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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. Classroom to clinic: incorporating adolescent spiritual/faith assessment into nurse practitioner education & practice.

    Science.gov (United States)

    Haley, Janice M

    2014-01-01

    Although nursing is well grounded in the conceptualization of person as body-mind-spirit, there is little evidence that advanced practice nurses routinely address the spirit in giving patient care, especially with adolescents in the outpatient setting. The neglect of spiritual aspects of care may be related to lack of a framework, or education/incorporation into nurse practitioner preparation. This article describes one method of integrating adolescent spiritual/faith assessment into a nurse practitioner clinical course. Readings, assignments, and a grading rubric are offered.

  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. 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 ...

  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. 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

  7. PRINCIPLES OF OSCE INCORPORATED IN LONG CASE ASSESSMENT

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    Vijayan

    2015-11-01

    Full Text Available : INTRODUCTION: Traditional long cases are having strengths and weaknesses. Several attempts were made to reduce weaknesses. OSCE and OSLER are the results of such attempts. Compartmentalization is a criticism against OSCE. OSLER may not be feasible. The strengths of OSCE are utilized here to improve the quality of long case. MATERIALS AND METHODS: Structuring and check listing of Obstetric examination was done. The examiner observed the students doing the obstetric examination and marks were awarded using the check list. Out of the total marks 25% was based on this check list and the remaining 75% were awarded in the conventional way. Feedback was collected from students and faculties. ANALYSIS AND DISCUSSION: Majority of faculty and students are not satisfied by the conventional long case assessment. Study was limited to Obstetrics, but can be extended to other disciplines. Clinical examination part is the ideal one for assessment after structuring and using a check list. This will definitely improve the acceptability of long cases and the skill development. CONCLUSIONS: Structuring and check listing of clinical examination in long cases is a feasible and acceptable method. It improves learning of clinical skills and the validity and reliability of assessment. It is not more time consuming.

  8. 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

  9. 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 provided...... 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....

  10. 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.

  11. 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

  12. 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…

  13. Oximetry system performance assessment with POM (acetal) phantoms incorporating hemoglobin calibration standards and customized saturation levels

    Science.gov (United States)

    Jang, Hyounguk; Singh, Karam; Wang, Hsing-Wen; Pfefer, T. J.; Chen, Yu

    2015-03-01

    Standardized approaches for performance assessment of biophotonic devices have the potential to facilitate system development and intercomparison, clinical trial standardization, recalibration, manufacturing quality control and quality assurance during clinical use. Evaluation of devices based on near-infrared spectroscopy (NIRS) for detection of hemoglobin (Hb) content and oxygenation have often involved tissue-simulating phantoms incorporating artificial dyes or flow systems. Towards the development of simple, effective techniques for objective, quantitative evaluation of basic NIRS system performance, we have developed and evaluated two test methods. These methods are based on cuvette inserts in solid turbid phantoms for measuring commercially-available Hb oximetry standards and custom-formulated oxy/deoxy-Hb solutions. Both approaches incorporate solid acetal, or polyoxymethylene (POM), as a tissue-simulating matrix material. First, inverse-adding-doubling (IAD) based on measurements with a spectrophotometer and an integrating sphere was used to measure POM optical properties and their stability over time. Second, two fiberopticprobe- based NIRS systems were used to measure concentration change of oxy- and deoxy-Hb in standard Hb solutions and customized Hb solutions by adding yeast. Differences in system performance were likely due to differences in light source outputs and fiberoptic probe design. Our preliminary results indicate that simple phantom-based approaches based on commercially available polymers and inclusions containing Hb standards, or controlled oxygenation levels may be useful for benchtop assessment of NIRS device quality for a variety of biophotonic devices.

  14. Recommendations from a global cross-company data sharing initiative on the incorporation of recovery phase animals in safety assessment studies to support first-in-human clinical trials.

    Science.gov (United States)

    Sewell, Fiona; Chapman, Kathryn; Baldrick, Paul; Brewster, David; Broadmeadow, Alan; Brown, Paul; Burns-Naas, Leigh Ann; Clarke, Janet; Constan, Alex; Couch, Jessica; Czupalla, Oliver; Danks, Andy; DeGeorge, Joseph; de Haan, Lolke; Hettinger, Klaudia; Hill, Marilyn; Festag, Matthias; Jacobs, Abby; Jacobson-Kram, David; Kopytek, Stephan; Lorenz, Helga; Moesgaard, Sophia Gry; Moore, Emma; Pasanen, Markku; Perry, Rick; Ragan, Ian; Robinson, Sally; Schmitt, Petra M; Short, Brian; Lima, Beatriz Silva; Smith, Diane; Sparrow, Sue; van Bekkum, Yvette; Jones, David

    2014-10-01

    An international expert group which includes 30 organisations (pharmaceutical companies, contract research organisations, academic institutions and regulatory bodies) has shared data on the use of recovery animals in the assessment of pharmaceutical safety for early development. These data have been used as an evidence-base to make recommendations on the inclusion of recovery animals in toxicology studies to achieve scientific objectives, while reducing animal use. Recovery animals are used in pharmaceutical development to provide information on the potential for a toxic effect to translate into long-term human risk. They are included on toxicology studies to assess whether effects observed during dosing persist or reverse once treatment ends. The group devised a questionnaire to collect information on the use of recovery animals in general regulatory toxicology studies to support first-in-human studies. Questions focused on study design, the rationale behind inclusion or exclusion and the impact this had on internal and regulatory decisions. Data on 137 compounds (including 53 biologicals and 78 small molecules) from 259 studies showed wide variation in where, when and why recovery animals were included. An analysis of individual study and programme design shows that there are opportunities to reduce the use of recovery animals without impacting drug development. PMID:25078890

  15. Recommendations from a global cross-company data sharing initiative on the incorporation of recovery phase animals in safety assessment studies to support first-in-human clinical trials.

    Science.gov (United States)

    Sewell, Fiona; Chapman, Kathryn; Baldrick, Paul; Brewster, David; Broadmeadow, Alan; Brown, Paul; Burns-Naas, Leigh Ann; Clarke, Janet; Constan, Alex; Couch, Jessica; Czupalla, Oliver; Danks, Andy; DeGeorge, Joseph; de Haan, Lolke; Hettinger, Klaudia; Hill, Marilyn; Festag, Matthias; Jacobs, Abby; Jacobson-Kram, David; Kopytek, Stephan; Lorenz, Helga; Moesgaard, Sophia Gry; Moore, Emma; Pasanen, Markku; Perry, Rick; Ragan, Ian; Robinson, Sally; Schmitt, Petra M; Short, Brian; Lima, Beatriz Silva; Smith, Diane; Sparrow, Sue; van Bekkum, Yvette; Jones, David

    2014-10-01

    An international expert group which includes 30 organisations (pharmaceutical companies, contract research organisations, academic institutions and regulatory bodies) has shared data on the use of recovery animals in the assessment of pharmaceutical safety for early development. These data have been used as an evidence-base to make recommendations on the inclusion of recovery animals in toxicology studies to achieve scientific objectives, while reducing animal use. Recovery animals are used in pharmaceutical development to provide information on the potential for a toxic effect to translate into long-term human risk. They are included on toxicology studies to assess whether effects observed during dosing persist or reverse once treatment ends. The group devised a questionnaire to collect information on the use of recovery animals in general regulatory toxicology studies to support first-in-human studies. Questions focused on study design, the rationale behind inclusion or exclusion and the impact this had on internal and regulatory decisions. Data on 137 compounds (including 53 biologicals and 78 small molecules) from 259 studies showed wide variation in where, when and why recovery animals were included. An analysis of individual study and programme design shows that there are opportunities to reduce the use of recovery animals without impacting drug development.

  16. 78 FR 68058 - Next Generation Risk Assessment: Incorporation of Recent Advances in Molecular, Computational...

    Science.gov (United States)

    2013-11-13

    ... AGENCY Next Generation Risk Assessment: Incorporation of Recent Advances in Molecular, Computational, and..., ``Next Generation Risk Assessment: Incorporation of Recent Advances in Molecular, Computational, and... period was published on September 30, 2013. At the request of the American Chemistry Council, the...

  17. 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.

  18. 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...

  19. 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.

  20. 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...

  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. 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.

  3. 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

  4. 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…

  5. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Bonnema, Bruce Edward

    2002-02-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Bonnema, B.E.

    2002-01-16

    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.

  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. Environmental risk assessment of metals: tools for incorporating bioavailability.

    Science.gov (United States)

    Janssen, C R; Heijerick, D G; De Schamphelaere, K A C; Allen, H E

    2003-03-01

    In this paper, some of the main processes and parameters which affect metal bioavailability and toxicity in the aquatic environment and its implications for metal risk assessment procedures will be discussed. It has become clear that, besides chemical processes (speciation, complexation), attention should also be given to physiological aspects for predicting metal toxicity. The development of biotic ligand models (BLMs), which combine speciation models with more biologically oriented models (e.g. GSIM), has offered an answer to this need. The various BLMs which have been developed and/or refined for a number of metals (e.g. Cu, Ag, Zn) and species (algae, crustaceans, fish) are discussed here. Finally, the potential of the BLM approach is illustrated through a theoretical exercise in which chronic zinc toxicity to Daphnia magna is predicted in three regions, taking the physico-chemical characteristics of these areas into account.

  10. 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.)

  11. Incorporation of pharmacogenomics into routine clinical practice: the Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline development process.

    Science.gov (United States)

    Caudle, Kelly E; Klein, Teri E; Hoffman, James M; Muller, Daniel J; Whirl-Carrillo, Michelle; Gong, Li; McDonagh, Ellen M; Sangkuhl, Katrin; Thorn, Caroline F; Schwab, Matthias; Agundez, Jose A G; Freimuth, Robert R; Huser, Vojtech; Lee, Ming Ta Michael; Iwuchukwu, Otito F; Crews, Kristine R; Scott, Stuart A; Wadelius, Mia; Swen, Jesse J; Tyndale, Rachel F; Stein, C Michael; Roden, Dan; Relling, Mary V; Williams, Marc S; Johnson, Samuel G

    2014-02-01

    The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy. CPIC has focused initially on well-known examples of pharmacogenomic associations that have been implemented in selected clinical settings, publishing nine to date. Each CPIC guideline adheres to a standardized format and includes a standard system for grading levels of evidence linking genotypes to phenotypes and assigning a level of strength to each prescribing recommendation. CPIC guidelines contain the necessary information to help clinicians translate patient-specific diplotypes for each gene into clinical phenotypes or drug dosing groups. This paper reviews the development process of the CPIC guidelines and compares this process to the Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines.

  12. Incorporating detectability of threatened species into environmental impact assessment.

    Science.gov (United States)

    Garrard, Georgia E; Bekessy, Sarah A; McCarthy, Michael A; Wintle, Brendan A

    2015-02-01

    Environmental impact assessment (EIA) is a key mechanism for protecting threatened plant and animal species. Many species are not perfectly detectable and, even when present, may remain undetected during EIA surveys, increasing the risk of site-level loss or extinction of species. Numerous methods now exist for estimating detectability of plants and animals. Despite this, regulations concerning survey protocol and effort during EIAs fail to adequately address issues of detectability. Probability of detection is intrinsically linked to survey effort; thus, minimum survey effort requirements are a useful way to address the risks of false absences. We utilized 2 methods for determining appropriate survey effort requirements during EIA surveys. One method determined the survey effort required to achieve a probability of detection of 0.95 when the species is present. The second method estimated the survey effort required to either detect the species or reduce the probability of presence to 0.05. We applied these methods to Pimelea spinscens subsp. spinescens, a critically endangered grassland plant species in Melbourne, Australia. We detected P. spinescens in only half of the surveys undertaken at sites where it was known to exist. Estimates of the survey effort required to detect the species or demonstrate its absence with any confidence were much higher than the effort traditionally invested in EIA surveys for this species. We argue that minimum survey requirements be established for all species listed under threatened species legislation and hope that our findings will provide an impetus for collecting, compiling, and synthesizing quantitative detectability estimates for a broad range of plant and animal species. PMID:25155009

  13. Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

    Directory of Open Access Journals (Sweden)

    Charlotte E. Young

    2015-11-01

    Full Text Available Background: Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives: To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design: A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results: Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines and reviewing drafts (ten guidelines. More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions: Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training

  14. 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.

  15. Incorporation of conventional animal welfare assessment techniques into organic certification and farming

    OpenAIRE

    Leeb, Christine; Whay, Becky; MAIN, David

    2004-01-01

    Providing assurances to consumers on the adherence to certain animal welfare-related standards is an important element of organic and farm assurance schemes. This project has ensured that preliminary welfare assessment protocols developed in a conventional farm assurance system (RSPCA Freedom Food scheme) are available for incorporation into organic (& conventional) certification schemes. The final system (available at www.vetschool.bris.ac.uk/animalwelfare) is an assessment tool that can pr...

  16. 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

  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. Assessing clinical competency: reports from discussion groups.

    Science.gov (United States)

    Turnwald, Grant; Stone, Elizabeth; Bristol, David; Fuentealba, Carmen; Hardie, Lizette; Hellyer, Peter; Jaeger, Laurie; Kerwin, Sharon; Kochevar, Deborah; Lissemore, Kerry; Olsen, Christopher; Rogers, Kenita; Sabin, Beth; Swanson, Cliff; Warner, Angeline

    2008-01-01

    This report describes proposed new models for assessment of eight of the nine clinical competencies the American Veterinary Medical Association Council on Education requires for accreditation. The models were developed by discussion groups at the Association of American Veterinary Medical Colleges' Clinical Competency Symposium. Clinical competencies and proposed models (in parentheses) are described. Competency 1: comprehensive patient diagnosis (neurologic examination on a dog, clinical reasoning skills); Competency 2: comprehensive treatment planning (concept mapping, computerized case studies); Competency 3: anesthesia, pain management (student portfolio); Competency 4: surgery skills (objective structured clinical examination, cased-based examination, "super dog" model); Competency 5: medicine skills (clinical reasoning and case management, skills checklist); Competency 6: emergency and intensive care case management (computerized case study or scenario); Competency 7: health promotion, disease prevention/biosecurity (360 degrees evaluation, case-based computer simulation); Competency 8: client communications and ethical conduct (Web-based evaluation forms, client survey, communicating with stakeholders, telephone conversation, written scenario-based cases). The report also describes faculty recognition for participating in clinical competency assessments.

  19. 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

  20. 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

  1. 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…

  2. Mapping and assessing clinical handover training interventions

    NARCIS (Netherlands)

    Stoyanov, Slavi; Boshuizen, Els; Groene, Oliver; Van der Klink, Marcel; Kicken, Wendy; Drachsler, Hendrik; Barach, Paul

    2013-01-01

    Stoyanov, S., Boshuizen, H. P. A., Groene, O., Van der Klink, M., Kicken, W., Drachsler, H., & Barach, P. (2012). Mapping and assessing clinical handover training interventions. British Medical Journal Quality & Safety, 21, i50-i57. doi:10.1136/bmjqs-2012-001169

  3. Triangular model integrating clinical teaching and assessment.

    Science.gov (United States)

    Abdelaziz, Adel; Koshak, Emad

    2014-01-01

    Structuring clinical teaching is a challenge facing medical education curriculum designers. A variety of instructional methods on different domains of learning are indicated to accommodate different learning styles. Conventional methods of clinical teaching, like training in ambulatory care settings, are prone to the factor of coincidence in having varieties of patient presentations. Accordingly, alternative methods of instruction are indicated to compensate for the deficiencies of these conventional methods. This paper presents an initiative that can be used to design a checklist as a blueprint to guide appropriate selection and implementation of teaching/learning and assessment methods in each of the educational courses and modules based on educational objectives. Three categories of instructional methods were identified, and within each a variety of methods were included. These categories are classroom-type settings, health services-based settings, and community service-based settings. Such categories have framed our triangular model of clinical teaching and assessment.

  4. 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...

  5. 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.

  6. 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…

  7. Assessing clinical ethics consultation: processes and outcomes.

    Science.gov (United States)

    Batten, Jason

    2013-06-01

    The vast majority of hospitals use clinical ethics consultation (CEC) as a service to address ethical issues in patient care. Both proponents and critics alike recognize a need to evaluate CEC. I review three outcomes of CEC that have been formally evaluated: healthcare cost, clinical indicators in the intensive care unit, and user satisfaction. These outcome indicators cannot be used to evaluate the worth of CEC because they are contingent and outside of the consultant's control. However, the failure of outcomes-based assessment poses no threat to CEC since the service is continually justified by the fundamental necessity of resolving ethical problems in patient care. While outcome indicators can be used as heuristics to investigate quality issues in CEC, process indicators can capture the quality of CEC more directly. Therefore, further research should be directed toward developing process-based conceptual models for CEC and various methods for assessing these processes. PMID:23967789

  8. Triangular model integrating clinical teaching and assessment

    Directory of Open Access Journals (Sweden)

    Abdelaziz A

    2014-03-01

    Full Text Available Adel Abdelaziz,1,2 Emad Koshak3 1Medical Education Development Unit, Faculty of Medicine, Al Baha University, Al Baha, Saudi Arabia; 2Medical Education Department, Faculty of Medicine, Suez Canal University, Egypt; 3Dean and Internal Medicine Department, Faculty of Medicine, Al Baha University, Al Baha, Saudi Arabia Abstract: Structuring clinical teaching is a challenge facing medical education curriculum designers. A variety of instructional methods on different domains of learning are indicated to accommodate different learning styles. Conventional methods of clinical teaching, like training in ambulatory care settings, are prone to the factor of coincidence in having varieties of patient presentations. Accordingly, alternative methods of instruction are indicated to compensate for the deficiencies of these conventional methods. This paper presents an initiative that can be used to design a checklist as a blueprint to guide appropriate selection and implementation of teaching/learning and assessment methods in each of the educational courses and modules based on educational objectives. Three categories of instructional methods were identified, and within each a variety of methods were included. These categories are classroom-type settings, health services-based settings, and community service-based settings. Such categories have framed our triangular model of clinical teaching and assessment. Keywords: curriculum development, teaching, learning, assessment, apprenticeship, community-based settings, health service-based settings

  9. Concepts of Causality in Psychopathology: Applications in Clinical Assessment, Clinical Case Formulation and Functional Analysis

    NARCIS (Netherlands)

    Haynes, S.H.; O'Brien, W.H.; Kaholokula, J.K.; Witteman, C.L.M.

    2012-01-01

    This paper discusses and integrates concepts of causality in psychopathology, clinical assessment, clinical case formulation and the functional analysis. We propose that identifying causal variables, relations and mechanisms in psychopathology and clinical assessment can lead to more powerful and e

  10. 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.

  11. A Methodology To Incorporate The Safety Culture Into Probabilistic Safety Assessments

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sunghyun; Kim, Namyeong; Jae, Moosung [Hanyang University, Seoul (Korea, Republic of)

    2015-10-15

    In order to incorporate organizational factors into PSA, a methodology needs to be developed. Using the AHP to weigh organizational factors as well as the SLIM to rate those factors, a methodology is introduced in this study. The safety issues related to nuclear safety culture have occurred increasingly. The quantification tool has to be developed in order to include the organizational factor into Probabilistic Safety Assessments. In this study, the state-of-the-art for the organizational evaluation methodologies has been surveyed. This study includes the research for organizational factors, maintenance process, maintenance process analysis models, a quantitative methodology using Analytic Hierarchy Process, Success Likelihood Index Methodology. The purpose of this study is to develop a methodology to incorporate the safety culture into PSA for obtaining more objective risk than before. The organizational factor considered in nuclear safety culture might affect the potential risk of human error and hardware-failure. The safety culture impact index to monitor the plant safety culture can be assessed by applying the developed methodology into a nuclear power plant.

  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. 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 to

  14. Clinical assessment of bone mass in children

    Directory of Open Access Journals (Sweden)

    L A Sheplyagina

    2005-01-01

    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.

  15. 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.

  16. 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

  17. 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

  18. What is needed to incorporate clinical pharmacogenetic tests into the practice of psychopharmacotherapy?

    Science.gov (United States)

    de Leon, Jose; Spina, Edoardo

    2016-01-01

    This editorial considers two questions in psychopharmacotherapy: 1) What is needed to market pharmacogenetic tests in the US, since the US appears to lead other countries? and 2) What is needed for US-marketed pharmacogenetic tests to be incorporated by prescribers into long-term practice? US marketing of pharmacogenetic tests requires 1) understanding the pharmacological complexity of drug response, 2) modifying the oversight of non-FDA regulatory agencies, 3) clarifying the FDA's role and 4) promoting innovative marketing. The incorporation of pharmacogenetic tests into long-term practice requires 1) not jeopardizing pharmacogenetic testing by short-sighted marketing of non-validated tests, 2) educating prescribers about benefits, 3) educating patients about limitations and 4) considering the differences between isolated testing and generalized testing incorporating big data.

  19. What is needed to incorporate clinical pharmacogenetic tests into the practice of psychopharmacotherapy?

    Science.gov (United States)

    de Leon, Jose; Spina, Edoardo

    2016-01-01

    This editorial considers two questions in psychopharmacotherapy: 1) What is needed to market pharmacogenetic tests in the US, since the US appears to lead other countries? and 2) What is needed for US-marketed pharmacogenetic tests to be incorporated by prescribers into long-term practice? US marketing of pharmacogenetic tests requires 1) understanding the pharmacological complexity of drug response, 2) modifying the oversight of non-FDA regulatory agencies, 3) clarifying the FDA's role and 4) promoting innovative marketing. The incorporation of pharmacogenetic tests into long-term practice requires 1) not jeopardizing pharmacogenetic testing by short-sighted marketing of non-validated tests, 2) educating prescribers about benefits, 3) educating patients about limitations and 4) considering the differences between isolated testing and generalized testing incorporating big data. PMID:26580456

  20. Assessing students' English language proficiency during clinical placement: A qualitative evaluation of a language framework.

    Science.gov (United States)

    San Miguel, Caroline; Rogan, Fran

    2015-06-01

    The increase in nursing students for whom English is an additional language requires clinical facilitators to assess students' performance regarding clinical skills, nursing communication and English language. However, assessing language proficiency is a complex process that is often conflated with cultural norms and clinical skills, and facilitators may lack confidence in assessing English language. This paper discusses an evaluation of a set of guidelines developed in a large metropolitan Australian university to help clinical facilitators make decisions about students' English language proficiency. The study found that the guidelines were useful in helping facilitators assess English language. However, strategies to address identified language problems needed to be incorporated to enable the guidelines to also be used as a teaching tool. The study concludes that to be effective, such guidelines need embedding within a systematic approach that identifies and responds to students who may be underperforming due to a low level of English language proficiency.

  1. 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...

  2. Proteomic analysis of hyperadhesive Candida glabrata clinical isolates reveals a core wall proteome and differential incorporation of adhesins.

    Science.gov (United States)

    Gómez-Molero, Emilia; de Boer, Albert D; Dekker, Henk L; Moreno-Martínez, Ana; Kraneveld, Eef A; Ichsan; Chauhan, Neeraj; Weig, Michael; de Soet, Johannes J; de Koster, Chris G; Bader, Oliver; de Groot, Piet W J

    2015-12-01

    Attachment to human host tissues or abiotic medical devices is a key step in the development of infections by Candida glabrata. The genome of this pathogenic yeast codes for a large number of adhesins, but proteomic work using reference strains has shown incorporation of only few adhesins in the cell wall. By making inventories of the wall proteomes of hyperadhesive clinical isolates and reference strain CBS138 using mass spectrometry, we describe the cell wall proteome of C. glabrata and tested the hypothesis that hyperadhesive isolates display differential incorporation of adhesins. Two clinical strains (PEU382 and PEU427) were selected, which both were hyperadhesive to polystyrene and showed high surface hydrophobicity. Cell wall proteome analysis under biofilm-forming conditions identified a core proteome of about 20 proteins present in all C. glabrata strains. In addition, 12 adhesin-like wall proteins were identified in the hyperadherent strains, including six novel adhesins (Awp8-13) of which only Awp12 was also present in CBS138. We conclude that the hyperadhesive capacity of these two clinical C. glabrata isolates is correlated with increased and differential incorporation of cell wall adhesins. Future studies should elucidate the role of the identified proteins in the establishment of C. glabrata infections. PMID:26546455

  3. 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...... the 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 on future...

  4. 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.

  5. 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.

  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. 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.

  8. 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...

  9. 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...

  10. Assessment of student competency in a simulated speech-language pathology clinical placement.

    Science.gov (United States)

    Hill, Anne E; Davidson, Bronwyn J; McAllister, Sue; Wright, Judith; Theodoros, Deborah G

    2014-10-01

    Clinical education programs in speech-language pathology enable the transition of students' knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students' performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS(®): Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students' performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.

  11. 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.

  12. [Incorporation of manganese in human hair, a criterion for assessment of exposure].

    Science.gov (United States)

    Grund, W

    1980-01-01

    The capability of bradytrophic tissue to store traces of certain elements was used to drawn conclusions as to occupational exposure, with particular reference being made to human hair. Manganese, present in the form of MnO2 aerosol in weld smoke, is of particular relevance to electric welders. Manganese levels were recorded from hair samples obtained from 254 shipyard welders and 237 control persons, the assay being undertaken by means of the neutron activation analysis. Manganese incorporation in hair of shifyard welders usually was five times as high as that in hair of individuals with no exposure, with shipyard welding being characterised by highly unfavourable space conditions. Correlations were also secured between contamination, on the one hand, and effective welding time per day, job conditions, and welding techniques, on the other. No relationships were found to exist between manganese levels in hair and serum. Manganese assessment from human hair, so far undertaken by neutron activation analysis, is a non-invasive exposure test and, therefore, suitable for identifying particularly endangered electric welders for early prophylactic action.

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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…

  19. 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.

  20. Flow cytometric assessment of specific leucine incorporation in the open Mediterranean

    Science.gov (United States)

    Talarmin, A.; van Wambeke, F.; Catala, P.; Courties, C.; Lebaron, P.

    2011-02-01

    The surface of the Mediterranean Sea is a low-phosphate-low-chlorophyll marine area where marine heterotrophic prokaryotes significantly contribute to the biogeochemical cycles of all biogenic elements such as carbon, notably through the mineralization of dissolved organic compounds. Cell-specific leucine incorporation rates were determined in early summer in the open stratified Mediterranean Sea. The bulk leucine incorporation rate was on average 5 ± 4 pmol leu l-1 h-1 (n=30). Cell-specific 3H-leucine incorporation rates were assayed using flow cytometry coupled to cell sorting. Heterotrophic prokaryotes (Hprok) were divided into cytometric groups according to their side scatter and green fluorescence properties: high nucleic acid containing cells (HNA) with high scatter (HNA-hs) and low scatter (HNA-ls) and low nucleic acid containing cells (LNA). Cell-specific leucine incorporation rates of these cytometric groups ranged from 2 to 54, 0.9 to 11, and 1 to 12 × 10-21 mol cell-1 h-1, respectively. LNA cells represented 45 to 63% of the Hprok abundance, and significantly contributed to the bulk leucine incorporation rates, from 12 to 43%. HNA/LNA ratios of cell-specific leucine incorporation were on average 2.0 ± 0.7 (n=30). In surface layers (from 0 m down to the deep chlorophyll depth, DCM), cell-specific rates of HNA-hs were elevated (7 and 13 times greater than LNA and HNA-ls, respectively). Nevertheless, on average HNA-hs (26%) and LNA (27%) equally contributed to the bulk leucine incorporation in these layers. Prochlorococcus cells were easily sorted near the DCM and displayed cell-specific leucine incorporation rates ranging from 3 to 55 × 10-21 mol leu cell-1 h-1, i.e. as high as HNA-hs'. These sorted groups could therefore be defined as key-players in the process of leucine incorporation into proteins. The mixotrophic features of certain photosynthetic prokaryotes and the high contribution of LNA cells to leucine incorporation within the microbial

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. 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...

  7. Incorporating a gender perspective into the development of clinical guidelines: a training course for guideline developers

    Directory of Open Access Journals (Sweden)

    Burgers Jako S

    2007-11-01

    Full Text Available Abstract Background Dutch guideline-developing organizations do not focus systematically on differences between men and women when developing guidelines, even though there is increasing evidence that being male or female may have an effect on health and health outcomes. In collaboration with two prominent Dutch guideline-developing organizations, we designed a training course to encourage systematic attention to sex differences in guideline development procedures. Methods The course is targeted towards guideline developers. Its aims are to improve awareness concerning the relevance of considering sex differences in the guideline development process, as well as the competence and skills necessary for putting this into practice. The design and teaching methods of the course are based on adult learning styles and principles of changing provider behaviour. It was adjusted to the working methods of guideline organizations. The course was taught to, and evaluated by, a group of staff members from two guideline organizations in the Netherlands. Results The course consists of five modules, each of which corresponds to a key step in the guideline development process. The participants rated the training course positively on content, programme, and trainers. Their written comments suggest that the course met its objectives. Conclusion The training course is the first to address sex differences in guideline development. Results from the pilot test suggest that the course achieved its objectives. Because its modules and teaching methods of the course are widely transferable, the course could be useful for many organizations that are involved in developing guidelines. Follow-up studies are needed to assess the long-term effect of the course on the actions of guideline developers and its utility in other settings.

  8. 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

  9. Clinical practice of risk assessment of sexual violence

    OpenAIRE

    Judge, Joseph Gerard

    2012-01-01

    Background: Risk assessment of sexual violence involves evidence based evaluation of the risks posed by sexual offenders. It informs risk management; the provision of treatment that reduces the risk of future sexual violence. Previous research has focused on assessment of the predictive accuracy of different risk assessment tools, as well as the identification of risk factors that are associated with recidivism. In contrast, the clinical practice of risk assessment is a research a...

  10. 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.

  11. 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...

  12. Incorporating Shading Losses in Solar Photovoltaic Potential Assessment at the Municipal Scale

    OpenAIRE

    Nguyen, HA; Pearce, Joshua

    2012-01-01

    International audience; Recently several algorithms have been developed to calculate the solar photovoltaic (PV) potential on the basis of 2.5D raster data that can capture urban morphology. This study provides a new algorithm that (i) incorporates both terrain and near surface shadowing effects on the beam component; (ii) scales down the diffuse components of global irradiation; and (iii) utilizes free and open source GRASS and the module r.sun in modeling irradiation. This algorithm is semi...

  13. 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...

  14. 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

  15. 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

  16. 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.

  17. Potential for Incorporation of Genetic Polymorphism Data in Human Health Risk Assessment

    Science.gov (United States)

    This overview summarizes several EPA assessment publications evaluating the potential impact of genetic polymorphisms in ten metabolizing enzymes on the variability in enzyme function across ethnically diverse populations.

  18. 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.

  19. 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…

  20. 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

  1. 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...

  2. Incorporating natural hazard assessments into municipal master-plans; case-studies from Israel

    Science.gov (United States)

    Katz, Oded

    2010-05-01

    The active Dead Sea Rift (DSR) runs along the length of Israel, making the entire state susceptible to earthquake-related hazards. Current building codes generally acknowledge seismic hazards and direct engineers towards earthquake-resistant structures. However, hazard mapping on a scale fit for municipal/governmental planning is subject to local initiative and is currently not mandatory as seems necessary. In the following, a few cases of seismic-hazard evaluation made by the Geological Survey of Israel are presented, emphasizing the reasons for their initiation and the way results were incorporated (or not). The first case is a seismic hazard qualitative micro-zonation invited by the municipality of Jerusalem as part of a new master plan. This work resulted in maps (1:50,000; GIS format) identifying areas prone to (1) amplification of seismic shaking due to site characteristics (outcrops of soft rocks or steep topography) and (2) sites with earthquake induced landslide (EILS) hazard. Results were validated using reports from the 1927, M=6.2 earthquake that originated along the DSR about 30km east of Jerusalem. Although the hazard maps were accepted by municipal authorities, practical use by geotechnical engineers working within the frame of the new master-plan was not significant. The main reason for that is apparently a difference of opinion between the city-engineers responsible for implementing the new master-plan and the geologists responsible of the hazard evaluation. The second case involves evaluation of EILS hazard for two towns located further north along the DSR, Zefat and Tiberias. Both were heavily damaged more than once by strong earthquakes in past centuries. Work was carried out as part of a governmental seismic-hazard reduction program. The results include maps (1:10,000 scales) of sites with high EILS hazard identified within city limits. Maps (in GIS format) were sent to city engineers with reports explaining the methods and results. As far as

  3. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    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.

  5. 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

  6. Incorporating climate and ocean change into extinction risk assessments for 82 coral species.

    Science.gov (United States)

    Brainard, Russell E; Weijerman, Mariska; Eakin, C Mark; McElhany, Paul; Miller, Margaret W; Patterson, Matt; Piniak, Gregory A; Dunlap, Matthew J; Birkeland, Charles

    2013-12-01

    Many marine invertebrate species facing potential extinction have uncertain taxonomies and poorly known demographic and ecological traits. Uncertainties are compounded when potential extinction drivers are climate and ocean changes whose effects on even widespread and abundant species are only partially understood. The U.S. Endangered Species Act mandates conservation management decisions founded on the extinction risk to species based on the best available science at the time of consideration-requiring prompt action rather than awaiting better information. We developed an expert-opinion threat-based approach that entails a structured voting system to assess extinction risk from climate and ocean changes and other threats to 82 coral species for which population status and threat response information was limited. Such methods are urgently needed because constrained budgets and manpower will continue to hinder the availability of desired data for many potentially vulnerable marine species. Significant species-specific information gaps and uncertainties precluded quantitative assessments of habitat loss or population declines and necessitated increased reliance on demographic characteristics and threat vulnerabilities at genus or family levels. Adapting some methods (e.g., a structured voting system) used during other assessments and developing some new approaches (e.g., integrated assessment of threats and demographic characteristics), we rated the importance of threats contributing to coral extinction risk and assessed those threats against population status and trend information to evaluate each species' extinction risk over the 21st century. This qualitative assessment resulted in a ranking with an uncertainty range for each species according to their estimated likelihood of extinction. We offer guidance on approaches for future biological extinction risk assessments, especially in cases of data-limited species likely to be affected by global-scale threats

  7. 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.

  8. Nurses' involvement in interdisciplinary team evaluations: incorporating the family perspective into child assessment.

    Science.gov (United States)

    Papenfus, H; Bryan, A A

    1998-05-01

    An expanded nursing role in interdisciplinary team evaluations of children with special needs would include seeking the family's perspective in a systematic yet sensitive way. Nursing's background in family and child health can offer valuable insight. This article reviews family nursing assessment categories, reframes them for use in assessing the family's perspective in relation to the child's health and educational needs, and presents a systematic integrated history and assessment format for gathering child and family data. This approach promotes family collaboration in understanding family, child health, and educational issues. The holistic understanding gained by the school nurse through this systematic process enhances insight in interdisciplinary team planning. The nursing written report with preliminary conclusions facilitates an organized presentation of data, setting the stage for family and interdisciplinary team mutual exploration of options and facilitating greater likelihood of successful outcomes. PMID:9672856

  9. 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.

  10. 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

  11. 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...

  12. Making the Case for Simulation-Based Assessments to Overcome the Challenges in Evaluating Clinical Competency.

    Science.gov (United States)

    Leigh, Gwen; Stueben, Frances; Harrington, Deedra; Hetherman, Stephen

    2016-05-13

    The use of simulation in nursing has increased substantially in the last few decades. Most schools of nursing have incorporated simulation into their curriculum but few are using simulation to evaluate clinical competency at the end of a semester or prior to graduation. Using simulation for such high stakes evaluation is somewhat novel to nursing. Educators are now being challenged to move simulation to the next level and use it as a tool for evaluating clinical competency. Can the use of simulation for high-stakes evaluation add to or improve our current evaluation methods? Using patient simulation for evaluation in contrast to a teaching modality has important differences that must be considered. This article discusses the difficulties of evaluating clinical competency, and makes the case for using simulation based assessment as a method of high stakes evaluation. Using simulation for high-stakes evaluation has the potential for significantly impacting nursing education.

  13. 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…

  14. 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…

  15. STUDENTS' SELF-ASSESSMENT IN PRE-CLINICAL AND CLINICAL EDUCATION OF PROSTHETIC DENTISTRY

    Directory of Open Access Journals (Sweden)

    Dimiter Kirov

    2014-09-01

    Full Text Available Background: The ability to self-assess is a critical skill that all health professionals must be able to do, in order to achieve competence. This is essential for the doctors of dental medicine. During their education and practice they apply different clinical and para-clinical procedures. The aim is to evaluate the students' self-assessment skills during the education of clinic and pre-clinic of prosthetic dentistry. Material and methods: After the completion of certain work - preparation for full veneer crown, a questionnaire was provided to each student in preclinical course (n=30 and clinical course (n=30 for self-evaluation. The questionnaire involved: axial reduction, occlusal reduction, facial and lingual reduction, smoothing and finishing. The answers were based on the standard for the university grading scale. Than, the same questionnaire was fulfilled by the assistant professor without seeing students' self-evaluation. Results and Discussion: Results have been reported in percentages. 100% respond rate has been achieved. The students from the preclinical course tend to overestimate their performance (50%. The students from the clinical course tend to submit overall lower grades than the faculty evaluation (25%. Conclusions: The students from clinics have better self-assessment skills. The discrepancy was most pronounced in the junior students. The different evaluations (self-assessment and assistant professor's help students to improve their understanding of certain principles and improve the teaching effectiveness of education of prosthetic dentistry.

  16. 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

  17. 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....

  18. 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...

  19. 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...

  20. 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

  1. 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)

  2. Quantitative assessment of scatter correction techniques incorporated in next generation dual-source computed tomography

    Science.gov (United States)

    Mobberley, Sean David

    Accurate, cross-scanner assessment of in-vivo air density used to quantitatively assess amount and distribution of emphysema in COPD subjects has remained elusive. Hounsfield units (HU) within tracheal air can be considerably more positive than -1000 HU. With the advent of new dual-source scanners which employ dedicated scatter correction techniques, it is of interest to evaluate how the quantitative measures of lung density compare between dual-source and single-source scan modes. This study has sought to characterize in-vivo and phantom-based air metrics using dual-energy computed tomography technology where the nature of the technology has required adjustments to scatter correction. Anesthetized ovine (N=6), swine (N=13: more human-like rib cage shape), lung phantom and a thoracic phantom were studied using a dual-source MDCT scanner (Siemens Definition Flash. Multiple dual-source dual-energy (DSDE) and single-source (SS) scans taken at different energy levels and scan settings were acquired for direct quantitative comparison. Density histograms were evaluated for the lung, tracheal, water and blood segments. Image data were obtained at 80, 100, 120, and 140 kVp in the SS mode (B35f kernel) and at 80, 100, 140, and 140-Sn (tin filtered) kVp in the DSDE mode (B35f and D30f kernels), in addition to variations in dose, rotation time, and pitch. To minimize the effect of cross-scatter, the phantom scans in the DSDE mode was obtained by reducing the tube current of one of the tubes to its minimum (near zero) value. When using image data obtained in the DSDE mode, the median HU values in the tracheal regions of all animals and the phantom were consistently closer to -1000 HU regardless of reconstruction kernel (chapters 3 and 4). Similarly, HU values of water and blood were consistently closer to their nominal values of 0 HU and 55 HU respectively. When using image data obtained in the SS mode the air CT numbers demonstrated a consistent positive shift of up to 35 HU

  3. 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

  4. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Greenberg, A.; McSweeney, T.; Allen, J.; Lepofsky, M. [Battelle Memorial Inst., Columbus, OH (United States); Abkowitz, M. [Dept. of Civil Engineering, Vanderbilt Univ., Nashville, TN (United States)

    2004-07-01

    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.

  6. 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.

  7. A selenium-deficient Caco-2 cell model for assessing differential incorporation of chemical or food selenium into glutathione peroxidase.

    Science.gov (United States)

    Zeng, Huawei; Botnen, James H; Johnson, Luann K

    2008-01-01

    Assessing the ability of a selenium (Se) sample to induce cellular glutathione peroxidase (GPx) activity in Se-deficient animals is the most commonly used method to determine Se bioavailability. Our goal is to establish a Se-deficient cell culture model with differential incorporation of Se chemical forms into GPx, which may complement the in vivo studies. In the present study, we developed a Se-deficient Caco-2 cell model with a serum gradual reduction method. It is well recognized that selenomethionine (SeMet) is the major nutritional source of Se; therefore, SeMet, selenite, or methylselenocysteine (SeMSC) was added to cell culture media with different concentrations and treatment time points. We found that selenite and SeMSC induced GPx more rapidly than SeMet. However, SeMet was better retained as it is incorporated into proteins in place of methionine; compared with 8-, 24-, or 48-h treatment, 72-h Se treatment was a more sensitive time point to measure the potential of GPx induction in all tested concentrations. Based on induction of GPx activity, the cellular bioavailability of Se from an extract of selenobroccoli after a simulated gastrointestinal digestion was comparable with that of SeMSC and SeMet. These in vitro data are, for the first time, consistent with previous published data regarding selenite and SeMet bioavailability in animal models and Se chemical speciation studies with broccoli. Thus, Se-deficient Caco-2 cell model with differential incorporation of chemical or food forms of Se into GPx provides a new tool to study the cellular mechanisms of Se bioavailability.

  8. 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......, but in a systemized way. The workshop contains practices in the use of different approaches and playing rules related to clinical assessment – seen as a way of musical asking, repeating and setting goals. As well, the workshop incorporates the use of video recordings in music therapy to analyze and search......). An Ethnographic Descriptive Approach to Video Micro Analysis. In: Wosch, T. & Wigram, T. (Eds.). Microanalysis in music therapy. London: Jessica Kingsley Publishers. Jacobsen, S. L. (2012). Music Therapy Assessment and Development of Parental Competences in Families Where Children Have Experienced Emotional...

  9. Promoting Assessment Efficacy through an Integrated System for Online Clinical Assessment of Practical Skills

    Science.gov (United States)

    Hay, Peter J.; Engstrom, Craig; Green, Anita; Friis, Peter; Dickens, Sue; Macdonald, Doune

    2013-01-01

    This paper presents evaluation outcomes from an externally funded research project involving the online clinical assessment of practical skills (eCAPS) using web-based video technologies within a university medical programme. eCAPS was implemented to trial this web-based approach for promoting the efficacy of "practical" skills assessment in knee…

  10. 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...

  11. 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.

  12. Manual Linear Movements to Assess Spasticity in a Clinical Setting

    Science.gov (United States)

    Marinelli, Lucio; Trompetto, Carlo; Mori, Laura; Vigo, Gabriele; Traverso, Elisabetta; Colombano, Federica; Abbruzzese, Giovanni

    2013-01-01

    In a clinical setting, where motor-driven systems are not readily available, the major difficulty in the assessment of the stretch reflex lies in the control of passive limb displacement velocity. A potential approach to this problem arises from the use of manual sinusoidal movements (made by continuous alternating flexions and extensions) paced by an external stimulus. Unfortunately, there are conditions in which sinusoidal movements induce interfering phenomena such as the shortening reaction or postactivation depression. In the present paper, a novel manual method to control the velocity of passive linear movements is described and the results obtained from both healthy subjects and spastic patients are reported. This method is based on the synchronisation of movements with tones played by a metronome at different speeds. In a first set of experiments performed in healthy subjects, we demonstrated consistent control of velocity during passive limb movements using this method. Four joints usually examined during muscle tone assessment were tested: wrist, elbow, knee and ankle joints. Following this, we conducted a longitudinal assessment of the stretch reflex amplitude in wrist flexor muscles in patients with spasticity treated with botulinum toxin type A. The evaluators were not only able to vary the movement velocity based on the metronome speed, but also could reproduce the respective speeds two weeks later, despite the changing degree of hypertonia. This method is easy to perform in a clinical setting and hardware requirements are minimal, making it an attractive and robust procedure for the widespread clinical assessment of reflex hypertonia. PMID:23335966

  13. Breast clinic triage tool: telephone assessment of new referrals.

    Science.gov (United States)

    Cusack, Leila; Brennan, Meagan; Weissenberg, Leisha; Moore, Katrina

    2012-04-01

    Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone.

  14. 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.

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

    DEFF Research Database (Denmark)

    Jacobsen, Stine Lindahl

    (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......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...

  16. 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.

  17. [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

  18. 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...

  19. 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...

  20. 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

  1. 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.

  2. Assessment scales in stroke: clinimetric and clinical considerations

    Directory of Open Access Journals (Sweden)

    Harrison JK

    2013-02-01

    Full Text Available Jennifer K Harrison,1 Katherine S McArthur,2 Terence J Quinn21Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; 2Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UKAbstract: As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of "clinimetric" analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.Keywords: Barthel Index, clinimetrics, clinical trial, disability, methodology, modified Rankin Scale, National Institutes Health Stroke Scale, scales, stroke, outcomes

  3. Proteomic analysis of hyperadhesive Candida glabrata clinical isolates reveals a core wall proteome and differential incorporation of adhesins

    NARCIS (Netherlands)

    E. Gómez-Molero; A.D. de Boer; H.L. Dekker; A. Moreno-Martínez; E.A. Kraneveld; . Ichsan; N. Chauhan; M. Weig; J.J. de Soet; C.G. de Koster; O. Bader; P.W.J. de Groot

    2015-01-01

    Attachment to human host tissues or abiotic medical devices is a key step in the development of infections by Candida glabrata. The genome of this pathogenic yeast codes for a large number of adhesins, but proteomic work using reference strains has shown incorporation of only few adhesins in the cel

  4. 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

  5. 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.

  6. 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

  7. Impact of evidence-based standardized assessment on the disability clinical interview for diagnosis of service-connected PTSD: a cluster-randomized trial.

    Science.gov (United States)

    Speroff, Theodore; Sinnott, Patricia L; Marx, Brian; Owen, Richard R; Jackson, James C; Greevy, Robert; Sayer, Nina; Murdoch, Maureen; Shane, Andrea C; Smith, Jeffrey; Alvarez, JoAnn; Nwosu, Samuel K; Keane, Terence; Weathers, Frank; Schnurr, Paula P; Friedman, Matthew J

    2012-12-01

    Posttraumatic stress disorder (PTSD) is one of the fastest growing compensated medical conditions. The present study compared usual disability examiner practices for PTSD with a standardized assessment that incorporates evidence-based assessments. The design was a multicenter, cluster randomized, parallel-group study involving 33 clinical examiners and 384 veterans at 6 Veterans Affairs medical centers. The standardized group incorporated the Clinician Administered PTSD Scale and the World Health Organization Disability Assessment Schedule-II into their assessment interview. The main outcome measures were completeness and accuracy of PTSD diagnosis and completeness of functional assessment. The standardized assessments were 85% complete for diagnosis compared to 30% for nonstandardized assessments (p < .001), and, for functional impairment, 76% versus 3% (p < .001). The findings demonstrate that the quality of PTSD disability examination would be improved by using evidence-based assessment.

  8. 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...

  9. The development of a clinical outcomes survey research application: Assessment CenterSM

    Science.gov (United States)

    Rothrock, Nan E.; Hanrahan, Rachel T.; Jansky, Liz J.; Harniss, Mark; Riley, William

    2013-01-01

    Introduction The National Institutes of Health sponsored Patient-Reported Outcome Measurement Information System (PROMIS) aimed to create item banks and computerized adaptive tests (CATs) across multiple domains for individuals with a range of chronic diseases. Purpose Web-based software was created to enable a researcher to create study-specific Websites that could administer PROMIS CATs and other instruments to research participants or clinical samples. This paper outlines the process used to develop a user-friendly, free, Web-based resource (Assessment CenterSM) for storage, retrieval, organization, sharing, and administration of patient-reported outcomes (PRO) instruments. Methods Joint Application Design (JAD) sessions were conducted with representatives from numerous institutions in order to supply a general wish list of features. Use Cases were then written to ensure that end user expectations matched programmer specifications. Program development included daily programmer “scrum” sessions, weekly Usability Acceptability Testing (UAT) and continuous Quality Assurance (QA) activities pre- and post-release. Results Assessment Center includes features that promote instrument development including item histories, data management, and storage of statistical analysis results. Conclusions This case study of software development highlights the collection and incorporation of user input throughout the development process. Potential future applications of Assessment Center in clinical research are discussed. PMID:20306332

  10. 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

  11. 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.

  12. Circulating Tumor Cells (CTC) and Cell-Free DNA (cfDNA) Workshop 2016: Scientific Opportunities and Logistics for Cancer Clinical Trial Incorporation.

    Science.gov (United States)

    Lowes, Lori E; Bratman, Scott V; Dittamore, Ryan; Done, Susan; Kelley, Shana O; Mai, Sabine; Morin, Ryan D; Wyatt, Alexander W; Allan, Alison L

    2016-09-08

    Despite the identification of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) as potential blood-based biomarkers capable of providing prognostic and predictive information in cancer, they have not been incorporated into routine clinical practice. This resistance is due in part to technological limitations hampering CTC and cfDNA analysis, as well as a limited understanding of precisely how to interpret emergent biomarkers across various disease stages and tumor types. In recognition of these challenges, a group of researchers and clinicians focused on blood-based biomarker development met at the Canadian Cancer Trials Group (CCTG) Spring Meeting in Toronto, Canada on 29 April 2016 for a workshop discussing novel CTC/cfDNA technologies, interpretation of data obtained from CTCs versus cfDNA, challenges regarding disease evolution and heterogeneity, and logistical considerations for incorporation of CTCs/cfDNA into clinical trials, and ultimately into routine clinical use. The objectives of this workshop included discussion of the current barriers to clinical implementation and recent progress made in the field, as well as fueling meaningful collaborations and partnerships between researchers and clinicians. We anticipate that the considerations highlighted at this workshop will lead to advances in both basic and translational research and will ultimately impact patient management strategies and patient outcomes.

  13. Circulating Tumor Cells (CTC) and Cell-Free DNA (cfDNA) Workshop 2016: Scientific Opportunities and Logistics for Cancer Clinical Trial Incorporation.

    Science.gov (United States)

    Lowes, Lori E; Bratman, Scott V; Dittamore, Ryan; Done, Susan; Kelley, Shana O; Mai, Sabine; Morin, Ryan D; Wyatt, Alexander W; Allan, Alison L

    2016-01-01

    Despite the identification of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) as potential blood-based biomarkers capable of providing prognostic and predictive information in cancer, they have not been incorporated into routine clinical practice. This resistance is due in part to technological limitations hampering CTC and cfDNA analysis, as well as a limited understanding of precisely how to interpret emergent biomarkers across various disease stages and tumor types. In recognition of these challenges, a group of researchers and clinicians focused on blood-based biomarker development met at the Canadian Cancer Trials Group (CCTG) Spring Meeting in Toronto, Canada on 29 April 2016 for a workshop discussing novel CTC/cfDNA technologies, interpretation of data obtained from CTCs versus cfDNA, challenges regarding disease evolution and heterogeneity, and logistical considerations for incorporation of CTCs/cfDNA into clinical trials, and ultimately into routine clinical use. The objectives of this workshop included discussion of the current barriers to clinical implementation and recent progress made in the field, as well as fueling meaningful collaborations and partnerships between researchers and clinicians. We anticipate that the considerations highlighted at this workshop will lead to advances in both basic and translational research and will ultimately impact patient management strategies and patient outcomes. PMID:27618023

  14. Circulating Tumor Cells (CTC) and Cell-Free DNA (cfDNA) Workshop 2016: Scientific Opportunities and Logistics for Cancer Clinical Trial Incorporation

    Science.gov (United States)

    Lowes, Lori E.; Bratman, Scott V.; Dittamore, Ryan; Done, Susan; Kelley, Shana O.; Mai, Sabine; Morin, Ryan D.; Wyatt, Alexander W.; Allan, Alison L.

    2016-01-01

    Despite the identification of circulating tumor cells (CTCs) and cell-free DNA (cfDNA) as potential blood-based biomarkers capable of providing prognostic and predictive information in cancer, they have not been incorporated into routine clinical practice. This resistance is due in part to technological limitations hampering CTC and cfDNA analysis, as well as a limited understanding of precisely how to interpret emergent biomarkers across various disease stages and tumor types. In recognition of these challenges, a group of researchers and clinicians focused on blood-based biomarker development met at the Canadian Cancer Trials Group (CCTG) Spring Meeting in Toronto, Canada on 29 April 2016 for a workshop discussing novel CTC/cfDNA technologies, interpretation of data obtained from CTCs versus cfDNA, challenges regarding disease evolution and heterogeneity, and logistical considerations for incorporation of CTCs/cfDNA into clinical trials, and ultimately into routine clinical use. The objectives of this workshop included discussion of the current barriers to clinical implementation and recent progress made in the field, as well as fueling meaningful collaborations and partnerships between researchers and clinicians. We anticipate that the considerations highlighted at this workshop will lead to advances in both basic and translational research and will ultimately impact patient management strategies and patient outcomes. PMID:27618023

  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. Use of clinical simulation for assessment in EHR-procurement

    DEFF Research Database (Denmark)

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

    2013-01-01

    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 and how......In Denmark, two large regions cooperate in a public intervention process of acquiring a new eHealth-platform to support the daily clinical work of approximately 40,000 users in 14 hospitals. It is essential that the new platform, besides fulfilling comprehensive detailed specifications, supports...... the daily work practice consisting of numerous mixed tasks executed by many different clinical actors in various settings. Within health informatics it has proven beneficial to use human factors approaches in the design process to secure systems that are responsive to the actual field of application. While...

  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. The process of clinical assessment: cognitions of the evaluator

    Directory of Open Access Journals (Sweden)

    Carmelo Ibáñez Aguirre

    2013-08-01

    Full Text Available The cognitive paradigm of the past few decades opens several new possibilities for psychological evaluation.  The objective of this essay is to emphasize the possibilities related to the quality of self-evaluation, specifically professional self-assessment, meaning a critical analysis of one’s own evaluation process. In this essay, metacognition activities and strategies are examined, as are the ways in which these activities and strategies relate to metacognition and cognitive skills. The intent of this theoretical essay is to offer answers to the clinical evaluator’s professional experience. The results indicate that the clinical professional must consider strategies to improve metacognition and cognitive skills through reflection, self-analysis and self-criticism to improve the quality and efficiency of their work.

  19. 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.

  20. 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

  1. 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.

  2. 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

  3. Consistency of DIAGNOdent instruments for clinical assessment of fissure caries.

    Science.gov (United States)

    Astvaldsdóttir, Alfheidur; Holbrook, W Peter; Tranaeus, Sofia

    2004-08-01

    DIAGNOdent (KaVo, Biberach, Germany) has shown high diagnostic accuracy and intra-operator agreement for caries detection, both in vitro and in vivo. The aims of this study were to compare DIAGNOdent with visual examination (VI) and bitewing radiographs (BW) for clinical assessment of occlusal fissures, and to evaluate inter-device consistency of clinical recording using four different DIAGNOdent instruments; secondly, to correlate DIAGNOdent readings with microbial culture of the measured site. The subjects were young adults, the material comprising 34 occlusal fissures, scheduled for restorative treatment at the Dental School Clinic of the University of Iceland. Two examiners conducted visual and radiographic assessments. One examiner measured each site with four DIAGNOdent instruments in random order. The fissure was then opened and lesion depth was classified on a 4-point scale. Bacterial samples were taken from the fissure before and after opening. Intra-operator agreement was high (r = 0.85-0.98). Inter-device correlation for the four DIAGNOdent instruments was significant in all cases (r = 0.81-0.92). However, a common cut-off point could not be determined. There was weak but significant correlation between DIAGNOdent readings and all three classes of lesion depth. Level of infection showed very weak correlation with the DIAGNOdent readings. It was concluded that DIAGNOdent is more reliable in detecting dentinal caries if a proper cut-off point is used than in indicating actual lesion depth. Readings from the different instruments were not directly comparable, however, owing to the lack of a common cut-off point.

  4. 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

  5. Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.

    Science.gov (United States)

    Khan, Sundas; McCullagh, Lauren; Press, Anne; Kharche, Manish; Schachter, Andy; Pardo, Salvatore; McGinn, Thomas

    2016-02-01

    Electronic health record (EHR)-based clinical decision support (CDS) tools are rolled out with the urgency to meet federal requirements without time for usability testing and refinement of the user interface. As part of a larger project to design, develop and integrate a pulmonary embolism CDS tool for emergency physicians, we conducted a formative assessment to determine providers' level of interest and input on designs and content. This was a study to conduct a formative assessment of emergency medicine (EM) physicians that included focus groups and key informant interviews. The focus of this study was twofold, to determine the general attitude towards CDS tool integration and the ideal integration point into the clinical workflow. To accomplish this, we first approached EM physicians in a focus group, then, during key informant interviews, we presented workflow designs and gave a scenario to help the providers visualise how the CDS tool works. Participants were asked questions regarding the trigger location, trigger words, integration into their workflow, perceived utility and heuristic of the tool. Results from the participants' survey responses to trigger location, perceived utility and efficiency, indicated that the providers felt the tool would be more of a hindrance than an aid. However, some providers commented that they had not had exposure to CDS tools but had used online calculators, and thought the tools would be helpful at the point-of-care if integrated into the EHR. Furthermore, there was a preference for an order entry wireframe. This study highlights several factors to consider when designing CDS tools: (1) formative assessment of EHR functionality and clinical environment workflow, (2) focus groups and key informative interviews to incorporate providers' perceptions of CDS and workflow integration and/or (3) the demonstration of proposed workflows through wireframes to help providers visualise design concepts.

  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. 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.

  8. 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...

  9. 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.

  10. Methyldibromo glutaronitrile: clinical experience and exposure-based risk assessment.

    Science.gov (United States)

    Zachariae, Claus; Rastogi, Suresh; Devantier, Charlotte; Menné, Torkil; Johansen, Jeanne Duus

    2003-03-01

    In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3.5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8-month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149-390 ppm of MDGN, liquid hand soap 144-399 ppm, a rinsing cream 293 ppm and shampoos 78-79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149-390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure-based risk assessment process add to the evidence and need for re-defining safe-use concentrations of MDGN in cosmetic products.

  11. Quality assessment of clinical guidelines in China: 1993-2010

    Institute of Scientific and Technical Information of China (English)

    CHEN Yao-long; XIE Chang-chun; YANG Ke-hu; YAO Liang; XIAO Xiao-juan; WANG Qi; WANG Ze-hao; LIANG Fu-xiang; LIANG Hui; WANG Xin; SHEN Xi-ping

    2012-01-01

    Background Clinical practice guidelines (CPGs) play an important role in healthcare in China as well as in the world.However,the current status and trends of Chinese CPGs are unknown.The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature.Methods To identify Chinese CPGs,a systematic search of relevant literature databases (CBM,WANFANG,VIP,and CNKI) was performed for the period January 1978 to December 2010.We used the AGREE Ⅱ instrument to assess the quality of the included guidelines.Results We evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256different developers.Only four guidelines (1%) described the systematic methods for searching and selecting the evidence,14 (5%) guidelines indicated an explicit link between the supporting evidence and the recommendations,only one guideline used the Grading of Recommendations Assessment,Development and Evaluation (GRADE) system.Thirty-one guidelines (12%) mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline.From the assessment with the Appraisal of Guidelines for Research and Ecaluation Ⅱ (AGREE Ⅱ),the mean scores were low for the domains "scope and purpose" (19%) and "clarity of presentation" (26%)and very low for the other domains ("rigour of development" 7%,"stakeholder involvement" 8%,"applicability" 6% and "editorial independence" 2%).Conclusions Compared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries,Chinese CPGs received lower scores,which indicates a relatively poor quality of the guidelines.However,there was some increase over time.

  12. 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

  13. 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

  14. [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.

  15. [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

  16. Filtering Medline for a clinical discipline: diagnostic test assessment framework

    Science.gov (United States)

    Iansavichus, Arthur V; Wilczynski, Nancy L; Kastner, Monika; Baier, Leslie A; Shariff, Salimah Z; Rehman, Faisal; Weir, Matthew; McKibbon, K Ann; Haynes, R Brian

    2009-01-01

    Objective To develop and test a Medline filter that allows clinicians to search for articles within a clinical discipline, rather than searching the entire Medline database. Design Diagnostic test assessment framework with development and validation phases. Setting Sample of 4657 articles published in 2006 from 40 journals. Reviews Each article was manually reviewed, and 19.8% contained information relevant to the discipline of nephrology. The performance of 1 155 087 unique renal filters was compared with the manual review. Main outcome measures Sensitivity, specificity, precision, and accuracy of each filter. Results The best renal filters combined two to 14 terms or phrases and included the terms “kidney” with multiple endings (that is, truncation), “renal replacement therapy”, “renal dialysis”, “kidney function tests”, “renal”, “nephr” truncated, “glomerul” truncated, and “proteinuria”. These filters achieved peak sensitivities of 97.8% and specificities of 98.5%. Performance of filters remained excellent in the validation phase. Conclusions Medline can be filtered for the discipline of nephrology in a reliable manner. Storing these high performance renal filters in PubMed could help clinicians with their everyday searching. Filters can also be developed for other clinical disciplines by using similar methods. PMID:19767336

  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. PRACTICAL CHRONIC PAIN ASSESSMENT TOOLS IN CLINICAL PRACTICE.

    Science.gov (United States)

    Loncarić-Katušin, Mirjana; Milošević, Milan; Žilić, Antonio; Mišković, Petar; Majerić-Kogler, Višnja; Žunić, Josip

    2016-03-01

    The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patients' Global Impression of Change scale. All statistical analyses were done using the IBM SPSS Statistics version 19.0.0.1 (www.spss.com). CP predominantly occurs in older age group. Patients with musculoskeletal pain accounted for the highest percentage (n = 316; 29%), followed by those with neuropathic pain (n = 253; 23.20%) and those with low back pain (n = 225; 20.60%). The mean pain intensity rating scale score was 8.3 ± 1.8 a week before the examination and the mean quality of sleep score was 6.8 ± 1.9. Moderate and severe sleep quality disorder was significantly present in patients over 65 years of age (p = 0.007), patients with musculoskeletal and neuropathic pain, back pain, and those having rated Patients' Global Impression of Change scale as worsening (p = 0.001). The severity of pain and poor quality of sleep are the leading causes of deterioration of the Patients' Global Impression of Change scale in patients suffering from musculoskeletal and neuropathic pain. In order to treat CP comprehensively, it is important for GPs to evaluate the outcomes of clinical treatment using tools for CP assessment. PMID:27276768

  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. Standardized Clinical Assessment And Management Plans (SCAMPs) Provide A Better Alternative To Clinical Practice Guidelines

    Science.gov (United States)

    Farias, Michael; Jenkins, Kathy; Lock, James; Rathod, Rahul; Newburger, Jane; Bates, David W.; Safran, Dana G.; Friedman, Kevin; Greenberg, Josh

    2014-01-01

    Variability in medical practice in the United States leads to higher costs without achieving better patient outcomes. Clinical practice guidelines, which are intended to reduce variation and improve care, have several drawbacks that limit the extent of buy-in by clinicians. In contrast, standardized clinical assessment and management plans (SCAMPs) offer a clinician-designed approach to promoting care standardization that accommodates patients’ individual differences, respects providers’ clinical acumen, and keeps pace with the rapid growth of medical knowledge. Since early 2009 more than 12,000 patients have been enrolled in forty-nine SCAMPs in nine states and Washington, D.C. In one example, a SCAMP was credited with increasing clinicians’ rate of compliance with a recommended specialist referral for children from 19.6 percent to 75 percent. In another example, SCAMPs were associated with an 11–51 percent decrease in total medical expenses for six conditions when compared with a historical cohort. Innovative tools such as SCAMPs should be carefully examined by policy makers searching for methods to promote the delivery of high-quality, cost-effective care. PMID:23650325

  1. 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.

  2. When is it rational to participate in a clinical trial? A game theory approach incorporating trust, regret and guilt

    Directory of Open Access Journals (Sweden)

    Djulbegovic Benjamin

    2012-06-01

    Full Text Available Abstract Background Randomized controlled trials (RCTs remain an indispensable form of human experimentation as a vehicle for discovery of new treatments. However, since their inception RCTs have raised ethical concerns. The ethical tension has revolved around “duties to individuals” vs. “societal value” of RCTs. By asking current patients “to sacrifice for the benefit of future patients” we risk subjugating our duties to patients’ best interest to the utilitarian goal for the good of others. This tension creates a key dilemma: when is it rational, from the perspective of the trial patients and researchers (as societal representatives of future patients, to enroll in RCTs? Methods We employed the trust version of the prisoner’s dilemma since interaction between the patient and researcher in the setting of a clinical trial is inherently based on trust. We also took into account that the patient may have regretted his/her decision to participate in the trial, while a researcher may feel guilty because he/she abused the patient’s trust. Results We found that under typical circumstances of clinical research, most patients can be expected not to trust researchers, and most researchers can be expected to abuse the patients’ trust. The most significant factor determining trust was the success of experimental or standard treatments, respectively. The more that a researcher believes the experimental treatment will be successful, the more incentive the researcher has to abuse trust. The analysis was sensitive to the assumptions about the utilities related to success and failure of therapies that are tested in RCTs. By varying all variables in the Monte Carlo analysis we found that, on average, the researcher can be expected to honor a patient’s trust 41% of the time, while the patient is inclined to trust the researcher 69% of the time. Under assumptions of our model, enrollment into RCTs represents a rational strategy that can meet

  3. 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

  4. 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

  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.

  6. Monitoring outcomes of arthritis and longitudinal data collection in routine care using a patient questionnaire that incorporates a clinical note on one piece of paper.

    Science.gov (United States)

    Yazici, Yusuf

    2007-08-01

    Patient questionnaires are the quantitative tools available to rheumatologists to monitor their patients' health status and responses to therapy. The Health Assessment Questionnaire (HAQ) and its derivatives have been shown to be the most significant predictors of functional and work disability, costs, joint replacement surgery, and mortality; generally at higher levels of significance than joint counts, radiographs, and laboratory tests. Every encounter of a patient with a rheumatologist provides an opportunity to collect data. Yet patient questionnaires, which can be used in all rheumatic diseases, including osteoarthritis, systemic lupus erythematosus, fibromyalgia, scleroderma, and ankylosing spondylitis, are not included in routine care by most rheumatologists. Questionnaires can be adapted to include a simple subjective-objective-assessment-plan (SOAP) clinical encounter note that helps with data entry and also provides all the necessary information for clinical decision making in one sheet of paper. Data that are feasible to collect in clinical care provide the optimal approach to assessing quantitatively how patients are doing. If data are not collected and recorded, that opportunity, on that day, is lost forever. Rheumatologists would find it valuable to adapt questionnaires to the care they provide for all their patients, to document and improve the care they provide, and add quantitative data to standard clinical care.

  7. 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.

  8. 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

  9. Hand-held echocardiography: added value in clinical cardiological assessment

    Directory of Open Access Journals (Sweden)

    Ballo Piercarlo

    2005-03-01

    Full Text Available Abstract Background The ultrasonic industry has recently produced echocardiographic Hand Held Devices (miniaturized, compact and battery-equipped echocardiographic systems. Their potential usefulness has been successfully assessed in a wide range of clinical conditions. The aim of the study was to verify if the routine use of a basic model of echocardiographic Hand Held Device (HHD could be an important diagnostic tool during outpatient cardiologic consulting or in non-cardiologic hospital sections. Methods 87 consecutive patients were included in this study; they underwent routine physical examination, resting ECG and echocardiographic evaluation using a basic model of HHD performed by trained echocardiographists; the cardiologist, whenever possible, formulated a diagnosis. The percentage of subjects in whom the findings were judged reasonably adequate for final diagnostic and therapeutic conclusions was used to quantify the "conclusiveness" of HHD evaluation. Successively, all patients underwent a second echocardiographic evaluation, by an examiner with similar echocardiographic experience, performed using a Standard Echo Device (SED. The agreement between the first and the second echocardiographic exam was also assessed. Results Mean examination time was 6.7 ± 1.5 min. using HHD vs. 13.6 ± 2.4 min. using SED. The echocardiographic examination performed using HHD was considered satisfactory in 74/87 patients (85.1% conclusiveness. Among the 74 patients for whom the examination was conclusive, the diagnosis was concordant with that obtained with the SED examination in 62 cases (83.8% agreement. Conclusion HHD may generally allow a reliable cardiologic basic evaluation of outpatient or subjects admitted to non-cardiologic sections, more specifically in particular subgroups of patients, with a gain in terms of time, shortening patient waiting lists and reducing healthy costs.

  10. Hand-held echocardiography: added value in clinical cardiological assessment

    Science.gov (United States)

    Giannotti, Giovanna; Mondillo, Sergio; Galderisi, Maurizio; Barbati, Riccardo; Zacà, Valerio; Ballo, Piercarlo; Agricola, Eustachio; Guerrini, Francesco

    2005-01-01

    Background The ultrasonic industry has recently produced echocardiographic Hand Held Devices (miniaturized, compact and battery-equipped echocardiographic systems). Their potential usefulness has been successfully assessed in a wide range of clinical conditions. The aim of the study was to verify if the routine use of a basic model of echocardiographic Hand Held Device (HHD) could be an important diagnostic tool during outpatient cardiologic consulting or in non-cardiologic hospital sections. Methods 87 consecutive patients were included in this study; they underwent routine physical examination, resting ECG and echocardiographic evaluation using a basic model of HHD performed by trained echocardiographists; the cardiologist, whenever possible, formulated a diagnosis. The percentage of subjects in whom the findings were judged reasonably adequate for final diagnostic and therapeutic conclusions was used to quantify the "conclusiveness" of HHD evaluation. Successively, all patients underwent a second echocardiographic evaluation, by an examiner with similar echocardiographic experience, performed using a Standard Echo Device (SED). The agreement between the first and the second echocardiographic exam was also assessed. Results Mean examination time was 6.7 ± 1.5 min. using HHD vs. 13.6 ± 2.4 min. using SED. The echocardiographic examination performed using HHD was considered satisfactory in 74/87 patients (85.1% conclusiveness). Among the 74 patients for whom the examination was conclusive, the diagnosis was concordant with that obtained with the SED examination in 62 cases (83.8% agreement). Conclusion HHD may generally allow a reliable cardiologic basic evaluation of outpatient or subjects admitted to non-cardiologic sections, more specifically in particular subgroups of patients, with a gain in terms of time, shortening patient waiting lists and reducing healthy costs. PMID:15790409

  11. Assessment of first-year veterinary students' clinical skills using objective structured clinical examinations.

    Science.gov (United States)

    Hecker, Kent; Read, Emma K; Vallevand, Andrea; Krebs, Gord; Donszelmann, Darlene; Muelling, Christoph K W; Freeman, Sarah L

    2010-01-01

    The DVM program at the University of Calgary offers a Clinical Skills course each year for the first three years. The course is designed to teach students the procedural skills required for entry-level general veterinary practice. Objective Structured Clinical Examinations (OSCEs) were used to assess students' performance on these procedural skills. A series of three OSCEs were developed for the first year. Content was determined by an exam blueprint, exam scoring sheets were created, rater training was provided, a mock OSCE was performed with faculty and staff, and the criterion-referencing Ebel method was used to set cut scores for each station using two content experts. Each station and the overall exam were graded as pass or fail. Thirty first-year DVM students were assessed. Content validity was ensured by the exam blueprint and expert review. Reliability (coefficient α) of the stations from the three OSCE exams ranged from 0.0 to 0.71. The three exam reliabilities (Generalizability Theory) were, for OSCE 1, G=0.56; OSCE 2, G=0.37; and OSCE 3, G=0.32. Preliminary analysis has suggested that the OSCEs demonstrate face and content validity, and certain stations demonstrated adequate reliability. Overall exam reliability was low, which reflects issues with first-time exam delivery. Because this year was the first that this course was taught and this exam format was used, work continues in the program on the teaching of the procedural skills and the development and revision of OSCE stations and scoring checklists.

  12. 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.

  13. 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

  14. 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

  15. [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

  16. Clinical acumen but psychometric naivete in neuropsychological assessment of educational disorders.

    Science.gov (United States)

    Reynolds, C R

    1986-01-01

    Many advances in clinical neuropsychology have resulted from the excellent clinical, observational skills developed in the field. In the development of assessment tools for clinical practice, advances in the field have not paralleled advances in applied psychometrics, especially in the assessment of educationally handicapped children. The Boder Test of Reading Spelling Patterns is examined as a detailed example of outstanding clinical acumen leading to a valuable heuristic that failed when translated into a practical assessment tool, primarily due to a lack of attention to the psychometric aspects of the scale. Implications of the failure to apply modern psychometric standards to test development in clinical neuropsychology are discussed. PMID:14589646

  17. 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.

  18. The Assessment of Patient Clinical Outcome: Advantages, Models, Features of an Ideal Model

    Directory of Open Access Journals (Sweden)

    Mou’ath Hourani

    2016-06-01

    Full Text Available Background: The assessment of patient clinical outcome focuses on measuring various aspects of the health status of a patient who is under healthcare intervention. Patient clinical outcome assessment is a very significant process in the clinical field as it allows health care professionals to better understand the effectiveness of their health care programs and thus for enhancing the health care quality in general. It is thus vital that a high quality, informative review of current issues regarding the assessment of patient clinical outcome should be conducted. Aims & Objectives: 1 Summarizes the advantages of the assessment of patient clinical outcome; 2 reviews some of the existing patient clinical outcome assessment models namely: Simulation, Markov, Bayesian belief networks, Bayesian statistics and Conventional statistics, and Kaplan-Meier analysis models; and 3 demonstrates the desired features that should be fulfilled by a well-established ideal patient clinical outcome assessment model. Material & Methods: An integrative review of the literature has been performed using the Google Scholar to explore the field of patient clinical outcome assessment. Conclusion: This paper will directly support researchers, clinicians and health care professionals in their understanding of developments in the domain of the assessment of patient clinical outcome, thus enabling them to propose ideal assessment models.

  19. Expanding the Aperture of Psychological Assessment: Introduction to the Special Section on Innovative Clinical Assessment Technologies and Methods

    Science.gov (United States)

    Trull, Timothy J.

    2007-01-01

    Contemporary psychological assessment is dominated by tried-and-true methods like clinical interviewing, self-report questionnaires, intellectual assessment, and behavioral observation. These approaches have served as the mainstays of psychological assessment for decades. To be sure, these methods have survived over the years because clinicians…

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

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie

    2014-01-01

    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...... 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......, the SIS group had a lower scapular muscle control, 3) When addressing the possibility for measuring scapular kinematics clinically, the findings show a substantially larger number of clinical assessment methods for scapular position and function than previously reported. None of the included clinical...

  1. Aligning clinical assessment with course elements in prosthodontic dentistry: a South African case.

    Science.gov (United States)

    Maart, Ronel Deidre; Bitzer, Elias Matthys

    2013-09-01

    Clinical tests were introduced as an additional clinical assessment tool in the prosthodontics curriculum of the fourth-year undergraduate dentistry program at one South African university. This study compared the relationship between the students' performance in the clinical tests and daily clinical grades on the one hand with their theoretical performance on the other. It also explored the perceptions of the academic staff on the validity of clinical tests as an assessment tool. The analysis of the students' test results showed insignificant relationships between their clinical daily grades and their grades for assessing theory. However, clinical assessment via tests is well accepted by the course staff, and they perceived them to be more reliable than daily clinical grades as assessment methods. The findings of the study support other studies that concluded that the daily grades of dental students poorly correlate with their competency exams module. The findings also relate well to the lecturers' views that clinical tests were more reliable as a clinical assessment tool than the students' daily clinical grade. PMID:24002850

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. 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.

  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. 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.

  9. 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.

  10. 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…

  11. 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…

  12. In Vivo Assessment of Bone Regeneration in Alginate/Bone ECM Hydrogels with Incorporated Skeletal Stem Cells and Single Growth Factors

    Science.gov (United States)

    Gothard, David; Smith, Emma L.; Kanczler, Janos M.; Black, Cameron R.; Wells, Julia A.; Roberts, Carol A.; White, Lisa J.; Qutachi, Omar; Peto, Heather; Rashidi, Hassan; Rojo, Luis; Stevens, Molly M.; El Haj, Alicia J.; Rose, Felicity R. A. J.; Shakesheff, Kevin M.; Oreffo, Richard O. C.

    2015-01-01

    The current study has investigated the use of decellularised, demineralised bone extracellular matrix (ECM) hydrogel constructs for in vivo tissue mineralisation and bone formation. Stro-1-enriched human bone marrow stromal cells were incorporated together with select growth factors including VEGF, TGF-β3, BMP-2, PTHrP and VitD3, to augment bone formation, and mixed with alginate for structural support. Growth factors were delivered through fast (non-osteogenic factors) and slow (osteogenic factors) release PLGA microparticles. Constructs of 5 mm length were implanted in vivo for 28 days within mice. Dense tissue assessed by micro-CT correlated with histologically assessed mineralised bone formation in all constructs. Exogenous growth factor addition did not enhance bone formation further compared to alginate/bone ECM (ALG/ECM) hydrogels alone. UV irradiation reduced bone formation through degradation of intrinsic growth factors within the bone ECM component and possibly also ECM cross-linking. BMP-2 and VitD3 rescued osteogenic induction. ALG/ECM hydrogels appeared highly osteoinductive and delivery of angiogenic or chondrogenic growth factors led to altered bone formation. All constructs demonstrated extensive host tissue invasion and vascularisation aiding integration and implant longevity. The proposed hydrogel system functioned without the need for growth factor incorporation or an exogenous inducible cell source. Optimal growth factor concentrations and spatiotemporal release profiles require further assessment, as the bone ECM component may suffer batch variability between donor materials. In summary, ALG/ECM hydrogels provide a versatile biomaterial scaffold for utilisation within regenerative medicine which may be tailored, ultimately, to form the tissue of choice through incorporation of select growth factors. PMID:26675008

  13. Assessing uncertainty in outsourcing clinical services at tertiary health centers.

    Science.gov (United States)

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A

    2007-01-01

    When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract.

  14. 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

  15. 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...

  16. 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.

  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.

    2016-02-01

    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.

  19. 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.

  20. 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…

  1. 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

  2. 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

  3. [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

  4. 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)

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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...

  13. 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

  14. 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)

  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 (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.

  16. 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

  17. 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...

  18. 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

  19. 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.

  20. 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.

  1. 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...

  2. 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

  3. 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.

  4. 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

  5. Clinical protocol for assessment and management in dental trauma

    OpenAIRE

    Maria Carolina Bandeira Macena; Ana Catarina Leite; Viviane Colares; Sandra vieira; Luiz Guedes de Carvalho Neto

    2009-01-01

    Objective: To present a clinical protocol based on current literature in order to optimize the emergency care of dental trauma in deciduous and permanent dentition. Methods: A documental study held by means of literature review of studies available in the following data basis: MEDLINE, Cochrane, Pubmed, Lilacs, and BBO SCIELO, using as keywords: dental injury, classification, diagnosis and epidemiology. The protocols produced by the International Association of Dental Trauma (IADT) and the Am...

  6. 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

    analysis) is rarely available in the clinic, the clinician needs applicable assessment tools to characterise scapular alterations.The aims were to compile a schematic overview of the available clinical scapular assessment methods and critically appraise the methodological quality of the involved studies...... an exhaustive list of scapular assessment methods on the basis of an initial search; 2) Additionally search for studies including clinimetric outcome measures of the identified assessment methods; 3) Critically appraise the methodological quality of the identified measurement properties in each study; and 4...

  7. Reliable and Valid Assessment of Clinical Bronchoscopy Performance

    DEFF Research Database (Denmark)

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

    2012-01-01

    : The 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...

  8. Clinical Assessment of Child and Adolescent Sleep Disturbance.

    Science.gov (United States)

    Kuhn, Brett R.; Mayfield, Joan W.; Kuhn, Robert H.

    1999-01-01

    Provides guidelines for counselors interested in developing their own assessment procedure to evaluate child and adolescent sleep disturbance. Guidelines include reviewing the developmental and medical history, screening for parental psychopathology, obtaining a child behavior rating scale and sleep diary, and conducting a semistructured clinical…

  9. 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

  10. 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…

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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...

  17. Is it the time to rethink clinical decision-making strategies? From a single clinical outcome evaluation to a Clinical Multi-criteria Decision Assessment (CMDA).

    Science.gov (United States)

    Migliore, Alberto; Integlia, Davide; Bizzi, Emanuele; Piaggio, Tomaso

    2015-10-01

    There are plenty of different clinical, organizational and economic parameters to consider in order having a complete assessment of the total impact of a pharmaceutical treatment. In the attempt to follow, a holistic approach aimed to provide an evaluation embracing all clinical parameters in order to choose the best treatments, it is necessary to compare and weight multiple criteria. Therefore, a change is required: we need to move from a decision-making context based on the assessment of one single criteria towards a transparent and systematic framework enabling decision makers to assess all relevant parameters simultaneously in order to choose the best treatment to use. In order to apply the MCDA methodology to clinical decision making the best pharmaceutical treatment (or medical devices) to use to treat a specific pathology, we suggest a specific application of the Multiple Criteria Decision Analysis for the purpose, like a Clinical Multi-criteria Decision Assessment CMDA. In CMDA, results from both meta-analysis and observational studies are used by a clinical consensus after attributing weights to specific domains and related parameters. The decision will result from a related comparison of all consequences (i.e., efficacy, safety, adherence, administration route) existing behind the choice to use a specific pharmacological treatment. The match will yield a score (in absolute value) that link each parameter with a specific intervention, and then a final score for each treatment. The higher is the final score; the most appropriate is the intervention to treat disease considering all criteria (domain an parameters). The results will allow the physician to evaluate the best clinical treatment for his patients considering at the same time all relevant criteria such as clinical effectiveness for all parameters and administration route. The use of CMDA model will yield a clear and complete indication of the best pharmaceutical treatment to use for patients

  18. 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

  19. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

    Science.gov (United States)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2013-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based…

  20. 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.

  1. 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

  2. Marine and offshore safety assessment by incorporative risk modeling in a fuzzy-Bayesian network of an induced mass assignment paradigm.

    Science.gov (United States)

    Eleye-Datubo, A G; Wall, A; Wang, J

    2008-02-01

    The incorporation of the human element into a probabilistic risk-based model is one that requires a possibilistic integration of appropriate techniques and/or that of vital inputs of linguistic nature. While fuzzy logic is an excellent tool for such integration, it tends not to cross its boundaries of possibility theory, except via an evidential reasoning supposition. Therefore, a fuzzy-Bayesian network (FBN) is proposed to enable a bridge to be made into a probabilistic setting of the domain. This bridge is formalized by way of the mass assignment theory. A framework is also proposed for its use in maritime safety assessment. Its implementation has been demonstrated in a maritime human performance case study that utilizes performance-shaping factors as the input variables of this groundbreaking FBN risk model.

  3. An innovative method to assess clinical reasoning skills: Clinical reasoning tests in the second national medical science Olympiad in Iran

    Directory of Open Access Journals (Sweden)

    Shafaghi Afshin

    2011-10-01

    for each test and total score were highest for KF and CIP. The correlation between scores for each test and grade point average was low to intermediate for all four of the tests. Conclusion The combination of these four clinical reasoning tests is a reliable evaluation tool that can be implemented to assess clinical reasoning skills in talented undergraduate medical students, however these data may not generalizable to whole medical students population. The CIP and KF tests showed the greatest potential to measure clinical reasoning skills. Grade point averages did not necessarily predict performance in the clinical domain of the national competitive examination for medical school students.

  4. Assessing the remedy: the case for contracts in clinical trials.

    Science.gov (United States)

    Edwards, Sarah J L

    2011-04-01

    Current orthodoxy in research ethics assumes that subjects of clinical trials reserve rights to withdraw at any time and without giving any reason. This view sees the right to withdraw as a simple extension of the right to refuse to participate all together. In this paper, however, I suggest that subjects should assume some responsibilities for the internal validity of the trial at consent and that these responsibilities should be captured by contract. This would allow the researcher to impose a penalty on the subject if he were to withdraw without good reason and on a whim. This proposal still leaves open the possibility of withdrawing without penalty when it is in the subject's best interests to do so. Giving researchers recourse to legal remedy may now be necessary to protect the science, as existing methods used to increase retention are inadequate for one reason or another.

  5. 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

  6. 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

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant...... in maize to 1% in tomato. Complete and partially validated diagnoses were 44% of all queries. The remaining 56% were rejected. Several basic weaknesses were found in data recording and symptom recognition. A greater consistency and precision in naming diseases would increase the number of completely...... decision-making of extension service providers, researchers, plant health authorities as well as information and technology providers....

  7. Students' and teachers' perceptions of clinical assessment program: A qualitative study in a PBL curriculum

    Directory of Open Access Journals (Sweden)

    van der Vleuten Cees

    2009-12-01

    Full Text Available Abstract Background "Examinations drive students' learning." This statement refers to what is assumed to be one of the strongest relationships in education. We explored in this research how and why students differ in their approaches to learning, how assessment affects deep learning, and which barriers stand in the way of good assessment and learning in the clinical years of a Problem Based Learning (PBL graduate entry medical curriculum. Findings Method: We conducted a qualitative, phenomenological study using semi-structured group interviews with students and semi-structured individual interviews with teachers and students. The transcripts were analyzed, and themes were identified. Setting: The research was conducted at the King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia from November 2007 to March 2008. Results: A total of 28 students participated in 7 focus group interviews. Semi-structured individual interviews were conducted with 12 teachers and 12 students. The analysis yielded four themes: summative assessment, formative assessment, continuous assessment of clinical attachments, and learning objectives. Conclusions The results of this study confirm that assessment affects students' perceptions of learning and how they learn. These effects are not uniformly positive. According to the students, the predominantly summative assessment program offers little inducement to engage in deep learning. They express a clear preference for formative assessment, which may foster a deeper approach to learning. Efforts to achieve more clinically relevant assessment with adequate balance between the various types of assessment are required. Research is needed to decide this balance.

  8. The effect of in-training assessment on clinical confidence in postgraduate education

    DEFF Research Database (Denmark)

    Ringsted, Charlotte; Pallisgaard, Jane; Østergaard, Doris;

    2004-01-01

    INTRODUCTION: The literature on how in-training assessment (ITA) works in practice and what educational outcomes can actually be achieved is limited. One of the aims of introducing ITA is to increase trainees' clinical confidence; this relies on the assumption that assessment drives learning thro...

  9. 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…

  10. Knowledge of the D-dimer test result influences clinical probability assessment of pulmonary embolism

    NARCIS (Netherlands)

    R.A. Douma; J.B.F. Kessels; H.R. Büller; V.E.A. Gerdes

    2010-01-01

    Background: In patients with suspected pulmonary embolism (PE), an unlikely or non-high probability assessment combined with a normal D-dimer test can safely exclude the diagnosis. We studied the influence of early D-dimer knowledge on clinical probability assessment. Methods: A questionnaire was se

  11. Patient preference regarding assessment of clinical follow-up after percutaneous coronary intervention: the PAPAYA study

    NARCIS (Netherlands)

    Kok, M.; Birgelen, von C.; Lam, M.K.; Lowik, M.; Houwelingen, van G.; Stoel, M.; Louwerenburg, H.; Man, de F.H.; Hartmann, M.; Doggen, C.J.; Til, van J.A.; IJzerman, M.J.

    2015-01-01

    Aims: To keep patients in long-term clinical follow-up programmes after percutaneous coronary intervention (PCI), knowledge of the patient-preferred mode for follow-up assessment is crucial. We systematically assessed patient preference, and explored potential relationships with age and gender.Metho

  12. Patient preference regarding assessment of clinical follow-up after percutaneous coronary intervention: the PAPAYA study

    NARCIS (Netherlands)

    Kok, Marlies M.; Birgelen, von Clemens; Lam, Ming Kai; Löwik, Marije M.; Houwelingen, van K. Gert; Stoel, Martin G.; Louwerenburg, J. (Hans) W.; Man, de Frits H.A.F.; Hartmann, Marc; Doggen, Carine J.M.; Til, van Janine A.; IJzerman, Maarten J.

    2016-01-01

    Aims: To keep patients in long-term clinical follow-up programmes after percutaneous coronary intervention (PCI), knowledge of the patient-preferred mode for follow-up assessment is crucial. We systematically assessed patient preference, and explored potential relationships with age and gender.Metho

  13. 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…

  14. Stroke rehabilitation: clinical picture, assessment, and therapeutic challenge.

    Science.gov (United States)

    Richards, Carol L; Malouin, Francine; Nadeau, Sylvie

    2015-01-01

    This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by describing the different types of stroke that can occur in adults, their potential consequences on a person's capacity to function in daily life and statistics on the number of strokes and their burden on families and the economy. The assessment of stroke severity, recovery of function over time, and the impact of initial stroke severity and age on potential recovery are then addressed as well as the concept of rehabilitation to enhance recovery. Fueled by the synthesis of an ever-increasing research knowledge base and the creation of stroke rehabilitation recommendations for optimal delivery of rehabilitation services and of therapeutic interventions, stroke rehabilitation has changed dramatically. Examples of improvements in stroke rehabilitation in Canada are given with emphasis on the "best practices" inspired stroke rehabilitation continuum recently recommended for the Province of Quebec. The need for an improved community-based rehabilitation approach that includes regular follow-ups and community-based programs promoting reintegration is emphasized. The importance of knowledge translation strategies to promote the uptake of best-practice recommendations is illustrated by describing the activities of the Sensorimotor Rehabilitation Research Team. Over the past 3 years, the researchers of this team and clinicians in three rehabilitation centers, two in Montreal and one in Quebec City, have collaborated to adopt standardized assessment tools, create a common stroke registry, a best-practice recommended approach to interventions and the participation of clinicians in the research process.

  15. 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.

  16. 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.

  17. A model of the pre-assessment learning effects of assessment is operational in an undergraduate clinical context

    Directory of Open Access Journals (Sweden)

    Cilliers Francois J

    2012-03-01

    Full Text Available Abstract Background No validated model exists to explain the learning effects of assessment, a problem when designing and researching assessment for learning. We recently developed a model explaining the pre-assessment learning effects of summative assessment in a theory teaching context. The challenge now is to validate this model. The purpose of this study was to explore whether the model was operational in a clinical context as a first step in this process. Methods Given the complexity of the model, we adopted a qualitative approach. Data from in-depth interviews with eighteen medical students were subject to content analysis. We utilised a code book developed previously using grounded theory. During analysis, we remained alert to data that might not conform to the coding framework and open to the possibility of deploying inductive coding. Ethical clearance and informed consent were obtained. Results The three components of the model i.e., assessment factors, mechanism factors and learning effects were all evident in the clinical context. Associations between these components could all be explained by the model. Interaction with preceptors was identified as a new subcomponent of assessment factors. The model could explain the interrelationships of the three facets of this subcomponent i.e., regular accountability, personal consequences and emotional valence of the learning environment, with previously described components of the model. Conclusions The model could be utilized to analyse and explain observations in an assessment context different to that from which it was derived. In the clinical setting, the (negative influence of preceptors on student learning was particularly prominent. In this setting, learning effects resulted not only from the high-stakes nature of summative assessment but also from personal stakes, e.g. for esteem and agency. The results suggest that to influence student learning, consequences should accrue from

  18. 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

  19. 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

  20. 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…

  1. Clinical assessment of the Hitachi 736-30 chemistry analyzer.

    Science.gov (United States)

    Schotters, S B; McBride, J H; Rodgerson, D O; McGinley, M H; Pisa, M

    1990-01-01

    We assessed the Hitachi 736-30 as a possible replacement for the SMAC I and as a laboratory cost-saving measure. For 24 analytes, both intra- and interassay precisions were acceptable; they also had good measuring ranges. Essentially no interference from lipemia was observed, while minimal interference from bilirubin was demonstrated. Hemoglobin interfered in the measurement of 12 of the analytes. Correlation with the SMAC I, Demand, Astra-8, ACA, and Varian Atomic Absorption Spectrophotometer was found to be acceptable, except for chloride which showed poor correlation with SMAC I and Astra-8 (Hitachi = 0.888 [SMAC] + 11.102, r = 0.9652; Hitachi = 0.885 [Astra] + 10.264, r = 0.9136). The Hitachi 736-30 offers reagent and method flexibility, high volume capability, and "walk-away" operation.

  2. 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.

  3. Cardiomyopathy in congenital and acquired generalized lipodystrophy: a clinical assessment.

    Science.gov (United States)

    Lupsa, Beatrice C; Sachdev, Vandana; Lungu, Andreea O; Rosing, Douglas R; Gorden, Phillip

    2010-07-01

    Lipodystrophy is a rare disorder characterized by loss of adipose tissue and low leptin levels. This condition is characterized by severe dyslipidemia, insulin resistance, diabetes mellitus, and steatohepatitis. Another phenotypic feature that occurs with considerable frequency in generalized lipodystrophy is cardiomyopathy. We report here the cardiac findings in a cohort of patients with generalized congenital and acquired lipodystrophy, and present a literature review of the cardiac findings in patients with generalized lipodystrophy. We studied 44 patients with generalized congenital and acquired lipodystrophy, most of them enrolled in a clinical trial of leptin therapy. Patients underwent electrocardiograms and transthoracic echocardiograms to evaluate their cardiac status. We followed these patients for an extended time period, some of them up to 8 years. Evaluation of our cohort of patients with generalized lipodystrophy shows that cardiomyopathy is a frequent finding in this population. Most of our patients had hypertrophic cardiomyopathy, and only a small number had features of dilated cardiomyopathy. Hypertrophic cardiomyopathy was more frequent in patients with seipin mutation, a finding consistent with the literature. The underlying mechanism for cardiomyopathy in lipodystrophy is not clear. Extreme insulin resistance and the possibility of a "lipotoxic cardiomyopathy" should be entertained as possible explanations.

  4. 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.

  5. 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.

  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. Objective Structured Clinical Examinations (OSCEs, psychiatry and the Clinical assessment of Skills and Competencies (CASCSame Evidence, Different Judgement

    Directory of Open Access Journals (Sweden)

    Marwaha Steven

    2011-05-01

    Full Text Available Abstract Background The Objective Structured Clinical Examination (OSCE, originally developed in the 1970's, has been hailed as the "gold standard" of clinical assessments for medical students and is used within medical schools throughout the world. The Clinical assessment of Skills and Competencies (CASC is an OSCE used as a clinical examination gateway, granting access to becoming a senior Psychiatrist in the UK. Discussion Van der Vleuten's utility model is used to examine the CASC from the viewpoint of a senior psychiatrist. Reliability may be equivalent to more traditional examinations. Whilst the CASC is likely to have content validity, other forms of validity are untested and authenticity is poor. Educational impact has the potential to change facets of psychiatric professionalism and influence future patient care. There are doubts about acceptability from candidates and more senior psychiatrists. Summary Whilst OSCEs may be the best choice for medical student examinations, their use in post graduate psychiatric examination in the UK is subject to challenge on the grounds of validity, authenticity and educational impact.

  8. Incorporating a Healthy Living Curriculum within Family Behavior Therapy: A Clinical Case Example in a Woman with a History of Domestic Violence, Child Neglect, Drug Abuse, and Obesity

    Directory of Open Access Journals (Sweden)

    Holly B. LaPota

    2014-01-01

    Full Text Available Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems. This research was supported by a grant from the National Institute on Drug Abuse (1R01DA020548-01A1 awarded to Brad Donohue. The authors wish to thank Sally K. Miller, PhD, APN, FAANP and Associate Professor, UNLV School of Nursing for her work in completing the initial in-home health evaluation/physical for the current project.

  9. 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

  10. 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

  11. 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.

  12. Clinical assessment of periodontal conditions in patients treated with nifedipine.

    Science.gov (United States)

    Neumann, C; Willershausen-Zönnchen, B; Klug, C; Darius, H

    1996-03-19

    Calcium antagonists are widely used in treating acute and chronic coronary insufficiency disorders. A major side effect of long-term treatment is gingival hyperplasia. In the present study, 70 patients taking nifedipine for at least six months and 70 controls similar in age, gender, approximal hygiene and systemic disease with at least 6 anterior teeth in upper and lower arches were examined. Their periodontal conditions were determined by modified Sulcus-Bleeding-Index (mSBI), modified Approximal-Plaque-Index (mAPI), Community Periodontal Index of Treatment Needs (CPITN), a hyperplasia index quantifying the extent of gingival overgrowth, probing depths, clinical attachment loss and the modified Phenytoin-Gingival-Inflammation-Index (mPGI). A mild to moderate gingival hyperplasia was diagnosed in 21 of 70 patients resulting in a prevalence of 30% compared to 8.5% in controls. The hyperplastic changes were situated mainly in the anterior region of the dentition. Significant differences between both groups could be found comparing the severity of the gingival hyperplasia, the CPITN, mSBI, probing depths and the part of mPGI evaluating colour and turgor of the gingiva (p periodontal treatment need and the approximal hygiene of the patients. No statistically significant correlation could be found between the severity of gingival hyperplasia and the age and gender of the patient, or the dose or duration of nifedipine therapy. Gingival changes seemed to be more pronounced in patients with cardiovascular disorders than in patients under hemodialysis. The high incidence of gingival hyperplasia in patients receiving nifedipine on a long-term basis emphasises the role of the dentist and general practitioner in the early detection and prophylaxis of gingival changes and requires a thorough information to the patient concerning periodontal side effects.

  13. 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

  14. Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches

    Directory of Open Access Journals (Sweden)

    Lam Mak-Ham

    2009-08-01

    Full Text Available Abstract Anterior cruciate ligament (ACL injury is common in knee joint accounting for 40% of sports injury. ACL injury leads to knee instability, therefore, understanding knee stability assessments would be useful for diagnosis of ACL injury, comparison between operation treatments and establishing return-to-sport standard. This article firstly introduces a management model for ACL injury and the contribution of knee stability assessment to the corresponding stages of the model. Secondly, standard clinical examination, intra-operative stability measurement and motion analysis for functional assessment are reviewed. Orthopaedic surgeons and scientists with related background are encouraged to understand knee biomechanics and stability assessment for ACL injury patients.

  15. 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

  16. 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

  17. Comparing the organisational structure of the preoperative assessment clinic at eight university hospitals.

    Science.gov (United States)

    Edward, G M; Biervliet, J D; Hollmann, M W; Schlack, W S; Preckel, B

    2008-01-01

    The preoperative assessment clinic (PAC) has been implemented in most major hospitals. However, there is no uniformity in the way PACs are organised. We compared the organisational structure of the PACs from all eight university hospitals in The Netherlands, looking at the following variables: number of patients visiting the PAC, staffing of the PAC, opening hours, scheduling, and additional preoperative diagnostic testing. The number of patients seen yearly varies from 7.000 to 13.500. In all clinics, the preoperative assessment was performed by anaesthetists and residents. In five PACs, preoperative assessment was also performed by physician assistants or nurse practitioners. Opening hours varied. Consultations are by appointment, 'walk-in', or a combination of these two. In four clinics additional testing is performed at the PAC itself. This study shows that the organisational structure of the PAC at similar university hospitals varies greatly; this can have important implications when designing a benchmarking process.

  18. Determination of {sup 131}Iodine Incorporation of the attending personnel at a nuclear medical clinic; Bestimmung von {sup 131}Jod-Inkorporationen beim Pflegepersonal einer nuklearmedizinischen Klinik

    Energy Technology Data Exchange (ETDEWEB)

    Petzold, J.; Lincke, T.; Petzold, L.; Sabri, O.; Seese, A. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Alborzi, H.; Keller, A.; Meyer, K.

    2007-07-01

    During a radioiodine therapy, the patients discharge {sup 131}I also via the breathing air. At the attending personnel of a therapy station, contaminations and incorporations up to 400 Bq could be found by means of whole body counting. The height of the measured values depends only on the duration of stay of the personnel in the patients room. (orig.)

  19. 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...

  20. Integrating learning assessment and supervision in a competency framework for clinical workplace education.

    Science.gov (United States)

    Embo, M; Driessen, E; Valcke, M; van der Vleuten, C P M

    2015-02-01

    Although competency-based education is well established in health care education, research shows that the competencies do not always match the reality of clinical workplaces. Therefore, there is a need to design feasible and evidence-based competency frameworks that fit the workplace reality. This theoretical paper outlines a competency-based framework, designed to facilitate learning, assessment and supervision in clinical workplace education. Integration is the cornerstone of this holistic competency framework.

  1. 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...

  2. 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...

  3. Evaluation of an eportfolio for the assessment of clinical competence in a baccalaureate nursing program.

    Science.gov (United States)

    Garrett, Bernard M; MacPhee, Maura; Jackson, Cathryn

    2013-10-01

    This paper reports a study undertaken to evaluate the implementation of an electronic portfolio (eportfolio) tool for the assessment of clinical competence in a Bachelor of Science in Nursing program. Baccalaureate nursing programs increasingly use information and communications technologies to support student learning, assess and record progress. Portfolio based practice assessment and electronic portfolios represent growing trends to enhance learning via student reflection and self-identification of further learning needs. Using an action-research process, a mixed-methods evaluation strategy explored the efficacy of the eportfolio in its second year of use. Website tracking analytics and descriptive statistics were used to explore trends in eportfolio usage. Instructor and student surveys and focus groups were carried out at the end of the second year. Instructors valued the eportfolios convenience, improved transparency, an improved ability to track student progress, enhanced theory-practice links, and the competency based assessment framework. Students valued accessibility and convenience, but expressed concerns over assessment data openness and processes for standardization. Both groups felt that the eportfolio navigation required simplification. Electronic portfolios represent a technological evolution from paper-based clinical assessment systems. Although there appear to be many student and instructor advantages in using eportfolios, to maximize successful implementation, clinical teachers require additional training in this new pedagogic approach. Strategies to assist an institutional culture shift towards more transparent assessment processes may also need consideration.

  4. An exploration of student midwives' experiences of the Objective Structured Clinical Examination assessment process.

    Science.gov (United States)

    Barry, Maebh; Noonan, Maria; Bradshaw, Carmel; Murphy-Tighe, Sylvia

    2012-08-01

    This paper reports on a qualitative descriptive study that explored student midwives' experiences of the Objective Structured Clinical Examination assessment process for obstetric emergencies within a university setting. The development of fundamental clinical skills is an important component in preparing students to meet the responsibilities of a midwife. There is an international concern that the transfer of midwifery education into universities may impact on the development of midwifery clinical skills. Objective Structured Clinical Examinations (OSCEs) have the potential to promote integration and consolidation of skills prior to clinical placement. Twenty six students (n=36) from two midwifery programmes (BSc and Higher Diploma) participated in four focus groups and Burnard's (2006) framework was used for data analysis. Three main themes emerged following analysis: preparation for the OSCE assessment, the OSCE process and learning through simulating practice. Preparation for the OSCE's which included lectures, demonstrations, and practice of OSCE's facilitated by lecturers and by the students themselves, was considered central to the process. Learning via OSCEs was perceived to be more effective in comparison to other forms of assessment and prepared students for clinical practice. Positive aspects of the process and areas for improvement were identified. Using OSCE's increased the depth of learning for the students with the steps taken in preparation for the OSCE's proving to be a valuable learning tool. This study adds to the evidence on the use of OSCE's in midwifery education. PMID:21999901

  5. An urban American Indian health clinic's response to a community needs assessment.

    Science.gov (United States)

    Dennis, Mary Kate; Momper, Sandra L

    2016-01-01

    Utilizing community-based methods, we assessed the behavioral and physical health needs of a Detroit metropolitan Indian health clinic. The project goal was to identify health service needs for urban American Indians/Alaska Natives and develop the infrastructure for culturally competent and integrative behavioral and physical health care. We conducted 38 semi-structured interviews and 12 focus groups with service providers and community members. Interview and focus group data indicated a need for 1) more culturally competent services and providers, 2) more specialized health services, and 3) more transportation options. We then report on the Indian health clinic's and community's accomplishments in response to the needs assessment. PMID:27668592

  6. Self-assessment and students’ study strategies in a community of clinical practice: A qualitative study

    Directory of Open Access Journals (Sweden)

    Hanan M. Al-Kadri

    2012-02-01

    Full Text Available : Self-assessment is recognized as a necessary skill for lifelong learning. It is widely reported to offer numerous advantages to the learner. The research evaluated the impact of students’ and supervisors’ self-assessment and feedback training on students’ perceptions and practices of self-assessment. Moreover, it evaluated the effect of self-assessment process on students’ study strategies within a community of clinical practice.: We conducted a qualitative phenomenological study from May 2008 to December 2009. We held 37 semi-structured individual interviews with three different cohorts of undergraduate medical students until we reached data saturation. The cohorts were exposed to different contexts while experiencing their clinical years’ assessment program. In the interviews, students’ perceptions and interpretations of ‘self-assessment practice’ and ‘supervisor-provided feedback’ within different contexts and the resulting study strategies were explored.: The analysis of interview data with the three cohorts of students yielded three major themes: strategic practice of self-assessment, self-assessment and study strategies, and feedback and study strategies. It appears that self-assessment is not appropriate within a summative context, and its implementation requires cultural preparation. Despite education and orientation on the two major components of the self-assessment process, feedback was more effective in enhancing deeper study strategies.: This research suggests that the theoretical advantages linked to the self-assessment process are a result of its feedback component rather than the practice of self-assessment isolated from feedback. Further research exploring the effects of different contextual and personal factors on students’ self-assessment is needed.

  7. 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)

  8. The Information Quality Triangle: a methodology to assess clinical information quality.

    Science.gov (United States)

    Choquet, Rémy; Qouiyd, Samiha; Ouagne, David; Pasche, Emilie; Daniel, Christel; Boussaïd, Omar; Jaulent, Marie-Christine

    2010-01-01

    Building qualitative clinical decision support or monitoring based on information stored in clinical information (or EHR) systems cannot be done without assessing and controlling information quality. Numerous works have introduced methods and measures to qualify and enhance data, information models and terminologies quality. This paper introduces an approach based on an Information Quality Triangle that aims at providing a generic framework to help in characterizing quality measures and methods in the context of the integration of EHR data in a clinical datawarehouse. We have successfully experimented the proposed approach at the HEGP hospital in France, as part of the DebugIT EU FP7 project.

  9. 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;

    of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway PurposeFrom a biomechanical perspective, the scapula plays a key role in the shoulder and arm function as a stable base for optimal muscle activation both at rest and during functional tasks.There is evidence...... motion analysis) is rarely available in the clinic, the clinician needs applicable assessment tools to characterise scapular alterations.The aims were to compile a schematic overview of the available clinical scapular assessment methods and critically appraise the methodological quality of the involved...... an exhaustive list of scapular assessment methods on the basis of an initial search; 2) Additionally search for studies including clinimetric outcome measures of the identified assessment methods; 3) Critically appraise the methodological quality of the identified measurement properties in each study; and 4...

  10. Clinical application of music therapy assessment within the field of child protection

    DEFF Research Database (Denmark)

    Jacobsen, Stine Lindahl; Killén, Kari

    2015-01-01

    The focus of this article is the theoretical understanding behind, and the clinical application of, a newly developed music-therapy assessment tool, Assessment of Parenting Competencies (APC). While the psychometric properties have been analyzed successfully in prior publications, the advantages...... 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...

  11. [Development of a portfolio for competency-based assessment in a clinical clerkship curriculum].

    Science.gov (United States)

    Roh, HyeRin; Lee, Jong-Tae; Yoon, Yoo Sang; Rhee, Byoung Doo

    2015-12-01

    The purpose of this report was to describe our experience in planning and developing a portfolio for a clinical clerkship curriculum. We have developed a portfolio for assessing student competency since 2007. During an annual workshop on clinical clerkship curricula, clerkship directors from five Paik hospitals of Inje University met to improve the assessment of the portfolio. We generated templates for students to record their activities and reflection and receive feedback. We uploaded these templates to our school's website for students to download freely. Annually, we have held a faculty development seminar and a workshop for portfolio assessment and feedback. Also, we established an orientation program on how to construct a learning portfolio for students. Future actions include creating a ubiquitous portfolio system, extending the portfolio to the entire curriculum, setting up an advisor system, and managing the quality of the portfolio. This study could be helpful for medical schools that plan to improve their portfolio assessment with an outcome-based approach.

  12. 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 paediatrics in seven centres. A video case library showing children with common clinical conditions was established, and a short video was added to the oral examination. We evaluated students' and internal and external examiners' perceptions by questionnaires. RESULTS: A total of 81% of the students reported...... 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...

  13. 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

  14. 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.

  15. Assessment of positive functioning in clinical psychology: theoretical and practical issues.

    Science.gov (United States)

    Joseph, Stephen; Wood, Alex

    2010-11-01

    Positive psychology has led to an increasing emphasis on the promotion of positive functioning in clinical psychology research and practice, raising issues of how to assess the positive in clinical setting. Three key considerations are presented. First, existing clinical measures may already be assessing positive functioning, if positive and negative functioning exist on a single continuum (such as on bipolar dimensions from happiness to depression, and from anxiety to relaxation). Second, specific measures of positive functioning (e.g., eudemonic well-being) could be used in conjunction with existing clinical scales. Third, completely different measures would be needed depending on whether well-being is defined as emotional or medical functioning, or as humanistically orientated growth (e.g., authenticity). It is important that clinical psychologists introduce positive functioning into their research and practice in order to widen their armoury of therapeutic interventions, but in doing so researchers and practitioners need also to be aware that they are shifting the agenda of clinical psychology. As such, progress in clinical psychology moving toward the adoption of positive functioning requires reflection on epistemological foundations.

  16. Clinical assessment of freezing of gait in Parkinson's disease from computer-generated animation.

    Science.gov (United States)

    Morris, Tiffany R; Cho, Catherine; Dilda, Valentina; Shine, James M; Naismith, Sharon L; Lewis, Simon J G; Moore, Steven T

    2013-06-01

    The current 'gold standard' for clinical evaluation of freezing of gait (FOG) in Parkinson's disease (PD) is determination of the number of FOG episodes from video by independent raters. We have previously described a robust technique for objective FOG assessment from lower-limb acceleration. However, there is no existing method for validation of autonomous FOG measures in the absence of video documentation. In this study we compared the results of clinical evaluation of FOG from computer-generated animations (derived from body-mounted inertial sensors) during a timed up and go test with the 'gold standard' of clinical video assessment, utilizing a cohort of 10 experienced raters from four PD centers. Agreement between the 10 clinical observers for scoring of FOG from computer animations was more robust for the relative duration of freeze events (percent time frozen; intraclass correlation coefficient of 0.65) than number of FOG episodes, and was comparable with clinical evaluation of the patient from video (intraclass correlation coefficient 0.73). This result suggests that percent time frozen should be considered (along with number of FOG events) to better convey FOG severity. The ability of clinical observers to quantify FOG from computer-generated animation derived from lower-limb motion data provides a potential approach to validation of accelerometry-based FOG identification outside of the clinic.

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. AAC assessment and clinical-decision making: the impact of experience.

    Science.gov (United States)

    Dietz, Aimee; Quach, Wendy; Lund, Shelley K; McKelvey, Miechelle

    2012-09-01

    People with complex communication needs often require a comprehensive augmentative and alternative communication (AAC) assessment to maximize participation in daily interactions. Assessment of AAC is a complex process and limited practice guidelines exist. The purpose of this qualitative study was to explore how 25 speech-language pathologists with varying levels of experience approach the AAC assessment process. Participants were classified as either (a) General Practice Speech-Language Pathologists (GPSLPs), (b) AAC Clinical Specialists (AAC-CS), or (c) AAC Research/Policy Specialists (AAC-RS). In-depth, semi-structured interviews were conducted to explore the participants' approach to AAC assessment. The results revealed that GPSLPs approach AAC assessment differently than the AAC-CS and AAC-RS; however, the Specialists reported a similar approach that may help guide the development of practice guidelines for AAC assessment.

  2. Computer Assisted Objective Structured Clinical Examination: A useful tool for dermatology undergraduate assessment

    Directory of Open Access Journals (Sweden)

    Chander Grover

    2012-01-01

    Full Text Available Background: Dermatology is a minor subject in undergraduate medical curriculum in India. The dermatology clinical postings are generally poorly attended, and the clinical acumen of an average medical graduate in this specialty is quite low. Aims: To develop and implement Computer Assisted Objective Structured Clinical Examination (CA-OSCE as a means of end of dermatology posting evaluation. Also, to assess its effectiveness in improving the motivation, attendance and learning of undergraduate students with respect to their visual recognition skills and problem solving ability. Methods: We designed and introduced CA-OSCE as a means of end of posting assessment. The average attendance and assessment scores of students undergoing CA-OSCE were compiled and compared using ′independent t test′ with the scores of previous year′s students who had undergone assessment with essay type questions. Results: The average attendance and average assessment scores for the candidates undergoing CA-OSCE were found to 83.36% and 77.47%, respectively as compared to 64.09% and 52.07%, respectively for previous years′ students. The difference between the two groups was found to be statistically significant. Student acceptability of the technique was also high, and their subjective feedback was encouraging. Conclusion: CA-OSCE is a useful tool for assessment of dermatology undergraduates. It has the potential to drive them to attend regularly as well as to test their higher cognitive skills of analysis and problem solving.

  3. Psoriasis: severity assessment in clinical practice. Conclusions from workshop discussions and a prospective multicentre survey of psoriasis severity.

    NARCIS (Netherlands)

    Kerkhof, P.C.M. van de; Kragballe, K.; Austad, J.; Berth-Jones, J.; Cambazard, F.; Brassinne, M. de la; Ljungberg, A.; Murphy, G.; Papp, K.; Wozel, G.

    2006-01-01

    Psoriasis treatment is highly individualized. Although a standardized assessment of psoriasis severity for clinical practice may be theoretically advantageous for the purposes of determining treatment, the relevance of currently available research tools in clinical practice is uncertain. Our objecti

  4. 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.

  5. 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

  6. 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

  7. Evaluation of clinical spasticity assessment in cerebral palsy using inertial sensors

    NARCIS (Netherlands)

    Noort, van den J.C.; Scholtes, V.A.B.; Harlaar, J.

    2009-01-01

    Spasticity is clinically assessed using goniometry to measure the joint angle of the catch (AOC) during fast passive muscle stretch. The precision and accuracy of the goniometric AOC measurements are questionable, because of the inevitable joint repositioning after occurrence of the catch. This stud

  8. Risk assessment of clinical reactions to legumes in peanut-allergic children

    DEFF Research Database (Denmark)

    Jensen, Louise Bjerremann; Andersen, Milene; Skov, Per Stahl;

    2008-01-01

    for risk assessment of possible clinical reactions to other legumes (soybean, lupine, fresh, and blanched green pea). Seventy-five consecutive patients with a positive oral food challenge to peanut were included in the study. All tests were run as part of the routine allergy examination. A high proportion...

  9. 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…

  10. Scale for the assessment and rating of ataxia: development of a new clinical scale.

    NARCIS (Netherlands)

    Schmitz-Hubsch, T.; Montcel, S.T. du; Baliko, L.; Berciano, J.; Boesch, S.; Depondt, C.; Giunti, P.; Globas, C.; Infante, J.; Kang, J.S.; Kremer, H.P.H.; Mariotti, C.; Melegh, B.; Pandolfo, M.; Rakowicz, M.; Ribai, P.; Rola, R.; Schols, L.; Szymanski, S.; Warrenburg, B.P.C. van de; Durr, A.; Klockgether, T.; Fancellu, R.

    2006-01-01

    OBJECTIVE: To develop a reliable and valid clinical scale measuring the severity of ataxia. METHODS: The authors devised the Scale for the Assessment and Rating of Ataxia (SARA) and tested it in two trials of 167 and 119 patients with spinocerebellar ataxia. RESULTS: The mean time to administer SARA

  11. 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…

  12. 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.

  13. Clinical impact of vasomotor function assessment and the role of ACE-inhibitors and statins

    NARCIS (Netherlands)

    Asselbergs, FW; van der Harst, P; Jessurun, GAJ; Tio, RA; van Gilst, WH

    2005-01-01

    Impaired endothelial function is recognised as one of the earliest events of atherogenesis. Endothelium-dependent vasomotion has been the principal method to assess endothelial function. In this article, we will discuss the clinical value of the different techniques to evaluate endothelium-dependent

  14. Self-care assessment as an indicator for clinical supervision in nursing

    Directory of Open Access Journals (Sweden)

    Sílvia Marlene Monteiro Teixeira

    2016-01-01

    Full Text Available Objective : to evaluate the needs of clinical supervision for nurses to assess the degree of dependence on self- care and planning of nursing interventions. Methods : analytical study, cross-cutting nature, collecting data from a sample of 110 patients. Results : it was shown the differences in the identification of the degree of dependence between registers and experts, as well as the selection of operations for each self-care and failures to the original assessment of the filling level (no evaluation self-care/no identification of the degree of dependence. Conclusion : there were gaps in the nursing process; they have proposed strategies such as clinical supervision sessions, training, case studies, protocols and guidance documents, to be included in a clinical supervision in nursing model.

  15. Self-care assessment as an indicator for clinical supervision in nursing

    Directory of Open Access Journals (Sweden)

    Sílvia Marlene Monteiro Teixeira

    2016-06-01

    Full Text Available Objective: to evaluate the needs of clinical supervision for nurses to assess the degree of dependence on self-care and planning of nursing interventions. Methods: analytical study, cross-cutting nature, collecting data from a sample of 110 patients. Results: it was shown the differences in the identification of the degree of dependence between registers and experts, as well as the selection of operations for each self-care and failures to the original assessment of the filling level (no evaluation self-care/no identification of the degree of dependence. Conclusion: there were gaps in the nursing process; they have proposed strategies such as clinical supervision sessions, training, case studies, protocols and guidance documents, to be included in a clinical supervision in nursing model.

  16. 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.

  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. Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists.

    Science.gov (United States)

    McAllister, Sue; Kruger, Samantha; Doeltgen, Sebastian; Tyler-Boltrek, Emma

    2016-10-01

    Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning. PMID:27405423

  19. 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.

  20. Transient elastography for the assessment of chronic liver disease: Ready for the clinic?

    Institute of Scientific and Technical Information of China (English)

    JFL Cobbold; S Morin; SD Taylor-Robinson

    2007-01-01

    Transient elastography is a recently developed noninvasive technique for the assessment of hepatic fibrosis.The technique has been subject to rigorous evaluation in a number of studies in patients with chronic liver disease of varying aetiology. Transient elastography has been compared with histological assessment of percutaneous liver biopsy, with high sensitivity and specificity for the diagnosis of cirrhosis, and has also been used to assess pre-cirrhotic disease. However, the cut-off values between different histological stages vary substantially in different studies, patient groups and aetiology of liver disease. More recent studies have examined the possible place of transient elastography in clinical practice, including risk stratification for the development of complications of cirrhosis. This review describes the technique of transient elastography and discusses the interpretation of recent studies, emphasizing its applicability in the clinical setting.

  1. 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.

  2. 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

  3. 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.

  4. Why peer assessment helps to improve clinical performance in undergraduate physical therapy education: a mixed methods design

    NARCIS (Netherlands)

    Maas, M.J.M.; Sluijsmans, D.M.; Wees, P.J. van der; Heerkens, Y.F.; Nijhuis-Van der Sanden, M.W.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers' performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills

  5. Why peer assessment helps to improve clinical performance in undergraduate physical therapy education : A mixed methods design

    NARCIS (Netherlands)

    Maas, Marjo; Sluijsmans, Dominique; Wees, Philip van der; Heerkens, Yvonne; Nijhuis-van der Sanden, Maria; Vleuten, Cees van der

    2014-01-01

    Background: Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers’ performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills

  6. 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

  7. 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.

  8. [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

  9. 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.

  10. 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

  11. Definitions for response and progression in ovarian cancer clinical trials incorporating RECIST 1.1 and CA 125 agreed by the Gynecological Cancer Intergroup (GCIG)

    DEFF Research Database (Denmark)

    Rustin, Gordon John Sampson; Vergote, Ignace; Eisenhauer, Elizabeth;

    2011-01-01

    The Gynecological Cancer Intergroup (GCIG) has previously reached consensus regarding the criteria that should be used in clinical trial protocols to define progression-free survival after first-line therapy as well as the criteria to define response to treatment in recurrent disease using the se...

  12. 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

    disease cf. 59/131 and 52/131, respectively, in remission). Nasal crusting was the most common nasal complaint recorded (52/144, 36 %) and bloody rhinorrhoea was the most common symptom in patients with disease activity. Rhinoscopy was highly sensitive in diagnosing disease activity (100 %). Subglottic...... stenosis was the most common head and neck manifestation (27/121, 22 %) and 74 % were symptomatic. In conclusion, the pattern and frequency of clinical ENT manifestations in GPA have been described in a large patient cohort. The use of tools readily available in the ENT clinic was essential to assess...

  13. 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.

  14. Incidence of unanticipated difficult airway using an objective airway score versus a standard clinical airway assessment

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet; Rosenstock, Charlotte Valentin; Wetterslev, Jørn;

    2013-01-01

    the examination and registration of predictors for difficult mask ventilation with a non-specified clinical airway assessment on prediction of difficult mask ventilation.Method/Design: We cluster-randomized 28 Danish departments of anaesthesia to airway assessment either by the SARI or by usual non......-specific assessment. Data from patients' pre-operative airway assessment are registered in the Danish Anaesthesia Database. Objective scores for intubation and mask ventilation grade the severity of airway managements. The accuracy of predicting difficult intubation and mask ventilation is measured for each group...... reduction equalling a number needed to treat of 180. Sample size estimation is adjusted for the study design and based on standards for randomization on cluster-level. With an average cluster size of 2,500 patients, 70,000 patients will be enrolled over a 1-year trial period. The database is programmed so...

  15. Assessment Procedures for Narcissistic Personality Disorder: A Comparison of the Personality Diagnostic Questionnaire-4 and Best-Estimate Clinical Judgments

    Science.gov (United States)

    Miller, Joshua D.; Campbell, W. Keith; Pilkonis, Paul A.; Morse, Jennifer Q.

    2008-01-01

    This study examined the degree of correspondence between two assessments for narcissistic personality disorder (NPD) in a mixed clinical and community sample--one using a self-report measure (Personality Diagnostic Questionnaire-4) and the other using clinical judgments derived from an assessment based on the longitudinal, expert, all data (LEAD)…

  16. 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 w...

  17. Clinical reasoning assessment through medical expertise theories: past, present and future directions.

    Science.gov (United States)

    Boushehri, Elham; Soltani Arabshahi, Kamran; Monajemi, Alireza

    2015-01-01

    Exploration into the concept of "medical expert" dates back to more than 50 years ago, yet yielding three leading theories in the area of clinical reasoning, namely, knowledge structure, hypotheticdeductive, and dual process. Each theory defines "medical expert" in a dissimilar way. Therefore, the methods of assessment through which the experts are identified have been changed during the time. In this paper, we tried to categorize and introduce some widely used tests for identification of experts within the framework of existing main theories. Implementation of the proposed categorization for providing future assessment tools is discussed.

  18. 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 use...... of highly sensitive tests/measures) that then is followed by utilizing more specific tests/measures to pare down this imprecise differential diagnosis list is suggested. Physical assessment measures are then suggested to discern impairments, activity and participation restrictions for athletes with hip...

  19. 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;

    2014-01-01

    a 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...... in neuromuscular activity of scapular stabilising muscles were observed, 2) and when provided with visual EMG feedback, the SIS group performed equally well as the No-SIS group, However, when assessing the neuromuscular function with and without the use of biofeedback, the findings show that without biofeedback...

  20. Assessment of soil nitrogen and related enzymes as influenced by the incorporation time of field pea cultivated as a catch crop in Alfisol.

    Science.gov (United States)

    Piotrowska-Długosz, Anna; Wilczewski, Edward

    2014-12-01

    The effect of the time of catch crop (field pea) incorporation [catch crop incorporated in the autumn (A) or in the spring (B) versus plots without a catch crop (C)] on the soil enzymes related to N transformation (urease - UR, protease - PRO, nitrate reductase - NR, arginine ammonification rate - AAR), the total N and mineral N as well as microbial biomass N (MBN) contents were investigated in a 3-year experiment. The catch crop was sown at the beginning of August and plowed in the autumn in 2008, 2009 and 2010 or left as mulch during the winter. Soil samples for microbial activity were taken from spring barley plots that were grown in 2009, 2010 and 2011 before sowing (March), during the tillering phase (May), shooting (June) and after the harvesting of spring barley (August). The use of catch crop significantly increased the soil mineral and MBN contents as well as the activities of PRO and NR as compared to the control soil. The spring incorporation of the field pea significantly increased the MBN content in contrast to the autumn application, while the activity of N-cycle enzymes were clearly unaffected (UR and AAR) regardless of the time of the incorporation of field pea or else the results were inconsistent (PRO and NR). When the catch crop was incorporated in the spring, a significantly higher content of mineral N as compared to autumn incorporation was noted on only two of the four sampling dates. The enzymatic activity (PRO and AAR) was about 1.3-2.8 times higher in May and June as compared with March and August. Both spring or autumn incorporation of catch crop can be a useful management practice to increase the soil mineral N content and enhance the soil biological activity.

  1. Lifting the veil: how to use clinical neuropsychology to assess dementia.

    Science.gov (United States)

    Burrell, James R; Piguet, Olivier

    2015-11-01

    Neurologists often struggle to interpret the results of neuropsychological testing, even though cognitive assessments are an integral component of the diagnostic process in dementia syndromes. This article reviews the principles underlying clinical neuropsychology, background on common neuropsychological tests, and tips on how to interpret the results when assessing patients with dementia. General cognitive screening tools, appropriate for use by general neurologists and psychiatrists, as well as specific cognitive tests examining the main cognitive domains (attention and orientation, memory, visuospatial function, language and executive function) in patients with dementia are considered. Finally, the pattern of deficits, helpful in defining clinical dementia phenotypes and sometimes in predicting the underlying molecular pathology, are outlined. Such clinicopathological associations will become invaluable as disease-modifying treatments for dementia are developed and implemented.

  2. 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

  3. 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.

  4. 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...

  5. 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...

  6. 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

  7. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

    Science.gov (United States)

    García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L; Agreda, J Javier Soldevilla

    2014-01-01

    A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.

  8. 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.

  9. Health impact assessment and evaluation of a clinical waste management policy for Cameroon

    Directory of Open Access Journals (Sweden)

    Gabriel Gulis

    2013-09-01

    Full Text Available Health impact assessment (HIA was carried out to evaluate development of a clinical waste management policy for Cameroon. Fifteen stakeholders of different portfolios within the health sector were selected during a HIA initiating study trip to the Northwest region of Cameroon. Questionnaires were then developed and emailed to the stakeholders. The stakeholders identified cross-contamination, environmental pollution, physical injuries and poor waste management sites as potential risk factors that can be associated with poor clinical waste management. They recommended strong economic and political capital as a prerequisite for the development and implementation of a successful clinical waste policy. Local impacts on health, according to the stakeholders, should be prioritized in deciding any treatment and disposal option. The whole HIA process run through 2008-2010.

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal.

    Science.gov (United States)

    Kent, David M; Rothwell, Peter M; Ioannidis, John P A; Altman, Doug G; Hayward, Rodney A

    2010-01-01

    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. PMID:20704705

  15. 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.

  16. Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry.

    Science.gov (United States)

    Vasikaran, Samuel D

    2015-05-01

    The provision of clinical interpretation of results, either verbally or in the printed report, may be considered an integral part of clinical biochemistry diagnostic service. Proficiency testing or external quality assessment (EQA) of such activity may be useful in education, training, continuing professional development and ensuring the quality of such service. Details of the Patient Report Comments Program (RPCProgram) developed by the Royal College of Pathologists of Australasia (RCPA) Chemical Pathology Quality Assurance Programs Pty Ltd (QAP) is described in this review. The program is aimed at pathologists, clinical scientists and trainees. Registered participants are provided a report with case details and a set of clinical biochemistry results at monthly intervals and submit an interpretative comment for the report. Comments received are broken up into components that are translated into common key phrases. An expert panel evaluates the key phrases, classifies them according to appropriateness and drafts a suggested comment, a case summary and a rationale, which are included in a summary report returned to participants. There is considerable diversity in the quality of interpretative comments received from participants of the PRCProgram. The primary purpose of EQA of interpretative commenting is educational self-assessment, and they are recognized as a continuing professional development activity. Whilst there is some evidence for the utility of interpretative comments in improving patient outcomes, evidence for the utility of EQA in improving quality of comments is awaited.

  17. 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.

  18. 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)

  19. Assessing sub-clinical psychosis phenotypes in the general population--a multidimensional approach.

    Science.gov (United States)

    Rössler, Wulf; Ajdacic-Gross, Vladeta; Müller, Mario; Rodgers, Stephanie; Haker, Helene; Hengartner, Michael P

    2015-02-01

    Several studies have demonstrated that expression of a psychosis phenotype can be observed below the threshold of its clinical detection. To date, however, no conceptual certainty has been reported for the validity and reliability of sub-clinical psychosis. Our main objectives were to assess the prevalence rates and severity of various psychosis symptoms in a representative community sample. Furthermore, we wanted to analyze which latent factors are depicted by several currently used psychosis questionnaires. We also examined how those latent factors for sub-clinical psychosis are linked to psychosocial factors, normal personality traits, and coping abilities related to chronic stress. Most of the eight subscales from the Paranoia Checklist and the Structured Interview for Assessing Perceptual Anomalies had a very similar type of distribution, i.e., an inverse Gaussian (Wald) distribution. This supported the notion of a continuity of psychotic symptoms, which we would expect to find for continuously distributed symptoms within the general population. Sub-clinical psychosis can be reduced to two different factors - one representing odd beliefs about the world and odd behavior, and the other one representing anomalous perceptions (such as hallucinations). Persons with odd beliefs and behavior are under greater burden and more susceptible to psychosocial risks than are persons with anomalous perceptions. These sub-clinical psychosis syndromes are also related to stable personality traits. In conclusion, we obtained strong support for the notion that there is no natural cut-off separating psychotic illness from good health. Sub-clinical psychosis of any kind is not trivial because it is associated with various types of social disability. PMID:25523751

  20. 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

  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. 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

  3. D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial

    NARCIS (Netherlands)

    Snijders, Dominic; Schoorl, Margreet; Schoorl, Marianne; Bartels, Piet C.; van der Werf, Tjip S.; Boersma, Wim G.

    2012-01-01

    Background: D-dimer levels are in several studies elevated in patients with CAP. In this study we assess the use of D-dimer levels and its association with severity assessment and clinical outcome in patients hospitalised with community-acquired pneumonia. Methods: In a subset of randomised trial pa

  4. Incorporating OASIS into the Visiting Nurses Association.

    Science.gov (United States)

    Clark, L L

    1998-01-01

    Beginning in 1994, the Visiting Nurses Association, Western Pennsylvania, began to investigate incorporating an outcome measurement system within its organization for the purposes of marketing quality results, benchmarking achievements, and defining quality of care for both internal and external review groups. In the fall of 1995, this agency was accepted into the Outcome Based Quality Improvement (OBQI) Demonstration Project, also known as the Medicare Quality Assurance Project, which the Health Care Financing Administration has funded for the purpose of measuring clinical and utilization outcomes in the home care arena. This article reviews the processes the agency used to develop and incorporate the entire OBQI process into its systems, including the incorporation of the Outcome Assessment Information Set (OASIS). The OASIS is a set of outcome measurement questions developed by Dr. Peter Shaughnessy at the Center for Health Policy Research in Denver. The process also includes training of staff and development of forms, point-of-care software with a vendor, and plans of action for improving outcomes that have been quantified through OBQI efforts.

  5. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

    Science.gov (United States)

    Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

    2016-07-01

    Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients. PMID:27351769

  6. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

    Science.gov (United States)

    Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

    2016-07-01

    Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients.

  7. The Diagnostic Validity and Reliability of an Internet-Based Clinical Assessment Program for Mental Disorders

    Science.gov (United States)

    Klein, Britt; Meyer, Denny; Austin, David William; Abbott, Jo-Anne M

    2015-01-01

    Background Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. Objective The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. Methods Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. Results With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS’ sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). Conclusions The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. Trial Registration Australian and New Zealand Clinical Trials

  8. 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

  9. Toxicity assessment of molecularly targeted drugs incorporated into multiagent chemotherapy regimens for pediatric Acute Lymphocytic Leukemia (ALL): Review from an International Consensus Conference

    NARCIS (Netherlands)

    T.M. Horton (Terzah); R. Sposto (Richard); P. Brown (Patrick); C.P. Reynolds (Patrick); S.P. Hunger (Stephen); N.J. Winick (Naomi); E.A. Raetz (Elizabeth); W.L. Carroll (William); R.J. Arceci (Robert); M.J. Borowitz (Michael); P.S. Gaynon (Paul); L. Gore (Lia); S. Jeha (Sima); B.J. Maurer (Barry); S.E. Siegel (Stuart); A. Biondi (Andrea); P. Kearns (Pamela); A. Narendran (Aru); L.B. Silverman (Lewis); M.A. Smith (Malcolm); C.M. Zwaan (Michel); J.A. Whitlock (James)

    2010-01-01

    textabstractOne of the challenges of incorporating molecularly targeted drugs into multi-agent chemotherapy (backbone) regimens is defining dose-limiting toxicities (DLTs) of the targeted agent against the background of toxicities of the backbone regimen. An international panel of 22 pediatric acute

  10. 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

  11. Developing an Evaluation Tool for Assessing Clinical Ethics Consultation Skills in Simulation Based Education: The ACES Project.

    Science.gov (United States)

    Wasson, Katherine; Parsi, Kayhan; McCarthy, Michael; Siddall, Viva Jo; Kuczewski, Mark

    2016-06-01

    The American Society for Bioethics and Humanities has created a quality attestation (QA) process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (ACES) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described. PMID:25794891

  12. Developing an Evaluation Tool for Assessing Clinical Ethics Consultation Skills in Simulation Based Education: The ACES Project.

    Science.gov (United States)

    Wasson, Katherine; Parsi, Kayhan; McCarthy, Michael; Siddall, Viva Jo; Kuczewski, Mark

    2016-06-01

    The American Society for Bioethics and Humanities has created a quality attestation (QA) process for clinical ethics consultants; the pilot phase of reviewing portfolios has begun. One aspect of the QA process which is particularly challenging is assessing the interpersonal skills of individual clinical ethics consultants. We propose that using case simulation to evaluate clinical ethics consultants is an approach that can meet this need provided clear standards for assessment are identified. To this end, we developed the Assessing Clinical Ethics Skills (ACES) tool, which identifies and specifies specific behaviors that a clinical ethics consultant should demonstrate in an ethics case simulation. The aim is for the clinical ethics consultant or student to use a videotaped case simulation, along with the ACES tool scored by a trained rater, to demonstrate their competence as part of their QA portfolio. The development and piloting of the tool is described.

  13. 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.

  14. Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment.

    Directory of Open Access Journals (Sweden)

    Ann Green

    Full Text Available INTRODUCTION: To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses. METHODS: A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship. RESULTS: Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p = 0.03, assessing adherence (50% vs 78%, p<0.001 and WHO staging (63% vs 91%, p<0.001. Nurse ART initiation indicators were successfully completed at 95-100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin; STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects. CONCLUSIONS: Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a

  15. 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

  16. A COMPARATIVE STUDY TO ASSESS FETAL MALNUTRITION BY CLINICAL ASSESSMENT OF NUTRITIONAL STATUS SCORE (CAN SCORE AND ANTHROPOMETRIC INDICES

    Directory of Open Access Journals (Sweden)

    Thammanna

    2015-09-01

    Full Text Available CONTEXT: Fetal malnutrition is a major problem in developing countries like India. It is associated with increased mortality and long term sequel . There are various methods to determine nutritional status of newborns like weight for gestational age, Ponderal index, Body mass index, mid arm circumference/ head circumference ratio etc., but each have their own limitations. The terms fetal malnutrition and small for gestational age are not synonymous and one may occur without the other. Clinical assessment of nutrition al status score (CAN Score developed by Metcoff is a reliable test for identification of fetal malnutrition. This study was under taken to identify incidence of fetal malnutrition by CAN Score and to compare it with other anthropometric indices. METHODS: It was a prospective study conducted in a tertiary care hospital. 256 neonates were assessed using CAN Score and anthropometry was recorded. Neonates were classified as per weight for age. Ponderal index, body mass index, mid arm circumference/ head circum ference ratio, body mass index were calculated and compared with CAN Score for accuracy in identifying fetal malnutrition. RESULTS: Incidence of fetal malnutrition as per CAN Score was 26.17%, 6.4% of Appropriate for gestational age babies were malnourishe d. Weight for age parameter classified 28.52% of babies as malnourished; Ponderal index classified 23.44% as malnourished, body mass index and mid arm circumference/ head circumference ratio classified 39.45% and 34.38% neonates as malnourished respectivel y. Weight for age and body mass index had sensitivity of 83.58% and 80.6% respectively in identifying fetal malnutrition. CONCLUSION: CAN score is a simple clinical method for identification of fetal malnutrition without use of any sophisticated equipments and it can even detect malnourished babies who are missed by other anthropometric methods

  17. Mining disease risk patterns from nationwide clinical databases for the assessment of early rheumatoid arthritis risk.

    Science.gov (United States)

    Chin, Chu Yu; Weng, Meng Yu; Lin, Tzu Chieh; Cheng, Shyr Yuan; Yang, Yea Huei Kao; Tseng, Vincent S

    2015-01-01

    Rheumatoid arthritis (RA) is a chronic autoimmune rheumatic disease that can cause painful swelling in the joint lining, morning stiffness, and joint deformation/destruction. These symptoms decrease both quality of life and life expectancy. However, if RA can be diagnosed in the early stages, it can be controlled with pharmacotherapy. Although many studies have examined the possibility of early assessment and diagnosis, few have considered the relationship between significant risk factors and the early assessment of RA. In this paper, we present a novel framework for early RA assessment that utilizes data preprocessing, risk pattern mining, validation, and analysis. Under our proposed framework, two risk patterns can be discovered. Type I refers to well-known risk patterns that have been identified by existing studies, whereas Type II denotes unknown relationship risk patterns that have rarely or never been reported in the literature. These Type II patterns are very valuable in supporting novel hypotheses in clinical trials of RA, and constitute the main contribution of this work. To ensure the robustness of our experimental evaluation, we use a nationwide clinical database containing information on 1,314 RA-diagnosed patients over a 12-year follow-up period (1997-2008) and 965,279 non-RA patients. Our proposed framework is employed on this large-scale population-based dataset, and is shown to effectively discover rich RA risk patterns. These patterns may assist physicians in patient assessment, and enhance opportunities for early detection of RA. The proposed framework is broadly applicable to the mining of risk patterns for major disease assessments. This enables the identification of early risk patterns that are significantly associated with a target disease.

  18. 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.

  19. 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.

  20. Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room.

    Science.gov (United States)

    Bijlsma, Nicole; Cohen, Marc M

    2016-02-02

    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.

  1. 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

  2. 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.

  3. Establishing proof of mechanism: Assessing target modulation in early-phase clinical trials.

    Science.gov (United States)

    Kummar, Shivaani; Do, Khanh; Coyne, Geraldine O'Sullivan; Chen, Alice; Ji, Jiuping; Rubinstein, Larry; Doroshow, James H

    2016-08-01

    Since modulation of the putative target and the observed anti-tumor effects form the basis for the clinical development of a molecularly targeted therapy, early-phase clinical trials should be designed to demonstrate proof-of-mechanism in tissues of interest. In addition to establishing safety and the maximum tolerated dose, first-in-human clinical trials should be designed to demonstrate target modulation, define the proposed mechanism of action, and evaluate pharmacokinetic-pharmacodynamic relationships of a new anti-cancer agent. Assessing target modulation in paired tumor biopsies in patients with solid tumors presents multiple challenges, including procedural issues such as patient safety, ethical considerations, and logistics of sample handling and processing. In addition, the availability of qualified biomarker assay technologies, resources to conduct such studies, and real-time analysis of samples to detect inter-species differences that may affect the determination of optimal sampling time points must be taken into account. This article provides a discussion of the challenges that confront the practical application of pharmacodynamic studies in early-phase clinical trials of anti-cancer agents. PMID:27663476

  4. 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.

  5. VALIDITY OF TWO CLINICAL KNEE STRENGTH ASSESSMENTS COMPARED TO THE REFERENCE STANDARD

    Directory of Open Access Journals (Sweden)

    Philipp Weng

    2015-12-01

    Full Text Available Objectives: Patello femoral Pain (PFP is the most common lower limb condition encountered in clinical practice. It recently emerged as the third highest ranked topic out of 185 in the Chartered Society of Physiotherapy Musculoskeletal Research Priority Project. For a valid assessment of knee strength during rehabilitation, the isometric test using the isokinetic dynamometer (Cybex and the hand-held dynamometer (HHD is not well received with clinical practice. An alternative way is through functional hop tests which clinicians have used to assess their patients' lower extremity muscular strength. This study investigates the validity of knee strength assessments conducted with the HHD and the hoptest compared to the isokinetic dynamometer and also explores differences between genders of the three assessments. Design: Each assessment included one submaximal and three recorded maximal efforts of the dominant leg. Quadriceps muscle strength was displayed in normalized torques. Correlation coefficients and box-and-whisker plots was used to analyze the data. Setting: Movement analysis laboratory Participants: Sixteen males (age 23.5 ± 4.23 years, height 1.79 ± 0.08 m and body mass 76.21 ± 10.58 kg, BMI 23.82 ± 2.38 kg/m² and 16 females (age 25.38 ± 5.49 years, height 1.67 ± 0.08 m and body mass 71.99 ± 16.05 kg, BMI 25.83 ± 4.74 kg/m² between 18 and 40 years old without any musculoskeletal injuries participated. Main outcome measures: Knee moments normalized for bodyweight (Nm/kg for dynamometers and distance jumped for single legged hoptest. Results: The strongest significant correlation was found for the comparison between the HHD and Cybex (r=0.71, r²=0.504, p=0.001. Correlation between the HHD and hoptest (r=0.4, r²=0.19, p=0.013, and Cybex and hoptest (r=0.53, r²=0.295, p=0.001 were poor. Comparing genders, the normalized knee extension moment on the Cybex was 28.8% lower and with the HHD 22.3% lower for females. Conclusions: Single

  6. 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.

  7. 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...

  8. 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.

  9. 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.

  10. Clinical assessment of hepatic de novo lipogenesis in non-alcoholic fatty liver disease.

    Science.gov (United States)

    Paglialunga, Sabina; Dehn, Clayton A

    2016-01-01

    Non-alcoholic fatty liver disease (NAFLD) is heralded as the next big global epidemic. Hepatic de novo lipogenesis (DNL), the synthesis of new fatty acids from non-lipid sources, is thought to play a pivotal role in the development of NAFLD. While there is currently no NAFLD-specific therapeutic agent available, pharmaceutical drugs aimed at reducing hepatic fat accretion may prove to be a powerful ally in the treatment and management of this disease. With a focus on NAFLD, the present review summarizes current techniques examining DNL from a clinical perspective, and describes the merits and limitations of three commonly used assays; stable-label isotope tracer studies, fatty acid indexes and indirect calorimetry as non-invasive measures of hepatic DNL. Finally, the application of DNL assessments in the pharmacological and nutraceutical treatment of NAFLD/NASH is summarized. In a clinical research setting, measures of DNL are an important marker in the development of anti-NAFLD treatments.

  11. 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...

  12. 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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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 < 0.001). A significant difference was observed between three educational levels, including externships, 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

  14. 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...

  15. 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 

  16. A clinical protocol to increase chewing and assess mastication in children with feeding disorders.

    Science.gov (United States)

    Volkert, Valerie M; Peterson, Kathryn M; Zeleny, Jason R; Piazza, Cathleen C

    2014-09-01

    Children with feeding disorders often cannot or do not chew when presented with table food. Children with chewing deficits also often swallow the bite before masticating it appropriately, which we will refer to as early swallowing. In the current study, we evaluated a clinical protocol to increase chews per bite, assess mastication, and eliminate early swallowing with three children with feeding disorders. The current study adds to a small body of literature on chewing and mastication of children with feeding disorders. Suggestions for future research are also discussed. PMID:24902589

  17. 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...

  18. 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

    Department of Research and Innovation, University College Lillebaelt, Denmark3Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway INTRODUCTION From a biomechanical perspective, the scapula plays a key role in the shoulder and arm function as a stable...... 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 articles were...... methods; 3) Critically appraise the methodological quality of the identified measurement properties in each study; and 4) Identify the assessment methods with acceptable results in the domains of validity and reliability as well as responsiveness, from studies which best meet the standards for acceptable...

  19. 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.

  20. 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...... rotation (ER), internal rotation (IR), flexion (FLEX) and extension (EXT) using a hand-held dynamometer. Nine subjects (five males, four females), physically active for at least 2.5 h a week, were included. Twelve standardized isometric strength tests were performed twice with a 1-week interval in between...... 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 the 12...

  1. 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.

  2. 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.

  3. Evaluating cognitive impairment in the clinical setting: practical screening and assessment tools.

    Science.gov (United States)

    Valcour, Victor G

    2011-12-01

    HIV-associated neurocognitive disorders (HAND) remain a substantial problem in the era of combination antiretroviral therapy. Neither the Mini Mental State Exam nor the HIV Dementia Scale is sufficiently sensitive for HAND. The Montreal Cognitive Assessment shows promise, but current data suggest that adding an additional test will be needed to improve sensitivity for the clinical setting. Patient reporting of symptoms is insensitive as most cases of HAND are asymptomatic. Examination of cerebrospinal fluid (CSF) is sometimes warranted in select patients to evaluate for CSF HIV RNA detectability. CSF escape of virus, when CSF HIV RNA is detectable but plasma HIV RNA is not, appears to be a relatively uncommon event in the clinical setting where the level of detectability for typical clinical assays is around 50 copies/mL. In cases of CSF escape, cognitive improvement has been linked to changes in antiretroviral regimens that are aimed at either overcoming antiretroviral resistance or improving central nervous system (CNS) penetration-effectiveness. Currently, for most patients with HAND in the absence of unusual features, there are insufficient data for a recommendation to routinely intensify therapy with a neurointensive antiretroviral regimen; however, there is considerable uncertainty given emerging data and variability in approach among experts in the field. This article summarizes a case-based presentation by Victor G. Valcour, MD, at the 14th Annual Clinical Conference for the Ryan White HIV/AIDS Program held in Tampa, Florida, in June 2011. The Clinical Conference is sponsored by the IAS-USA under the Health Resources and Services Administration (HRSA) contract number HHSH250200900010C.

  4. A clinical case study of the use of ecological momentary assessment in obsessive compulsive disorder.

    Science.gov (United States)

    Tilley, P J Matt; Rees, Clare S

    2014-01-01

    Accurate assessment of obsessions and compulsions is a crucial step in treatment planning for Obsessive-Compulsive Disorder (OCD). In this clinical case study, we sought to determine if the use of Ecological Momentary Assessment (EMA) could provide additional symptom information beyond that captured during standard assessment of OCD. We studied three adults diagnosed with OCD and compared the number and types of obsessions and compulsions captured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) compared to EMA. Following completion of the Y-BOCS interview, participants then recorded their OCD symptoms into a digital voice recorder across a 12-h period in reply to randomly sent mobile phone SMS prompts. The EMA approach yielded a lower number of symptoms of obsessions and compulsions than the Y-BOCS but produced additional types of obsessions and compulsions not previously identified by the Y-BOCS. We conclude that the EMA-OCD procedure may represent a worthy addition to the suite of assessment tools used when working with clients who have OCD. Further research with larger samples is required to strengthen this conclusion.

  5. 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.

  6. 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.

  7. How Transdiagnostic Factors of Personality and Psychopathology Can Inform Clinical Assessment and Intervention.

    Science.gov (United States)

    Rodriguez-Seijas, Craig; Eaton, Nicholas R; Krueger, Robert F

    2015-01-01

    Research suggests that many mental disorders-mood and anxiety, substance use, and personality psychopathology-are related through relatively few latent transdiagnostic factors. With regard to the comorbidity of personality disorders and common mental disorders, factor structures such as internalizing-externalizing have been replicated in numerous samples, across the life span, and around the globe. One critical feature of transdiagnostic factors is that they serve as a point of intersection between personality and psychopathology, making them particularly relevant phenomena for applied clinical work. Although numerous studies have supported the significance of transdiagnostic factors for research and classification purposes, there has been comparatively less articulation of how such factors might be of benefit to practicing assessment clinicians. Herein, we present an overview of transdiagnostic factor research findings, and we apply these findings to the clinical topics of assessment, diagnosis, and treatment. For clinicians as well as researchers, the use of transdiagnostic constructs presents positive implications for efforts to understand, characterize, and ameliorate psychopathology-including its manifestations as personality disorder-in a valid, effective, and efficient way.

  8. 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

  9. 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.

  10. Predicting reoffense in pedophilic child molesters by clinical diagnoses and risk assessment.

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    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

  11. Assessing Scientific Practices Using Machine-Learning Methods: How Closely Do They Match Clinical Interview Performance?

    Science.gov (United States)

    Beggrow, Elizabeth P.; Ha, Minsu; Nehm, Ross H.; Pearl, Dennis; Boone, William J.

    2013-07-01

    The landscape of science education is being transformed by the new Framework for Science Education (National Research Council, A framework for K-12 science education: practices, crosscutting concepts, and core ideas. The National Academies Press, Washington, DC, 2012), which emphasizes the centrality of scientific practices—such as explanation, argumentation, and communication—in science teaching, learning, and assessment. A major challenge facing the field of science education is developing assessment tools that are capable of validly and efficiently evaluating these practices. Our study examined the efficacy of a free, open-source machine-learning tool for evaluating the quality of students' written explanations of the causes of evolutionary change relative to three other approaches: (1) human-scored written explanations, (2) a multiple-choice test, and (3) clinical oral interviews. A large sample of undergraduates (n = 104) exposed to varying amounts of evolution content completed all three assessments: a clinical oral interview, a written open-response assessment, and a multiple-choice test. Rasch analysis was used to compute linear person measures and linear item measures on a single logit scale. We found that the multiple-choice test displayed poor person and item fit (mean square outfit >1.3), while both oral interview measures and computer-generated written response measures exhibited acceptable fit (average mean square outfit for interview: person 0.97, item 0.97; computer: person 1.03, item 1.06). Multiple-choice test measures were more weakly associated with interview measures (r = 0.35) than the computer-scored explanation measures (r = 0.63). Overall, Rasch analysis indicated that computer-scored written explanation measures (1) have the strongest correspondence to oral interview measures; (2) are capable of capturing students' normative scientific and naive ideas as accurately as human-scored explanations, and (3) more validly detect understanding

  12. Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease

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    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.

  13. Sleep disturbances and cognitive decline: recommendations on clinical assessment and the management.

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    Guarnieri, Biancamaria; Cerroni, Gianluigi; Sorbi, Sandro

    2015-01-01

    In 2004, in Genoa (Italy), the Italian Dementia Research Association (SINDem) was born. The first congress of this new scientific society took place in Rome in 2006. SINDem soon recognized the importance to investigate sleep problems in cognitive decline and created a national "sleep study group "composed by neurologists and sleep specialists. In 2012, The SINDem study group, in close relationship with the Italian Association of sleep medicine (AIMS), published the study "Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients ", confirming the high prevalence of sleep disturbances in a wide Italian population of persons with cognitive decline. The study was supported by a grant from the Italian Minister of Health and was conducted with the fundamental contribution of the Italian National Research Center (CNR). In 2014, the same group published the paper "Recommendations of the Sleep Study Group of the Italian Dementia Research Association (SINDem) on clinical assessment and management of sleep disorders in individuals with mild cognitive impairment and dementia: a clinical review". The recommendations are wide and directed to professionals (neurologists but not exclusively) to try to establish uniform levels of care, promote collaborative studies into areas of uncertainty, and define the qualitative characteristics of Dementia Reference Centers about sleep disturbances. PMID:26742676

  14. Joint Estimation of Treatment and Placebo Effects in Clinical Trials with Longitudinal Blinding Assessments

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    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

  15. Multicenter external quality assessment program for PCR detection of Mycobacterium ulcerans in clinical and environmental specimens.

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    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.

  16. External quality assessment on detection of hepatitis C virus RNA in clinical laboratories of China

    Institute of Scientific and Technical Information of China (English)

    WANG Lu-nan; ZHANG Rui; SHEN Zi-yu; CHEN Wen-xiang; LI Jin-ming

    2008-01-01

    Background As with many studies carried out in European countries, a quality assurance program has been established by the National Center for Clinical Laboratories in China (NCCL). The results showed that the external quality assessment significantly improves laboratory performance for quantitative evaluation of hepatitis C virus (HCV) RNA.Methods Serum panels were delivered twice annuatly to the clinical laboratories which performed HCV RNA detection in China. Each panel made up of 5 coded samples. All laboratories were requested to carry out the detection within the required time period and report on testing results which contained qualitative and/or quantitative test findings, reagents used and relevant information about apparatus. All the positive samples were calibrated against the first International Standard for HCV RNA in a collaborative study and the range of comparison target value (TG) designated as ±0.5 log.Results The numbers of laboratories reporting on qualitative testing results for the first and second time external quality assessment were 168 and 167 in the year of 2003 and increased to 209 and 233 in 2007; the numbers of laboratories reporting on quantitative testing results were 134 and 147 in 2003 and rose to 340 and 339 in 2007. Deviation between the mean value for quantitative results at home in 2003 and the target value was above 0.5 log, which was comparatively high.By 2007, the target value was close to the national average except for the low concentrated specimens (103 IU/ml). The percentage of results within the range of GM±0.5 log10 varied from 8.2% to 93.5%. Some laboratories had some difficulties in the exact quantification of the lowest (3.00 log IU/ml) as well as of the highest viral levels (6.37 log IU/ml) values, very near to the limits of the dynamic range of the assays.Conclusions The comparison of these results with the previous study confirms that a regular participation in external quality assessment (EQA) assures the

  17. Evaluation of clinical skills for first-year surgical residents using orientation programme and objective structured clinical evaluation as a tool of assessment

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    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.

  18. Structural and diffusion imaging versus clinical assessment to monitor amyotrophic lateral sclerosis

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    Arturo Cardenas-Blanco

    2016-01-01

    Full Text Available Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects upper and lower motor neurons. Observational and intervention studies can be tracked using clinical measures such as the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R but for a complete understanding of disease progression, objective in vivo biomarkers of both central and peripheral motor pathway pathology are highly desirable. The aim of this study was to determine the utility of structural and diffusion imaging as central nervous system biomarkers compared to the standard clinical measure, ALSFRS-R, to track longitudinal evolution using three time-point measurements. N = 34 patients with ALS were scanned and clinically assessed three times at a mean of three month time intervals. The MRI biomarkers were structural T1-weighted volumes for cortical thickness measurement as well as deep grey matter volumetry, voxel-based morphometry and diffusion tensor imaging (DTI. Cortical thickness focused specifically on the precentral gyrus while quantitative DTI biomarkers focused on the corticospinal tracts. The evolution of imaging biomarkers and ALSFRS-R scores over time were analysed using a mixed effects model that accounted for the scanning interval as a fixed effect variable, and, the initial measurements and time from onset as random variables. The mixed effects model showed a significant decrease in the ALSFRS-R score, (p  0.5. In addition, deep grey matter volumetry and voxel-based morphometry also identified no significant changes. Furthermore, the availability of three time points was able to indicate that there was a linear progression in both clinical and fractional anisotropy measures adding to the validity of these results. The results indicate that DTI is clearly a superior imaging marker compared to atrophy for tracking the evolution of the disease and can act as a central nervous biomarker in longitudinal studies. It

  19. Structural and diffusion imaging versus clinical assessment to monitor amyotrophic lateral sclerosis

    Science.gov (United States)

    Cardenas-Blanco, Arturo; Machts, Judith; Acosta-Cabronero, Julio; Kaufmann, Joern; Abdulla, Susanne; Kollewe, Katja; Petri, Susanne; Schreiber, Stefanie; Heinze, Hans-Jochen; Dengler, Reinhard; Vielhaber, Stefan; Nestor, Peter J.

    2016-01-01

    Amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects upper and lower motor neurons. Observational and intervention studies can be tracked using clinical measures such as the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) but for a complete understanding of disease progression, objective in vivo biomarkers of both central and peripheral motor pathway pathology are highly desirable. The aim of this study was to determine the utility of structural and diffusion imaging as central nervous system biomarkers compared to the standard clinical measure, ALSFRS-R, to track longitudinal evolution using three time-point measurements. N = 34 patients with ALS were scanned and clinically assessed three times at a mean of three month time intervals. The MRI biomarkers were structural T1-weighted volumes for cortical thickness measurement as well as deep grey matter volumetry, voxel-based morphometry and diffusion tensor imaging (DTI). Cortical thickness focused specifically on the precentral gyrus while quantitative DTI biomarkers focused on the corticospinal tracts. The evolution of imaging biomarkers and ALSFRS-R scores over time were analysed using a mixed effects model that accounted for the scanning interval as a fixed effect variable, and, the initial measurements and time from onset as random variables. The mixed effects model showed a significant decrease in the ALSFRS-R score, (p  0.5). In addition, deep grey matter volumetry and voxel-based morphometry also identified no significant changes. Furthermore, the availability of three time points was able to indicate that there was a linear progression in both clinical and fractional anisotropy measures adding to the validity of these results. The results indicate that DTI is clearly a superior imaging marker compared to atrophy for tracking the evolution of the disease and can act as a central nervous biomarker in longitudinal studies. It remains, however, less

  20. Laboratory and clinical tests of a prototype pressure sensor for clincial assessment of prosthetic socket fit.

    Science.gov (United States)

    Polliack, A A; Craig, D D; Sieh, R C; Landsberger, S; Mcneal, D R

    2002-04-01

    Lower limb prosthetic socket fabrication is a highly refined process relying on the prosthetist's skill and experience. Despite their best efforts, patients often return with complications. Additionally, clinical application of technological advances for the quantification of biomechanical factors at the socket interface has not changed in practice. Measuring pressure levels at the stump/socket interface could provide valuable information in the process of prosthetic socket fabrication, fit and modification. This paper presents findings on the performance of a prototype capacitance pressure sensor designed for prosthetic socket use. Bench tests using compressed air were performed to measure accuracy, hysteresis and drift responses in both a flatbed chamber and a custom-modified pressure vessel. For the contoured testing, the sensors were placed on nine sites on a positive trans-tibial stump mould and enveloped with a silicone liner. Additionally, a preliminary clinical evaluation was performed with two trans-tibial amputee subjects at the nine sites during normal ambulation. Bench test results showed that the prototype capacitance sensor performed well in all categories, exhibiting a 2.42% (flatbed) and 9.96% (contoured) accuracy error, a 12.93% (flatbed) and 12.95% (contoured) hysteresis error, and a 4.40% (flatbed) and 6.20% (contoured) drift error. The clinical study showed that after three hours of continual use, no noticeable sensor drift occurred between pre and post-test calibration values. The results from this study were encouraging and the authors hope to conduct further laboratory and clinical trials to assess the influence of shear force and dynamic loading on sensor response.

  1. 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…

  2. 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

  3. Artificial gait in complete spinal cord injured subjects: how to assess clinical performance

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    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.

  4. Complacent and conflicting scientific expertise in British and American drug regulation: clinical risk assessment of triazolam.

    Science.gov (United States)

    Abraham, J; Sheppard, J

    1999-12-01

    This paper presents a case study in the production and interpretation of regulatory science, focusing on the conflicting British and American clinical risk assessments of triazolam (Halcion) - the most controversial sleeping pill in the world. The regulation of triazolam is shown to be more permissive in the USA than in the UK. Six principal socio-political factors are put forward to explain this; differential regulatory trust; regulators' socio-technical data selections; medico-scientific disciplinary influences; organizational and professional interests; conflicts of interest of expert advisers; and the growth of the neo-liberal regulatory state. The risk assessments of both the British and American regulatory agencies are shown to be complacent relative to technical standards which the agencies themselves later accepted. It is suggested that, when the interests of pharmaceutical manufacturers and patients diverge, regulatory assessments are crucially affected by whether regulators are predisposed to award the benefit of the scientific doubts to the manufacturers or patients, and by the balance of such predispositions both within and between regulatory institutions of scientific expertise. The triazolam case indicates that the amount of trust placed in the pharmaceutical industry by the British American regulatory systems may hamper detection of flaws in manufacturers' medical data in a timely manner and, as a consequence, compromise patients' interests. Some policy implications for drug regulation are sketched. PMID:11624110

  5. 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

  6. Non-suicidal self-injury: clinical presentation, assessment and management.

    Science.gov (United States)

    Dhingra, Katie; Ali, Parveen

    2016-09-28

    Non-suicidal self-injury is a common behaviour in adolescents and young adults, and may be associated with mental health disorders, risk of suicidal behaviour (ideation and attempts), and a need for clinical services. Nurses, in particular those working in emergency departments and mental health settings, have a crucial role in the assessment, treatment and care of individuals who have self-injured. It is essential for nurses to assess an individual's risk of more serious harm or accidental death, regardless of intent. It is also important to understand the variations in non-suicidal self-injurious behaviour in terms of its presentation, features and functions, to provide appropriate person-centred care. Nurses should assist individuals in identifying the triggers or cues for their behaviour, exploring treatment options, and monitoring their behaviour and risk in the long term. This article describes the profile of people who self-injure, and the issues related to assessment and management of such patients presenting in emergency departments. A description of who self-injures and why, and how people self-injure; developmental aspects of these behaviours, including short and long-term outcomes; and the available treatments is presented. PMID:27682567

  7. Complacent and conflicting scientific expertise in British and American drug regulation: clinical risk assessment of triazolam.

    Science.gov (United States)

    Abraham, J; Sheppard, J

    1999-12-01

    This paper presents a case study in the production and interpretation of regulatory science, focusing on the conflicting British and American clinical risk assessments of triazolam (Halcion) - the most controversial sleeping pill in the world. The regulation of triazolam is shown to be more permissive in the USA than in the UK. Six principal socio-political factors are put forward to explain this; differential regulatory trust; regulators' socio-technical data selections; medico-scientific disciplinary influences; organizational and professional interests; conflicts of interest of expert advisers; and the growth of the neo-liberal regulatory state. The risk assessments of both the British and American regulatory agencies are shown to be complacent relative to technical standards which the agencies themselves later accepted. It is suggested that, when the interests of pharmaceutical manufacturers and patients diverge, regulatory assessments are crucially affected by whether regulators are predisposed to award the benefit of the scientific doubts to the manufacturers or patients, and by the balance of such predispositions both within and between regulatory institutions of scientific expertise. The triazolam case indicates that the amount of trust placed in the pharmaceutical industry by the British American regulatory systems may hamper detection of flaws in manufacturers' medical data in a timely manner and, as a consequence, compromise patients' interests. Some policy implications for drug regulation are sketched.

  8. Non-suicidal self-injury: clinical presentation, assessment and management.

    Science.gov (United States)

    Dhingra, Katie; Ali, Parveen

    2016-09-28

    Non-suicidal self-injury is a common behaviour in adolescents and young adults, and may be associated with mental health disorders, risk of suicidal behaviour (ideation and attempts), and a need for clinical services. Nurses, in particular those working in emergency departments and mental health settings, have a crucial role in the assessment, treatment and care of individuals who have self-injured. It is essential for nurses to assess an individual's risk of more serious harm or accidental death, regardless of intent. It is also important to understand the variations in non-suicidal self-injurious behaviour in terms of its presentation, features and functions, to provide appropriate person-centred care. Nurses should assist individuals in identifying the triggers or cues for their behaviour, exploring treatment options, and monitoring their behaviour and risk in the long term. This article describes the profile of people who self-injure, and the issues related to assessment and management of such patients presenting in emergency departments. A description of who self-injures and why, and how people self-injure; developmental aspects of these behaviours, including short and long-term outcomes; and the available treatments is presented.

  9. 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

  10. Net benefits: assessing the effectiveness of clinical networks in Australia through qualitative methods

    Directory of Open Access Journals (Sweden)

    Cunningham Frances C

    2012-11-01

    Full Text Available Abstract Background In the 21st century, government and industry are supplementing hierarchical, bureaucratic forms of organization with network forms, compatible with principles of devolved governance and decentralization of services. Clinical networks are employed as a key health policy approach to engage clinicians in improving patient care in Australia. With significant investment in such networks in Australia and internationally, it is important to assess their effectiveness and sustainability as implementation mechanisms. Methods In two purposively selected, musculoskeletal clinical networks, members and stakeholders were interviewed to ascertain their perceptions regarding key factors relating to network effectiveness and sustainability. We adopted a three-level approach to evaluating network effectiveness: at the community, network, and member levels, across the network lifecycle. Results Both networks studied are advisory networks displaying characteristics of the ‘enclave’ type of non-hierarchical network. They are hybrids of the mandated and natural network forms. In the short term, at member level, both networks were striving to create connectivity and collaboration of members. Over the short to medium term, at network level, both networks applied multi-disciplinary engagement in successfully developing models of care as key outputs, and disseminating information to stakeholders. In the long term, at both community and network levels, stakeholders would measure effectiveness by the broader statewide influence of the network in changing and improving practice. At community level, in the long term, stakeholders acknowledged both networks had raised the profile, and provided a ‘voice’ for musculoskeletal conditions, evidencing some progress with implementation of the network mission while pursuing additional implementation strategies. Conclusions This research sheds light on stakeholders’ perceptions of assessing clinical

  11. Clinical features and in vivo confocal microscopy assessment in 12 patients with ocular cicatricial pemphigoid

    Science.gov (United States)

    Long, Qin; Zuo, Ya-Gang; Yang, Xue; Gao, Ting-Ting; Liu, Jie; Li, Ying

    2016-01-01

    AIM To describe the clinical features and microstructural characteristics assessed by in vivo confocal microscopy (IVCM) in patients with ocular cicatricial pemphigoid (OCP). METHODS A descriptive, uncontrolled case series study. Patients diagnosed with OCP were examined by clinical history, slit-lamp biomicroscopy features and IVCM images. The results of direct immunofluorescence (DIF) biopsies and indirect immunofluorescence (IIF) were also recorded. Local and systemic immunosuppressive therapy were administered and adjusted according to response. RESULTS A total of 12 consecutive OCP patients (7 male, 5 female; mean age 60.42±10.39y) were recruited. All patients exhibited bilateral progressive conjunctival scarring and recurrent chronic conjunctivitis was the most frequent clinical pattern. The mean duration of symptoms prior to diagnosis of OCP was 2.95±2.85y (range: 5mo to 10y). The Foster classification varied from stage I to IV and 20 eyes (83%) were within or greater than Foster stage III on presentation. Two of the 12 patients (17%) demonstrated positive DIF; 3 of the 12 (25%) patients reported positive IIF. The mean duration of the follow-up period was 20.17±11.88mo (range: 6 to 48mo). IVCM showed variable degrees of abnormality in the conjuctiva-cornea and conjuctival scarring was detected in all the involved eyes. Corneal stromal cell activation and dendritic cell infiltration presented as ocular surface inflammation, ocular surface keratinization along with the destroyed Vogt palisades was noted in eyes with potential limbal stem cell deficiency. After treatment, remission of ocular surface inflammation was achieved in all the patients, 18 eyes (75%) remained stable, 6 eyes (25%) had recurrent conjunctivitis and cicatrization in 2 eyes (8%) was progressing. CONCLUSION As an autoimmune disease, OCP manifests as variable degrees of clinical and laboratory abnormalities with both local and systemic immunosuppressive treatment playing important roles

  12. An observer study for direct comparison of clinical efficacy of electronic to film portal images and their incorporation in a network; Apport de l'imagerie de haute energie dans un service de radiotherapie et incorporation de celle-ci dans un systeme en reseau

    Energy Technology Data Exchange (ETDEWEB)

    Pradier, O.; Hille, A.; Schmidberger, H.; Hess, C.F. [Gottingen Universitat, Klinik und Poliklinik fur Trahlentherapie und Radioonkologie (Germany)

    2001-06-01

    An observer study for direct comparison of clinical efficacy of electronic to film portal images and their incorporation in a network. To directly compare the clinical efficacy of electronic to film portal images and the advantages of comparing directly on the monitor the simulation image and the portal image. Material and methods. - This study was designed to compare clinical efficacy of electronic to film portal images acquired using a liquid matrix ion-chamber electronic portal imaging device (EPID) and a conventional film system. Two radiation oncologists served as observers and evaluated a total of 30 sets of images for three different treatment sites: lung, pelvis, and head/neck. Each set of images included a simulation image, a portal film, a video paper print of electronic portal images, and a video prints of electronic portal images. Four to six anatomical landmarks were selected from each treatment site. Each observer was asked to rate each landmark in terms of its clinical visibility and to rate the ease of making the pertinent verification decision in the corresponding electronic and film portal images with the aid of the simulation image. The time needed to obtain and analyse a conventional portal image and an EPID would be analysed for the radiotherapist and the medical technicians. Results- Ratings for the visibility of landmarks and for the verification decision of treatment ports were similar for electronic and film images for most landmarks. However, vertebral bodies and several landmarks in the pelvis such as the acetabulum and pubic symphysis were more visible in the electronic portal images than in the portal film images. For the medical technicians, the EPID is more comfortable, and they do not need to develop any images. Conclusion. -The visibility of landmarks in electronic portal images is comparable to that in film portal images. Verification of treatment ports based only on electronic portal images acquired using an electronic portal

  13. 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.

  14. 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

  15. 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

  16. 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

  17. Comparison of Clinical Interpretation with Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice: The Assessing Angiography (A2) Project

    Science.gov (United States)

    Nallamothu, Brahmajee K.; Spertus, John A.; Lansky, Alexandra J.; Cohen, David J.; Jones, Philip G.; Kureshi, Faraz; Dehmer, Gregory J.; Drozda, Joseph P.; Walsh, Mary Norine; Brush, John E.; Koenig, Gerald C.; Waites, Thad F.; Gantt, D. Scott; Kichura, George; Chazal, Richard A.; O’Brien, Peter K.; Valentine, C. Michael; Rumsfeld, John S.; Reiber, Johan H.C.; Elmore, Joann G.; Krumholz, Richard A.; Weaver, W. Douglas; Krumholz, Harlan M.

    2013-01-01

    Background Studies conducted decades ago described substantial disagreement and errors in physicians’ angiographic interpretation of coronary stenosis severity. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation were subsequently made. Methods & Results We compared clinical interpretation of stenosis severity in coronary lesions with an independent assessment using quantitative coronary angiography (QCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention (PCI) at 7 U.S. hospitals in 2011. To assess agreement, we calculated mean difference in percent diameter stenosis between clinical interpretation and QCA and a Cohen’s weighted kappa statistic. Of 216 treated lesions, median percent diameter stenosis was 80.0% (Q1 and Q3, 80.0 and 90.0%) with 213 (98.6%) assessed as ≥70%. Mean difference in percent diameter stenosis between clinical interpretation and QCA was +8.2 ± 8.4%, reflecting an average higher percent diameter stenosis by clinical interpretation (P<0.001). A weighted kappa of 0.27 (95% CI, 0.18 to 0.36) was found between the 2 measurements. Of 213 lesions considered ≥70% by clinical interpretation, 56 (26.3%) were <70% by QCA though none was <50%. Differences between the 2 measurements were largest for intermediate lesions by QCA (50 to <70%) with variation existing across sites. Conclusions Physicians tended to assess coronary lesions treated with PCI as more severe than measurements by QCA. Almost all treated lesions were ≥70% by clinical interpretation, while approximately a quarter were <70% by QCA. These findings suggest opportunities to improve clinical interpretation of coronary angiography. PMID:23470859

  18. Electrocardiogram assessment in non-anaesthetized clinically healthy agouti (Dasyprocta primnolopha, Wagler 1831

    Directory of Open Access Journals (Sweden)

    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.

  19. 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

    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...... consultants and 10 residents were asked to estimate the age of each participant using three different photographic presentations: facial photograph, whole-body photograph, and combined facial and whole-body photographs. Data were analyzed by means of summary statistics and linear mixed models. RESULTS......: The 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...

  20. Computer-aided assessment of transient ischemic attacks. A clinical evaluation.

    Science.gov (United States)

    Reggia, J A; Tabb, D R; Price, T R; Banko, M; Hebel, R

    1984-12-01

    We developed and evaluated a computer-based system to assist with the difficult problem of assessing the conditions of patients with transient ischemic attacks (TIAs). The program used criteria to classify a patient's illness localize the neurologic deficit, screen for 46 causative or mimicking disorders, recommend additional tests, and suggest management steps. We evaluated this program in 103 patients with TIAs. The TIA program's localization and classification of patients generally agreed with those made by stroke specialists at our institution, demonstrating that computer programs can reproduce the decision criteria of stroke specialists. With revisions, the TIA program or similar systems could be useful for objective disease classification in clinical trials or epidemiologic studies. In contrast, the TIA program's treatment recommendations were often found to differ significantly from the actual treatments administered by non-stroke specialists.

  1. A model of the pre-assessment learning effects of assessment is operational in an undergraduate clinical context.

    NARCIS (Netherlands)

    Cilliers, F.J.; Schuwirth, L.W.; Vleuten, C.P.M. van der

    2012-01-01

    BACKGROUND: No validated model exists to explain the learning effects of assessment, a problem when designing and researching assessment for learning. We recently developed a model explaining the pre-assessment learning effects of summative assessment in a theory teaching context. The challenge now

  2. Cotton Incorporated Documents Industry Gains at ICAC

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Those who attack the cotton industry for its perceived impact on the environment will need to have their facts straight, thanks to a major research project undertaken by Cotton Incorporated: a life-cycle assessment (LCA) for cotton.

  3. Survey of self-assessed preparedness for clinical practice in one Croatian medical school

    Directory of Open Access Journals (Sweden)

    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.

  4. Diffusion-weighted imaging in assessing renal pathology of chronic kidney disease: A preliminary clinical study

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. 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

  6. Clinical assessment of the autonomic nervous system in diabetes mellitus and its correlation with glycemic control

    Directory of Open Access Journals (Sweden)

    Uday B Nayak

    2013-01-01

    Full Text Available Aim: Clinical assessment of the autonomic nervous system in Diabetes mellitus (DM and its correlation with glycemic control. STUDY DESIGN: Cross sectional study of 50 adult diabetes patients. Materials and Methods: Fifty patients with DM who were on regular treatment with either insulin and/or oral hypoglycemic agents were studied. Cardiovascular autonomic neuropathy (CAN score was calculated using the clinical test variables. Results: Of the 50 patients 30 had no CAN, 10 had early CAN and 10 had severe CAN. The mean of CAN score increased with duration of diabetes. The mean HbA 1C was 7.73. The mean CAN score was higher in patients who had complication of diabetes as compared to patients without complications. The heart rate variability with respiration was found to be 15.84 ± 7.02/min. The mean valsalva ratio was 1.31 ± 0.23. The mean drop in BP on standing was 7.30 ± 7.24 mmHg. The mean 30:15 ratio was 1.06 ± 0.04. The mean rise in diastolic BP on sustained hand grip was 16.04 ± 4.11 mmHg. Conclusions: The prevalence of autonomic neuropathy in DM as assessed by CAN score was 40%. The CAN score did not correlate with the duration of DM. The HbA 1C had a significant correlation with the severity of autonomic neuropathy. Occurrence of CAN correlated with the presence of peripheral neuropathy but not with the presence of retinopathy or nephropathy. All individual tests in the battery of CAN score were significantly associated with the presence of autonomic neuropathy, except 30:15 ratio.

  7. An Assessment of Decision-Making Processes: The Feasibility of Incorporating Climate Change Information into Land Protection Planning (External Review Draft)

    Science.gov (United States)

    This report was 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). This draft report is a review of decision-making pro...

  8. 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

  9. Implementation of External Quality Assessment Scheme in Clinical Chemistry for District Laboratories in Bhutan.

    Science.gov (United States)

    Jamtsho, Rixin; Nuchpramool, Wilairat

    2012-07-01

    External Quality Assessment Scheme (EQAS) involves evaluation of a number of laboratories by an outside agency on the performance of a number of laboratories based on their analytical performance of tests on samples supplied by the external agency. In developing countries, establishment of national EQAS by preparing homemade quality control material is a useful scheme in terms of resources and time to monitor the laboratory performance. The objective of this study is to implement an EQAS to monitor the analytical performance of the district laboratories in Bhutan. Baseline information was collected through questionnaires. Lyophilized human serum including normal and abnormal levels were prepared and distributed to 19 participating laboratories. Nine routine analytes were included for the study. Their results were evaluated using Variance index scores (VIS) and Coefficient of variations (CV) was compared with Clinical Laboratory Improvement Act (CLIA) Proficiency Testing Criteria (PT) for each analyte. There was significant decrease in CV at the end of the study. The percentages of results in acceptable VIS as 'A' were 63, 60, 66, 69, 73 and 74, 75, 76 and 79 % in November 2009-July 2010 respectively. From our results, we concluded that, establishment of EQAS through distribution of home-made quality control material could be the useful scheme to monitor the laboratory performance in clinical chemistry in Bhutan.

  10. 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

  11. 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

  12. MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture

    Energy Technology Data Exchange (ETDEWEB)

    Mellado, J.M. [Hospital Reina Sofia de Tudela, Servicio de Radiodiagnostico, Tudela, Navarra (Spain); Calmet, J.; Ballabriga, J.; Gine, J. [Hospital Universitari de Tarragona Joan XXIII, Servei de Cirurgia Ortopedica i Traumatologia, Tarragona (Spain); Olona, M. [Hospital Universitari de Tarragona Joan XXIII, Servei de Medicina Preventiva i Epidemiologia, Tarragona (Spain); Camins, A. [Hospital Universitari de Tarragona Joan XXIII, Institut de Diagnostic per la Imatge, Tarragona (Spain); Perez del Palomar, L. [Hospital Ernest Lluch, Servicio de Radiologia, Calatayud, Zaragoza (Spain)

    2006-10-15

    The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon. (orig.)

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Teaching clinically relevant dental anatomy in the dental curriculum: description and assessment of an innovative module.

    Science.gov (United States)

    Obrez, Ales; Briggs, Charlotte; Buckman, James; Goldstein, Loren; Lamb, Courtney; Knight, William G

    2011-06-01

    The primary objective of the preclinical dental anatomy course in the predoctoral dental curriculum is to introduce students to cognitive and psychomotor skills related to the morphology and spatial and functional relationships of human dentition. Traditionally, didactic content for the subject is found in textbooks and course manuals and summarized by the faculty in lectures to the entire class. Psychomotor skills associated with recognition and reproduction of tooth morphology are traditionally learned by examining preserved tooth specimens and their cross-sections, combined with producing two-dimensional line drawings and carving teeth from wax blocks. These activities have little direct clinical application. In most cases, students are passive in the learning process, and assessment of student performance is unilateral and subjective. A recently revised dental anatomy module at the University of Illinois at Chicago College of Dentistry integrates independent class preparation with active small-group discussion and patient scenario-based wax-up exercises to replace missing tooth structure on manikin teeth. The goal of the revision is to shift emphasis away from decontextualized technical learning toward more active and clinically applicable learning that improves conceptual understanding while contributing to early acquisition of psychomotor skills. This article describes the rationale, components, and advantages of the revised module and presents a pre-post comparison of student learning outcomes for three class cohorts (N=203).

  15. Assessment of Inflammatory and Cardiovascular Markers in Type 2 Diabetes without Clinical Evidence of Cardiac Events

    Directory of Open Access Journals (Sweden)

    Marwan Al-Nimer

    2014-09-01

    Full Text Available Purpose: There is no doubt that several inflammatory markers were detected in type 2 diabetes (T2D. Cardiovascular events were also associated with T2D or complicated T2D. Co-existence of cardiovascular and inflammatory biomarkers in T2D patients in the absence of cardiovascular morbidity have been mentioned in a few articles. This study aimed to assess the association of C-reactive protein as inflammatory marker with serum NT-proBNP (a diagnostic marker of heart failure with nitric oxide (a marker of vascular endothelial function in T2D patients without clinical evidence of heart failure. Material and Method: A total of 75 T2D patients recruited from the Center of Diabetes and 25 healthy subjects served as controls were enrolled in the study. Patients without clinical evidence of heart failure or recent infection were included in the study. Serum C- reactive protein, NT-proBNP, and nitric oxide were determined. Results: High serum NT-proBNP levels (≥600 pg/ml indicating the presence of moderate to severe heart failure was detected in 10.7% of subjects. Serum nitric oxide levels were significantly lower (60.98±30.75 µmol compared with those in healthy subjects (120.3±12.5 µmol. Serum nitric oxide significantly and inversely correlated with serum NT-proBNP level (r=-0.228, p<0.05. Seven out of 14 patients with positive C-reactive protein had significantly high serum NT-proBNP level (≥600 pg/ml. Patients with positive C-reactive protein significantly have low serum nitric oxide level compared with those expressed negative C-reactive protein reaction. Discussion: Biomarkers of cardiovascular events in T2D patients without clinical evidence of heart failure are detected in the presence of inflammatory process. Turk Jem 2014; 18: 75-78

  16. A clinical rating scale for the assessment of facial aging in Indian population

    Directory of Open Access Journals (Sweden)

    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. Defect formation in aqueous environment: Theoretical assessment of boron incorporation in nickel ferrite under conditions of an operating pressurized-water nuclear reactor (PWR)

    Science.gov (United States)

    Rák, Zs.; Bucholz, E. W.; Brenner, D. W.

    2015-06-01

    A serious concern in the safety and economy of a pressurized water nuclear reactor is related to the accumulation of boron inside the metal oxide (mostly NiFe2O4 spinel) deposits on the upper regions of the fuel rods. Boron, being a potent neutron absorber, can alter the neutron flux causing anomalous shifts and fluctuations in the power output of the reactor core. This phenomenon reduces the operational flexibility of the plant and may force the down-rating of the reactor. In this work an innovative approach is used to combine first-principles calculations with thermodynamic data to evaluate the possibility of B incorporation into the crystal structure of NiFe2O4 , under conditions typical to operating nuclear pressurized water nuclear reactors. Analyses of temperature and pH dependence of the defect formation energies indicate that B can accumulate in NiFe2O4 as an interstitial impurity and may therefore be a major contributor to the anomalous axial power shift observed in nuclear reactors. This computational approach is quite general and applicable to a large variety of solids in equilibrium with aqueous solutions.

  19. 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...

  20. Assessment of biofilm formation in device-associated clinical bacterial isolates in a tertiary level hospital

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. 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

  3. [Comparison of clinical assessment and invasive evaluation of hemodynamic parameters in septic shock].

    Science.gov (United States)

    Vucić, N; Pilas, V

    1995-06-01

    The authors compare, in this prospective study, the accuracy of their own clinical assessment of hemodynamic parameters and severity of disease with the findings obtained by right heart catheterization in 50 patients with septic shock. The purpose of the study was to determine whether Swan-Ganz catheter insertion was necessary in all patients with septic shock. As soon as the diagnosis was established, the value of pulmonary capillary wedge pressure was estimated, as well as presence or absence of pathological uptake/supply dependency in all patients. The latter is an excellent indicator of severity of disease. The accurate assessment was noted in 27 (54%) patients (1. investigator), and in 30 (60%) patients (2. investigator). The sensitivity of detection of pathological uptake/supply dependency amounted to 53% and 65%; specificity was 73% and 79%, respectively. The therapy was altered in 21 patients (42%) after catheter insertion. The results were tested with chi2-test (p < 0.01). The findings of this study warrant catheter insertion in patients with septic shock. PMID:8649145

  4. Clinical judgment and decision making in wound assessment and management: is experience enough?

    Science.gov (United States)

    Logan, Gemma

    2015-03-01

    The assessment and management of wounds forms a large proportion of community nurses' workload, often requiring judgment and decision-making in complex, challenging and uncertain circumstances. The processes through which nurses form judgments and make decisions within this context are reviewed in this article against existing theories on these on these subjects. There is variability in wound assessment and management practice which may be attributed to uncertainties within the context, a lack of knowledge in appropriate treatment choices and the inability to correctly value the importance of the clinical information presented. Nurses may be required to draw on intuition to guide their judgments and decision-making by association with experience and expertise. In addition, a step-by-step analytical approach underpinned by an evidence base may be required to ensure accuracy in practice. Developing an understanding of the different theories of judgment and decision-making may facilitate nurses' abilities to reflect on their own decision tasks, thereby enhancing the care provided.

  5. Clinical Aspects of Trace Elements: Zinc in Human Nutrition - Assessment of Zinc Status

    Directory of Open Access Journals (Sweden)

    Michelle M Pluhator

    1996-01-01

    Full Text Available Because the limiting and vulnerable zinc pool has not been identified, it becomes a challenge to determine which of the many zinc pools is most susceptible to deficiency. As a consequence, defining and assessing zinc status in the individual patient is a somewhat uncertain process. Laboratory analysis of zinc status is difficult because no single biochemical criterion can reliably reflect zinc body stores. Many indexes have been examined in the hopes of discovering a method for the assessment of zinc nutriture. None of the methods currently used can be wholeheartedly recommended because they are fraught with problems that affect their use and interpretation. However, these methods remain in use for clinical and research purposes, though their benefits and drawbacks must always be acknowledged. Until an acceptable method of analysis is discovered, clinicians must rely for confirmation of zinc deficiency on a process of supplementing with zinc and observing the patient’s response. The main indexes (plasma/serum, erythrocyte, leukocyte, neutrophil, urine, hair and salivary zinc levels, taste acuity and oral zinc tolerance tests, and measurement of metallothionein levels are reviewed. Measurement of plasma or erythrocyte metallothionein levels shows promise as a future tool for the accurate determination of zinc status.

  6. 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

  7. Relatedness of Mycobacterium avium subspecies hominissuis clinical isolates of human and porcine origins assessed by MLVA.

    Science.gov (United States)

    Leão, Célia; Canto, Ana; Machado, Diana; Sanches, Ilda Santos; Couto, Isabel; Viveiros, Miguel; Inácio, João; Botelho, Ana

    2014-09-17

    Mycobacterium avium subsp. hominissuis (MAH) is an important opportunistic pathogen, infecting humans and animals, notably pigs. Several methods have been used to characterize MAH strains. RFLP and PFGE typing techniques have been used as standard methods but are technically demanding. In contrast, the analysis of VNTR loci is a simpler, affordable and highly reliable PCR-based technique, allowing a numerical and reproductive digitalization of typing data. In this study, the analysis of Mycobacterium avium tandem repeats (MATRs) loci was adapted to evaluate the genetic diversity of epidemiological unrelated MAH clinical strains of human (n=28) and porcine (n=69) origins, collected from diverse geographical regions across mainland Portugal. These MAH isolates were found to be genetically diverse and genotypes are randomly distributed across the country. Some of the human strains shared identical VNTR profiles with porcine isolates. Our study shows that the VNTR genotyping using selected MATR loci is a useful analysis technique for assessing the genetic diversity of MAH isolates from Portugal. This typing method could be successfully applied in other countries toward the implementation of a worldwide open-access database of MATR-VNTR profiles of MAH isolates, allowing a better assessment of the global epidemiology traits of this important pathogenic species.

  8. Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students

    Science.gov (United States)

    Haider, Adil H.; Sexton, Janel; Sriram, N.; Cooper, Lisa A.; Efron, David T.; Swoboda, Sandra; Villegas, Cassandra V.; Haut, Elliott R.; Bonds, Morgan; Pronovost, Peter J.; Lipsett, Pamela A.; Freischlag, Julie A.; Cornwell, Edward E.

    2012-01-01

    Context Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. Objective To estimate unconscious race and social class bias among first-year medical students and investigate its relationship with assessments made during clinical vignettes. Design, Setting, and Participants A secure Web-based survey was administered to 211 medical students entering classes at Johns Hopkins School of Medicine, Baltimore, Maryland, in August 2009 and August 2010. The survey included the Implicit Association Test (IAT) to assess unconscious preferences, direct questions regarding students’ explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust. Adjusting for student demographics, multiple logistic regression was used to determine whether responses to the vignettes were associated with unconscious race or social class preferences. Main Outcome Measures Association of scores on an established IAT for race and a novel IAT for social class with vignette responses. Results Among the 202 students who completed the survey, IAT responses were consistent with an implicit preference toward white persons among 140 students (69%, 95% CI, 61%–75%). Responses were consistent with a preference toward those in the upper class among 174 students (86%, 95% CI, 80%–90%). Assessments generally did not vary by patient race or occupation, and multivariable analyses for all vignettes found no significant relationship between implicit biases and clinical assessments. Regression coefficient for the association between pain assessment and race IAT scores was −0.49 (95% CI, −1.00 to 0.03) and for social class, the coefficient was −0.04 (95% CI

  9. Progress on incorporating the patient perspective in outcome assessment in rheumatology and the emergence of life impact measures at OMERACT 9.

    LENUS (Irish Health Repository)

    Kirwan, John R

    2009-09-01

    The Patient Perspective Workshop included over 100 researchers and 18 patient participants from 8 countries. Following preconference reading and short plenary presentations, breakout groups considered work undertaken on measurement of sleep, assessing interventions to develop the effective consumer, and assessing psychological and educational interventions. The workshop explored the best way to identify other outcome domains (and instruments) that should be measured in observational or interventional studies with broader intentions than simply altering outcomes captured in the traditional "core set" plus fatigue. Four sleep questionnaires showed promise and will be the subject of further study. The Effective Consumer scale (EC-17) was reviewed and the concept Effective Consumer was well received. Participants thought it worthwhile to measure the skills and attributes of an effective consumer and develop an intervention that would include education in all of the scale\\'s categories. Assessment of educational and psychological interventions requires a wider set of instruments than is currently used; these should relate to the purpose of the intervention. This principle was extended to include wider measures of the impact of disease on life, as indicated in the International Classification of Functioning, Disability and Health. Life impact measure sets covering domains appropriate to different rheumatic conditions and focused on different interventions might be defined by future OMERACT consensus. Measurement instruments within these domains that are valid for use in rheumatic conditions can then be identified and, in the case of psychological and educational interventions, chosen to fit with the purpose of the intervention.

  10. "Incorporating epigenetic data into the risk assessment process for the toxic metals arsenic, cadmium, chromium, lead, and mercury: strategies and challenges."

    Directory of Open Access Journals (Sweden)

    Paul eRay

    2014-07-01

    Full Text Available Exposure to toxic metals poses a serious human health hazard based on ubiquitous environmental presence, the extent of exposure, and the toxicity and disease states associated with exposure. This global health issue warrants accurate and reliable models derived from the risk assessment process to predict disease risk in populations. There has been considerable interest recently in the impact of environmental toxicants such as toxic metals on the epigenome. Epigenetic modifications are somatically inherited alterations to an individual’s genome without a change in the DNA sequence, and include, but are not limited to, three commonly studied alterations: DNA methylation, histone modification, and non-coding RNA expression. Given the role of epigenetic alterations in regulating gene and thus protein expression, there is the potential for the integration of toxic metal-induced epigenetic alterations as informative factors in the risk assessment process. In the present review, epigenetic alterations induced by five high priority toxic metals/metalloids are prioritized for analysis and their possible inclusion into the risk assessment process is discussed.

  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. 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

  13. 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.

  14. Incorporating Agricultural Management Practices into the Assessment of Soil Carbon Change and Life-Cycle Greenhouse Gas Emissions of Corn Stover Ethanol Production

    Energy Technology Data Exchange (ETDEWEB)

    Qin, Zhangcai [Argonne National Lab. (ANL), Argonne, IL (United States); Canter, Christina E. [Argonne National Lab. (ANL), Argonne, IL (United States); Dunn, Jennifer B. [Argonne National Lab. (ANL), Argonne, IL (United States); Mueller, Steffen [Univ. of Illinois, Chicago, IL (United States); Kwon, Ho-young [International Food Policy Research Inst., Washington, DC (United States); Han, Jeongwoo [Argonne National Lab. (ANL), Argonne, IL (United States); Wander, Michelle M. [Univ. of Illinois, Champaign, IL (United States); Wang, Michael [Argonne National Lab. (ANL), Argonne, IL (United States)

    2015-09-01

    Land management practices such as cover crop adoption or manure application that can increase soil organic carbon (SOC) may provide a way to counter SOC loss upon removal of stover from corn fields for use as a biofuel feedstock. This report documents the data, methodology, and assumptions behind the incorporation of land management practices into corn-soybean systems that dominate U.S. grain production using varying levels of stover removal in the GREETTM (Greenhouse gases, Regulated Emissions, and Energy use in Transportation) model and its CCLUB (Carbon Calculator for Land Use change from Biofuels production) module. Tillage (i.e., conventional, reduced and no tillage), corn stover removal (i.e., at 0, 30% and 60% removal rate), and organic matter input techniques (i.e., cover crop and manure application) are included in the analysis as major land management practices. Soil carbon changes associated with land management changes were modeled with a surrogate CENTURY model. The resulting SOC changes were incorporated into CCLUB while GREET was expanded to include energy and material consumption associated with cover crop adoption and manure application. Life-cycle greenhouse gas (GHG) emissions of stover ethanol were estimated using a marginal approach (all burdens and benefits assigned to corn stover ethanol) and an energy allocation approach (burdens and benefits divided between grain and stover ethanol). In the latter case, we considered corn grain and corn stover ethanol to be produced at an integrated facility. Life-cycle GHG emissions of corn stover ethanol are dependent upon the analysis approach selected (marginal versus allocation) and the land management techniques applied. The expansion of CCLUB and GREET to accommodate land management techniques can produce a wide range of results because users can select from multiple scenario options such as choosing tillage levels, stover removal rates, and whether crop yields increase annually or remain constant

  15. Assessment of scale-dependent foraging behaviour in southern elephant seals incorporating the vertical dimension: a development of the First Passage Time method.

    Science.gov (United States)

    Bailleul, Frederic; Pinaud, David; Hindell, Mark; Charrassin, Jean-Benoît; Guinet, Christophe

    2008-09-01

    1. Identifying the spatial scales at which top marine predators forage is important for understanding oceanic ecosystems. Several methods quantify how individuals concentrate their search effort along a given path. Among these, First-Passage Time (FPT) analysis is particularly useful to identify transitions in movement patterns (e.g. between searching and feeding). This method has mainly been applied to terrestrial animals or flying seabirds that have little or no vertical component to their foraging, so we examined the differences between classic FPT and a modification of this approach using the time spent at the bottom of a dive for characterizing the foraging activity of a diving predator: the southern elephant seal. 2. Satellite relayed data loggers were deployed on 20 individuals during three successive summers at the Kerguelen Islands, providing a total of 72 978 dives from eight juvenile males and nine adult females. 3. Spatial scales identified using the time spent at the bottom of a dive ( = 68.2 +/- 42.1 km) were smaller than those obtained by the classic FPT analysis ( = 104.7 +/- 67.3 km). Moreover, foraging areas identified using the new approach clearly overlapped areas where individuals increased their body condition, indicating that it accurately reflected the foraging activity of the seals. 4. These results suggest that incorporating the vertical dimension into FPT provides a different result to the surface path alone. Close to the Antarctic continent, within the pack-ice, sinuosity of the path could be explained by a high sea-ice concentration (restricting elephant seal movements), and was not necessarily related to foraging activity. 5. Our approach distinguished between actual foraging activity and changes in behaviour induced by the physical environment like sea ice, and could be applied to other diving predators. Inclusion of diving parameters appears to be essential to identify the spatial scale of foraging areas of diving animals. PMID

  16. An Improved Major Component Assessment and Its Application Incorporating Analytic Hierarchy Process%一种结合层次分析法的改进型主成分评价法及其应用

    Institute of Scientific and Technical Information of China (English)

    王嗣超; 张丰; 关明雨

    2014-01-01

    主成分分析法和层次分析法是计算多目标综合性指标中常用的方法。主成分分析法偏重于对数据所包含信息的处理,而层次分析法更依靠于专家在设定权重过程中的人为经验。通过在主成分分析法中引入层次分析法中的判断矩阵,提出了一种改进型主成分分析法。通过对评选优秀篮球教练员的实证分析,验证了新方法的优越性。%Major component assessment and analytic hierarchy process are commonly used meth-ods in computing multi-purpose comprehensive index. Major component analysis puts emphasis on the processing of information incorporated in data while analytic hierarchy process relies on experts’ experience in setting weight. In this study, an improved major component analysis in-corporating the assessment matrix in analytic hierarchy process is proposed. The superiority of the new method is testified in analyzing the selection of excellent basketball trainers.

  17. 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…

  18. Assessment of the water chemical quality improvement based on human health risk indexes: Application to a drinking water treatment plant incorporating membrane technologies.

    Science.gov (United States)

    López-Roldán, Ramón; Rubalcaba, Alicia; Martin-Alonso, Jordi; González, Susana; Martí, Vicenç; Cortina, Jose Luis

    2016-01-01

    A methodology has been developed in order to evaluate the potential risk of drinking water for the health of the consumers. The methodology used for the assessment considered systemic and carcinogenic effects caused by oral ingestion of water based on the reference data developed by the World Health Organisation (WHO) and the Risk Assessment Information System (RAIS) for chemical contaminants. The exposure includes a hypothetical dose received by drinking this water according to the analysed contaminants. An assessment of the chemical quality improvement of produced water in the Drinking Water Treatment Plant (DWTP) after integration of membrane technologies was performed. Series of concentration values covering up to 261 chemical parameters over 5 years (2008-2012) of raw and treated water in the Sant Joan Despí DWTP, at the lower part of the Llobregat River basin (NE Spain), were used. After the application of the methodology, the resulting global indexes were located below the thresholds except for carcinogenic risk in the output of DWTP, where the index was slightly above the threshold during 2008 and 2009 before the upgrade of the treatment works including membrane technologies was executed. The annual evolution of global indexes showed a reduction in the global values for all situations: HQ systemic index based on RAIS dropped from 0.64 to 0.42 for surface water and from 0.61 to 0.31 for drinking water; the R carcinogenic index based on RAIS was negligible for input water and varied between 4.2×10(-05) and 7.4×10(-06) for drinking water; the W systemic index based on the WHO data varied between 0.41 and 0.16 for surface water and between 0.61 and 0.31 for drinking water. A specific analysis for the indexes associated with trihalomethanes (THMs) showed the same pattern.

  19. 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...

  20. Improvement of learning domains of nursing students with the use of authentic assessment pedagogy in clinical practice.

    Science.gov (United States)

    Chong, Edmund Jun Meng; Lim, Jessica Shih Wei; Liu, Yuchan; Lau, Yvonne Yen Lin; Wu, Vivien Xi

    2016-09-01

    With evolving healthcare demands, nursing educators need to constantly review their teaching methodologies in order to enhance learners' knowledge and competency of skills in the clinical settings. Learning is an active process in which meaning is accomplished on the basis of experience and that authentic assessment pedagogy will enable nursing students to play an active part in their learning. The study was conducted with an aim to examine nursing students' learning domains through the introduction of the authentic assessment pedagogy during their clinical practice. A quasi-experimental study (n = 54) was conducted over a period of 10 weeks at a local tertiary hospital. The experimental group was exposed to the authentic assessment pedagogy and were taught to use the assessment rubrics as an instrument to help enhance their learning. Students were assessed and scored according to the assessment rubrics, which were categorized into four domains; cognitive, psychomotor, affective and critical thinking abilities. The findings indicated that an overall score for the four domains between the experimental and control groups were significant, with p value of Critical thinking scores were indicative of consistent improvement within the experimental group. The findings confirmed that learning outcomes of the nursing students were enhanced through the early introduction of the authentic assessment pedagogy in the clinical setting. PMID:27583814