35% and 3.99% (n=6) and the inter assay CV were 8.55%, 4.82% and 4.48% for 50, 300, 1800 μg/L, respectively. The average recovery rate was 101/88%. The plasma sGC level in normal group was (824.50 ± 225.11) μg/L. The plasma sGC levels in both UA and AMI groups were significantly higher than that in normal group (P<0.01). Coxregression analysis revealed that sGC was significantly correlated with P-selectin in AMI and UA groups (r=0.652, P<0.01). Conclusion: The sGC may be an important molecular marker of platelet activation and destruction. (authors)

  17. Artificial gait in complete spinal cord injured subjects: how to assess clinical performance

    Directory of Open Access Journals (Sweden)

    Karla Rocha Pithon

    2015-02-01

    Full Text Available Objective Adapt the 6 minutes walking test (6MWT to artificial gait in complete spinal cord injured (SCI patients aided by neuromuscular electrical stimulation. Method Nine male individuals with paraplegia (AIS A participated in this study. Lesion levels varied between T4 and T12 and time post injured from 4 to 13 years. Patients performed 6MWT 1 and 6MWT 2. They used neuromuscular electrical stimulation, and were aided by a walker. The differences between two 6MWT were assessed by using a paired t test. Multiple r-squared was also calculated. Results The 6MWT 1 and 6MWT 2 were not statistically different for heart rate, distance, mean speed and blood pressure. Multiple r-squared (r2 = 0.96 explained 96% of the variation in the distance walked. Conclusion The use of 6MWT in artificial gait towards assessing exercise walking capacity is reproducible and easy to apply. It can be used to assess SCI artificial gait clinical performance.

  18. Objective structured clinical examination for undergraduates: Is it a feasible approach to standardized assessment in India?

    Directory of Open Access Journals (Sweden)

    Kavita R Bhatnagar

    2011-01-01

    Full Text Available Background: There has been a growing concern among medical educators about the quality of medical graduates trained in various medical colleges in our country. Data based on the faculty and student perceptions of undergraduate curriculum indicate a need for laying more stress on practical skills during their training and assessment. The Objective Structured Clinical Examination (OSCE is a reliable and an established and effective multistation test for the assessment of practical skills in an objective and a transparent manner. The aim of this article is to sensitize universities, examiners, organizers, faculty, and students across India to OSCE. Materials and Methods: We designed an assessment based on 22-station OSCE and administered it to 67 students during their final year, integrating all the domains of learning, that is higher order cognitive domain, psychomotor domain, and affective domain. Data analysis was done using SPSS version 15. Results: The OSCE was feasible to conduct and had high perceived construct validity. There was a significant correlation between the station score and total examination score for 19 stations. The reliability of this OSCE was 0.778. Both students and faculty members expressed a high degree of satisfaction with the format. Conclusion: Integrating a range of modalities into an OSCE in ophthalmology appears to represent a valid and reliable method of examination. The biggest limitation with this format was the direct expenditure of time and energy of those organizing an OSCE; therefore, sustaining the motivation of faculty might pose a challenge.

  19. Clinical and Radiographic Assessment of the Efficacy of Calcium Silicate Indirect Pulp Capping

    Science.gov (United States)

    Hashem, D.; Mannocci, F.; Patel, S.; Manoharan, A.; Brown, J.E.; Watson, T.F.

    2015-01-01

    The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is

  20. An approach to the clinical assessment and management of syncope in adults.

    Science.gov (United States)

    Ntusi, N A B; Coccia, C B I; Cupido, B J; Chin, A

    2015-08-01

    Syncope, defined as a brief loss of consciousness due to an abrupt fall in cerebral perfusion, remains a frequent reason for medical presentation. The goals of the clinical assessment of a patient with syncope are twofold: (i) to identify the precise cause in order to implement a mechanism-specific and effective therapeutic strategy; and (ii) to quantify the risk to the patient, which depends on the underlying disease,rather than the mechanism of the syncope. Hence, a structured approach to the patient with syncope is required. History-taking remains the most important aspect of the clinical assessment. The classification of syncope is based on the underlying pathophysiological mechanism causing the event, and includes cardiac, orthostatic and reflex (neurally mediated) mechanisms. Reflex syncope can be categorised into vasovagal syncope (from emotional or orthostatic stress), situational syncope (due to specific situational stressors), carotid sinus syncope(from pressure on the carotid sinus, e.g. shaving or a tight collar), and atypical reflex syncope (episodes of syncope or reflex syncope that cannot be attributed to a specific trigger or syncope with an atypical presentation). Cardiovascular causes of syncope may be structural(mechanical) or electrical. Orthostatic hypotension is caused by an abnormal drop in systolic blood pressure upon standing, and is defined asa decrease of >20 mmHg in systolic blood pressure or a reflex tachycardia of >20 beats/minute within 3 minutes of standing. The main causes of orthostatic hypotension are autonomic nervous system failure and hypovolaemia. Patients with life-threatening causes of syncope should be managed urgently and appropriately. In patients with reflex or orthostatic syncope it is important to address any exacerbating medication and provide general measures to increase blood pressure, such as physical counter-pressure manoeuvres. Where heart disease is found to bet he cause of the syncope, a specialist opinion is

  1. Review of clinical studies on dendritic cell-based vaccination of patients with malignant melanoma: assessment of correlation between clinical response and vaccine parameters

    DEFF Research Database (Denmark)

    Engell-Noerregaard, Lotte; Hansen, Troels Holz; Andersen, Mads Hald;

    2009-01-01

    During the past years numerous clinical trials have been carried out to assess the ability of dendritic cell (DC) based immunotherapy to induce clinically relevant immune responses in patients with malignant diseases. A broad range of cancer types have been targeted including malignant melanoma...... which in the disseminated stage have a very poor prognosis and only limited treatment options with moderate effectiveness. Herein we describe the results of a focused search of recently published clinical studies on dendritic cell vaccination in melanoma and review different vaccine parameters which are...... included for analysis covering a total of 626 patients with malignant melanoma treated with DC based therapy. Clinical response (CR, PR and SD) were found to be significantly correlated with the use of peptide antigens (p = 0.03), the use of any helper antigen/adjuvant (p = 0.002), and induction of antigen...

  2. Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score

    DEFF Research Database (Denmark)

    Pedersen, Line Kjeldgaard; Rahbek, Ole; Nikolajsen, Lone;

    2015-01-01

    tool should not only be reliable and valid, but also clinically feasible. The aim of this study was to select the most valid and feasible pain assessment tool for children with CI and translate that tool into Danish. Methods A literature review on studies on pain, pain assessment tools, feasibility and......, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalisation, proofreading, and final report. Results Studies show that the r-FLACC is superior regarding clinical feasibility. The r-FLACC is a useful tool for assessing pain in...... children with CI due to its ease to use in a clinical setting and its use of both core and individual pain behaviours. In the back translation review discrepancies of words between the original and the back-translated English versions were assessed and in three of nine discrepancies a word was changed. In...

  3. Application of a utility analysis to evaluate a novel assessment tool for clinically oriented physiology and pharmacology.

    Science.gov (United States)

    Cramer, Nicholas; Asmar, Abdo; Gorman, Laurel; Gros, Bernard; Harris, David; Howard, Thomas; Hussain, Mujtaba; Salazar, Sergio; Kibble, Jonathan D

    2016-09-01

    Multiple-choice questions are a gold-standard tool in medical school for assessment of knowledge and are the mainstay of licensing examinations. However, multiple-choice questions items can be criticized for lacking the ability to test higher-order learning or integrative thinking across multiple disciplines. Our objective was to develop a novel assessment that would address understanding of pathophysiology and pharmacology, evaluate learning at the levels of application, evaluation and synthesis, and allow students to demonstrate clinical reasoning. The rubric assesses student writeups of clinical case problems. The method is based on the physician's traditional postencounter Subjective, Objective, Assessment and Plan note. Students were required to correctly identify subjective and objective findings in authentic clinical case problems, to ascribe pathophysiological as well as pharmacological mechanisms to these findings, and to justify a list of differential diagnoses. A utility analysis was undertaken to evaluate the new assessment tool by appraising its reliability, validity, feasibility, cost effectiveness, acceptability, and educational impact using a mixed-method approach. The Subjective, Objective, Assessment and Plan assessment tool scored highly in terms of validity and educational impact and had acceptable levels of statistical reliability but was limited in terms of acceptance, feasibility, and cost effectiveness due to high time demands on expert graders and workload concerns from students. We conclude by making suggestions for improving the tool and recommend deployment of the instrument for low-stakes summative assessment or formative assessment. PMID:27445277

  4. Network meta-analysis incorporating randomized controlled trials and non-randomized comparative cohort studies for assessing the safety and effectiveness of medical treatments: challenges and opportunities

    OpenAIRE

    Cameron, Chris; Fireman, Bruce; Hutton, Brian; Clifford, Tammy; Coyle, Doug; Wells, George; Dormuth, Colin R.; Platt, Robert; Toh, Sengwee

    2015-01-01

    Network meta-analysis is increasingly used to allow comparison of multiple treatment alternatives simultaneously, some of which may not have been compared directly in primary research studies. The majority of network meta-analyses published to date have incorporated data from randomized controlled trials (RCTs) only; however, inclusion of non-randomized studies may sometimes be considered. Non-randomized studies can complement RCTs or address some of their limitations, such as short follow-up...

  5. Reliability of trachoma clinical grading--assessing grading of marginal cases.

    Directory of Open Access Journals (Sweden)

    Salman A Rahman

    2014-05-01

    Full Text Available BACKGROUND: Clinical examination of trachoma is used to justify intervention in trachoma-endemic regions. Currently, field graders are certified by determining their concordance with experienced graders using the kappa statistic. Unfortunately, trachoma grading can be highly variable and there are cases where even expert graders disagree (borderline/marginal cases. Prior work has shown that inclusion of borderline cases tends to reduce apparent agreement, as measured by kappa. Here, we confirm those results and assess performance of trainees on these borderline cases by calculating their reliability error, a measure derived from the decomposition of the Brier score. METHODS AND FINDINGS: We trained 18 field graders using 200 conjunctival photographs from a community-randomized trial in Niger and assessed inter-grader agreement using kappa as well as reliability error. Three experienced graders scored each case for the presence or absence of trachomatous inflammation-follicular (TF and trachomatous inflammation-intense (TI. A consensus grade for each case was defined as the one given by a majority of experienced graders. We classified cases into a unanimous subset if all 3 experienced graders gave the same grade. For both TF and TI grades, the mean kappa for trainees was higher on the unanimous subset; inclusion of borderline cases reduced apparent agreement by 15.7% for TF and 12.4% for TI. When we assessed the breakdown of the reliability error, we found that our trainees tended to over-call TF grades and under-call TI grades, especially in borderline cases. CONCLUSIONS: The kappa statistic is widely used for certifying trachoma field graders. Exclusion of borderline cases, which even experienced graders disagree on, increases apparent agreement with the kappa statistic. Graders may agree less when exposed to the full spectrum of disease. Reliability error allows for the assessment of these borderline cases and can be used to refine an

  6. Assessing airway inflammation in clinical practice – experience with spontaneous sputum analysis

    Directory of Open Access Journals (Sweden)

    Magnussen Helgo

    2008-02-01

    Full Text Available Abstract Background The assessment of airway inflammation for the diagnosis of asthma or COPD is still uncommon in pneumology-specialized general practices. In this respect, the measurement of exhaled nitric oxide (NO, as a fast and simple methodology, is increasingly used. The indirect assessment of airway inflammation, however, does have its limits and therefore there will always be a need for methods enabling a direct evaluation of airway inflammatory cell composition. Sampling of spontaneous sputum is a well-known, simple, economic and non-invasive method to derive a qualitative cytology of airway cells and here we aimed to assess today's value of spontaneous sputum cytology in clinical practice. Methods Three pneumologists provided final diagnoses in 481 patients having sputum cytology and we retrospectively determined posterior versus prior probabilities of inflammatory airway disorders. Moreover, in a prospective part comprising 108 patients, pneumologists rated their confidence in a given diagnosis before and after knowing sputum cytology and rated its impact on the diagnostic process on an analogue scale. Results Among the 481 patients, 45% were diagnosed as having asthma and/or airway hyperresponsiveness. If patients showed sputum eosinophilia, the prevalence of this diagnosis was elevated to 73% (n = 109, p Thirty-three of the 108 patients were excluded from the prospective part (26 insufficient samples, 7 incomplete questionnaires. In 48/75 cases the confidence into a diagnosis was raised after knowing sputum cytology, and in 15/75 cases the diagnosis was changed as cytology provided new clues. Conclusion Our data suggest that spontaneous sputum cytology is capable of assisting in the diagnosis of inflammatory airway diseases in the outpatient setting. Despite the limitations by the semiquantitative assessment and lower sputum quality, the supportive power and the low economic effort needed can justify the use of this method

  7. Clinical praxis for assessment of dry weight in Sweden and Denmark: A mixed-methods study.

    Science.gov (United States)

    Stenberg, Jenny; Lindberg, Magnus; Furuland, Hans

    2016-01-01

    Overhydration is an independent predictor of mortality in hemodialysis (HD) patients. More than 30% of HD patients are overhydrated, motivating the development of new methods for assessing hydration status. This study surveyed clinical praxis and local guidelines for dry weight (DW) assessment in Swedish and Danish HD units, and examined if differences in routines and utilization of bioimpedance spectroscopy (BIS) and other assistive technology affected frequency of DW adjustments and blood pressure (BP) levels. Cross-sectional information on praxis, guidelines and routines, plus treatment-related data from 99 stratified patients were collected. Qualitative data were analyzed with content analysis and interpreted in convergence with statistical analysis of quantitative data in a mixed-methods design. Local guidelines concerning DW existed in 54% of the units. A BIS device was present in 52%, but only half of those units used it regularly, and no correlations to frequency of DW adjustments or BP were found. HD nurses were authorized to adjust DW in 60% of the units; in these units, the frequency of DW adjustments was 1.6 times higher and systolic BP pre-HD 8 mmHg lower. There is a wide variation in routines for DW determination, and there are indications that authorization of HD nurses to adjust DW may improve DW assessment. BIS is sparsely used; its implementation may have been delayed by uncertainty over how to manage the device and interpret measurements. Hence, better methods and guidelines for assessing DW and using BIS need to be developed. PMID:26264888

  8. Clinical use of nuclear cardiology in the assessment of heart failure

    International Nuclear Information System (INIS)

    Nuclear cardiology is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays an important role in their assessment and management. Quantitative gated single positron emission computed tomography is used to assess quantitatively cardiac volume, left ventricular ejection fraction, stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging can not only identify nonischemic heart failure and ischemic heart failure, but also demonstrate myocardial viability. Diastolic heart failure also termed as heart failure with a preserved left ventricular ejection fraction is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate and time to peak filling rate. With newer techniques such as three-dimensional, quantitative gated single positron emission computed tomography can assess movement of the left ventricle, and wall thickening evaluation aids its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using 123I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using 123I-15-(p-iodophenyl) 3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to improve heart failure diagnosis. Nuclear cardiology techniques contribute significantly to identifying patients with heart failure and to guiding their management decisions. (authors)

  9. Estimation of the contribution of gamma-emission of incorporated cesium radioisotopes in interpretation of the results of the public survey to assess the thyroidal iodine content following a radiation accident at the nuclear power plant

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    Shinkarev S.M.

    2014-12-01

    Full Text Available Aim. A detail consideration has been done to assess an importance of the contribution of gamma-emission of incorporated cesium radioisotopes to the exposure rate measured near the thyroid by the public survey for following the Chernobyl accident. Empirical ratios have been derived to take into account that contribution under interpretation of the results of survey meter monitoring of the public. Materials and methods. Model calculations for typical radionuclide intake by the residents living in contaminated territories after the Chernobyl accident have been carried out in order to assess the contribution of gamma-emission of incorporated cesium radioisotopes to the exposure rate measured near the thyroid by the survey. Under such calculations two the most important modes of intake have been considered: 1 inhalation and 2 ingestion with cow milk. Results. According to the estimates received the contribution of gamma-emission of incorporated cesium radioisotopes to the exposure rate measured near the thyroid during the first 20 days does not exceed 20% for the residents of southern areas of Gomel region and 30% for the residents of Mogil'yov region. During 60 days following the accident that contribution is estimated to be within (50-80 % for the residents of southern areas of Gomel region and (80-95 % for the residents of Mogil'yov region. Conclusion. For the period of intensive thyroid measuring in the southern areas of Gomel region (the second part of May account of the contribution of gamma-emission of incorporated cesium radioisotopes is relatively unimportant, but for Mogil'yov region (the end of May — it is important to account for. For the thyroid measurements conducted in June of 1986 it is important for all residents living in Belarus to take into account the contribution of gamma-emission of incorporated cesium radioisotopes.

  10. Electrocardiogram assessment in non-anaesthetized clinically healthy agouti (Dasyprocta primnolopha, Wagler 1831

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    Anaemilia das N. Diniz

    2013-12-01

    Full Text Available The agouti is one of the most intensely hunted species throughout the Amazon and the semiarid regions of north-eastern Brazil. Considering the current tendency of wild animal management in captivity, the objective of this study was to determine heart reference values for agouti raised in captivity, based on electrocardiographic assessments (ECG. Adult agouti were selected without clinical signs of heart disease (n=30. The animals were restrained physically and then the ECG was performed. Standardized measurements were taken to establish the statistical analysis of the data. Analysis of the QRS complex showed values compatible with previous reports in peer animals and the limited data available for other wild and exotic species, except for the T wave that showed similar amplitude to the R wave in all the animals studied. The data obtained provided the first reference values for ECG tracings in agouti, contributing to a better understanding of heart electrophysiology in identifying myocardial pathology in these animals.

  11. Clinical assessment of a radioimmunoassay for free thyroxine using a modified tracer

    International Nuclear Information System (INIS)

    A radioimmunoassay for measuring free thyroxine in plasma was introduced by Amersham using a I-125-labeled T4 derivative that does not bind significantly to the thyroxine-binding proteins. This RIA was evaluated for its clinical utility in assessing 278 patients with thyroid and nonthyroidal diseases. The precision of the Amerlex free T4 assay was expressed as coefficient of variation. The correlation coefficients (r) of a dialysis method and a free thyroxine index were 0.871 and 0.911, respectively. Free T4 correctly classified 98% euthyroid, 92% hypothyroid, 100% hyperthyroid, 100% euthyroid with elevated TBG, and 87% of phenytoin patients. In addition, 80 patients with acute nonthyroidal illness were studied. Most of these patients have normal to low free T4, very low T3, and elevated rT3. We found this free T4 assay to be precise, easy to perform, and reliable in classifying thyroid status in most patients

  12. Survey of self-assessed preparedness for clinical practice in one Croatian medical school

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    Jenkins Sarah M

    2009-07-01

    Full Text Available Abstract Background The Croatian higher education system is in the process of reforming its medical curricula to comply with European Union standards. We conducted a survey of students enrolled at the University of Zagreb (Croatia asking them to rate their perception of preparedness for clinical practice prior to initiation of the reform process. The purpose of the survey was to identify self-perceived deficiencies in education and to establish a reference point for the later assessment of ongoing educational reform. Findings One-hundred and forty seven (N = 147 graduates reported the levels of perceived preparedness on 30 items grouped into 8 educational domains. Main domains were: understanding science, practical skills/patient management, holistic care, prevention, interpersonal skills, confidence/coping skills, collaboration, and self-directed learning. For each item, graduates self assessed their preparedness on a scale ranging from 1 to 4, with 1 = "Very inadequate", 2 = "Somewhat inadequate", 3 = "Somewhat adequate", and 4 = "Very adequate". In 7 out of 8 domains the achieved median score was ≥ 3. Students expressed low confidence (defined when ≥ 25% of respondents supplied a rating for the survey question as: "very inadequate" or "somewhat inadequate" with interpersonal skills (discussing terminal disease, counseling distraught patients, balancing professional and personal life, and in performing certain basic semi-invasive or invasive procedures. Conclusion Zagreb medical graduates identified several deficiencies within educational domains required for standard clinical practice. Ongoing educational efforts need to be directed towards the correction of these deficiencies in order to achieve standards required by the European Union.

  13. Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: A preliminary clinical study

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    Li, Qinghai; Li, Jinning; Zhang, Lan; Chen, Ying; Zhang, Minming [Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009 (China); Yan, Fuhua, E-mail: zemylife@163.com [Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025 (China)

    2014-05-15

    Objective: To investigate the clinical potential of diffusion-weighted imaging (DWI) in assessing renal pathology of chronic kidney disease (CKD). Methods: Seventy-one CKD patients and twelve healthy volunteers were examined using DWI with prospective acquisition correction. Renal biopsy specimens from the CKD patients were scored based on the severity of renal pathology and to confirm pathology type. CKD patients were divided into three groups according to pathology scores: mild, moderate, or severe. The association between renal apparent diffusion coefficient (ADC) values and pathology scores was investigated using Pearson's correlation and single factor analysis of variance. Multiple linear regression analysis was performed to explore associations between renal ADC values and pathology score, glomerular filtration rate, serum creatinine, and age. The Kruskal–Wallis H test was conducted to compare ADC values and pathology type. Results: Renal ADC values correlated negatively with pathology scores (r = −0.633, P < 0.001). The ADC values among the four groups (mild, moderate, severe impairment, and controls) were significantly different (F = 19.512, P < 0.001). However, when patients were stratified by pathology type, no significant differences were found in ADC values among these groups (χ{sup 2} = 9.929, P = 0.270). Further multiple linear regression analysis showed that only the pathology score and ADC values were related (t = −4.586, P = 0.000). Conclusions: DWI has clinical potential in assessing the severity of renal pathology in CKD and shows promise as a non-invasive and effective technique to guide therapy and follow-up.

  14. Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: A preliminary clinical study

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical potential of diffusion-weighted imaging (DWI) in assessing renal pathology of chronic kidney disease (CKD). Methods: Seventy-one CKD patients and twelve healthy volunteers were examined using DWI with prospective acquisition correction. Renal biopsy specimens from the CKD patients were scored based on the severity of renal pathology and to confirm pathology type. CKD patients were divided into three groups according to pathology scores: mild, moderate, or severe. The association between renal apparent diffusion coefficient (ADC) values and pathology scores was investigated using Pearson's correlation and single factor analysis of variance. Multiple linear regression analysis was performed to explore associations between renal ADC values and pathology score, glomerular filtration rate, serum creatinine, and age. The Kruskal–Wallis H test was conducted to compare ADC values and pathology type. Results: Renal ADC values correlated negatively with pathology scores (r = −0.633, P < 0.001). The ADC values among the four groups (mild, moderate, severe impairment, and controls) were significantly different (F = 19.512, P < 0.001). However, when patients were stratified by pathology type, no significant differences were found in ADC values among these groups (χ2 = 9.929, P = 0.270). Further multiple linear regression analysis showed that only the pathology score and ADC values were related (t = −4.586, P = 0.000). Conclusions: DWI has clinical potential in assessing the severity of renal pathology in CKD and shows promise as a non-invasive and effective technique to guide therapy and follow-up

  15. Multimodality assessment of cardiac involvement in Churg-Strauss syndrome patients in clinical remission

    International Nuclear Information System (INIS)

    Cardiac involvement in Churg-Strauss syndrome (CSS) is not uncommon, but its frequency varies widely and may depend on the activity of the disease. Therefore, the cardiac involvement in CSS patients in clinical remission was assessed in the present study. In 20 CSS patients in remission and 20 sex- and age-matched healthy controls, an electrocardiogram (ECG) stress test, echocardiography, and 24-h ECG Holter monitoring were performed, together with cardiac magnetic resonance imaging (cMRI). Cardiac involvement was present in 90% (18/20) of CSS patients. Left ventricular ejection fraction (LVEF) was on average lower in the CSS group than in controls (P<0.05), with 7 patients showing systolic heart failure (LVEF <50%). cMRI changes included late gadolinium enhancement lesions in the LV in 89% of patients (17/19), present in all layers of the myocardium. Signs of ongoing inflammation (early gadolinium enhancement) and edema (T2-weighted imaging) were present in 6/19 patients. Holter monitoring revealed both supraventricular and ventricular arrhythmias more frequently in CSS patients when compared with controls (P<0.05). Absolute eosinophil count before the initiation of treatment was higher in rhythm disturbances (P<0.05), and inversely correlated with LV systolic function (rho -0.65). Heart involvement in CSS patients who are in clinical remission is very common. It is characterized not only by fibrosis, but also by an active inflammatory process. The latter finding might influence therapeutic decisions in CSS patients in full clinical remission. (author)

  16. A clinical rating scale for the assessment of facial aging in Indian population

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    Sumit Sen

    2016-01-01

    Full Text Available Background: Estimation of facial aging has assumed growing importance due to the advent of several antiaging therapies. Evidence-based estimation of global facial aging is often necessary, especially for validation of these treatment modalities. Most available methods are expensive and have been used in fair skinned individuals. Aim: We attempted to develop a clinical rating scale for the estimation of global facial aging applied on an Indian population which has brown to black skin. We have also measured the association of this rating scale score with the chronological age. Methods: Initially, a 14- item summated rating scale was developed with inputs from five dermatologists and a clinical pharmacologist. The rating scale was applied to 105 consenting subjects with healthy facial skin between 30 to 90 years of age. Intra- and inter-rater reliability was assessed. Results: The summated rating score showed a significant positive correlation with the chronological age (Pearson′s correlation coefficient 0.834, P < 0.001. We omitted one item from the scale due to a low inter-rater agreement. The resulting 13-item rating scale was internally consistent (Cronbach′s alpha: 0.905, with substantial inter- and intra-rater reliability (intraclass correlation coefficient: 0.973 and 0.788, respectively. Principal components and predictive equation for perceptible age were identified on further computation. Limitations: Participants of this study were limited to a particular ethnic group from West Bengal and other neighboring states of Eastern India. Conclusions: We have developed and validated a 13-item rating scale for the quantification of global facial aging suitable for Indian (brown to black skin type. This scale can be utilized effectively for clinical estimation of global facial aging.

  17. Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: proven clinical value?

    Science.gov (United States)

    Pinna, Gian Domenico; Maestri, Roberto; La Rovere, Maria Teresa

    2015-04-01

    The baroreceptor-heart rate reflex (baroreflex sensitivity, BRS) is a key mechanism contributing to the neural regulation of the cardiovascular system. Several methods have been proposed so far to assess BRS by analyzing the spontaneous beat-to-beat fluctuations of arterial blood pressure and heart rate. These methods are inherently simple, non-invasive and low-cost. This study is an attempt to address the question of whether spontaneous baroreflex methods have proven to be of value in the clinical setting. In the first part of this article, we critically review most representative clinical studies using spontaneous BRS techniques either for risk stratification or treatment evaluation, these being major issues in the clinical management of the patients. In the second part, we address two important aspects of spontaneous BRS measurements: measurability and reliability. Estimation of BRS in the studies selected for the review was performed according to the sequence, transfer function, alpha-index and phase-rectified signal averaging method. Arterial blood pressure was recorded non-invasively during supine, short-term (Measurability and reliability can be a major issue in the measurement of spontaneous BRS, particularly in some patient populations like post-myocardial infarction and heart failure patents. Main causes of poor measurability are: non-sinus rhythm, a high rate of ectopic beats and the need for recorded time series of RR interval and arterial blood pressure to satisfy the constraints of the different BRS estimation algorithms. As for reliability, within-subject variability is rather high in the measurements of spontaneous BRS and, therefore, should be carefully taken into account when BRS measurements are used to detect treatment effects in individual patients. PMID:25798657

  18. ASSESSMENT OF UTI IN POSTMENOPAUSAL WOMEN ATTENDING OPD CLINIC OF CHITWAN MEDICAL COLLEGE, BHARATPUR, CHITWAN, NEPAL

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    Mamata Sharma Neupane

    2013-06-01

    Full Text Available Urinary tract infection (UTI is the most common bacterial infection in young and elderly women. Despite the higher incidence of bacteriuria in elderly women, most UTI research has been conducted in young women. Hence, the present paper investigates the assessment of UTI in postmenopausal women attending OPD Clinic of Chitwan Medical College, Bharatpur, Chitwan, Nepal. A cross-sectional study was conducted in OPD clinic of Chitwan Medical College Teaching Hospital from December, 2012 to April, 2013. Total 400 patients suspected with UTI were reviewed, out of which 173 (43.3 % of the suspected samples showed presence of potential pathogens causing UTI in postmenopausal women. Escherichia coli (E. coli was the predominant (65.1% bacterial pathogen. Amikacin was found to be most sensitive antimicrobial followed by Nitrofurantoin and Gentamcin. Ampicillin showed the higher percentage of resistant, compared to other antimicrobials. In conclusion, drug resistance among bacterial pathogens is an evolving process, regular surveillance and monitoring is necessary to provide effective treatment of UTIs.

  19. 2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations.

    Science.gov (United States)

    Guazzi, Marco; Arena, Ross; Halle, Martin; Piepoli, Massimo F; Myers, Jonathan; Lavie, Carl J

    2016-06-14

    In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research. PMID:27143685

  20. Assessment of Gastroesophageal Reflux in Children(2-12 Month Based on Clinical Findings and Ultrasonography

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    F Jassemi Zergani

    2012-07-01

    Full Text Available Introduction: Gastroesophageal reflux is a common gastrointestinal disorder among infants, which can cause complications, such as esophagitis and Barrett's esophagus if its diagnosis and treatment are delayed. On the other hand, similarity of Gastro esophageal Reflux symptoms with symptoms of other childhood diseases makes its diagnosis and treatment difficult. So a proper tool for early screening and diagnostic test is essential. Methods: This study was conducted on 221 infants(2 to 12 months with initial symptoms of gastro esophageal reflux(frequent vomiting, restlessness after feeding, no weight gain, coughing repeatedly and refusing to eat that referred to pediatric Clinic of Rajai Hospital in Tonekabon. Data was collected with demographic and infant gastro esophageal reflux questionnaire by use of the information in records and interview with parents. Then the samples were examined via sonography for gastroesophagial reflux. Results: After initial screening based on infants gastro esophageal reflux tool, gastro esophageal reflux by ultrasound was positive in 63/3% of infants. The mean esophageal diameter was (20/73±2/54mm in infants with gastro esophageal reflux and (23/71±2/35mm in infants without gastro esophageal reflux. Conclusion: Due to the similarity of gastro esophageal Reflux symptoms with clinical symptoms of other childhood diseases, use of an initial screening measurement for early assessment of gastro esophageal reflux in infants is necessary. Moreover, appropriate, available and low costs diagnostic method with little complication seems essential such as ultrasonography for confirm diagnosis and early treatment.

  1. Assessment of self-disorders in a non-clinical population: Reliability and association with schizotypy.

    Science.gov (United States)

    Torbet, Georgina; Schulze, Dani; Fiedler, Anna; Reuter, Benedikt

    2015-08-30

    This study explores whether self-disorders occur and can be assessed reliably in a non-clinical sample, and whether the prevalence of these anomalies depends upon the degree of psychometrically defined schizotypy. Participants with either high (n=30) or low (n=20) schizotypy scores were interviewed using a modified version of the Examination of Anomalous Self-Experience (EASE). The degree to which interviewees experienced self-disorder symptoms was rated by the interviewer and an independent rater. Inter-rater reliability was calculated for each item, domain scores and the total score. For the total, sample most items (=66) showed substantial or perfect agreement (κ>0.61), with a few (=6) showing moderate agreement (κ>0.41). Reliability scores were only slightly lower when just the more homogeneous group of individuals with high Schizotypal Personality Questionnaire (SPQ) scores were examined. As expected, high SPQ scores were associated with a high level of self-disorders. In sum, the results suggest that self-disorders can be measured reliably in non-clinical samples and are particularly frequent in individuals with pronounced schizotypical traits. PMID:26032462

  2. The modification of the thrombin generation test for the clinical assessment of dabigatran etexilate efficiency.

    Science.gov (United States)

    Gribkova, Irina V; Lipets, Elena N; Rekhtina, Irina G; Bernakevich, Alex I; Ayusheev, Dorzho B; Ovsepyan, Ruzanna A; Ataullakhanov, Fazoil I; Sinauridze, Elena I

    2016-01-01

    A new oral anticoagulant, dabigatran etexilate (DE, a prodrug of direct thrombin inhibitor (DTI) dabigatran), has been used clinically to prevent thrombosis. The assessment of dabigatran efficiency is necessary in some clinical cases, such as renal insufficiency, risk of bleeding, and drug interactions. However, a specific thrombin generation test (TGT) that is one of the most informative and sensitive to anticoagulant therapy (calibrated automated thrombinography (САТ)) shows a paradoxical increase of test parameters, such as endogenous thrombin potential (ETP) and peak thrombin, in patients receiving DE. The paradoxical behaviour of ETP and peak thrombin in these patients in the presence of DTIs is mostly caused by a decrease in the activity of thrombin in the α2-macroglobulin-thrombin complex that is used as a calibrator in CAT. For a correct estimation of the TGT parameters in patient's plasma containing DTIs we proposed to use our previously described alternative calibration method that is based on the measurement of the fluorescence signal of a well-known concentration of the reaction product (7-amino-4-methylcoumarin). In this study, the validity of such approach was demonstrated in an ex vivo study in patients with knee replacement and two special patients with multiple myeloma, who received DE for thrombosis prophylaxis. PMID:27377013

  3. Doppler string phantom for assessment of clinical doppler ultrasound velocity measurement

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    Yi Zhang

    2014-03-01

    Full Text Available Purpose: The Doppler string phantom provides accurate velocity of the string motion; it can be used to calibrate Doppler ultrasound (US velocity measurements and to evaluate variations due to intrinsic spectral broadening. We developed a semi‐automated method to estimate the mode velocity (Vmode and peak velocity (Vmax based on duplex US images from a string phantom, and use them to assess clinical Doppler US velocity measurement.Methods: Steady motion of a rubber O‐ring (20 – 110 cm/s in a CIRS Doppler String phantom (Model 043 was studied using GE LOGIQ E9 system with a 9L probe. 5 s of Doppler spectral data was averaged to generate a mean spectral profile. It was fitted by a Gaussian function and Vmode was defined as the velocity of the Gaussian peak, while Vmax is defined as the velocity at which the spectral profile falls to within 1 SD of the background. Vmode and Vmax were evaluated against the prescribed motor velocity. Repeatability and variation to scanning parameters were analyzed and reported in % range, i.e. (max – min / mean.Results: Vmode and Vmax had good repeatability over six days (6.0% for Vmode, 2.9% for Vmax. Gain, compression, scale, sample volume (SV depth and length, frequency and beam steering all had minimal impact on Vmode and Vmax (variations ≤ 4.4%. Doppler angle θ had minimal effect on Vmode (2.2% but a strong effect on Vmax (26% increase as θ increased from 10° to 60°. Vmode was linearly correlated with but overestimated the motor velocity (Pearson’s r = 1.05, R2 = 1.Conclusion: This study developed a simple yet robust Vmode and Vmax estimation method. Combined with a string phantom, these velocity estimators are shown to be a useful tool to evaluate clinical Doppler US system performance. For the tested system, only Doppler angle has an appreciable impact on Vmax estimation.--------------------------------------------Cite this article as: Zhang Y, Lynch T, Hangiandreou NJ. Doppler string phantom

  4. Clinical aspects, outcome assessment, and management of ankylosing spondylitis and postenteric reactive arthritis.

    Science.gov (United States)

    van der Linden, S; van der Heijde, D

    2000-07-01

    The cause of ankylosing spondylitis remains unclear. Proof that this disorder is an autoimmune disease attributable to crossreactivity between bacteria and HLA-B27 is still lacking. Differences in endogenous peptide presentation by HLA-B27 subtypes might be relevant in the etiopathogenesis. Fractures of the osteoporotic spine contribute to morbidity. Spinal cord injury may occur. MR imaging enables identifying sacroiliitis earlier than plain radiography. Sweet syndrome has now been described in patients with ankylosing spondylitis and Crohn disease. Progress has been made in the assessment of ankylosing spondylitis. There are now core sets for different settings and validated instruments for functioning and disease activity that will enable demonstrating efficacy of new therapeutic interventions. The debate continues on classification of postinfectious and reactive arthritis. Bacterial antigens may be found in the inflamed joints; occasionally 16S ribosomal RNA is also demonstrated. Antibiotics seem not to be effective in postenteric reactive arthritis. More than 25 years have now elapsed since the association between ankylosing spondylitis and HLA-B27 was first described in 1973. The cause of this disease is still unknown, but a lot of progress has been made regarding the molecular structure of HLA-B27, the spectrum of disease, the clinical and radiographic assessment of ankylosing spondylitis, and its treatment. Recent advances in research on ankylosing spondylitis are reviewed here. PMID:10910177

  5. Assessment of biofilm formation in device-associated clinical bacterial isolates in a tertiary level hospital

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    Summaiya A Mulla

    2011-01-01

    Full Text Available Background: Biofilm formation is a developmental process with intercellular signals that regulate growth. Biofilms contaminate catheters, ventilators, and medical implants; they act as a source of disease for humans, animals, and plants. Aim: In this study we have done quantitative assessment of biofilm formation in device-associated clinical bacterial isolates in response to various concentrations of glucose in tryptic soya broth and with different incubation time. Materials and Methods: The study was carried out on 100 positive bacteriological cultures of medical devices, which were inserted in hospitalized patients. The bacterial isolates were processed as per microtitre plate method with tryptic soya broth alone and with varying concentrations of glucose and were observed in response to time. Results: Majority of catheter cultures were positive. Out of the total 100 bacterial isolates tested, 88 of them were biofilm formers. Incubation period of 16-20 h was found to be optimum for biofilm development. Conclusions: Availability of nutrition in the form of glucose enhances the biofilm formation by bacteria. Biofilm formation depends on adherence of bacteria to various surfaces. Time and availability of glucose are important factors for assessment of biofilm progress.

  6. Clinical utility of the Multiple Errands Test in schizophrenia: A preliminary assessment.

    Science.gov (United States)

    Bulzacka, Ewa; Delourme, Gwenaëlle; Hutin, Valérie; Burban, Nathalie; Méary, Alexandre; Lajnef, Mohamed; Leboyer, Marion; Schürhoff, Franck

    2016-06-30

    Schizophrenia (SZ) is a chronic, severe disease, which results in misperception of reality, major social withdrawal, and cognitive disturbances. One type of cognitive disturbance, known as executive dysfunction, is widely considered as a primary determinant of functional outcome. However, classic neuropsychological measures of executive functioning (EF) poorly represent patients' functional outcome, and thus seem inappropriate for evaluating the real-world functional impact of diseases such as SZ. We hypothesized that the Multiple Errands Test (MET), an ecological assessment of executive function would show greater ability to measure everyday adaptive functioning SZ, compared to conventional EF assessment methods. 100 clinically stable SZ patients were administered the MET, Wisconsin Card Sorting Test - 64 and a paper version of MET. Correlation analyses were performed between each EF measure and functional outcome, as measured by the Social Autonomy Scale (SAS). After adjusting for age, education, IQ and illness duration, SAS was significantly predicted by MET global score. No other EF measure correlated with SAS. Results from this study suggest that MET offers a valuable prediction of daily life functional outcome in this large sample of SZ patients. Therefore, it could be used as a complementary measure to improve the identification of executive dysfunctions prior to psychosocial interventions. PMID:27138836

  7. Philadelphia Brief Assessment of Cognition in healthy and clinical Brazilian sample

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    Danilo Assis Pereira

    2012-03-01

    Full Text Available The Philadelphia Brief Assessment of Cognition (PBAC is a neuropsychological screening instrument that assesses five cognitive domains: working memory, visuospatial functioning, language, episodic memory and comportment. The aim is to verify if PBAC can properly be used in the Brazilian sample. Participated in this study: (a 200 healthy volunteers - 100 young [21.6(2.5 years old] and 100 older adults [70.1(7.3 years old]; >12 years of education; (b 30 Alzheimer's patients (AD [73.7(5.7 years old], 4-11 years in education. The PBAC scores: (a 95.8(2.6, 90.0(4.4 and (b 65.0(10.8 were correlated with the Mini-Mental State Examination (MMSE for young 29.1(0.9, older adults 28.3(1.4 and AD 18.4(3.0 groups. A positive correlation between MMSE and PBAC (r=0.9, p<0.001 was found. Negative correlations were observed between PBAC domains [memory (-0.63, visuospatial abilities (-0.44 and working memory (-0.3 tasks]. MANOVA showed a better male performance in visuospatial functioning (F=8.5, p=0.004. The Brazilian version of PBAC proved to be a promising screening instrument for clinical purposes.

  8. An integrated approach towards the nutritional assessment of the Sardinian donkey: a tool for clinical nutritionists

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    Maria Grazia Cappai

    2013-05-01

    Full Text Available The aims of the current study were to establish: i a species-specific approach for nutritional assessment during clinical checks on Sarda breed adult donkeys, and ii a suitable equation for body weight prediction, which at present is lacking. A total of 18 adult donkeys were sampled and the following criteria were recorded: body weight (BW, body condition score (BCS, muscular mass index (MMI, along with somatometric measures (height at withers; chest girth and metabolic profiles of each individual. The species-specific nutritional assessment based on the integrated approach turned out to correlate significantly (P<0.05 with the body condition score and levels of Na, P and cholesterol in blood. The parametric equation for predicting the BW (y=0.353a+0.443b-7.62, where a= height at withers in cm; b= chest girth in cm closely fit the determined BW, with a standard error of SE=±5 kg BW.

  9. Record High US Measles Cases: Patient Vaccination, Clinical Assessment and Management

    Centers for Disease Control (CDC) Podcasts

    2014-06-30

    This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Record High US Measles Cases: Patient Vaccination, Clinical Assessment and Management. In May 2014, the United States recorded the largest number of reported measles cases since 1994 and the number continues to rise. Most cases reported have been acquired in the U.S. and are associated with importations from countries where measles is still common. This highly contagious, acute viral illness spreads quickly in unvaccinated populations once reaching the U.S. The recent measles outbreaks highlight the importance of maintaining high vaccination coverage in the U.S. and ensuring age-appropriate vaccination for international travelers. During this COCA call, clinicians will learn the status of measles in the U.S. and CDC vaccination recommendations and guidelines for patient assessment and management.  Created: 6/30/2014 by : National Center for Immunization and Respiratory Diseases; Division of Viral Diseases; Healthcare Preparedness Activity (HPA); Office of Public Health Preparedness and Response (OPHPR).   Date Released: 6/30/2014.

  10. Preschool anxiety disorders: comprehensive assessment of clinical, demographic, temperamental, familial, and life stress correlates.

    Science.gov (United States)

    Dougherty, Lea R; Tolep, Marissa R; Bufferd, Sara J; Olino, Thomas M; Dyson, Margaret; Traditi, Jennifer; Rose, Suzanne; Carlson, Gabrielle A; Klein, Daniel N

    2013-01-01

    This study examined correlates of preschoolers' anxiety disorders using a comprehensive, multimethod design. Participants included a community sample of 541 three-year-old children, of whom 106 (19.6%) met criteria for at least 1 anxiety disorder. Child and parental psychopathology and life stress were assessed with clinical interviews. Child temperament and parenting behavior were assessed with laboratory observations. Mothers and fathers reported on their parenting styles. Compared to preschoolers with no anxiety disorder, preschoolers with an anxiety disorder were more likely to meet criteria for comorbid depressive and oppositional defiant disorders and to exhibit greater temperamental behavioral inhibition and lower positive affectivity, and more sleep problems. Children with anxiety disorders also experienced more stressful life events in the previous 6 months, and their mothers had a higher rate of current anxiety disorders. Compared to children with other anxiety disorders, children with only specific phobia exhibited a somewhat different pattern of associations than children with other anxiety disorders. Overall, the findings suggest that many of the correlates observed in older youth with anxiety disorders are also observed in preschoolers. PMID:23368788

  11. Assessment of service quality of public antiretroviral treatment (ART clinics in South Africa: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kinkel Hans F

    2012-07-01

    Full Text Available Abstract Background In South Africa the ever increasing demand for antiretroviral treatment (ART runs the risk of leading to sub-optimal care in public sector ART clinics that are overburdened and under resourced. This study assessed the quality of ART services to identify service areas that require improvement. Methods A cross-sectional study was carried out at 16 of 17 public ART clinics in the target area in greater Pretoria, South Africa. Trained participant observers presented as ART qualifying HIV positive patients that required a visit to assess treatment readiness. They evaluated each facility on five different occasions between June and November 2009, assessing the time it took to get an appointment, the services available and accessed, service quality and the duration of the visit. Services (reception area, clinician’s consultation, HIV counselling, pharmacy, nutrition counselling and social worker’s assessment were assessed against performance standards that apply to all clinics. Service quality was expressed as scores for clinic performance (CPS and service performance (SPS, defined as the percentage of performance standards met per clinic and service area. Results In most of the clinics (62.5% participant observers were able to obtain an appointment within one week, although on the day of their visit essential services could not always be accessed. The median CPS of the assessed facilities was 68.5 with four clinics not meeting minimum standards (CPS > 60. The service areas that performed least well were the clinician’s consultation (SPS 67.3 and HIV counselling (SPS 70.7. Most notably, clinicians performed a physical examination in only 41.1% of the visits and rarely did a complete TB symptom screening. Counsellors frequently failed to address prevention of HIV transmission. Conclusions Overall public sector ART clinics in greater Pretoria were easily accessible and their services were of an acceptable quality. However

  12. Disease quantification in dermatology: in vivo near-infrared spectroscopy measures correlate strongly with the clinical assessment of psoriasis severity

    Science.gov (United States)

    Greve, Tanja Maria; Kamp, Søren; Jemec, Gregor B. E.

    2013-03-01

    Accurate documentation of disease severity is a prerequisite for clinical research and the practice of evidence-based medicine. The quantification of skin diseases such as psoriasis currently relies heavily on clinical scores. Although these clinical scoring methods are well established and very useful in quantifying disease severity, they require an extensive clinical experience and carry a risk of subjectivity. We explore the opportunity to use in vivo near-infrared (NIR) spectra as an objective and noninvasive method for local disease severity assessment in 31 psoriasis patients in whom selected plaques were scored clinically. A partial least squares (PLS) regression model was used to analyze and predict the severity scores on the NIR spectra of psoriatic and uninvolved skin. The correlation between predicted and clinically assigned scores was R=0.94 (RMSE=0.96), suggesting that in vivo NIR provides accurate clinical quantification of psoriatic plaques. Hence, NIR may be a practical solution to clinical severity assessment of psoriasis, providing a continuous, linear, numerical value of severity.

  13. CLINICAL ASSESSMENT OF INTRAUTERINE GROWTH RESTRICTION AND ITS CORRELATION WITH FETAL OUTCOME

    Directory of Open Access Journals (Sweden)

    Sudha

    2013-10-01

    Full Text Available ABSTRACT : IUGR is one of the most serious challenges in both developed and developing contraries . I t is the single most important factor that determines in chances of child survival. In our country PGRF remain one of the commonest cause of neonates morbidity and mortality 30% of neonatal death are done to IUGR . D espite of all efforts by government 10 0% antenatal care is poor but women are seeking health facility for delivery at time ever more important to identify such high risk pregnancy and manage for better met and fetal examination (one step in 3 rd trimester can be used as a screening procedure f or detection of IUGR babies. MATERIAL AND METHODS : all pregnant women coming to the facility diagnosed to have IUGR by clinical method ( SFH, AG , clinical assessment of liquor were included in the study for duration of one year. M aternal and fetal outcome was noted in terms of mode of delivery and neonatal death, still birth, SGA, AGA. Apgar score of all the babies was noted to assess morbidity. OBSERVATION : O f the total antenatal women 200 were identify as IUGR by clinical method out of which most of were from age group 21 - 25 years comprising 72.4% of total cases. Maternal weight and height influence weight of the babies 75% IUGR babies were noted in height less than 145 cm. 78.5% were unbooked and 64 belong to rural population. various risk maternal factor s like hypertensive disorder 26%, anemia 16.5%, previous history of IUGR 9%, antepartum haemorrhage 6%, diabetes 1%, rh negative 4.5%, heart disease 1%, recurrent abortion 5% in 17% no identified risk factors were found, 80% were delivered vaginal, 67.5% b abies were SGA after birth as asses sed by clinical method, 68%, had A pgar score less than 7. Perinatal mortality constituted 27.3% of the babies. DISCUSSION : I ntrauterine growth restriction is one of the common abnormality encountered by the obstetrician, when present it increases perinatal morbidity and mortality. it is a

  14. Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic.

    Science.gov (United States)

    Haymes, Adam

    2016-04-01

    Each year venous thromboembolism (VTE) causes up to 60,000 deaths in the UK, many resulting from hospital-acquired thromboses following elective surgery. National Institute for Health and Clinical Excellence (NICE) guidelines state that all elective surgical patients should receive verbal and written information pre-operatively regarding the risks of developing VTE. This audit assessed elective surgical patient's prior awareness of VTE and examined how effective targeted patient education during the pre-operative assessment is in increasing this awareness. A 13 point questionnaire designed to assess a pre-operative patient's understanding of topics relating to VTE was provided to consecutive patients identified as being at risk of developing VTE at the end of their pre-operative assessment over a two-week period. A total of 68 questionnaires were completed. Provision of verbal and written information was poor (47 %, n = 32 and 47 %, n = 32 respectively). Despite this, 71 % (n = 48) of patients were aware of the consequences of developing VTE. Many patients correctly identified surgery (71 %, n = 48), immobility (71 %, n = 48) and being overweight (68 %, n = 46) as risk factors, but not dehydration (47 %, n = 32). Lack of awareness regarding personal methods to reduce the risk of developing a VTE post-operatively (24 %, n = 16) and potential side-effects of medical prophylaxis (32 %, n = 22) were also identified. Many patients already possess an awareness of VTE, however, specific knowledge regarding its risk factors and methods of prevention is lacking. Provision of targeted written and verbal educational information during the pre-operative assessment is an effective method of increasing a patient's awareness of these topics. Increased patient awareness may empower patients in their post-operative recovery and enable them to make more informed decisions regarding VTE prophylaxis options. PMID:25991380

  15. Welfare assessment: correlations and integration between a Qualitative Behavioural Assessment and a clinical/health protocol applied in veal calves farms

    OpenAIRE

    van Reenen, Cornelis G; Giulio Cozzi; Elena Tessitore; Marta Brscic; Francoise Wemelsfelder; Flaviana Gottardo

    2009-01-01

    This study is aimed at finding correlations and possible integration among Qualitative Behavioural Assessment (QBA) and a specific protocol of clinical/health evaluation. Both welfare assessment methods were based on direct animal observation and were applied in 24 Italian veal calves farms at 3 weeks (wks) of rearing. Principal component analysis (PCA) summarized 20 QBA descriptors on two main components (PC1 and PC2) with eigenvalues above 4 and explaining 29.6 and 20.3% of the variation re...

  16. Implementation of an Electronic Objective Structured Clinical Exam for Assessing Practical Skills in Pre-Professional Physiotherapy and Occupational Therapy Programs: Examiner and Course Coordinator Perspectives

    Science.gov (United States)

    Snodgrass, Suzanne J.; Ashby, Samantha E.; Rivett, Darren A.; Russell, Trevor

    2014-01-01

    Assessment of practical clinical skills is essential in the health fields. Objective Structured Clinical Exams (OSCEs), where examiners assess students performing clinical procedures on simulated patients (actors), are central to the evaluation of practical skills. However, traditional OSCEs require considerable time-investment to administer, and…

  17. Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office

    OpenAIRE

    Cawley MJ; Pacitti R; Warning W

    2011-01-01

    Objective: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians officeMethods: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceu...

  18. Assessing the HIV Care Continuum in Latin America: progress in clinical retention, cART use and viral suppression

    OpenAIRE

    Rebeiro, Peter F.; Carina Cesar; Shepherd, Bryan E.; Raquel B De Boni; Cortés, Claudia P.; Fernanda Rodriguez; Pablo Belaunzarán-Zamudio; Pape, Jean W; Denis Padgett; Daniel Hoces; McGowan, Catherine C; Pedro Cahn

    2016-01-01

    Introduction: We assessed trends in HIV Care Continuum outcomes associated with delayed disease progression and reduced transmission within a large Latin American cohort over a decade: clinical retention, combination antiretroviral therapy (cART) use and viral suppression (VS). Methods: Adults from Caribbean, Central and South America network for HIV epidemiology clinical cohorts in seven countries contributed data between 2003 and 2012. Retention was defined as two or more HIV care visits an...

  19. Development, validation and clinical assessment of a short questionnaire to assess disease-related knowledge in inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    Keegan, Denise

    2013-02-01

    Only two inflammatory bowel disease (IBD) knowledge scales are available, both primarily aimed at evaluating the effectiveness of clinical education programs. The aim of this study was to develop and validate a short knowledge questionnaire for clinical and academic research purposes.

  20. Assessment of menopausal symptoms among women attending various outreach clinics in South Canara District of India

    Science.gov (United States)

    Joseph, Nitin; Nagaraj, Kondagunta; Saralaya, Vittal; Nelliyanil, Maria; Rao, PP Jagadish

    2014-01-01

    Introduction: Menopausal symptoms experienced by women are known to affect their quality-of-life. The symptoms experienced at menopause are quite variable and their etiology is found to be multifactorial. This study was hence done to assess the pattern and severity of menopausal symptoms and to find out the factors associated with these symptoms. Materials and Methods: This cross-sectional study was conducted in various outreach clinics of Kasturba Medical College, Mangalore. Women in the age group of 40-65 years were included in the study by convenient sampling method. Data regarding menopausal symptom was obtained by interviewing each participant using the menopause rating scale questionnaire. Results: Mean age of the participants were 54.2 ± 7.2 years and mean age of attainment of menopause was 48.4 ± 4.5 years. Mean duration of menopause was found to be 7.5 ± 5.3 years. Commonest symptom reported was joint and muscular discomfort and physical and mental exhaustion seen in 94 (85.4%) participants. The mean number of symptoms reported by participants was 7.6 ± 2.8. Educated women reported significantly more symptoms (F = 2.218, P = 0.047). Somatic and urogenital symptoms were more among perimenopausal women and somatic symptoms were more among postmenopausal women. Fifty-eight (52.7%) participants had one or more severe symptoms. Severe symptoms were most among premenopausal women. Conclusion: The high proportion and severity of menopausal symptoms observed in this study group proves that menopausal symptoms are common and cannot be ignored. More of menopausal clinics are needed for awareness generation, early recognition and treatment of related morbidities. PMID:24970987

  1. Assessment of chemomechanical removal of carious lesions using Papacarie Duo ™: Randomized longitudinal clinical trial

    Directory of Open Access Journals (Sweden)

    Simone Ferreira Borges Matsumoto

    2013-01-01

    Full Text Available Background: Chemomechanical removal of carious lesions consists of the dissolution of carious tissue by the application of a natural or synthetic agent, followed by atraumatic mechanical removal. Aim: The aim of the present study was to assess the effectiveness of Papacarie Duo ® gel in the chemomechanical removal of carious lesions in primary teeth in comparison to the traditional method (low-speed bur. Settings and Design: A randomized clinical trial was conducted with 20 children between 5 and 8 years of age. Materials and Methods: Two teeth were treated in each child (split-mouth design, with the randomization of two methods: Group 1 - chemomechanical caries removal with Papacarie Duo™; and Group 2 - removal of carious dentin tissue using a low-speed bur. Both methods involved restoration with glass ionomer cement and follow up. The following aspects were evaluated: time required for the procedure; pain (face evaluation scale; rtention of the restorative material in the cavity; and the presence of secondary caries after 30 days. Statistical Analysis Used: Chi-squared test, Student′s t-test, and Wilcoxon test. Results: No statistically significant differences between methods were found regarding time required for the procedure (P = 0.13, the occurrence of pain (P = 0.585, or restoration status at the 30-day clinical evaluation (P = 0.713. Conclusion: The findings of the present study demonstrate that the two methods achieve similar results. The advantages of minimally invasive treatment, such as chemomechanical caries removal with Papacarie Duo™, are its ease of use, patient comfort, and the fact that it causes less damage to dental tissue.

  2. Assessment of noise levels in clinical and laboratory areas of dental teaching institution, Ahmedabad

    Directory of Open Access Journals (Sweden)

    Sujal M Parkar

    2014-01-01

    Full Text Available Aim: To measure and assess the noise levels produced by different dental equipments. Materials and Methods: Measurement of the noise level was performed in preclinics, clinics, and dental laboratory of different departments of Ahmedabad Dental College and Hospital. The noise levels were determined using a Mini sound meter (CEM USA, which was placed at the dentist′s and laboratory technician′s ear level and at a distance of 1 m from a main noise source. The level of noise was measured in decibel (dB while the instruments were at maximum running speed. Results: In dental laboratory, the nosiest dental equipment was gypsum lathe trimmer with the noise level ranging from 87.36 to 98.3 dB. In preclinical area, the sound produced by low-speed air-rotor ranges from 66.68 to 69.28 dB. In clinical areas, the highest noise produced was by high-speed air-rotor (73.36 to 81.8 dB. The noise created by suction pump when in contact with mucosa was in range from 73.1 to 80.32 dB. The noise levels generated during cutting were significantly higher (P < 0.05 than those of noncutting, which was proved in the course of the measurements. Conclusion: At the end of the study it can be concluded that the sound levels are below that causes damage to the human ear (85 dB. However, dental technicians and other personnel working all day in noisy laboratories could be at risk of Noise-Induced Hearing Loss if they did not choose not to wear ear protection.

  3. Clinical assessment of the effect of digital filtering on the detection of ventricular late potentials

    Directory of Open Access Journals (Sweden)

    P.R. Benchimol-Barbosa

    2002-11-01

    Full Text Available Ventricular late potentials are low-amplitude signals originating from damaged myocardium and detected on the body surface by ECG filtering and averaging. Digital filters present in commercial equipment may interfere with the ability of arrhythmia stratification. We compared 40-Hz BiSpec (BI and classical 40- to 250-Hz band-pass Butterworth bidirectional (BD filters in terms of impact on time domain variables and diagnostic properties. In a transverse retrospective age-adjusted case-control study, 221 subjects with sinus rhythm without bundle branch block were divided into three groups after signal-averaged ECG acquisition: GI (N = 40, clinically normal controls, GII (N = 158, subjects with coronary heart disease without sustained monomorphic ventricular tachycardia (SMVT, and GIII (N = 23, subjects with heart disease and documented SMVT. Conventional variables analyzed from vector magnitude data after averaging to 0.3 µV final noise were obtained by application of each filter to the averaged signal, and evaluated in pairs by numerical comparison and by diagnostic agreement assessment, using conventional and optimized thresholds of normality. Significant differences were found between BI and BD variables in all groups, with diagnostic results showing significant disagreement between both filters [kappa value of 0.61 (P<0.05 for GII and 0.31 for GIII (P = NS]. Sensitivity for SMVT was lower with BI than with BD (65.2 vs 91.3%, respectively, P<0.05. Filters provided significantly different numerical and diagnostic results and the BI filter showed only limited clinical application to risk stratification of ventricular arrhythmia.

  4. [Doppler echocardiography for the assessment of left ventricular diastolic function: methodology, clinical and prognostic value].

    Science.gov (United States)

    Galderisi, Maurizio; Dini, Frank Lloyd; Temporelli, Pier Luigi; Colonna, Paolo; de Simone, Giovanni

    2004-02-01

    To date, left ventricular diastolic function can be clinically assessed by Doppler echocardiography. The Doppler recording of mitral inflow and pulmonary venous flow provides main information about ventricular diastolic properties. At the level of the mitral inflow we can measure the early diastolic peak velocity (E), atrial peak velocity and derive their ratio, the E velocity deceleration time and isovolumic relaxation time, and calculate atrial filling fraction. At the level of the pulmonary veins, the peak systolic velocity (S), the peak diastolic velocity (D), the S/D ratio, the peak of reverse atrial velocity and its duration, above all in terms of difference with the mitral A duration, characterize the different patterns of diastolic function. Also the new ultrasound technologies are clinically useful to define ventricular diastolic properties. The myocardial early diastolic velocity (Em) detectable by pulsed tissue Doppler at the level of the mitral annulus, and the flow propagation velocity (Vp) recordable by color M-mode of left ventricular inflow, both relatively preload-independent, are measurements related to tau, the reference hemodynamic variable. The E/Em and E/Vp ratios provide accurate estimation of the changes in left ventricular end-diastolic pressure. They allow us to distinguish the pseudonormal and restrictive patterns from the normal pattern and are, therefore, alternative tools to Valsalva maneuver of mitral inflow and pulmonary venous flow. The predictive value of the pattern of abnormal relaxation (grade I of diastolic dysfunction) and both the reversible and irreversible restrictive patterns (grade III and IV respectively) is now demonstrated and permits important prognostic stratification and appropriate therapeutic management. PMID:15080528

  5. Assessment of human herpesvirus-6 infection in mesenchymal stromal cells ex vivo expanded for clinical use.

    Science.gov (United States)

    Pessina, A; Bonomi, A; Coccè, V; Bernardo, M E; Cometa, A M; Ferrari, M; Sisto, F; Cavicchini, L; Locatelli, F

    2009-12-01

    Infection or reactivation of human herpesvirus (HHV)-6 represents a potentially serious complication (often involving the central nervous system) in patients receiving either solid organ or hematopoietic stem cell transplantation. The objective of this study was to assess the risk of HHV-6 infection/reactivation in mesenchymal stromal cells (MSCs). MSCs are multipotent cells displaying immunomodulatory properties that have been already successfully used in the clinical setting to enhance hematopoietic stem cell engraftment and to treat steroid-refractory acute graft-versus-host disease. We analyzed 20 samples of ex vivo expanded MSCs, at different passages of culture, isolated both from bone marrow and from umbilical cord blood. Through Western blotting and immunocytochemistry techniques, we investigated the presence of the HHV-6 receptor (CD46) on cell surface, whereas the presence of HHV-6 DNA was evaluated by nested polymerase chain reaction assay. All of the MSC samples tested were positive for the virus receptor (CD46), suggesting their potential susceptibility to HHV-6. However, none of the MSC samples derived from cultures, performed in the perspective of clinical use, was found to harbor HHV-6. This preliminary observation on a consistent number of MSC samples, some of them tested at late in vitro passages, indicates a good safety profile of the product in terms of HHV-6 contamination. Nevertheless, it remains important to set up in vitro experimental models to study MSCs' susceptibility to HHV-6 (and HHV-7) infection, to verify their capacity to integrate the virus into cellular DNA, and to investigate which experimental conditions are able to induce virus reactivation. PMID:19664021

  6. A simplified method of T1ρ mapping in clinical assessment of knee joint

    International Nuclear Information System (INIS)

    We assessed the clinical utility of our proposed simplified method for T1ρ mapping calculations. Ten healthy subjects underwent scanning on a 3-tesla magnetic resonance system using an 8-channel phased-array coil. For each subject, we obtained sagittal T1ρ-prepared images using 5 different time of spin-lock pulses (TSL=1, 20, 40, 60, and 80 ms), produced conventional T1ρ maps (cT1ρ maps) using all TSLs, and recomputed our proposed simplified T1ρ maps (sT1ρ maps) using a decreasing number of TSLs (from 4 to 2). We then investigated the differences and correlations in T1ρ values of the tissues obtained using different numbers of spin-lock times. There was a strong positive correlation (single measure intraclass correlation coefficient=0.948; 95% confidence interval=0.911 to 0.970) in T1ρ values of tissues between the cT1ρ and sT1ρ [1, 80] maps. The 2 maps were comparable, though there was a small difference in T1ρ value between the two. The total scan time to acquire the data from 5 spin-lock times was 16 min 15 s. Similarity of the T1ρ [1, 80] map with the conventional approach reduced scan time by 60%, to 6 min 30 s. The clinical relevance of our proposed simplified method is potentially similar to that of the conventional method, and our method requires a shorter examination time and generally preserves the reliability of the T1ρ relaxation time of the tissues. (author)

  7. Lateral Calcaneal Artery Flaps in Atherosclerosis: Cadaveric Study, Vascular Assessment and Clinical Applications

    Science.gov (United States)

    Tanthanatip, Pattaya; Kuhaphensaeng, Paiboon; Ruamthanthong, Anuchit; Pitiseree, Anont; Suwantemee, Chaichoompol

    2015-01-01

    Background: Soft tissue defects of the lateral malleolus (LM) and Achilles tendon pose difficult reconstructive problems due to the bony prominence and limited local tissue available. The objectives were to study the anatomical landmarks of the lateral calcaneal artery (LCA) and patency of LCA in atherosclerotic patients. Methods: Part I: Thirty-four cadaveric feet were dissected to identify the LCA. The distance between the LCA and the most prominent point of the LM was measured horizontally (LCAa-LM), obliquely (LCAb-LM), and vertically (LCAc-LM). Part II: Thirty-two patients were divided in 2 groups as nonatherosclerotic and atherosclerotic groups. The LCA was assessed by both Doppler ultrasonography and computed tomographic angiography (CTA). Part III: Clinical applications were demonstrated. Results: Part I: Mean distances of LCAa-LM, LCAb-LM, and LCAc-LM were 24.76, 33.68, and 35.03 mm, respectively. The LCA originated 94.12% from the peroneal artery. Part II: Doppler ultrasonography detected the LCA at 90.62% and 87.50% in nonatherosclerotic and atherosclerotic groups, respectively, whereas 100.00% and 93.75%, respectively, were detected by CTA. No statistically significant difference was found in the patency of the LCA between nonatherosclerotic and atherosclerotic patients. Part III: Clinical applications were performed in atherosclerotic patients. Conclusions: The LM is a reliable point to identify the LCA, and the LCA flap can be raised safely in atherosclerotic patients. Preoperative CTA should be performed in severely atherosclerotic patients or cases of major lower extremity vascular injuries. PMID:26495230

  8. Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

    DEFF Research Database (Denmark)

    Evron, Lotte

    2009-01-01

    the healthcare system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In......Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... who refused referral were recruited in relation to a systematic falls screening programme performed by preventive home visitors. Accepters were selected among 72 participants successively completing the falls assessment clinic programme. The time between the interviews was 12 months; different levels...

  9. In vitro study of drug sensitivity of Plasmodium falciparum: assessment of semi-microtest by /sup 3/H-hypoxanthine incorporation

    Energy Technology Data Exchange (ETDEWEB)

    Le Bras, J.; Andrieu, B.; Hatin, I.; Savel, J.; Coulaud, J.P. (Hopital Claude-Bernard, 75 - Paris (France))

    1984-05-01

    Recent advances in cultivation methods and knowledge of in vitro response of Plasmodium falciparum to antimalarials have led to improved chemosensitivity tests. The semi-microtest is a useful tool for screening presumptive antimalarials, and also for the testing sensitivity of strains recovered from patients in hospital and field studies to currently used drugs. Microscopic parasite counts on thin blood films can be replaced by measurement of /sup 3/H-hypoxanthine by the uptake parasite. Conditions which ensure optimal parasite growth and high radioisotope incorporation are described. Wells containing less than 3.10/sup 4/ asexualparasites can be studied with this method. Results of the semi-microtest are closely correlated with those of microscopic parasite count. Advantages of both methods are discussed.

  10. THE USE OF QUALITY OF LIFE AUTOMATIZED ASSESSMENT TECHNOLOGY IN PATIENTS IN CLINICAL PRACTICE OF THE ONCOUROLOGICAL DEPARTMENT

    OpenAIRE

    V. I. Shirokorad; Yu. I. Shtevnina; S. L. Shvyrev; A. N. Makhson; Dolgih, D. V.

    2014-01-01

    Objective. The developing and introduction the quality of life (QL) automatized assessment in oncourological patients in clinical practice.Subjects and methods. General questionnaire EORTC QLQ-C30 and modules (QLQ-PR25 and QLQ-BLM30) were selected for QL assessment. The software tools of hospital information system were used for development. There were surveyed 236 oncourological patients.Results. Forms of unitary and dynamic researches were developed for result visualization, interactive mod...

  11. A Virtual Clinical Trial of FDG-PET Imaging of Breast Cancer: Effect of Variability on Response Assessment1

    OpenAIRE

    Harrison, Robert L.; Elston, Brian F.; Doot, Robert K.; Lewellen, Thomas K.; Mankoff, David A.; Kinahan, Paul E

    2014-01-01

    INTRODUCTION: There is growing interest in using positron emission tomography (PET) standardized uptake values (SUVs) to assess tumor response to therapy. However, many error sources compromise the ability to detect SUV changes. We explore relationships between these errors and overall SUV variability. METHODS: We used simulations in a virtual clinical trial framework to study impacts of error sources from scanning and analysis effects on assessment of SUV changes. We varied tumor diameter, s...

  12. ASSESSMENT OF BALANCE ABILITIES IN ELDERLY PEOPLE BY MEANS OF A CLINICAL TEST AND A LOW-COST FORCE PLATE

    OpenAIRE

    Sgrò, Francesco; Licari, Danilo; Coppola, Roberto; Lipoma, Mario

    2015-01-01

    Balance and mobility assessment, and the estimation of the risk of falls, represent crucial elements for supporting a healthy aging process. In this work, we evaluated the association of two approaches used to estimate standing balance and sit-to-stand abilities in community-dwelling older people. The clinical-based test was the Short Physical Performance Battery, while the laboratory-based assessments were realized by means of output measures obtained with the Wii Balance Board. The corre...

  13. Comparative assessment of trial-level surrogacy measures for candidate time-to-event surrogate endpoints in clinical trials

    OpenAIRE

    Shi, Qian; Renfro, Lindsay A.; Bot, Brian M; Burzykowski, Tomasz; Buyse, Marc; Sargent, Daniel J.

    2011-01-01

    Various meta-analytical approaches have been applied to evaluate putative surrogate endpoints (S) of primary clinical endpoints (T), however a systematic assessment of their performance is lacking. Existing methods in the meta-analytic framework can be grouped into two types conventional and model-based trial-level surrogacy (TLS) measures. Both conventional and model-based TLS measures assess the ability to predict the treatment effect on T based on an observed treatment effect on putative S...

  14. Initial clinical validation of Health Heritage, a patient-facing tool for personal and family history collection and cancer risk assessment.

    Science.gov (United States)

    Baumgart, Leigh A; Postula, Kristen J Vogel; Knaus, William A

    2016-04-01

    Personal and family health histories remain important independent risk factors for cancer; however they are currently not being well collected or used effectively. Health Heritage was designed to address this need. The purpose of this study was to validate the ability of Health Heritage to identify patients appropriate for further genetic evaluation and to accurately stratify cancer risk. A retrospective chart review was conducted on 100 random patients seen at an adult genetics clinic presenting with concern for an inherited predisposition to cancer. Relevant personal and family history obtained from the patients' medical records was entered into Health Heritage. Recommendations by Health Heritage were compared to national guidelines of eligibility for genetic evaluation. Agreement between Health Heritage referral for genetic evaluation and guideline eligibility for genetic evaluation was 97 % (sensitivity 98 % and specificity 88 %). Risk stratification for cancer was also compared between Health Heritage and those documented by a geneticist. For patients at increased risk for breast, ovarian, or colorectal cancer as determined by the geneticist, risk stratification by Health Heritage agreed 90, 93, and 75 %, respectively. Discordances in risk stratification were attributed to both complex situations better handled by the geneticist and Health Heritage's adherence to incorporating all information into its algorithms. Health Heritage is a clinically valid tool to identify patients appropriate for further genetic evaluation and to encourage them to confirm the assessment and management recommendations with cancer genetic experts. Health Heritage also provides an estimate of cancer risk that is complementary to a genetics team. PMID:26711915

  15. Trend of glycated hemoglobin testing in diabetic patients: to assess compliance with clinical practice guidelines

    International Nuclear Information System (INIS)

    Objective: To determine appropriate use of glycated hemoglobin (HbA1c) testing in accordance with current recommended guidelines. Study Design: Descriptive study. Place and Duration of Study: Chemical Pathology Department Shifa International Hospital, Islamabad from Oct 2011 to Oct 2012. Material and Methods: We randomly selected 170 known diabetic patients' data from our Laboratory Information System (LIS) who were retrospective analyzed for HbA1c to check for intervals and test frequency for each patient in one year. Patients with follow-up for at least one year at Shifa International Hospital, Islamabad and having their routine investigations in our chemical pathology laboratory were included. The concentrations of HbA1c for all the specimens were measured immunoturbidimetrically using a microparticle agglutination inhibition method. Four guidelines namely World Health Organization (WHO), American Diabetic Association (ADA), Canadian Diabetic Association (CDA) and National Institute for Health and Clinical Excellence (NICE) about HbA1c testing were utilized for data interpretation. All tests ordered within a 2 months period or more than 6 months following the previous order were labeled as inappropriate. Results: Only 35.8% of the patients were being properly monitored as per guidelines. Out of 64% patients who were inappropriately monitored, 12.9% had repeat orders within 2 months while 51.1% of patients were being monitored at longer interval against recommended guidelines. Conclusions: Glycated hemoglobin is a useful tool to objectively assess the prior glycemic control of patients with type 1 and type 2 diabetes. The study highlights that in large proportion of diabetic patients, HbA1c is not utilized properly as a tool to assess the risk of diabetic complications but in a small proportion is also tested unnecessarily which adds to avoidable health expenditure. (author)

  16. CLINICAL ASSESSMENT OF THE EFFECT OF LOW LEVEL LASER TREATMENT OF ORAL MUCOSA DECUBITUS ULCERS

    Directory of Open Access Journals (Sweden)

    Hristina Lalabonova

    2013-10-01

    Full Text Available Decubitus ulcers in the oral mucosa tend to be very painful causing discomforting sensation in patients in speaking and eating. Low energy lasers can provide an alternative method for the treatment of these ulcers.The aim of the present paper was to assess clinically the healing effect of low level laser irradiation on oral mucosa decubitus ulcers.Material and methods: A total of 90 patients with decubitus ulcers were treated in the present study; they were randomly assigned to three groups: group I included 30 patients treated with low level laser (LLL irradiation (wavelength of irradiation 658 nm; group II - 30 patients treated with laser irradiation of 904 nm; and group III (controls - 30 patients who received a standard conventional treatment with "granofurin" and "solcoseryl".The treatment sessions in all three groups were administered once daily. The patients in groups I and II were irradiated with focused irradiation at an angle from a distance using a conically shaped light probe 3 mm in diameter. The irradiated area was 0.5 cm2. The light was focused on the oral mucosa ulcer and the surrounding inflamed mucosa at a distance of 0.5 to 1 cm. Diode lasers were used in the study. The dosage of irradiation was 1.2 J/cm2.Results and discussion: The treatment effect was evaluated by changes in the studied parameters: pain intensity, erythema, and epithelialization. They were assessed at baseline, and at days 1, 3 and 5. Conclusions: LLLT administered with the proposed methodology manages pain rapidly and accelerates the process of epithelialization of decubitus ulcers in the soft tissues of the mouth.

  17. The feasibility of using electronic clinical outcome assessments in people with schizophrenia and their informal caregivers

    Directory of Open Access Journals (Sweden)

    Tolley C

    2015-03-01

    Full Text Available Chloe Tolley,1 Diana Rofail,2 Adam Gater,1 Justine K Lalonde31Adelphi Values Ltd, Bollington, UK; 2Roche Products Ltd, Welwyn Garden City, UK; 3Roche S.A.S, Paris, France Abstract: Many clinical outcome assessments (COAs were originally developed for completion via pen and paper. However, in recent years there have been movements toward electronic capture of such data in an effort to reduce missing data, provide time-stamped records, minimize administrative burden, and avoid secondary data entry errors. Although established in many patient populations, the implications of using electronic COAs in schizophrenia are unknown. In accordance with International Society for Pharmacoeconomics and Outcomes Research (ISPOR Task Force recommendations, in-depth cognitive debriefing and usability interviews were conducted with people with schizophrenia (n=12, their informal (unpaid caregivers (n=12, and research support staff (n=6 to assess the suitability of administration of various electronic COA measures using an electronic tablet device. Minimal issues were encountered by participants when completing or administering the COAs in electronic format, with many finding it easier to complete instruments in this mode than by pen and paper. The majority of issues reported were specific to the device functionality rather than the electronic mode of administration. Findings support data collection via electronic tablet in people with schizophrenia and their caregivers. The appropriateness of other forms of electronic data capture (eg, smartphones, interactive voice response systems, etc is a topic for future investigation. Keywords: ePRO, eCOA, mode of administration, electronic data capture, usability 

  18. Objective structured clinical examination for pharmacy students in Qatar: cultural and contextual barriers to assessment.

    Science.gov (United States)

    Wilby, K J; Black, E K; Austin, Z; Mukhalalati, B; Aboulsoud, S; Khalifa, S I

    2016-04-01

    This study aimed to evaluate the feasibility and psychometric defensibility of implementing a comprehensive objective structured clinical examination (OSCE) on the complete pharmacy programme for pharmacy students in a Middle Eastern context, and to identify facilitators and barriers to implementation within new settings. Eight cases were developed, validated, and had standards set according to a blueprint, and were assessed with graduating pharmacy students. Assessor reliability was evaluated using inter-class coefficients (ICCs). Concurrent validity was evaluated by comparing OSCE results to professional skills course grades. Field notes were maintained to generate recommendations for implementation in other contexts. The examination pass mark was 424 points out of 700 (60.6%). All 23 participants passed. Mean performance was 74.6%. Low to moderate inter-rater reliability was obtained for analytical and global components (average ICC 0.77 and 0.48, respectively). In conclusion, OSCE was feasible in Qatar but context-related validity and reliability concerns must be addressed prior to future iterations in Qatar and elsewhere. PMID:27432407

  19. Radiographic pelvimetry for assessment of dystocia in bitches: a clinical study in two Terrier breeds

    International Nuclear Information System (INIS)

    Radiographic pelvimetry was used to assess the role of pelvic anatomy in obstructive dystocia in bitches. Based on the history of previous whelpings,20 Boston terrier and 14 Scottish terrier bitches were divided into two equal groups: normally whelping bitches and bitches with obstructive dystocia. Additional whelpings during the period of study were closely observed and the pups were immediately weighed and measured. The bitches were clinically examined and the pelvis was radiographed in ventrodorsal and lateral projections. Measurements from the radiographs showed a significantly smaller pelvic size in the bitches with obstructive dystocia compared to the normally whelping bitches. Fetal-pelvic disproportion in the Scottish terrier was mainly due to a dorsoventrally flattened pelvic canal, whereas in the Boston terrier it arose from the combination of a dorsoventrally flattened pelvic canal and big fetuses with large heads. These results suggest that radiographic pelvimetry could be used to predict a disposition for dystocia in individual bitches, and as a basis for selection of breeding animals

  20. Use of epidemiology and clinical toxicology to assess environmental health problems

    Energy Technology Data Exchange (ETDEWEB)

    Cordle, F.

    1984-09-01

    Historically, epidemiology has played an important role in the changes that have taken place over time as epidemics of important infectious diseases have been replaced with modern epidemics of chronic, degenerative diseases such as elevated blood pressure, various types of cancers, diabetes, and stroke, among others. Two illustrations of the early uses of epidemiologic methods in investigations of disease outbreaks are described in the work of John Snow, who described outbreaks of cholera in the 1800s and J. Goldberger, who investigated the incidence of pellagra in the early 1900s. The more contemporary use of epidemiology and clinical toxicology to assess the outcome of human exposure to environmental contaminants in the food supply are described for exposure to the polychlorinated biphenyls (PCBs) and to the polybrominated biphenyls (PBBs). Exposure to the PCBs has occurred in a variety of locations worldwide, with the greatest exposure taking place in individuals of many countries who consume fish and in Japan and Taiwan through contaminated cooking oil. Exposure to PBBs has essentially been limited to the State of Michigan where widespread contamination of cattle, dairy products, and poultry has taken place.