[Evidence-based medicine and French medical students: an appraisal].

Science.gov (United States)

Orsat, M; Bigot, P; Rouprêt, M; Campillo, B; Beley, S; Chautard, D; Beaufreton, C; Richard, I; Saint-André, J-P; Azzouzi, A-R

2009-03-01

Nowadays, evidence-based medicine (EBM) is essential to learn and to practice medicine. The aim of the current study was to investigate the baseline level of knowledge of French students regarding EBM. Between April and May2008, a questionnaire was sent by e-mail to 900students in their last year of medical study. On 327 answers, 297 (91%), 94 (29%) and 85 (26%) students declared they read, write and speak medical English. Ninety (28%) read an article of a French medical review once a month and 43 (13%) read an article of an international medical review once a month. Three hundred and eleven (95%) knew the bases of medical research on the Internet and 219 (67%) used them. Twenty-four (7%) had already participated in a editorial staff of a medical article, 7 (2%) had been co-authors. Two hundred and seventy-two (83%) had made an oral presentation during a medical staff and 3 (1%) during a congress. Finally, 237 (73%) understood the interest of the critical analysis of an article at the ECN and 70 (21%) thought they were prepared. The incapacity of learning EBM is one of the limits of the French medical training system. The introduction of the reading critical of an article at the ECN is the concrete beginning of an answer to this problem.

Evidence-based medicine and hospital reform: tracing origins back to Florence Nightingale.

Science.gov (United States)

Aravind, Maya; Chung, Kevin C

2010-01-01

The use of reliable evidence to evaluate health care interventions has gained strong support within the medical community and in the field of plastic surgery in particular. Evidence-based medicine aims to improve health care and reduce costs through the use of sound clinical evidence in evaluating treatments, procedures, and outcomes. The field is hardly new, however, and most trace its origins back to the work of Cochrane in the 1970s and Sackett in the 1990s. Though she wouldn't know it, Florence Nightingale was applying the concepts of evidence-based reform to the medical profession more than a century before. She used medical statistics to reveal the nature of infection in hospitals and on the battlefield. Moreover, Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today.

Automatic evidence quality prediction to support evidence-based decision making.

Science.gov (United States)

Sarker, Abeed; Mollá, Diego; Paris, Cécile

2015-06-01

Evidence-based medicine practice requires practitioners to obtain the best available medical evidence, and appraise the quality of the evidence when making clinical decisions. Primarily due to the plethora of electronically available data from the medical literature, the manual appraisal of the quality of evidence is a time-consuming process. We present a fully automatic approach for predicting the quality of medical evidence in order to aid practitioners at point-of-care. Our approach extracts relevant information from medical article abstracts and utilises data from a specialised corpus to apply supervised machine learning for the prediction of the quality grades. Following an in-depth analysis of the usefulness of features (e.g., publication types of articles), they are extracted from the text via rule-based approaches and from the meta-data associated with the articles, and then applied in the supervised classification model. We propose the use of a highly scalable and portable approach using a sequence of high precision classifiers, and introduce a simple evaluation metric called average error distance (AED) that simplifies the comparison of systems. We also perform elaborate human evaluations to compare the performance of our system against human judgments. We test and evaluate our approaches on a publicly available, specialised, annotated corpus containing 1132 evidence-based recommendations. Our rule-based approach performs exceptionally well at the automatic extraction of publication types of articles, with F-scores of up to 0.99 for high-quality publication types. For evidence quality classification, our approach obtains an accuracy of 63.84% and an AED of 0.271. The human evaluations show that the performance of our system, in terms of AED and accuracy, is comparable to the performance of humans on the same data. The experiments suggest that our structured text classification framework achieves evaluation results comparable to those of human performance

High level issues in reliability quantification of safety-critical software

International Nuclear Information System (INIS)

Kim, Man Cheol

2012-01-01

For the purpose of developing a consensus method for the reliability assessment of safety-critical digital instrumentation and control systems in nuclear power plants, several high level issues in reliability assessment of the safety-critical software based on Bayesian belief network modeling and statistical testing are discussed. Related to the Bayesian belief network modeling, the relation between the assessment approach and the sources of evidence, the relation between qualitative evidence and quantitative evidence, how to consider qualitative evidence, and the cause-consequence relation are discussed. Related to the statistical testing, the need of the consideration of context-specific software failure probabilities and the inability to perform a huge number of tests in the real world are discussed. The discussions in this paper are expected to provide a common basis for future discussions on the reliability assessment of safety-critical software. (author)

Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

Directory of Open Access Journals (Sweden)

Johnston KN

2011-12-01

Full Text Available Kylie N Johnston1, Mary Young2, Karen A Grimmer-Somers1, Ral Antic3, Peter A Frith41International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia; 2Transitional and Community Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 3Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 4Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University Adelaide, South Australia, AustraliaBackground: Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.Methods: Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners' experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.Results: Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1 role clarity of the medical practitioner; (2 persuasive communication with the patient; (3 complexity of behavioral change required; (4 awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to

Reliability of "Google" for obtaining medical information

Directory of Open Access Journals (Sweden)

Mihir Kothari

2015-01-01

Full Text Available Internet is used by many patients to obtain relevant medical information. We assessed the impact of "Google" search on the knowledge of the parents whose ward suffered from squint. In 21 consecutive patients, the "Google" search improved the mean score of the correct answers from 47% to 62%. We found that "Google" search was useful and reliable source of information for the patients with regards to the disease etiopathogenesis and the problems caused by the disease. The internet-based information, however, was incomplete and not reliable with regards to the disease treatment.

Assessing medical students' self-regulation as aptitude in computer-based learning.

Science.gov (United States)

Song, Hyuksoon S; Kalet, Adina L; Plass, Jan L

2011-03-01

We developed a Self-Regulation Measure for Computer-based learning (SRMC) tailored toward medical students, by modifying Zimmerman's Self-Regulated Learning Interview Schedule (SRLIS) for K-12 learners. The SRMC's reliability and validity were examined in 2 studies. In Study 1, 109 first-year medical students were asked to complete the SRMC. Bivariate correlation analysis results indicated that the SRMC scores had a moderate degree of correlation with student achievement in a teacher-developed test. In Study 2, 58 third-year clerkship students completed the SRMC. Regression analysis results indicated that the frequency of medical students' usage of self-regulation strategies was associated with their general clinical knowledge measured by a nationally standardized licensing exam. These two studies provided evidence for the reliability and concurrent validity of the SRMC to assess medical students' self-regulation as aptitude. Future work should provide evidence to guide and improve instructional design as well as inform educational policy.

Integration of an Evidence Base into a Probabilistic Risk Assessment Model. The Integrated Medical Model Database: An Organized Evidence Base for Assessing In-Flight Crew Health Risk and System Design

Science.gov (United States)

Saile, Lynn; Lopez, Vilma; Bickham, Grandin; FreiredeCarvalho, Mary; Kerstman, Eric; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

This slide presentation reviews the Integrated Medical Model (IMM) database, which is an organized evidence base for assessing in-flight crew health risk. The database is a relational database accessible to many people. The database quantifies the model inputs by a ranking based on the highest value of the data as Level of Evidence (LOE) and the quality of evidence (QOE) score that provides an assessment of the evidence base for each medical condition. The IMM evidence base has already been able to provide invaluable information for designers, and for other uses.

Insightful practice: a reliable measure for medical revalidation

Science.gov (United States)

Guthrie, Bruce; Sullivan, Frank M; Mercer, Stewart W; Russell, Andrew; Bruce, David A

2012-01-01

Background Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback. Setting and participants 60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK. Methods A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a ‘good doctor’ were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice, defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory. Main outcome measures Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation. Results Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83). Conclusions Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed. PMID:22653078

Promoting evidence based medicine in preclinical medical students via a federated literature search tool.

Science.gov (United States)

Keim, Samuel Mark; Howse, David; Bracke, Paul; Mendoza, Kathryn

2008-01-01

Medical educators are increasingly faced with directives to teach Evidence Based Medicine (EBM) skills. Because of its nature, integrating fundamental EBM educational content is a challenge in the preclinical years. To analyse preclinical medical student user satisfaction and feedback regarding a clinical EBM search strategy. The authors introduced a custom EBM search option with a self-contained education structure to first-year medical students. The implementation took advantage of a major curricular change towards case-based instruction. Medical student views and experiences were studied regarding the tool's convenience, problems and the degree to which they used it to answer questions raised by case-based instruction. Surveys were completed by 70% of the available first-year students. Student satisfaction and experiences were strongly positive towards the EBM strategy, especially of the tool's convenience and utility for answering issues raised during case-based learning sessions. About 90% of the students responded that the tool was easy to use, productive and accessed for half or more of their search needs. This study provides evidence that the integration of an educational EBM search tool can be positively received by preclinical medical students.

Patient safety in anesthesia: learning from the culture of high-reliability organizations.

Science.gov (United States)

Wright, Suzanne M

2015-03-01

There has been an increased awareness of and interest in patient safety and improved outcomes, as well as a growing body of evidence substantiating medical error as a leading cause of death and injury in the United States. According to The Joint Commission, US hospitals demonstrate improvements in health care quality and patient safety. Although this progress is encouraging, much room for improvement remains. High-reliability organizations, industries that deliver reliable performances in the face of complex working environments, can serve as models of safety for our health care system until plausible explanations for patient harm are better understood. Copyright © 2015 Elsevier Inc. All rights reserved.

Transferring Aviation Practices into Clinical Medicine for the Promotion of High Reliability.

Science.gov (United States)

Powell-Dunford, Nicole; McPherson, Mark K; Pina, Joseph S; Gaydos, Steven J

2017-05-01

Aviation is a classic example of a high reliability organization (HRO)-an organization in which catastrophic events are expected to occur without control measures. As health care systems transition toward high reliability, aviation practices are increasingly transferred for clinical implementation. A PubMed search using the terms aviation, crew resource management, and patient safety was undertaken. Manuscripts authored by physician pilots and accident investigation regulations were analyzed. Subject matter experts involved in adoption of aviation practices into the medical field were interviewed. A PubMed search yielded 621 results with 22 relevant for inclusion. Improved clinical outcomes were noted in five research trials in which aviation practices were adopted, particularly with regard to checklist usage and crew resource-management training. Effectiveness of interventions was influenced by intensity of application, leadership involvement, and provision of staff training. The usefulness of incorporating mishap investigation techniques has not been established. Whereas aviation accident investigation is highly standardized, the investigation of medical error is characterized by variation. The adoption of aviation practices into clinical medicine facilitates an evolution toward high reliability. Evidence for the efficacy of the checklist and crew resource-management training is robust. Transference of aviation accident investigation practices is preliminary. A standardized, independent investigation process could facilitate the development of a safety culture commensurate with that achieved in the aviation industry.Powell-Dunford N, McPherson MK, Pina JS, Gaydos SJ. Transferring aviation practices into clinical medicine for the promotion of high reliability. Aerosp Med Hum Perform. 2017; 88(5):487-491.

Development of web-based reliability data base platform

International Nuclear Information System (INIS)

Hwang, Seok Won; Lee, Chang Ju; Sung, Key Yong

2004-01-01

Probabilistic safety assessment (PSA) is a systematic technique which estimates the degree of risk impacts to the public due to an accident scenario. Estimating the occurrence frequencies and consequences of potential scenarios requires a thorough analysis of the accident details and all fundamental parameters. The robustness of PSA to check weaknesses in a design and operation will allow a better informed and balanced decision to be reached. The fundamental parameters for PSA, such as the component failure rates, should be estimated under the condition of steady collection of the evidence throughout the operational period. However, since any single plant data does not sufficiently enough to provide an adequate PSA result, in actual, the whole operating data was commonly used to estimate the reliability parameters for the same type of components. The reliability data of any component type consists of two categories; the generic that is based on the operating experiences of whole plants, and the plant-specific that is based on the operation of a specific plant of interest. The generic data is highly essential for new or recently-built nuclear power plants (NPPs). Generally, the reliability data base may be categorized into the component reliability, initiating event frequencies, human performance, and so on. Among these data, the component reliability seems a key element because it has the most abundant population. Therefore, the component reliability data is essential for taking a part in the quantification of accident sequences because it becomes an input of various basic events which consists of the fault tree

Medical reliable network using concatenated channel codes through GSM network.

Science.gov (United States)

Ahmed, Emtithal; Kohno, Ryuji

2013-01-01

Although the 4(th) generation (4G) of global mobile communication network, i.e. Long Term Evolution (LTE) coexisting with the 3(rd) generation (3G) has successfully started; the 2(nd) generation (2G), i.e. Global System for Mobile communication (GSM) still playing an important role in many developing countries. Without any other reliable network infrastructure, GSM can be applied for tele-monitoring applications, where high mobility and low cost are necessary. A core objective of this paper is to introduce the design of a more reliable and dependable Medical Network Channel Code system (MNCC) through GSM Network. MNCC design based on simple concatenated channel code, which is cascade of an inner code (GSM) and an extra outer code (Convolution Code) in order to protect medical data more robust against channel errors than other data using the existing GSM network. In this paper, the MNCC system will provide Bit Error Rate (BER) equivalent to the BER for medical tele monitoring of physiological signals, which is 10(-5) or less. The performance of the MNCC has been proven and investigated using computer simulations under different channels condition such as, Additive White Gaussian Noise (AWGN), Rayleigh noise and burst noise. Generally the MNCC system has been providing better performance as compared to GSM.

Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.

Science.gov (United States)

Kaplan, Heather C; Sherman, Susan N; Cleveland, Charlena; Goldenhar, Linda M; Lannon, Carole M; Bailit, Jennifer L

2016-03-01

Antenatal corticosteroids (ANCS) reduce complications of preterm birth; however, not all eligible women receive them. Many hospitals and providers do not have the right processes and conditions to enable ANCS administration with high reliability. The objective of this study was to understand conditions that enable delivery of ANCS with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project. We conducted focus groups and semistructured interviews with members of the OPQC project team (n=27) and other care providers (n=70) using a purposeful sample of 6 sites involved in the OPQC ANCS project. Participants including nurses (n=57), attending obstetricians (n=17), physician trainees (n=21) and certified nurse midwives (n=2) were asked to reflect on their experiences and to identify factors contributing to optimal use of ANCS. Focus groups and interviews were transcribed verbatim and were analysed by a multidisciplinary team using an iterative approach that combined inductive and deductive methods to identify and categorise themes. Six major themes supporting reliable implementation of ANCS at these hospitals emerged including: (1) presence of a high reliability culture, (2) processes that emphasise high reliability, (3) timely and efficient administration process, (4) multiple disciplines are involved, (5) evidence of benefit supports ANCS use and (6) benefit is recognised at all levels of the care team. Our findings identify the key processes and supports needed to ensure delivery of ASCS with high reliability and are reinforced by implementation and reliability science. They are useful for foundation of the successful implementation of other evidence-based practices at high levels of reliability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Validity evidence for the measurement of the strength of motivation for medical school.

Science.gov (United States)

Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

2011-05-01

The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as the sources of validity evidence. The SMMS questionnaire was filled out by 1,494 medical students in different years of medical curriculum. The validity evidence for the internal structure was analyzed by principal components analysis with promax rotation. Validity evidence for relations to other variables was tested by comparing the SMMS scores with scores on the Academic Motivation Scale (AMS) and the exhaustion scale of Maslach Burnout Inventory-Student Survey (MBI-SS) for measuring study stress. Evidence for internal consistency was determined through the Cronbach's alpha for reliability. The analysis showed that the SMMS had a 3-factor structure. The validity in relations to other variables was established as both, the subscales and full scale scores significantly correlated positively with the intrinsic motivation scores and with the more autonomous forms of extrinsic motivation, the correlation decreasing and finally becoming negative towards the extrinsic motivation end of the spectrum. They also had significant negative correlations with amotivation scale of the AMS and exhaustion scale of MBI-SS. The Cronbach's alpha for reliability of the three subscales and full SMMS scores was 0.70, 0.67, 0.55 and 0.79. The strength of motivation for medical school has a three factor structure and acceptable validity evidence was found in our study.

Integrating evidence based medicine into undergraduate medical education: combining online instruction with clinical clerkships.

Science.gov (United States)

Aronoff, Stephen C; Evans, Barry; Fleece, David; Lyons, Paul; Kaplan, Lawrence; Rojas, Roberto

2010-07-01

Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). During the first 18 weeks of the 3rd year, students completed 6 online, didactic modules. Over the next 24 weeks, students developed questions independently from patients seen during clerkships and then retrieved and appraised relevant evidence. Online, faculty mentors reviewed student assignments submitted throughout the course to monitor progress. Mastery of the skills of EBM was assessed prior to and at the conclusion of the course using the Fresno test of competency. Paired data were available from 139 students. Postcourse test scores (M= 77.7; 95% CI = 59-96.4) were significantly higher than precourse scores (M= 66.6; 95% CI = 46.5-86.7), ponline, faculty mentored instruction. This method of instruction provided uniform instruction across geographic sites and medical specialties and permitted efficient use of faculty time.

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps

DEFF Research Database (Denmark)

Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe

2015-01-01

BACKGROUND: Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether...... or not app contents adhere to current medical evidence. OBJECTIVE: To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. METHODS: We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE......), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. RESULTS: Based on inclusion criteria, 52 studies were included...

The supply of medical radioisotopes - The Path to Reliability

International Nuclear Information System (INIS)

2011-01-01

The reliable supply of molybdenum-99 ( 99 Mo) and its decay product, technetium-99m ( 99m Tc), is a vital component of modern medical diagnostic practices. Disruptions in the supply chain of these radioisotopes can delay or prevent important medical testing services. Unfortunately, supply reliability has declined over the past decade, due to unexpected or extended shutdowns at the few ageing, 99 Mo-producing, research reactors and processing facilities. These shutdowns have recently created global supply shortages. This report provides the findings and analysis of two years of extensive examination of the 99 Mo/ 99m Tc supply chain by the OECD/NEA High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR). It puts forth a comprehensive policy approach that would help ensure long-term supply security of 99 Mo/ 99m Tc, detailing the essential steps to be taken by governments, industry and the health community to address the vulnerabilities of the supply chain, including its economic structure. (authors)

Structural reliability analysis under evidence theory using the active learning kriging model

Science.gov (United States)

Yang, Xufeng; Liu, Yongshou; Ma, Panke

2017-11-01

Structural reliability analysis under evidence theory is investigated. It is rigorously proved that a surrogate model providing only correct sign prediction of the performance function can meet the accuracy requirement of evidence-theory-based reliability analysis. Accordingly, a method based on the active learning kriging model which only correctly predicts the sign of the performance function is proposed. Interval Monte Carlo simulation and a modified optimization method based on Karush-Kuhn-Tucker conditions are introduced to make the method more efficient in estimating the bounds of failure probability based on the kriging model. Four examples are investigated to demonstrate the efficiency and accuracy of the proposed method.

The reliability of workplace-based assessment in postgraduate medical education and training: a national evaluation in general practice in the United Kingdom.

Science.gov (United States)

Murphy, Douglas J; Bruce, David A; Mercer, Stewart W; Eva, Kevin W

2009-05-01

To investigate the reliability and feasibility of six potential workplace-based assessment methods in general practice training: criterion audit, multi-source feedback from clinical and non-clinical colleagues, patient feedback (the CARE Measure), referral letters, significant event analysis, and video analysis of consultations. Performance of GP registrars (trainees) was evaluated with each tool to assess the reliabilities of the tools and feasibility, given raters and number of assessments needed. Participant experience of process determined by questionnaire. 171 GP registrars and their trainers, drawn from nine deaneries (representing all four countries in the UK), participated. The ability of each tool to differentiate between doctors (reliability) was assessed using generalisability theory. Decision studies were then conducted to determine the number of observations required to achieve an acceptably high reliability for "high-stakes assessment" using each instrument. Finally, descriptive statistics were used to summarise participants' ratings of their experience using these tools. Multi-source feedback from colleagues and patient feedback on consultations emerged as the two methods most likely to offer a reliable and feasible opinion of workplace performance. Reliability co-efficients of 0.8 were attainable with 41 CARE Measure patient questionnaires and six clinical and/or five non-clinical colleagues per doctor when assessed on two occasions. For the other four methods tested, 10 or more assessors were required per doctor in order to achieve a reliable assessment, making the feasibility of their use in high-stakes assessment extremely low. Participant feedback did not raise any major concerns regarding the acceptability, feasibility, or educational impact of the tools. The combination of patient and colleague views of doctors' performance, coupled with reliable competence measures, may offer a suitable evidence-base on which to monitor progress and

Examining Reliability and Validity of an Online Score (ALiEM AIR) for Rating Free Open Access Medical Education Resources.

Science.gov (United States)

Chan, Teresa Man-Yee; Grock, Andrew; Paddock, Michael; Kulasegaram, Kulamakan; Yarris, Lalena M; Lin, Michelle

2016-12-01

Since 2014, Academic Life in Emergency Medicine (ALiEM) has used the Approved Instructional Resources (AIR) score to critically appraise online content. The primary goals of this study are to determine the interrater reliability (IRR) of the ALiEM AIR rating score and determine its correlation with expert educator gestalt. We also determine the minimum number of educator-raters needed to achieve acceptable reliability. Eight educators each rated 83 online educational posts with the ALiEM AIR scale. Items include accuracy, usage of evidence-based medicine, referencing, utility, and the Best Evidence in Emergency Medicine rating score. A generalizability study was conducted to determine IRR and rating variance contributions of facets such as rater, blogs, posts, and topic. A randomized selection of 40 blog posts previously rated through ALiEM AIR was then rated again by a blinded group of expert medical educators according to their gestalt. Their gestalt impression was subsequently correlated with the ALiEM AIR score. The IRR for the ALiEM AIR rating scale was 0.81 during the 6-month pilot period. Decision studies showed that at least 9 raters were required to achieve this reliability. Spearman correlations between mean AIR score and the mean expert gestalt ratings were 0.40 for recommendation for learners and 0.35 for their colleagues. The ALiEM AIR scale is a moderately to highly reliable, 5-question tool when used by medical educators for rating online resources. The score displays a fair correlation with expert educator gestalt in regard to the quality of the resources. The score displays a fair correlation with educator gestalt. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Promoting networks between evidence-based medicine and values-based medicine in continuing medical education.

Science.gov (United States)

Altamirano-Bustamante, Myriam M; Altamirano-Bustamante, Nelly F; Lifshitz, Alberto; Mora-Magaña, Ignacio; de Hoyos, Adalberto; Avila-Osorio, María Teresa; Quintana-Vargas, Silvia; Aguirre, Jorge A; Méndez, Jorge; Murata, Chiharu; Nava-Diosdado, Rodrigo; Martínez-González, Oscar; Calleja, Elisa; Vargas, Raúl; Mejía-Arangure, Juan Manuel; Cortez-Domínguez, Araceli; Vedrenne-Gutiérrez, Fernand; Sueiras, Perla; Garduño, Juan; Islas-Andrade, Sergio; Salamanca, Fabio; Kumate-Rodríguez, Jesús; Reyes-Fuentes, Alejandro

2013-02-15

In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of

Evidence-Based Psychotherapy: Advantages and Challenges.

Science.gov (United States)

Cook, Sarah C; Schwartz, Ann C; Kaslow, Nadine J

2017-07-01

Evidence-based psychotherapies have been shown to be efficacious and cost-effective for a wide range of psychiatric conditions. Psychiatric disorders are prevalent worldwide and associated with high rates of disease burden, as well as elevated rates of co-occurrence with medical disorders, which has led to an increased focus on the need for evidence-based psychotherapies. This chapter focuses on the current state of evidence-based psychotherapy. The strengths and challenges of evidence-based psychotherapy are discussed, as well as misperceptions regarding the approach that may discourage and limit its use. In addition, we review various factors associated with the optimal implementation and application of evidence-based psychotherapies. Lastly, suggestions are provided on ways to advance the evidence-based psychotherapy movement to become truly integrated into practice.

Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2) in Adults with Non-Cancer Pain

Science.gov (United States)

Hayes, Corey J.; Bhandari, Naleen Raj; Kathe, Niranjan; Payakachat, Nalin

2017-01-01

Limited evidence exists on how non-cancer pain (NCP) affects an individual’s health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p reliable and valid measure of HRQoL for patients with NCP. PMID:28445438

Undergraduate medical students' perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria.

Science.gov (United States)

Alahdab, Fares; Firwana, Belal; Hasan, Rim; Sonbol, Mohamad Bassam; Fares, Munes; Alnahhas, Iyad; Sabouni, Ammar; Ferwana, Mazen

2012-08-12

Teaching evidence-based medicine (EBM) should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students' awareness of, attitudes toward, and competencies' in EBM. According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%), role models among professors and instructors (92%), a librarian (70%), institutional subscription to medical journals (94%), and sufficient IT hardware (58%). After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%), searching for evidence (39.8%), appraising the evidence (27.3%), understanding statistics (48%), and applying evidence at point of care (34.1%). However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria.

Undergraduate medical students’ perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria

Science.gov (United States)

2012-01-01

Background Teaching evidence-based medicine (EBM) should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. Methods The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students’ awareness of, attitudes toward, and competencies’ in EBM. Results According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%), role models among professors and instructors (92%), a librarian (70%), institutional subscription to medical journals (94%), and sufficient IT hardware (58%). After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%), searching for evidence (39.8%), appraising the evidence (27.3%), understanding statistics (48%), and applying evidence at point of care (34.1%). However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. Conclusion The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria. PMID:22882872

Interrater reliability of the mind map assessment rubric in a cohort of medical students

Directory of Open Access Journals (Sweden)

Zipp Genevieve

2009-04-01

Full Text Available Abstract Background Learning strategies are thinking tools that students can use to actively acquire information. Examples of learning strategies include mnemonics, charts, and maps. One strategy that may help students master the tsunami of information presented in medical school is the mind map learning strategy. Currently, there is no valid and reliable rubric to grade mind maps and this may contribute to their underutilization in medicine. Because concept maps and mind maps engage learners similarly at a metacognitive level, a valid and reliable concept map assessment scoring system was adapted to form the mind map assessment rubric (MMAR. The MMAR can assess mind map depth based upon concept-links, cross-links, hierarchies, examples, pictures, and colors. The purpose of this study was to examine interrater reliability of the MMAR. Methods This exploratory study was conducted at a US medical school as part of a larger investigation on learning strategies. Sixty-six (N = 66 first-year medical students were given a 394-word text passage followed by a 30-minute presentation on mind mapping. After the presentation, subjects were again given the text passage and instructed to create mind maps based upon the passage. The mind maps were collected and independently scored using the MMAR by 3 examiners. Interrater reliability was measured using the intraclass correlation coefficient (ICC statistic. Statistics were calculated using SPSS version 12.0 (Chicago, IL. Results Analysis of the mind maps revealed the following: concept-links ICC = .05 (95% CI, -.42 to .38, cross-links ICC = .58 (95% CI, .37 to .73, hierarchies ICC = .23 (95% CI, -.15 to .50, examples ICC = .53 (95% CI, .29 to .69, pictures ICC = .86 (95% CI, .79 to .91, colors ICC = .73 (95% CI, .59 to .82, and total score ICC = .86 (95% CI, .79 to .91. Conclusion The high ICC value for total mind map score indicates strong MMAR interrater reliability. Pictures and colors demonstrated moderate

Interrater reliability of the mind map assessment rubric in a cohort of medical students.

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D'Antoni, Anthony V; Zipp, Genevieve Pinto; Olson, Valerie G

2009-04-28

Learning strategies are thinking tools that students can use to actively acquire information. Examples of learning strategies include mnemonics, charts, and maps. One strategy that may help students master the tsunami of information presented in medical school is the mind map learning strategy. Currently, there is no valid and reliable rubric to grade mind maps and this may contribute to their underutilization in medicine. Because concept maps and mind maps engage learners similarly at a metacognitive level, a valid and reliable concept map assessment scoring system was adapted to form the mind map assessment rubric (MMAR). The MMAR can assess mind map depth based upon concept-links, cross-links, hierarchies, examples, pictures, and colors. The purpose of this study was to examine interrater reliability of the MMAR. This exploratory study was conducted at a US medical school as part of a larger investigation on learning strategies. Sixty-six (N = 66) first-year medical students were given a 394-word text passage followed by a 30-minute presentation on mind mapping. After the presentation, subjects were again given the text passage and instructed to create mind maps based upon the passage. The mind maps were collected and independently scored using the MMAR by 3 examiners. Interrater reliability was measured using the intraclass correlation coefficient (ICC) statistic. Statistics were calculated using SPSS version 12.0 (Chicago, IL). Analysis of the mind maps revealed the following: concept-links ICC = .05 (95% CI, -.42 to .38), cross-links ICC = .58 (95% CI, .37 to .73), hierarchies ICC = .23 (95% CI, -.15 to .50), examples ICC = .53 (95% CI, .29 to .69), pictures ICC = .86 (95% CI, .79 to .91), colors ICC = .73 (95% CI, .59 to .82), and total score ICC = .86 (95% CI, .79 to .91). The high ICC value for total mind map score indicates strong MMAR interrater reliability. Pictures and colors demonstrated moderate to strong interrater reliability. We conclude that the

Attitude and confidence of undergraduate medical programme educators to practice and teach evidence-based healthcare: a cross-sectional survey.

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Young, Taryn; Esterhuizen, Tonya M; Volmink, Jimmy; Clarke, Mike

2016-06-01

Medical student educators play critical roles in evidence-based healthcare (EBHC) teaching and learning and as role models practicing EBHC. This study assessed their confidence to practice and teach EBHC, their attitude to EBHC and barriers to practicing and teaching EBHC. We conducted a cross-sectional online survey of educators of undergraduate medical students at a South African academic institution. STATA 12 was used for quantitative data analysis. Responses to open-ended questions were coded, and further interpretation done using thematic content analysis. Forty two (19%) educators from various departments responded to the invitation sent to everyone formally involved in teaching undergraduate medical students. They had high levels of knowledge and understanding of EBHC. Many had received training in teaching and learning approaches, although EBHC training received was mainly on enabling competencies. Limitations to practicing EBHC included lack of time, clinical workload, limited access to Internet and resources, knowledge and skills. One quarter of the respondents indicated that they teach EBHC. Perceived barriers to teaching EBHC reported related to students (e.g. lack of interest), context (e.g. access to databases) and educators (e.g. competing priorities). Respondents' suggestions for support included reliable Internet access, easy point-of-care access to databases and resources, increasing awareness of EBHC, building capacity to practice and facilitate learning of EBHC and a supportive community of practice. Educators play a critical role in facilitating EBHC learning not just in the classroom, but also in practice. Without adequate support, training and development, they are ill equipped to be the role models future healthcare professionals need.

Reliability of medical audit in quality assessment of medical care

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Camacho Luiz Antonio Bastos

1996-01-01

Full Text Available Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6, depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.

Undergraduate medical students’ perceptions, attitudes, and competencies in evidence-based medicine (EBM, and their understanding of EBM reality in Syria

Directory of Open Access Journals (Sweden)

Alahdab Fares

2012-08-01

Full Text Available Abstract Background Teaching evidence-based medicine (EBM should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. Methods The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students’ awareness of, attitudes toward, and competencies’ in EBM. Results According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%, role models among professors and instructors (92%, a librarian (70%, institutional subscription to medical journals (94%, and sufficient IT hardware (58%. After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%, searching for evidence (39.8%, appraising the evidence (27.3%, understanding statistics (48%, and applying evidence at point of care (34.1%. However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. Conclusion The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria.

Reliability and validity of the Treatment Satisfaction Questionnaire for Medication among Portuguese-speaking Brazilian patients with hypertension.

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Sauer Liberato, Ana Carolina; Cunha Matheus Rodrigues, Roberta; Kim, MyoungJin; Mallory, Caroline

2016-07-01

This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. Cross-sectional descriptive exploratory study. A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. Within known limitations, clinicians will

Intra-rater and inter-rater reliability of a medical record abstraction study on transition of care after childhood cancer.

Directory of Open Access Journals (Sweden)

Micòl E Gianinazzi

Full Text Available The abstraction of data from medical records is a widespread practice in epidemiological research. However, studies using this means of data collection rarely report reliability. Within the Transition after Childhood Cancer Study (TaCC which is based on a medical record abstraction, we conducted a second independent abstraction of data with the aim to assess a intra-rater reliability of one rater at two time points; b the possible learning effects between these two time points compared to a gold-standard; and c inter-rater reliability.Within the TaCC study we conducted a systematic medical record abstraction in the 9 Swiss clinics with pediatric oncology wards. In a second phase we selected a subsample of medical records in 3 clinics to conduct a second independent abstraction. We then assessed intra-rater reliability at two time points, the learning effect over time (comparing each rater at two time-points with a gold-standard and the inter-rater reliability of a selected number of variables. We calculated percentage agreement and Cohen's kappa.For the assessment of the intra-rater reliability we included 154 records (80 for rater 1; 74 for rater 2. For the inter-rater reliability we could include 70 records. Intra-rater reliability was substantial to excellent (Cohen's kappa 0-6-0.8 with an observed percentage agreement of 75%-95%. In all variables learning effects were observed. Inter-rater reliability was substantial to excellent (Cohen's kappa 0.70-0.83 with high agreement ranging from 86% to 100%.Our study showed that data abstracted from medical records are reliable. Investigating intra-rater and inter-rater reliability can give confidence to draw conclusions from the abstracted data and increase data quality by minimizing systematic errors.

[Reliability of Primary Care computerised medication records].

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García-Molina Sáez, Celia; Urbieta Sanz, Elena; Madrigal de Torres, Manuel; Piñera Salmerón, Pascual; Pérez Cárceles, María D

2016-03-01

To quantify and to evaluate the reliability of Primary Care (PC) computerised medication records of as an information source of patient chronic medications, and to identify associated factors with the presence of discrepancies. A descriptive cross-sectional study. General Referral Hospital in Murcia. Patients admitted to the cardiology-chest diseases unit, during the months of February to April 2013, on home treatment, who agreed to participate in the study. Evaluation of the reliability of Primary Care computerised medication records by analysing the concordance, by identifying discrepancies, between the active medication in these records and that recorded in pharmacist interview with the patient/caregiver. Identification of associated factors with the presence of discrepancies was analysed using a multivariate logistic regression. The study included a total of 308 patients with a mean of 70.9 years (13.0 SD). The concordance of active ingredients was 83.7%, and this decreased to 34.7% when taking the dosage into account. Discrepancies were found in 97.1% of patients. The most frequent discrepancy was omission of frequency (35.6%), commission (drug added unjustifiably) (14.6%), and drug omission (12.7%). Age older than 65 years (1.98 [1.08 to 3.64]), multiple chronic diseases (1.89 [1.04 to 3.42]), and have a narcotic or psychotropic drug prescribed (2.22 [1.16 to 4.24]), were the factors associated with the presence of discrepancies. Primary Care computerised medication records, although of undoubted interest, are not be reliable enough to be used as the sole source of information on patient chronic medications when admitted to hospital. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Coordinating the norms and values of medical research, medical practice and patient worlds-the ethics of evidence based medicine in orphaned fields of medicine

NARCIS (Netherlands)

Vos, R.; Willems, D.; Houtepen, R.

2004-01-01

Evidence based medicine is rightly at the core of current medicine. If patients and society put trust in medical professional competency, and on the basis of that competency delegate all kinds of responsibilities to the medical profession, medical professionals had better make sure their competency

Fuzzy method of recognition of high molecular substances in evidence-based biology

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Olevskyi, V. I.; Smetanin, V. T.; Olevska, Yu. B.

2017-10-01

Nowadays modern requirements to achieving reliable results along with high quality of researches put mathematical analysis methods of results at the forefront. Because of this, evidence-based methods of processing experimental data have become increasingly popular in the biological sciences and medicine. Their basis is meta-analysis, a method of quantitative generalization of a large number of randomized trails contributing to a same special problem, which are often contradictory and performed by different authors. It allows identifying the most important trends and quantitative indicators of the data, verification of advanced hypotheses and discovering new effects in the population genotype. The existing methods of recognizing high molecular substances by gel electrophoresis of proteins under denaturing conditions are based on approximate methods for comparing the contrast of electrophoregrams with a standard solution of known substances. We propose a fuzzy method for modeling experimental data to increase the accuracy and validity of the findings of the detection of new proteins.

An instrument to characterize the environment for residents' evidence-based medicine learning and practice.

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Mi, Misa; Moseley, James L; Green, Michael L

2012-02-01

Many residency programs offer training in evidence-based medicine (EBM). However, these curricula often fail to achieve optimal learning outcomes, perhaps because they neglect various contextual factors in the learning environment. We developed and validated an instrument to characterize the environment for EBM learning and practice in residency programs. An EBM Environment Scale was developed following scale development principles. A survey was administered to residents across six programs in primary care specialties at four medical centers. Internal consistency reliability was analyzed with Cronbach's coefficient alpha. Validity was assessed by comparing predetermined subscales with the survey's internal structure as assessed via factor analysis. Scores were also compared for subgroups based on residency program affiliation and residency characteristics. Out of 262 eligible residents, 124 completed the survey (response rate 47%). The overall mean score was 3.89 (standard deviation=0.56). The initial reliability analysis of the 48-item scale had a high reliability coefficient (Cronbach α=.94). Factor analysis and further item analysis resulted in a shorter 36-item scale with a satisfactory reliability coefficient (Cronbach α=.86). Scores were higher for residents with prior EBM training in medical school (4.14 versus 3.62) and in residency (4.25 versus 3.69). If further testing confirms its properties, the EBM Environment Scale may be used to understand the influence of the learning environment on the effectiveness of EBM training. Additionally, it may detect changes in the EBM learning environment in response to programmatic or institutional interventions.

Metrological Reliability of Medical Devices

Science.gov (United States)

Costa Monteiro, E.; Leon, L. F.

2015-02-01

The prominent development of health technologies of the 20th century triggered demands for metrological reliability of physiological measurements comprising physical, chemical and biological quantities, essential to ensure accurate and comparable results of clinical measurements. In the present work, aspects concerning metrological reliability in premarket and postmarket assessments of medical devices are discussed, pointing out challenges to be overcome. In addition, considering the social relevance of the biomeasurements results, Biometrological Principles to be pursued by research and innovation aimed at biomedical applications are proposed, along with the analysis of their contributions to guarantee the innovative health technologies compliance with the main ethical pillars of Bioethics.

The Path to a Reliable Supply of Medical Radioisotopes

International Nuclear Information System (INIS)

Gas, Serge; Westmacott, Chad; Cameron, Ron; Lokhov, Alexey

2011-06-01

Medical imaging techniques using technetium-99m account for roughly 80% of all nuclear medicine procedures, representing over 30 million examinations worldwide every year. Disruptions in the supply chain of these medical isotopes - which have half-lives of 66 hours for molybdenum-99 ( 99 Mo) and 6 hours for technetium-99m ( 99m Tc), and thus must be produced continually - can lead to cancellations or delays in important medical testing services. Unfortunately, supply reliability has declined over the past decade, due to unexpected or extended shutdowns at the few ageing, 99 Mo-producing, research reactors and processing facilities. These shutdowns have created global supply shortages. At the request of its member countries, the OECD Nuclear Energy Agency (NEA) established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) in 2009. During its two-year mandate, the HLG-MR assessed the factors rendering the supply chain vulnerable and identified practical measures - near, medium and long term - to ensure the security of supply of this important medical isotope. Building on its findings and assessments, the HLG-MR developed a comprehensive policy approach to encourage long-term supply security of 99 Mo/' 99m Tc, detailing the essential steps to be taken by governments, industry and the health community to address the vulnerabilities within the supply chain, including changing an economic structure that does not support or reinforce reliable supply

Availability and accessibility of evidence-based information resources provided by medical libraries in Australia.

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Ritchie, A; Sowter, B

2000-01-01

This article reports on the results of an exploratory survey of the availability and accessibility of evidence-based information resources provided by medical libraries in Australia. Although barriers impede access to evidence-based information for hospital clinicians, the survey revealed that Medline and Cinahl are available in over 90% of facilities. In most cases they are widely accessible via internal networks and the Internet. The Cochrane Library is available in 69% of cases. The Internet is widely accessible and most libraries provide access to some full-text, electronic journals. Strategies for overcoming restrictions and integrating information resources with clinical workflow are being pursued. State, regional and national public and private consortia are developing agreements utilising on-line technology. These could produce cost savings and more equitable access to a greater range of evidence-based resources.

Exact reliability quantification of highly reliable systems with maintenance

Energy Technology Data Exchange (ETDEWEB)

Bris, Radim, E-mail: radim.bris@vsb.c [VSB-Technical University Ostrava, Faculty of Electrical Engineering and Computer Science, Department of Applied Mathematics, 17. listopadu 15, 70833 Ostrava-Poruba (Czech Republic)

2010-12-15

When a system is composed of highly reliable elements, exact reliability quantification may be problematic, because computer accuracy is limited. Inaccuracy can be due to different aspects. For example, an error may be made when subtracting two numbers that are very close to each other, or at the process of summation of many very different numbers, etc. The basic objective of this paper is to find a procedure, which eliminates errors made by PC when calculations close to an error limit are executed. Highly reliable system is represented by the use of directed acyclic graph which is composed from terminal nodes, i.e. highly reliable input elements, internal nodes representing subsystems and edges that bind all of these nodes. Three admissible unavailability models of terminal nodes are introduced, including both corrective and preventive maintenance. The algorithm for exact unavailability calculation of terminal nodes is based on merits of a high-performance language for technical computing MATLAB. System unavailability quantification procedure applied to a graph structure, which considers both independent and dependent (i.e. repeatedly occurring) terminal nodes is based on combinatorial principle. This principle requires summation of a lot of very different non-negative numbers, which may be a source of an inaccuracy. That is why another algorithm for exact summation of such numbers is designed in the paper. The summation procedure uses benefits from a special number system with the base represented by the value 2{sup 32}. Computational efficiency of the new computing methodology is compared with advanced simulation software. Various calculations on systems from references are performed to emphasize merits of the methodology.

Challenges of Obtaining Evidence-Based Information Regarding Medications and Male Fertility.

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Drobnis, Erma Z; Nangia, Ajay K

2017-01-01

In the clinic, the existing literature is insufficient to counsel our infertile men on medication use. Most studies have flaws that limit their application to evidence-based practice. In this chapter, we discuss the limitations of the current literature and the challenges to designing more useful studies. Among the most important weaknesses of existing studies is lack of power; that is, too few men are included to draw conclusions about the existence and size of medication effects. Adequate power is particularly important when confirming an absence of medication effect. Bias is also a problem in most studies. Early studies were rarely randomized, placebo-controlled, or blinded; a common example is patients receiving different medication regimes based on the severity of their symptoms-making it impossible to attribute differences between treated and untreated men to the medications. Additional bias is introduced by failing to include other factors that influence the outcome in the experimental design. A uniform population amenable to randomization and placebo-control are experimental species, and useful information has been gained from these models. However, application to humans is limited by differences from other species in route of drug administration, absorption of the drug, concentration in the male genital tract tissues, and genital tract physiology. To a lesser degree, there is variation among individual men in their response to drugs. In addition, drugs in the same class may have different effects, limiting the applicability of data across drugs of a single class. Complicating matters further, a toxic medication may seem to improve fertility endpoints by improving a disease condition that diminishes fertility. Finally, drug interactions have not been studied, and actual fertility data (pregnancy/fecundity) in humans are rare. A healthy dose of skepticism is warranted when evaluating studies of medications and male reproductive health.

History of evidence-based medicine

Directory of Open Access Journals (Sweden)

Roger L Sur

2011-01-01

Full Text Available This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice.

Memorial Hermann: high reliability from board to bedside.

Science.gov (United States)

Shabot, M Michael; Monroe, Douglas; Inurria, Juan; Garbade, Debbi; France, Anne-Claire

2013-06-01

In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution. The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement--RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems. The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line-associated bloodstream and ventilator-associated pneumonias decreased to essentially zero. MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review.

Science.gov (United States)

Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe; Skou Thomsen, Ann Sofia; Konge, Lars

2015-07-27

Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence.

Development, Validation, and Implementation of a Medical Judgment Metric

Directory of Open Access Journals (Sweden)

Rami A. Ahmed DO, MHPE

2017-06-01

Full Text Available Background: Medical decision making is a critical, yet understudied, aspect of medical education. Aims: To develop the Medical Judgment Metric (MJM, a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. Methods: The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. Results: Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987 as well as their evaluation of the expected patient outcome (Fleiss’s Kappa 0.791 to 0.906. For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen’s Kappa 0.851 to 0.880. Discussion : The MJM demonstrated preliminary evidence of reliability and validity.

Leveraging Social Media to Promote Evidence-Based Continuing Medical Education.

Science.gov (United States)

Flynn, Simone; Hebert, Paul; Korenstein, Deborah; Ryan, Mark; Jordan, William B; Keyhani, Salomeh

2017-01-01

New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME). To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME. We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians. The National Physicians Alliance (NPA) membership. NPA e-mail recipients, Facebook followers and friends, and Twitter followers. Clicks to the NPA's CME landing site. On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (pmedia might not be a preferred vehicle for disseminating CME. Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

Science.gov (United States)

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised

Assessing adherence to the evidence base in the management of poststroke dysphagia.

Science.gov (United States)

Burton, Christopher; Pennington, Lindsay; Roddam, Hazel; Russell, Ian; Russell, Daphne; Krawczyk, Karen; Smith, Hilary A

2006-01-01

To evaluate the reliability and responsiveness to change of an audit tool to assess adherence to evidence of effectiveness in the speech and language therapy (SLT) management of poststroke dysphagia. The tool was used to review SLT practice as part of a randomized study of different education strategies. Medical records were audited before and after delivery of the trial intervention. Seventeen SLT departments in the north-west of England participated in the study. The assessment tool was used to assess the medical records of 753 patients before and 717 patients after delivery of the trial intervention across the 17 departments. A target of 10 records per department per month was sought, using systematic sampling with a random start. Inter- and intra-rater reliability were explored, together with the tool's internal consistency and responsiveness to change. The assessment tool had high face validity, although internal consistency was low (ra = 0.37). Composite scores on the tool were however responsive to differences between SLT departments. Both inter- and intra-rater reliability ranged from 'substantial' to 'near perfect' across all items. The audit tool has high face validity and measurement reliability. The use of a composite adherence score should, however, proceed with caution as internal consistency is low.

Highly reliable TOFD UT Technique

International Nuclear Information System (INIS)

Acharya, G.D.; Trivedi, S.A.R.; Pai, K.B.

2003-01-01

The high performance of the time of flight diffraction technique (TOFD) with regard to the detection capabilities of weld defects such as crack, slag, lack of fusion has led to a rapidly increasing acceptance of the technique as a pre?service inspection tool. Since the early 1990s TOFD has been applied to several projects, where it replaced the commonly used radiographic testing. The use of TOM lead to major time savings during new build and replacement projects. At the same time the TOFD technique was used as base line inspection, which enables monitoring in the future for critical welds, but also provides documented evidence for life?time. The TOFD technique as the ability to detect and simultaneously size flows of nearly any orientation within the weld and heat affected zone. TOM is recognized as a reliable, proven technique for detection and sizing of defects and proven to be a time saver, resulting in shorter shutdown periods and construction project times. Thus even in cases where inspection price of TOFD per welds is higher, in the end it will result in significantly lower overall costs and improve quality. This paper deals with reliability, economy, acceptance criteria and field experience. It also covers comparative study between radiography technique Vs. TOFD. (Author)

Training medical providers in evidence-based approaches to suicide prevention.

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DeHay, Tamara; Ross, Sarah; McFaul, Mimi

2015-01-01

Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here. © The Author(s) 2015.

Evidence-based competencies for improving communication skills in graduate medical education: a review with suggestions for implementation.

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Henry, Stephen G; Holmboe, Eric S; Frankel, Richard M

2013-05-01

Communicating with patients is arguably the most common and important activity in medical practice, but this activity receives relatively little emphasis in graduate medical education. We propose 12 evidence-based communication competencies that program directors can adopt as a framework for teaching and evaluating residents' communication skills. We review supporting evidence for these competencies and argue that communication should be treated like a procedural skill that must be taught and evaluated by observing real resident-patient interactions. We make practical suggestions for implementing these competencies by addressing three critical components of a competency-based approach to communication skills: patient safety, faculty development, and direct observation of residents. This approach to teaching and assessing communication skills provides a rationale for incorporating routine direct observation into graduate medical education programs and also for designing communication skills training that ensures graduating residents develop the skills needed to provide safe, effective patient care.

An Evidence Based Approach to Designing Medical Support for Long Duration, Interplanetary Missions

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Watkins, S. D.; McGrath, T. L.; Bauman, D. K.; Wu, J. H.; Barsten, K. N.; Barr, Y. R.; Kerstman, E. L.

2011-01-01

The Exploration Medical Capability (ExMC) element is one of six elements under NASA's Human Research Program (HRP). The goal of the ExMC element is to address the risk of the "inability to adequately recognize or treat an ill or injured crewmember." This poster highlights the evidence-based approach that the ExMC element has taken to address this goal, and the ExMC element's current areas of interest.

A study of Knowledge, Attitude and Self-Assessment of Residents on Evidence-Based Dentistry at Faculty of Dentistry of Tabriz University of Medical Sciences

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Maryam Pourkazemi

2016-06-01

Full Text Available Introduction: Evidence-based dentistry is the combination of individual clinical experiences withthe highest-quality evidence available as the result of systematic studies.Evidence-based dentistryis an approach in which the clinician uses the best evidence available to make the most appropriatedecision for the patient. In this descriptive study, the knowledge, attitude and self-assessment ofTabriz dental school residents were examined on evidence-based dentistry in the academic year2014-2015. Methods: All residents of Tabriz Dentistry Faculty (100 in total were enrolled in the study.Thedata collection tool was a questionnaire, and the validity of the questionnaire was determined inprevious studies. To determine the reliability of the questionnaire, it was distributed among the20 residents ina pilot study. Descriptive statistical methods were used to study the data obtained.Chi-square, t-test, and Kruskal-Wallis tests were used to assess the relationship between variablesusing SPSS 20. Results: The results showed that the level of residents’ knowledge on evidence-based dentistrywas moderate and 94.4% of residents had a positive attitude toward EBD. The highest and lowestself-assessments were related to the terms PubMed and Cochrane Collaboration (CI=29.27-30.73,CI=42.06-43.32 CI=28.69-31.09with 95%confidence interval, respectively. Conclusion: Given the increasing importance of evidence-based dentistry and considering themoderate knowledge of the residents on the topic, a need is felt for proper planning to teach itat Tabriz University of Medical Sciences. Considering dentists’ positive attitude toward EBD, Itseems that there is an appropriate background for EBD education in the country

Development of a questionnaire to assess medical competencies: Reliability and validity of the Questionnaire

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Giesler, Marianne; Forster, Johannes; Biller, Silke; Fabry, Götz

2011-01-01

Introduction: While preparing a graduate survey for medical education in 2008 we realized that no instrument existed that would be suitable to evaluate whether the learning outcomes outlined in the Medical Licensure Act (ÄAppO) would be met. Therefore we developed the Freiburg Questionnaire to Assess Competencies in Medicine (Freiburger Fragebogen zur Erfassung von Kompetenzen in der Medizin, FKM)1 which has been revised and extended several times since then. Currently the FKM includes 45 items which are assigned to nine domains that correspond to the CanMEDS roles: medical expertise, communication, team-work, health and prevention, management, professionalism, learning, scholarship, and personal competencies. Methods: In order to test the reliability and validity of the questionnaire we have repeatedly surveyed medical students and residents since May 2008. In this article we report on the results of a cross-sectional study with 698 medical students from the preclinical and clinical years. In addition, we report the results of a survey of 514 residents who were up to two years into their residency. Results and conclusions: In summary, results show that the scales of the FKM are reliable (Cronbach’s α between .68 and .97). Significant differences in means between selected groups of students support the measure’s construct validity. Furthermore, there is evidence that the FKM might be used as a screening tool e.g. in graduate surveys to identify weaknesses in the medical education curriculum. PMID:21818241

What is the Best Evidence Medical Education?

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Rasoul Masoomi

2012-07-01

Full Text Available Best Evidence Medical Education (BEME is defined as: “The implementation by teachers and educational bodies in their practice, of methods and approaches to education based on the best evidence available.” Five steps have been recognized in the practice of BEME. These are: framing the question, developing a search strategy, evaluating the evidence, implementing change and evaluating that change. In this paper, I described the concept of BEME, its steps, and challenges.

Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

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Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

2017-08-07

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia.

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El-Mallakh, Peggy; Howard, Patricia B; Rayens, Mary Kay; Roque, Autumn P; Adkins, Sarah

2013-11-01

Organizational support is essential for successful implementation of evidence-based practice (EBP) in clinical settings. This 3-year study used a mixed qualitative and quantitative design to implement a medication management EBP in the treatment of schizophrenia in six community mental health clinics in a south-central state of the United States. Findings from organizational fidelity assessments indicate that support for EBP implementation was moderate. Organizational support was highest for prescriber access to relevant patient information at each medication visit, scheduling flexibility for patients' urgent problems, and availability of medication guidelines. Organizational support was lowest for medication availability and identification of treatment refractory patients. Findings suggest that leadership is essential to support successful implementation. Nurse educators can incorporate implementation research and leadership training into graduate nursing programs to facilitate successful EBP implementation in practice settings. Copyright 2013, SLACK Incorporated.

Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

DEFF Research Database (Denmark)

Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

2015-01-01

OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliabi......OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

Epistemologic inquiries in evidence-based medicine.

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Djulbegovic, Benjamin; Guyatt, Gordon H; Ashcroft, Richard E

2009-04-01

Since the term "evidence-based medicine" (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public,and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, education, criminology, and social work. Yet, EBM has attracted controversy: its critics allege that EBM uses a narrow concept of evidence and a naive conception of the relationships between evidence, theory, and practice. They also contend that EBM presents itself as a radical restructuring of medical knowledge that discredits more traditional ways of knowing in medicine, largely in the interests of people with a particular investment in the enterprise of large-scale clinical trials. Because EBM proposes aspecific relationship between theory, evidence, and knowledge, its theoretical basis can be understood as an epistemological system. Undertaking epistemological inquiry is important because the adoption of a particular epistemological view defines how science is conducted. In this paper, we challenge this critical view of EBM by examining how EBM fits into broad epistemological debates within the philosophy of science. We consider how EBM relates to some classical debates regarding the nature of science and knowledge. We investigate EBM from the perspective of major epistemological theories (logical-positivism/inductivism, deductivism/falsificationism/theory-ladeness of observations, explanationism/holism, instrumentalism, underdetermination theory by evidence). We first explore the relationship between evidence and knowledge and discuss philosophical support for the main way that evidence is used in medicine: (1) in the philosophical tradition that "rational thinkers respect their evidence," we show that EBM refers to making medical decisions that are consistent with evidence, (2) as a reliable sign, symptom, or mark to

A novel strategy to access high resolution DICOM medical images based on JPEG2000 interactive protocol

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Tian, Yuan; Cai, Weihua; Sun, Jianyong; Zhang, Jianguo

2008-03-01

The demand for sharing medical information has kept rising. However, the transmission and displaying of high resolution medical images are limited if the network has a low transmission speed or the terminal devices have limited resources. In this paper, we present an approach based on JPEG2000 Interactive Protocol (JPIP) to browse high resolution medical images in an efficient way. We designed and implemented an interactive image communication system with client/server architecture and integrated it with Picture Archiving and Communication System (PACS). In our interactive image communication system, the JPIP server works as the middleware between clients and PACS servers. Both desktop clients and wireless mobile clients can browse high resolution images stored in PACS servers via accessing the JPIP server. The client can only make simple requests which identify the resolution, quality and region of interest and download selected portions of the JPEG2000 code-stream instead of downloading and decoding the entire code-stream. After receiving a request from a client, the JPIP server downloads the requested image from the PACS server and then responds the client by sending the appropriate code-stream. We also tested the performance of the JPIP server. The JPIP server runs stably and reliably under heavy load.

Evidence-based medicine Training: Kazakhstan experience.

Science.gov (United States)

Kamalbekova, G; Kalieva, M

2015-01-01

practice. These were: failure in implementing, lack of understanding on the part of colleagues, commitment to traditional obsolete methods of treatment, discrepancy between some of the existing standards of diagnosis and treatment and principles of evidence-based medicine.To the question: «Are there any end products after listening to the seminar?» 67% of the respondents answered in affirmative. The end products were mainly marked by the publication of articles and abstracts, including international publications, and participation in the working group on the revision and development of clinical protocols. Barriers to implementation of Evidence-Based Medicine in education and practice are lack of funding to provide access to reliable sources of information, websites; outdated research methodology skills in medical education, lack of skills in critical evaluation of medical information; tradition of authoritarian relationships, use of past experience stencils; failure to comply with continuing education programs ("from training to professional development"). Knowledge of Evidence-Based Medicine, skills to perform searches for scientific data, to evaluate their validity and to transform scientific data into practical solutions are necessary for health workers in their daily activities. This culture needs to be rooted in modern medical education.

Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9 among patients on antihypertensive medications

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Desrosiers Marie-Pierre

2009-04-01

Full Text Available Abstract Background The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9, derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication. Methods A total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA. Results A total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test

Expert consensus v. evidence-based approaches in the revision of the DSM.

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Kendler, K S; Solomon, M

2016-08-01

The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions - which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process - should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.

Development and evaluation of a computer-based medical work assessment programme

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Spallek Michael

2008-12-01

Full Text Available Abstract Background There are several ways to conduct a job task analysis in medical work environments including pencil-paper observations, interviews and questionnaires. However these methods implicate bias problems such as high inter-individual deviations and risks of misjudgement. Computer-based observation helps to reduce these problems. The aim of this paper is to give an overview of the development process of a computer-based job task analysis instrument for real-time observations to quantify the job tasks performed by physicians working in different medical settings. In addition reliability and validity data of this instrument will be demonstrated. Methods This instrument was developed in consequential steps. First, lists comprising tasks performed by physicians in different care settings were classified. Afterwards content validity of task lists was proved. After establishing the final task categories, computer software was programmed and implemented in a mobile personal computer. At least inter-observer reliability was evaluated. Two trained observers recorded simultaneously tasks of the same physician. Results Content validity of the task lists was confirmed by observations and experienced specialists of each medical area. Development process of the job task analysis instrument was completed successfully. Simultaneous records showed adequate interrater reliability. Conclusion Initial results of this analysis supported the validity and reliability of this developed method for assessing physicians' working routines as well as organizational context factors. Based on results using this method, possible improvements for health professionals' work organisation can be identified.

Human reliability in high dose rate afterloading radiotherapy based on FMECA

International Nuclear Information System (INIS)

Deng Jun; Fan Yaohua; Yue Baorong; Wei Kedao; Ren Fuli

2012-01-01

Objective: To put forward reasonable and feasible recommendations against the procedure with relative high risk during the high dose rate (HDR) afterloading radiotherapy, so as to enhance its clinical application safety, through studying the human reliability in the process of carrying out the HDR afterloading radiotherapy. Methods: Basic data were collected by on-site investigation and process analysis as well as expert evaluation. Failure mode, effect and criticality analysis (FMECA) employed to study the human reliability in the execution of HDR afterloading radiotherapy. Results: The FMECA model of human reliability for HDR afterloading radiotherapy was established, through which 25 procedures with relative high risk index were found,accounting for 14.1% of total 177 procedures. Conclusions: FMECA method in human reliability study for HDR afterloading radiotherapy is feasible. The countermeasures are put forward to reduce the human error, so as to provide important basis for enhancing clinical application safety of HDR afterloading radiotherapy. (authors)

Reliability assessment using Bayesian networks. Case study on quantative reliability estimation of a software-based motor protection relay

International Nuclear Information System (INIS)

Helminen, A.; Pulkkinen, U.

2003-06-01

In this report a quantitative reliability assessment of motor protection relay SPAM 150 C has been carried out. The assessment focuses to the methodological analysis of the quantitative reliability assessment using the software-based motor protection relay as a case study. The assessment method is based on Bayesian networks and tries to take the full advantage of the previous work done in a project called Programmable Automation System Safety Integrity assessment (PASSI). From the results and experiences achieved during the work it is justified to claim that the assessment method presented in the work enables a flexible use of qualitative and quantitative elements of reliability related evidence in a single reliability assessment. At the same time the assessment method is a concurrent way of reasoning one's beliefs and references about the reliability of the system. Full advantage of the assessment method is taken when using the method as a way to cultivate the information related to the reliability of software-based systems. The method can also be used as a communicational instrument in a licensing process of software-based systems. (orig.)

Awareness and use of evidence-based medicine information among patients in Croatia: a nation-wide cross-sectional study.

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Nejašmić, Danijel; Miošić, Ivana; Vrdoljak, Davorka; Permozer Hajdarović, Snježana; Tomičić, Marion; Gmajnić, Rudika; Diminić Lisica, Ines; Sironić Hreljanović, Jelena; Pleh, Vlatka; Cerovečki, Venija; Tomljenović, Anita; Bekić, Sanja; Jerčić, Minka; Tuđa, Karla; Puljak, Livia

2017-08-31

To determine the use of evidence-based medicine (EBM) information and the level of awareness and knowledge of EBM among patients in Croatia. A cross-sectional study was conducted among 987 patients in 10 family medicine practices in Croatia. Patients from both urban (n=496) and rural (n=482) areas were surveyed. A 27-item questionnaire was used to collect data about sources that patients searched for medical information, patient awareness and use of Cochrane systematic reviews and other EBM resources, and their demographic characteristics. Half of the patients searched for medical information from sources other than physician. Internet was the most common place they searched for information. Very few patients indicated using EBM sources for medical information; one fifth of patients heard of EBM and 4% of the patients heard of the Cochrane Collaboration. Patients considered physician's opinion as the most reliable source of medical information. A logistic regression model showed that educational level and urban vs rural residence were the predictors of awareness about EBM and systematic reviews (P<0.001 for both). Our finding that patients consider a physician's opinion to be the most reliable source of health-related information could be used for promotion of high-quality health information among patients. More effort should be devoted to the education of patients in rural areas and those with less formal education. New avenues for knowledge translation and dissemination of high-quality health information among patients are necessary.

[Reliability and validity of assessment of educational outcomes obtained by students of Medical Rescue at Medical University of Warsaw].

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Panczyk, Mariusz; Stachacz, Grzegorz; Gałązkowski, Robert; Gotlib, Joanna

2016-01-01

In the interest of preservation of high degree of objectivity of information about students' educational outcomes, a system of assessment needs to meet criteria of appropriate reliability and validity. Analysis of reliability and validity of the system of assessment of students' educational outcomes for courses followed by an examination and covered by a curriculum in Medical Rescue at Medical University of Warsaw (MU W). A retrospective study enrolling a group of 421 students of eight subsequent full education cycles. Detailed data concerning grades for fourteen courses followed by an examination in the entire course of studies were collected. Reliability (Cronbach's alpha coefficient) and criteria validity (Spearman's rank correlation) were assessed. Internal consistency was estimated using a multiple regression model. The levels of assessment reliability for the general university, pre-clinical, and clinical scopes amounted to alpha: 0.42, 0.53, and 0.70, respectively. The strongest positive correlations between the results of pre-clinical and clinical trainings were found for the Anatomy course (r ≈ 0.30). Only in the case of the Pharmacology course it was found that students' achievements in this field were significantly correlated with all other courses of clinical training. The influence of educational outcomes in particular areas of clinical training on the final grade for the entire course of studies was diverse (β regression between 0.04 and 0.11). While the Pharmacology course had the strongest impact on final results, the Surgery course had the least influence on students' final grades (β = 0.04). 1. Sufficient reliability of the system of assessment of educational outcomes in Medical Rescue showed good precision and repeatability of assessment. 2. A low level of validity was caused by a failure to keep the appropriateness of the assessment of educational outcomes in several clinical courses. 3. Prognostic and diagnostic validity of methods used for

Evidence Based Medicine Teaching in Undergraduate Medical Education: A Literature Review

Directory of Open Access Journals (Sweden)

Misa Mi

2012-09-01

Full Text Available Objectives – To determine the year when evidence based medicine (EBM wasintroduced and the extent to which medical students were exposed to EBM inundergraduate medical education and to investigate how EBM interventions weredesigned, developed, implemented, and evaluated in the medical curriculum.Methods – A qualitative review of the literature on EBM interventions was conductedto synthesize results of studies published from January 1997 to December 2011. Acomprehensive search was performed on PubMed, CINAHL, Web of Science,Cochrane Library, ProQuest Dissertations & Theses, PsycINFO, and ERIC. Articleswere selected if the studies involved some form of quantitative and qualitativeresearch design. Articles were excluded if they studied EBM interventions in medicalschools outside the United States or if they examined EBM interventions for alliedhealth profession education or at the levels of graduate medical education andcontinuing medical education. Thirteen studies which met the selection criteria wereidentified and reviewed. Information was abstracted including study design, year andsetting of EBM intervention, instructional method, instruction delivery format,outcome measured, and evaluation method.Results – EBM was introduced to preclinical years in three studies, integrated intoclinical clerkship rotations in primary care settings in eight studies, and spannedpreclinical and clinical curricula in two studies. The duration of EBM interventionsdiffered, ranging from a workshop of three student contact hours to a curriculum of 30 student contact hours. Five studies incorporated interactive and clinically integrated teaching and learning activities to support student learning. Diverse research designs, EBM interventions, and evaluation methods resulted in heterogeneity in results across the 13 studies.Conclusions – The review reveals wide variations in duration of EBM interventions, instructional methods, delivery formats for EBM

Average effect estimates remain similar as evidence evolves from single trials to high-quality bodies of evidence: a meta-epidemiologic study.

Science.gov (United States)

Gartlehner, Gerald; Dobrescu, Andreea; Evans, Tammeka Swinson; Thaler, Kylie; Nussbaumer, Barbara; Sommer, Isolde; Lohr, Kathleen N

2016-01-01

The objective of our study was to use a diverse sample of medical interventions to assess empirically whether first trials rendered substantially different treatment effect estimates than reliable, high-quality bodies of evidence. We used a meta-epidemiologic study design using 100 randomly selected bodies of evidence from Cochrane reports that had been graded as high quality of evidence. To determine the concordance of effect estimates between first and subsequent trials, we applied both quantitative and qualitative approaches. For quantitative assessment, we used Lin's concordance correlation and calculated z-scores; to determine the magnitude of differences of treatment effects, we calculated standardized mean differences (SMDs) and ratios of relative risks. We determined qualitative concordance based on a two-tiered approach incorporating changes in statistical significance and magnitude of effect. First trials both overestimated and underestimated the true treatment effects in no discernible pattern. Nevertheless, depending on the definition of concordance, effect estimates of first trials were concordant with pooled subsequent studies in at least 33% but up to 50% of comparisons. The pooled magnitude of change as bodies of evidence advanced from single trials to high-quality bodies of evidence was 0.16 SMD [95% confidence interval (CI): 0.12, 0.21]. In 80% of comparisons, the difference in effect estimates was smaller than 0.5 SMDs. In first trials with large treatment effects (>0.5 SMD), however, estimates of effect substantially changed as new evidence accrued (mean change 0.68 SMD; 95% CI: 0.50, 0.86). Results of first trials often change, but the magnitude of change, on average, is small. Exceptions are first trials that present large treatment effects, which often dissipate as new evidence accrues. Copyright © 2016 Elsevier Inc. All rights reserved.

Perceptual attraction in tool use: evidence for a reliability-based weighting mechanism.

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Debats, Nienke B; Ernst, Marc O; Heuer, Herbert

2017-04-01

Humans are well able to operate tools whereby their hand movement is linked, via a kinematic transformation, to a spatially distant object moving in a separate plane of motion. An everyday example is controlling a cursor on a computer monitor. Despite these separate reference frames, the perceived positions of the hand and the object were found to be biased toward each other. We propose that this perceptual attraction is based on the principles by which the brain integrates redundant sensory information of single objects or events, known as optimal multisensory integration. That is, 1 ) sensory information about the hand and the tool are weighted according to their relative reliability (i.e., inverse variances), and 2 ) the unisensory reliabilities sum up in the integrated estimate. We assessed whether perceptual attraction is consistent with optimal multisensory integration model predictions. We used a cursor-control tool-use task in which we manipulated the relative reliability of the unisensory hand and cursor position estimates. The perceptual biases shifted according to these relative reliabilities, with an additional bias due to contextual factors that were present in experiment 1 but not in experiment 2 The biased position judgments' variances were, however, systematically larger than the predicted optimal variances. Our findings suggest that the perceptual attraction in tool use results from a reliability-based weighting mechanism similar to optimal multisensory integration, but that certain boundary conditions for optimality might not be satisfied. NEW & NOTEWORTHY Kinematic tool use is associated with a perceptual attraction between the spatially separated hand and the effective part of the tool. We provide a formal account for this phenomenon, thereby showing that the process behind it is similar to optimal integration of sensory information relating to single objects. Copyright © 2017 the American Physiological Society.

Statistical reliability assessment of software-based systems

International Nuclear Information System (INIS)

Korhonen, J.; Pulkkinen, U.; Haapanen, P.

1997-01-01

Plant vendors nowadays propose software-based systems even for the most critical safety functions. The reliability estimation of safety critical software-based systems is difficult since the conventional modeling techniques do not necessarily apply to the analysis of these systems, and the quantification seems to be impossible. Due to lack of operational experience and due to the nature of software faults, the conventional reliability estimation methods can not be applied. New methods are therefore needed for the safety assessment of software-based systems. In the research project Programmable automation systems in nuclear power plants (OHA), financed together by the Finnish Centre for Radiation and Nuclear Safety (STUK), the Ministry of Trade and Industry and the Technical Research Centre of Finland (VTT), various safety assessment methods and tools for software based systems are developed and evaluated. This volume in the OHA-report series deals with the statistical reliability assessment of software based systems on the basis of dynamic test results and qualitative evidence from the system design process. Other reports to be published later on in OHA-report series will handle the diversity requirements in safety critical software-based systems, generation of test data from operational profiles and handling of programmable automation in plant PSA-studies. (orig.) (25 refs.)

Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department.

Science.gov (United States)

Manning, Michael W; Bean, Eric W; Miller, Andrew C; Templer, Suzanne J; Mackenzie, Richard S; Richardson, David M; Bresnan, Kristin A; Greenberg, Marna R

2018-01-01

The Association of American Medical Colleges' (AAMC) initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to "identify system failures and contribute to a culture of safety and improvement." We set out to determine the feasibility of using medical students' action learning projects (ALPs) to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED) setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism). These prospective quality improvement (QI) initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management) to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home) for patients. Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders' positions that were involved in the respective patient's care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students' projects. After implementation, 86% (38/44) of queried ED providers felt comfortable with medical students being a part of future ED QI

Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes From a Multisite Study of Clinical Performance Examinations in Seven Medical Schools.

Science.gov (United States)

Park, Yoon Soo; Hyderi, Abbas; Heine, Nancy; May, Win; Nevins, Andrew; Lee, Ming; Bordage, Georges; Yudkowsky, Rachel

2017-11-01

To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlations), and consequences (composite score). Student performance varied by case and task. In the PNs, justification of differential diagnosis was the most discriminating task. G-studies showed that schools accounted for less than 1% of total variance; however, for the PNs, there were differences in scores for varying cases and tasks across schools, indicating a school effect. Composite score reliability was maximized when the PN was weighted between 30% and 40%. Raters preferred using case-specific scoring guidelines with clear point-scoring systems. This multisite study presents validity evidence for PN scores based on scoring rubric and case-specific scoring guidelines that offer rigor and feedback for learners. Variability in PN scores across participating sites may signal different approaches to teaching clinical reasoning among medical schools.

Reliability-Based Code Calibration

DEFF Research Database (Denmark)

Faber, M.H.; Sørensen, John Dalsgaard

2003-01-01

The present paper addresses fundamental concepts of reliability based code calibration. First basic principles of structural reliability theory are introduced and it is shown how the results of FORM based reliability analysis may be related to partial safety factors and characteristic values....... Thereafter the code calibration problem is presented in its principal decision theoretical form and it is discussed how acceptable levels of failure probability (or target reliabilities) may be established. Furthermore suggested values for acceptable annual failure probabilities are given for ultimate...... and serviceability limit states. Finally the paper describes the Joint Committee on Structural Safety (JCSS) recommended procedure - CodeCal - for the practical implementation of reliability based code calibration of LRFD based design codes....

Using patients' charts to assess medical trainees in the workplace: a systematic review.

Science.gov (United States)

Al-Wassia, Heidi; Al-Wassia, Rolina; Shihata, Shadi; Park, Yoon Soo; Tekian, Ara

2015-04-01

The objective of this review is to summarize and critically appraise existing evidence on the use of chart stimulated recall (CSR) and case-based discussion (CBD) as an assessment tool for medical trainees. Medline, Embase, CINAHL, PsycINFO, Educational Resources Information Centre (ERIC), Web of Science, and the Cochrane Central Register of Controlled Trials were searched for original articles on the use of CSR or CBD as an assessment method for trainees in all medical specialties. Four qualitative and three observational non-comparative studies were eligible for this review. The number of patient-chart encounters needed to achieve sufficient reliability varied across studies. None of the included studies evaluated the content validity of the tool. Both trainees and assessors expressed high level of satisfaction with the tool; however, inadequate training, different interpretation of the scoring scales and skills needed to give feedback were addressed as limitations for conducting the assessment. There is still no compelling evidence for the use of patient's chart to evaluate medical trainees in the workplace. A body of evidence that is valid, reliable, and documents the educational effect in support of the use of patients' charts to assess medical trainees is needed.

The Internet School of Medicine: use of electronic resources by medical trainees and the reliability of those resources.

Science.gov (United States)

Egle, Jonathan P; Smeenge, David M; Kassem, Kamal M; Mittal, Vijay K

2015-01-01

Electronic sources of medical information are plentiful, and numerous studies have demonstrated the use of the Internet by patients and the variable reliability of these sources. Studies have investigated neither the use of web-based resources by residents, nor the reliability of the information available on these websites. A web-based survey was distributed to surgical residents in Michigan and third- and fourth-year medical students at an American allopathic and osteopathic medical school and a Caribbean allopathic school regarding their preferred sources of medical information in various situations. A set of 254 queries simulating those faced by medical trainees on rounds, on a written examination, or during patient care was developed. The top 5 electronic resources cited by the trainees were evaluated for their ability to answer these questions accurately, using standard textbooks as the point of reference. The respondents reported a wide variety of overall preferred resources. Most of the 73 responding medical trainees favored textbooks or board review books for prolonged studying, but electronic resources are frequently used for quick studying, clinical decision-making questions, and medication queries. The most commonly used electronic resources were UpToDate, Google, Medscape, Wikipedia, and Epocrates. UpToDate and Epocrates had the highest percentage of correct answers (47%) and Wikipedia had the lowest (26%). Epocrates also had the highest percentage of wrong answers (30%), whereas Google had the lowest percentage (18%). All resources had a significant number of questions that they were unable to answer. Though hardcopy books have not been completely replaced by electronic resources, more than half of medical students and nearly half of residents prefer web-based sources of information. For quick questions and studying, both groups prefer Internet sources. However, the most commonly used electronic resources fail to answer clinical queries more than half

Final year medical students' views on simulation-based teaching: a comparison with the Best Evidence Medical Education Systematic Review.

Science.gov (United States)

Paskins, Zoë; Peile, Ed

2010-01-01

Simulation is being increasingly used in medical education. The aim of this study was to explore in more depth the features of simulation-based teaching that undergraduate medical students value using the Best Evidence Medical Education (BEME) Systematic Review features that lead to effective learning as a framework. Thematic analysis of four semi-structured focus groups with final year medical students who had been taught acute care skills using a medium-fidelity whole-body simulator manikin (SimMan). Twelve key themes were identified, namely, feedback, integration into curriculum, learning style, learning environment, realism, teamwork, communication skills, confidence/increased self-efficacy, anxiety, performance, perceptions of foundation year 1 (FY1) and SimMan as a resource. Each theme is described with supporting quotes. Six of the ten features listed in the BEME review appeared to be of particular value to the medical students. This study provides a richer understanding of these features. In addition, new insights into the effect of simulation on confidence, anxiety and self-efficacy are discussed which may be affected by the 'performance' nature of simulation role-play. Students also contribute critical thought about the use of SimMan as a resource and provide novel ideas for reducing 'downtime'.

High-reliability computing for the smarter planet

International Nuclear Information System (INIS)

Quinn, Heather M.; Graham, Paul; Manuzzato, Andrea; Dehon, Andre

2010-01-01

The geometric rate of improvement of transistor size and integrated circuit performance, known as Moore's Law, has been an engine of growth for our economy, enabling new products and services, creating new value and wealth, increasing safety, and removing menial tasks from our daily lives. Affordable, highly integrated components have enabled both life-saving technologies and rich entertainment applications. Anti-lock brakes, insulin monitors, and GPS-enabled emergency response systems save lives. Cell phones, internet appliances, virtual worlds, realistic video games, and mp3 players enrich our lives and connect us together. Over the past 40 years of silicon scaling, the increasing capabilities of inexpensive computation have transformed our society through automation and ubiquitous communications. In this paper, we will present the concept of the smarter planet, how reliability failures affect current systems, and methods that can be used to increase the reliable adoption of new automation in the future. We will illustrate these issues using a number of different electronic devices in a couple of different scenarios. Recently IBM has been presenting the idea of a 'smarter planet.' In smarter planet documents, IBM discusses increased computer automation of roadways, banking, healthcare, and infrastructure, as automation could create more efficient systems. A necessary component of the smarter planet concept is to ensure that these new systems have very high reliability. Even extremely rare reliability problems can easily escalate to problematic scenarios when implemented at very large scales. For life-critical systems, such as automobiles, infrastructure, medical implantables, and avionic systems, unmitigated failures could be dangerous. As more automation moves into these types of critical systems, reliability failures will need to be managed. As computer automation continues to increase in our society, the need for greater radiation reliability is necessary

High-reliability computing for the smarter planet

Energy Technology Data Exchange (ETDEWEB)

Quinn, Heather M [Los Alamos National Laboratory; Graham, Paul [Los Alamos National Laboratory; Manuzzato, Andrea [UNIV OF PADOVA; Dehon, Andre [UNIV OF PENN; Carter, Nicholas [INTEL CORPORATION

2010-01-01

The geometric rate of improvement of transistor size and integrated circuit performance, known as Moore's Law, has been an engine of growth for our economy, enabling new products and services, creating new value and wealth, increasing safety, and removing menial tasks from our daily lives. Affordable, highly integrated components have enabled both life-saving technologies and rich entertainment applications. Anti-lock brakes, insulin monitors, and GPS-enabled emergency response systems save lives. Cell phones, internet appliances, virtual worlds, realistic video games, and mp3 players enrich our lives and connect us together. Over the past 40 years of silicon scaling, the increasing capabilities of inexpensive computation have transformed our society through automation and ubiquitous communications. In this paper, we will present the concept of the smarter planet, how reliability failures affect current systems, and methods that can be used to increase the reliable adoption of new automation in the future. We will illustrate these issues using a number of different electronic devices in a couple of different scenarios. Recently IBM has been presenting the idea of a 'smarter planet.' In smarter planet documents, IBM discusses increased computer automation of roadways, banking, healthcare, and infrastructure, as automation could create more efficient systems. A necessary component of the smarter planet concept is to ensure that these new systems have very high reliability. Even extremely rare reliability problems can easily escalate to problematic scenarios when implemented at very large scales. For life-critical systems, such as automobiles, infrastructure, medical implantables, and avionic systems, unmitigated failures could be dangerous. As more automation moves into these types of critical systems, reliability failures will need to be managed. As computer automation continues to increase in our society, the need for greater radiation reliability is

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

Science.gov (United States)

Mousavi, Seyed Mohammad Hadi; Dargahi, Hossein; Mohammadi, Sara

2016-10-01

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it

Teaching evidence-based medical care: description and evaluation.

Science.gov (United States)

Grad, R; Macaulay, A C; Warner, M

2001-09-01

This paper describes and evaluates several years of a seminar series designed to stimulate residents to seek evidence-based answers to their clinical questions and incorporate this evidence into practice. At the first session, 86 of 89 (97%) residents completed a baseline needs assessment questionnaire. Post-course self-assessment questionnaires measured change from the first to the final seminar session in six domains of interest and skill, as well as residents' preferred sources of information for clinical problem solving up to 2 years after the course. Before the seminars, 48% of residents reported that textbooks were their most important source of information for solving clinical problems. A total of 58 of 75 (77%) residents completed the first post-course questionnaire. Residents reported significant increases in skill at formulating clinical questions and searching for evidence-based answers, appraising reviews, and deciding when and how to incorporate new findings into practice. Use of secondary sources of information such as "Best Evidence," moved up in importance from before the course to after the course. First-year family practice residents who completed our seminar series have reported increased skill at blending consideration of a clinical problem with the use of secondary sources of information to access evidence to support their health care decisions.

Improving data retrieval quality: Evidence based medicine perspective.

Science.gov (United States)

Kamalov, M; Dobrynin, V; Balykina, J; Kolbin, A; Verbitskaya, E; Kasimova, M

2015-01-01

The actively developing approach in modern medicine is the approach focused on principles of evidence-based medicine. The assessment of quality and reliability of studies is needed. However, in some cases studies corresponding to the first level of evidence may contain errors in randomized control trials (RCTs). Solution of the problem is the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Studies both in the fields of medicine and information retrieval are conducted for developing search engines for the MEDLINE database [1]; combined techniques for summarization and information retrieval targeted to solving problems of finding the best medication based on the levels of evidence are being developed [2]. Based on the relevance and demand for studies both in the field of medicine and information retrieval, it was decided to start the development of a search engine for the MEDLINE database search on the basis of the Saint-Petersburg State University with the support of Pavlov First Saint-Petersburg State Medical University and Tashkent Institute of Postgraduate Medical Education. Novelty and value of the proposed system are characterized by the use of ranking method of relevant abstracts. It is suggested that the system will be able to perform ranking based on studies level of evidence and to apply GRADE criteria for system evaluation. The assigned task falls within the domain of information retrieval and machine learning. Based on the results of implementation from previous work [3], in which the main goal was to cluster abstracts from MEDLINE database by subtypes of medical interventions, a set of algorithms for clustering in this study was selected: K-means, K-means ++, EM from the sklearn (http://scikit-learn.org) and WEKA (http://www.cs.waikato.ac.nz/~ml/weka/) libraries, together with the methods of Latent Semantic Analysis (LSA) [4] choosing the first 210 facts and the model "bag of words" [5] to represent clustered documents

Trainees' Perceptions of Feedback: Validity Evidence for Two FEEDME (Feedback in Medical Education) Instruments.

Science.gov (United States)

Bing-You, Robert; Ramesh, Saradha; Hayes, Victoria; Varaklis, Kalli; Ward, Denham; Blanco, Maria

2018-01-01

Construct: Medical educators consider feedback a core component of the educational process. Effective feedback allows learners to acquire new skills, knowledge, and attitudes. Learners' perceptions of feedback are an important aspect to assess with valid methods in order to improve the feedback skills of educators and the feedback culture. Although guidelines for delivering effective feedback have existed for several decades, medical students and residents often indicate that they receive little feedback. A recent scoping review on feedback in medical education did not reveal any validity evidence on instruments to assess learner's perceptions of feedback. The purpose of our study was to gather validity evidence on two novel FEEDME (Feedback in Medical Education) instruments to assess medical students' and residents' perceptions of the feedback that they receive. After the authors developed an initial instrument with 54 items, cognitive interviews with medical students and residents suggested that 2 separate instruments were needed, one focused on the feedback culture (FEEDME-Culture) and the other on the provider of feedback (FEEDME-Provider). A Delphi study with 17 medical education experts and faculty members assessed content validity. The response process was explored involving 31 medical students and residents at 2 academic institutions. Exploratory factor analysis and reliability analyses were performed on completed instruments. Two Delphi consultation rounds refined the wording of items and eliminated several items. Learners found both instruments easy and quick to answer; it took them less than 5 minutes to complete. Learners preferred an electronic format of the instruments over paper. Factor analysis revealed a two- and three-factor solution for the FEEDME-Culture and FEEDME-Provider instruments, respectively. Cronbach's alpha was greater than 0.80 for all factors. Items on both instruments were moderately to highly correlated (range, r = .3-.7). Our

Implementation of evidence-based medicine in a health promotion teaching block for Thai medical students.

Science.gov (United States)

Liabsuetrakul, Tippawan; Suntharasaj, Thitima; Sangsupawanich, Pasuree; Kongkamol, Chanon; Pornsawat, Panumad

2017-12-01

Evidence-based medicine (EBM) is well known in medical practice. Although health promotion (HP) is promoted worldwide, there is still some debate as to whether EBM is needed or useful in the teaching of health promotion. To assess the perceived usefulness of EBM in the teaching of HP among medical students and faculty members. A comparative study was conducted between two groups of fourth-year medical students in the academic year 2012 during the five-week Health Promotion Teaching Block at Prince of Songkla University, southern Thailand. A one-week EBM course was conducted with half the students in the first week of the block and the other half of the students in the last week of the block. All activities in the HP block were similar except for the different periods of the one-week of EBM teaching. The effect on knowledge, ability and perceived application of EBM in future practice was assessed by student self-evaluations before versus after taking the EBM course, and by faculty member evaluation of the students' end-of-block presentations. All evaluation items were rated from 1 (lowest) to 5 (highest). Data were analyzed using a t-test or Wilcoxon test, as appropriate. The students' self-evaluations of knowledge and ability on EBM between the two groups were similar. The perception that teaching EBM is beneficial in health promotion and future practice increased significantly ( phigher scores for the first group than the second group, although the rating differences were not at the level of significance. Ninety percent of the students believed that EBM was a useful addition to the teaching of HP. Medical students and faculty members perceived that EBM is useful in the HP context. Future studies to evaluate the effect of using evidence-based teaching for health promotion are needed.

Continuing medical education effect on physician knowledge: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

Science.gov (United States)

Bordage, Georges; Carlin, Brian; Mazmanian, Paul E

2009-03-01

Physicians are continuously engaging in continuing medical education (CME) activities. Whether CME activities actually improve their knowledge and whether multiple media, instructional techniques, and exposures are better than single experiences are questions that are still under discussion. The Johns Hopkins Evidence-based Practice Center for Healthcare Research and Quality conducted a systematic review of the effectiveness of CME (Agency for Healthcare Research and Quality Evidence Report) from which the guideline panel used 28 (+/- 2) studies to answer these questions about improvements in knowledge. The studies were selected based on the presence of an adequate control group from an initial pool of 136 studies on CME. Despite the heterogeneity of the studies reviewed and the low quality of the evidence, the results from the majority of the studies (79%) showed that CME activities were associated with improvements in physician knowledge. The evidence gathered about the use of media and instructional techniques and the frequency of exposure suggests that multimedia, multiple instructional techniques, and multiple exposures be used whenever possible in CME. Future studies of CME should include assessment of applied knowledge, and should incorporate programmatic and collaborative studies of CME.

Reliability estimation of safety-critical software-based systems using Bayesian networks

International Nuclear Information System (INIS)

Helminen, A.

2001-06-01

Due to the nature of software faults and the way they cause system failures new methods are needed for the safety and reliability evaluation of software-based safety-critical automation systems in nuclear power plants. In the research project 'Programmable automation system safety integrity assessment (PASSI)', belonging to the Finnish Nuclear Safety Research Programme (FINNUS, 1999-2002), various safety assessment methods and tools for software based systems are developed and evaluated. The project is financed together by the Radiation and Nuclear Safety Authority (STUK), the Ministry of Trade and Industry (KTM) and the Technical Research Centre of Finland (VTT). In this report the applicability of Bayesian networks to the reliability estimation of software-based systems is studied. The applicability is evaluated by building Bayesian network models for the systems of interest and performing simulations for these models. In the simulations hypothetical evidence is used for defining the parameter relations and for determining the ability to compensate disparate evidence in the models. Based on the experiences from modelling and simulations we are able to conclude that Bayesian networks provide a good method for the reliability estimation of software-based systems. (orig.)

Using Medical Student Quality Improvement Projects to Promote Evidence-Based Care in the Emergency Department

Directory of Open Access Journals (Sweden)

Michael W. Manning

2017-12-01

Full Text Available Introduction The Association of American Medical Colleges’ (AAMC initiative for Core Entrustable Professional Activities for Entering Residency includes as an element of Entrustable Professional Activity 13 to “identify system failures and contribute to a culture of safety and improvement.” We set out to determine the feasibility of using medical students’ action learning projects (ALPs to expedite implementation of evidence-based pathways for three common patient diagnoses in the emergency department (ED setting (Atrial fibrillation, congestive heart failure, and pulmonary embolism. Methods These prospective quality improvement (QI initiatives were performed over six months in three Northeastern PA hospitals. Emergency physician mentors were recruited to facilitate a QI experience for third-year medical students for each project. Six students were assigned to each mentor and given class time and network infrastructure support (information technology, consultant experts in lean management to work on their projects. Students had access to background network data that revealed potential for improvement in disposition (home for patients. Results Under the leadership of their mentors, students accomplished standard QI processes such as performing the background literature search and assessing key stakeholders’ positions that were involved in the respective patient’s care. Students effectively developed flow diagrams, computer aids for clinicians and educational programs, and participated in recruiting champions for the new practice standard. They met with other departmental clinicians to determine barriers to implementation and used this feedback to help set specific parameters to make clinicians more comfortable with the changes in practice that were recommended. All three clinical practice guidelines were initiated at consummation of the students’ projects. After implementation, 86% (38/44 of queried ED providers felt comfortable

Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

Science.gov (United States)

Fung, Foon Yin; Linn, Yeh Ching

2015-01-01

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM. PMID:25949261

Achieving High Reliability with People, Processes, and Technology.

Science.gov (United States)

Saunders, Candice L; Brennan, John A

2017-01-01

High reliability as a corporate value in healthcare can be achieved by meeting the "Quadruple Aim" of improving population health, reducing per capita costs, enhancing the patient experience, and improving provider wellness. This drive starts with the board of trustees, CEO, and other senior leaders who ingrain high reliability throughout the organization. At WellStar Health System, the board developed an ambitious goal to become a top-decile health system in safety and quality metrics. To achieve this goal, WellStar has embarked on a journey toward high reliability and has committed to Lean management practices consistent with the Institute for Healthcare Improvement's definition of a high-reliability organization (HRO): one that is committed to the prevention of failure, early identification and mitigation of failure, and redesign of processes based on identifiable failures. In the end, a successful HRO can provide safe, effective, patient- and family-centered, timely, efficient, and equitable care through a convergence of people, processes, and technology.

ATTITUDE AND PERCEPTION OF FACULTIES TOWARDS TEACHING EVIDENCE BASED MEDICINE TO PRE - CLINICAL & PARA - CLINICAL MEDICAL STUDENTS

Directory of Open Access Journals (Sweden)

Bhavita Patel

2015-02-01

Full Text Available NTRODUCTION: Evidence - based medicine (EBM is defined as the „conscientious, explicit, and judicious use of current best evidence‟. It i s an important tool for lifelong learning in medicine, and medical students can develop the skills necessary to understand and use EBM. The teaching of EBM in Sumandeep Vidyapeeth is as part of Evidence Based Education System (EBES. The university has imp lemented the 16 hours of teaching with project work on Evidence Based Medicine in 1st MBBS and 2nd MBBS curriculum in addition to MBBS syllabus. AIMS & OBJECTIVES: This study was planned to take feedback from all the faculties those who are involved in Evi dence based Medicine teaching to evaluate their attitude and perception towards this innovative teaching method and to recommend improvements. MATERIAL & METHODS: A Descriptive, self - structured , pilot pretested questionnaire based cross sectional study was conducted in the year 2013 - 2014 among 40 faculties from 7 Departments like Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology, Pathology and Forensic Medicine teaching Evidence Base d Medicine to students at S.B.K.S MI & RC, Sumandeep Vidyapeeth. Data was expressed as percentage. RESULTS: The response rate for the study was 75%. Almost 87% of faculties agreed that teaching EBM is a welcoming development during pre and para clinical ye ars. About 80% faculties agreed that it will help them in future clinical learning. 87% faculties agreed that literature and research searching improves their day to day teaching. About 77% of faculties have attended workshop and training held in Universit y and 83% of faculties agreed that they are interested in more learning and improving skills necessary to incorporate Evidence based medicine into their discipline. Barriers included shortage of time and need for training in teaching EBM. CONCLUSION: Facul ties of this University teaching Pre - clinical and Para - clinical medical students recognized

Using Evidence Credibility Decay Model for dependence assessment in human reliability analysis

International Nuclear Information System (INIS)

Guo, Xingfeng; Zhou, Yanhui; Qian, Jin; Deng, Yong

2017-01-01

Highlights: • A new computational model is proposed for dependence assessment in HRA. • We combined three factors of “CT”, “TR” and “SP” within Dempster–Shafer theory. • The BBA of “SP” is reconstructed by discounting rate based on the ECDM. • Simulation experiments are illustrated to show the efficiency of the proposed method. - Abstract: Dependence assessment among human errors plays an important role in human reliability analysis. When dependence between two sequent tasks exists in human reliability analysis, if the preceding task fails, the failure probability of the following task is higher than success. Typically, three major factors are considered: “Closeness in Time” (CT), “Task Relatedness” (TR) and “Similarity of Performers” (SP). Assume TR is not changed, both SP and CT influence the degree of dependence level and SP is discounted by the time as the result of combine two factors in this paper. In this paper, a new computational model is proposed based on the Dempster–Shafer Evidence Theory (DSET) and Evidence Credibility Decay Model (ECDM) to assess the dependence between tasks in human reliability analysis. First, the influenced factors among human tasks are identified and the basic belief assignments (BBAs) of each factor are constructed based on expert evaluation. Then, the BBA of SP is discounted as the result of combining two factors and reconstructed by using the ECDM, the factors are integrated into a fused BBA. Finally, the dependence level is calculated based on fused BBA. Experimental results demonstrate that the proposed model not only quantitatively describe the fact that the input factors influence the dependence level, but also exactly show how the dependence level regular changes with different situations of input factors.

A web-based team-oriented medical error communication assessment tool: development, preliminary reliability, validity, and user ratings.

Science.gov (United States)

Kim, Sara; Brock, Doug; Prouty, Carolyn D; Odegard, Peggy Soule; Shannon, Sarah E; Robins, Lynne; Boggs, Jim G; Clark, Fiona J; Gallagher, Thomas

2011-01-01

Multiple-choice exams are not well suited for assessing communication skills. Standardized patient assessments are costly and patient and peer assessments are often biased. Web-based assessment using video content offers the possibility of reliable, valid, and cost-efficient means for measuring complex communication skills, including interprofessional communication. We report development of the Web-based Team-Oriented Medical Error Communication Assessment Tool, which uses videotaped cases for assessing skills in error disclosure and team communication. Steps in development included (a) defining communication behaviors, (b) creating scenarios, (c) developing scripts, (d) filming video with professional actors, and (e) writing assessment questions targeting team communication during planning and error disclosure. Using valid data from 78 participants in the intervention group, coefficient alpha estimates of internal consistency were calculated based on the Likert-scale questions and ranged from α=.79 to α=.89 for each set of 7 Likert-type discussion/planning items and from α=.70 to α=.86 for each set of 8 Likert-type disclosure items. The preliminary test-retest Pearson correlation based on the scores of the intervention group was r=.59 for discussion/planning and r=.25 for error disclosure sections, respectively. Content validity was established through reliance on empirically driven published principles of effective disclosure as well as integration of expert views across all aspects of the development process. In addition, data from 122 medicine and surgical physicians and nurses showed high ratings for video quality (4.3 of 5.0), acting (4.3), and case content (4.5). Web assessment of communication skills appears promising. Physicians and nurses across specialties respond favorably to the tool.

Workplace-based assessment of communication skills: A pilot project addressing feasibility, acceptance and reliability

Science.gov (United States)

Weyers, Simone; Jemi, Iman; Karger, André; Raski, Bianca; Rotthoff, Thomas; Pentzek, Michael; Mortsiefer, Achim

2016-01-01

Background: Imparting communication skills has been given great importance in medical curricula. In addition to standardized assessments, students should communicate with real patients in actual clinical situations during workplace-based assessments and receive structured feedback on their performance. The aim of this project was to pilot a formative testing method for workplace-based assessment. Our investigation centered in particular on whether or not physicians view the method as feasible and how high acceptance is among students. In addition, we assessed the reliability of the method. Method: As part of the project, 16 students held two consultations each with chronically ill patients at the medical practice where they were completing GP training. These consultations were video-recorded. The trained mentoring physician rated the student’s performance and provided feedback immediately following the consultations using the Berlin Global Rating scale (BGR). Two impartial, trained raters also evaluated the videos using BGR. For qualitative and quantitative analysis, information on how physicians and students viewed feasibility and their levels of acceptance was collected in written form in a partially standardized manner. To test for reliability, the test-retest reliability was calculated for both of the overall evaluations given by each rater. The inter-rater reliability was determined for the three evaluations of each individual consultation. Results: The formative assessment method was rated positively by both physicians and students. It is relatively easy to integrate into daily routines. Its significant value lies in the personal, structured and recurring feedback. The two overall scores for each patient consultation given by the two impartial raters correlate moderately. The degree of uniformity among the three raters in respect to the individual consultations is low. Discussion: Within the scope of this pilot project, only a small sample of physicians and

Workplace-based assessment of communication skills: A pilot project addressing feasibility, acceptance and reliability

Directory of Open Access Journals (Sweden)

Weyers, Simone

2016-11-01

Full Text Available Background: Imparting communication skills has been given great importance in medical curricula. In addition to standardized assessments, students should communicate with real patients in actual clinical situations during workplace-based assessments and receive structured feedback on their performance. The aim of this project was to pilot a formative testing method for workplace-based assessment. Our investigation centered in particular on whether or not physicians view the method as feasible and how high acceptance is among students. In addition, we assessed the reliability of the method.Method: As part of the project, 16 students held two consultations each with chronically ill patients at the medical practice where they were completing GP training. These consultations were video-recorded. The trained mentoring physician rated the student’s performance and provided feedback immediately following the consultations using the Berlin Global Rating scale (BGR. Two impartial, trained raters also evaluated the videos using BGR. For qualitative and quantitative analysis, information on how physicians and students viewed feasibility and their levels of acceptance was collected in written form in a partially standardized manner. To test for reliability, the test-retest reliability was calculated for both of the overall evaluations given by each rater. The inter-rater reliability was determined for the three evaluations of each individual consultation.Results: The formative assessment method was rated positively by both physicians and students. It is relatively easy to integrate into daily routines. Its significant value lies in the personal, structured and recurring feedback. The two overall scores for each patient consultation given by the two impartial raters correlate moderately. The degree of uniformity among the three raters in respect to the individual consultations is low.Discussion: Within the scope of this pilot project, only a small sample

Workplace-based assessment of communication skills: A pilot project addressing feasibility, acceptance and reliability.

Science.gov (United States)

Weyers, Simone; Jemi, Iman; Karger, André; Raski, Bianca; Rotthoff, Thomas; Pentzek, Michael; Mortsiefer, Achim

2016-01-01

Background: Imparting communication skills has been given great importance in medical curricula. In addition to standardized assessments, students should communicate with real patients in actual clinical situations during workplace-based assessments and receive structured feedback on their performance. The aim of this project was to pilot a formative testing method for workplace-based assessment. Our investigation centered in particular on whether or not physicians view the method as feasible and how high acceptance is among students. In addition, we assessed the reliability of the method. Method: As part of the project, 16 students held two consultations each with chronically ill patients at the medical practice where they were completing GP training. These consultations were video-recorded. The trained mentoring physician rated the student's performance and provided feedback immediately following the consultations using the Berlin Global Rating scale (BGR). Two impartial, trained raters also evaluated the videos using BGR. For qualitative and quantitative analysis, information on how physicians and students viewed feasibility and their levels of acceptance was collected in written form in a partially standardized manner. To test for reliability, the test-retest reliability was calculated for both of the overall evaluations given by each rater. The inter-rater reliability was determined for the three evaluations of each individual consultation. Results: The formative assessment method was rated positively by both physicians and students. It is relatively easy to integrate into daily routines. Its significant value lies in the personal, structured and recurring feedback. The two overall scores for each patient consultation given by the two impartial raters correlate moderately. The degree of uniformity among the three raters in respect to the individual consultations is low. Discussion: Within the scope of this pilot project, only a small sample of physicians and

Validating evidence based decision making in health care

DEFF Research Database (Denmark)

Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak

Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register o...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational.......Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

How reliable are Functional Movement Screening scores? A systematic review of rater reliability.

Science.gov (United States)

Moran, Robert W; Schneiders, Anthony G; Major, Katherine M; Sullivan, S John

2016-05-01

Several physical assessment protocols to identify intrinsic risk factors for injury aetiology related to movement quality have been described. The Functional Movement Screen (FMS) is a standardised, field-expedient test battery intended to assess movement quality and has been used clinically in preparticipation screening and in sports injury research. To critically appraise and summarise research investigating the reliability of scores obtained using the FMS battery. Systematic literature review. Systematic search of Google Scholar, Scopus (including ScienceDirect and PubMed), EBSCO (including Academic Search Complete, AMED, CINAHL, Health Source: Nursing/Academic Edition), MEDLINE and SPORTDiscus. Studies meeting eligibility criteria were assessed by 2 reviewers for risk of bias using the Quality Appraisal of Reliability Studies checklist. Overall quality of evidence was determined using van Tulder's levels of evidence approach. 12 studies were appraised. Overall, there was a 'moderate' level of evidence in favour of 'acceptable' (intraclass correlation coefficient ≥0.6) inter-rater and intra-rater reliability for composite scores derived from live scoring. For inter-rater reliability of composite scores derived from video recordings there was 'conflicting' evidence, and 'limited' evidence for intra-rater reliability. For inter-rater reliability based on live scoring of individual subtests there was 'moderate' evidence of 'acceptable' reliability (κ≥0.4) for 4 subtests (Deep Squat, Shoulder Mobility, Active Straight-leg Raise, Trunk Stability Push-up) and 'conflicting' evidence for the remaining 3 (Hurdle Step, In-line Lunge, Rotary Stability). This review found 'moderate' evidence that raters can achieve acceptable levels of inter-rater and intra-rater reliability of composite FMS scores when using live ratings. Overall, there were few high-quality studies, and the quality of several studies was impacted by poor study reporting particularly in relation to

The patient experience of high technology medical imaging: A systematic review of the qualitative evidence

International Nuclear Information System (INIS)

Munn, Zachary; Jordan, Zoe

2011-01-01

Background: When presenting to an imaging department, the person who is to be imaged is often in a vulnerable state, and can experience the scan in a number of ways. It is the role of the radiographer to produce a high quality image and facilitate patient care throughout the imaging process. A qualitative systematic review was performed to synthesise the existent evidence on the patient experience of high technology medical imaging. Only papers relating to Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) were identified. Inclusion criteria: Studies that were of a qualitative design that explored the phenomenon of interest, the patient experience of high technology medical imaging. Participants included anyone who had undergone one of these procedures. Methods: A systematic search of medical and allied health databases was conducted. Articles identified during the search process that met the inclusion criteria were then critically appraised for methodological quality independently by two reviewers. Results: During the search and inclusion process, 15 studies were found that were deemed of suitable quality to be included in the review. From the 15 studies, 127 findings were extracted from the included studies. These were analysed in more detail to observe common themes, and then grouped into 33 categories. From these 33 categories, 11 synthesised findings were produced. The 11 synthesised findings highlight the diverse, unique and challenging ways in which people experience imaging with MRI and CT scanners. Conclusion: The results of the review demonstrate the diverse ways in which people experience medical imaging. All health professionals involved in imaging need to be aware of the different ways each patient may experience imaging.

Optimal, Reliability-Based Code Calibration

DEFF Research Database (Denmark)

Sørensen, John Dalsgaard

2002-01-01

Reliability based code calibration is considered in this paper. It is described how the results of FORM based reliability analysis may be related to the partial safety factors and characteristic values. The code calibration problem is presented in a decision theoretical form and it is discussed how...... of reliability based code calibration of LRFD based design codes....

Analyses of inter-rater reliability between professionals, medical students and trained school children as assessors of basic life support skills.

Science.gov (United States)

Beck, Stefanie; Ruhnke, Bjarne; Issleib, Malte; Daubmann, Anne; Harendza, Sigrid; Zöllner, Christian

2016-10-07

Training of lay-rescuers is essential to improve survival-rates after cardiac arrest. Multiple campaigns emphasise the importance of basic life support (BLS) training for school children. Trainings require a valid assessment to give feedback to school children and to compare the outcomes of different training formats. Considering these requirements, we developed an assessment of BLS skills using MiniAnne and tested the inter-rater reliability between professionals, medical students and trained school children as assessors. Fifteen professional assessors, 10 medical students and 111-trained school children (peers) assessed 1087 school children at the end of a CPR-training event using the new assessment format. Analyses of inter-rater reliability (intraclass correlation coefficient; ICC) were performed. Overall inter-rater reliability of the summative assessment was high (ICC = 0.84, 95 %-CI: 0.84 to 0.86, n = 889). The number of comparisons between peer-peer assessors (n = 303), peer-professional assessors (n = 339), and peer-student assessors (n = 191) was adequate to demonstrate high inter-rater reliability between peer- and professional-assessors (ICC: 0.76), peer- and student-assessors (ICC: 0.88) and peer- and other peer-assessors (ICC: 0.91). Systematic variation in rating of specific items was observed for three items between professional- and peer-assessors. Using this assessment and integrating peers and medical students as assessors gives the opportunity to assess hands-on skills of school children with high reliability.

Awareness, knowledge, and attitude of dentistry students in Kerman towards evidence-based dentistry

Science.gov (United States)

Sarani, Arezoo; Sarani, Melika; Abdar, Mohammad Esmaeli; Abdar, Zahra Esmaeili

2016-01-01

Introduction Evidence-based care helps dentists provide quality dental services to patients, and such care is based on the use of reliable information about treatment and patient care from a large number of papers, books, and published textbooks. This study aimed to determine the knowledge, awareness, and attitude of dentistry students towards evidence-based dentistry. Methods In this cross-sectional study, all dentistry students who were studying in their sixth semester and higher in the Kerman School of Dentistry (n = 73) were studied. The data were analyzed using SPSS version 17 and the independent-samples t-tests and the ANOVA test. Results The means of the students’ knowledge, awareness, and attitude scores were 29.2 ± 10.8, 29.9 ± 8.12 and 44.5 ± 5.3, respectively. Among demographic variables, only the number of semesters showed a significant difference with knowledge, awareness, and attitude of dentistry students toward evidence-based dentistry (p = 0.001). Conclusion According to the results of this study, knowledge and awareness of dentistry students at Kerman University of Medical Sciences towards evidence-based dentistry were average and have a neutral attitude. Thus, providing necessary training in this regard will cause promoting the knowledge, awareness, and improved attitudes of dentistry students. PMID:27382446

Reliability and Validity of the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2 in Adults with Non-Cancer Pain

Directory of Open Access Journals (Sweden)

Corey J. Hayes

2017-04-01

Full Text Available Limited evidence exists on how non-cancer pain (NCP affects an individual’s health-related quality of life (HRQoL. This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2, a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12 and SF Physical Component Summary (PCS12 were tested for reliability (internal consistency and test-retest reliability and validity (construct: convergent and discriminant; criterion: concurrent and predictive. A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach’s alpha and Mosier’s alpha > 0.8, and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC: 0.64; PCS12 ICC: 0.73. Both scales were significantly associated with a number of chronic conditions (p < 0.05. The PCS12 was strongly correlated with perceived health (r = 0.52 but weakly correlated with perceived mental health (r = 0.25. The MCS12 was moderately correlated with perceived mental health (r = 0.42 and perceived health (r = 0.33. Increasing PCS12 and MCS12 scores were significantly associated with lower odds of reporting future physical and cognitive limitations (PCS12: OR = 0.90 95%CI: 0.89–0.90, MCS12: OR = 0.94 95%CI: 0.93–0.94. In summary, the SF-12v2 is a reliable and valid measure of HRQoL for patients with NCP.

Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Sánchez-Mendiola Melchor

2012-11-01

Full Text Available Abstract Background Evidence-Based Medicine (EBM is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills in undergraduate medical students with a randomized controlled trial. Methods The educational intervention was a one-semester EBM course in the 5th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5th year class (M5 EBM vs. M5 non-EBM groups, and quasi-experimental with static-groups comparisons for the 4th year (M4, not yet exposed and 6th year (M6, exposed 6 months to a year earlier groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor’s questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ test. Results 289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM. Critical appraisal skills and attitude scores were higher in the intervention group (M5 and in the group of students exposed to EBM instruction during the previous year (M6. The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (pd=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test. M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group. Conclusions Formal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the

Evidence-based monitoring and evaluation of the faith-based ...

African Journals Online (AJOL)

Background: The Islamic Medical Association of Uganda, has been implementing the faith-based approach to HIV prevention without baseline data on expected positive outcomes. Objectives: To establish evidence-based baseline data on expected positive outcomes of the faith-based approach to HIV prevention. Methods: ...

On evidence and evidence-based medicine: lessons from the philosophy of science.

Science.gov (United States)

Goldenberg, Maya J

2006-06-01

The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920-1950). At the same time, the term "evidence-based medicine" has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should be challenged on the grounds of how 'evidence' has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause.

How evidence-based are the recommendations in evidence-based guidelines?

Directory of Open Access Journals (Sweden)

Finlay A McAlister

2007-08-01

Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.

Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review.

Science.gov (United States)

Oh, Eui Geum

2016-06-01

As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. Copyright © 2016. Published by Elsevier B.V.

Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review

Directory of Open Access Journals (Sweden)

Eui Geum Oh, PhD, RN

2016-06-01

Full Text Available As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR, a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.

Rationality versus reality: the challenges of evidence-based decision making for health policy makers.

Science.gov (United States)

McCaughey, Deirdre; Bruning, Nealia S

2010-05-26

Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Directory of Open Access Journals (Sweden)

Bruning Nealia S

2010-05-01

Full Text Available Abstract Background Current healthcare systems have extended the evidence-based medicine (EBM approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM and evidence-based policy making (EBPM because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Science.gov (United States)

2010-01-01

Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the

Evaluation of Evidence-based Nursing Pain Management Practice.

Science.gov (United States)

Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

2015-08-01

It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The Heart of the Matter of Opinion and Evidence: The Value of Evidence-Based Medicine

OpenAIRE

Masvidal, Daniel; Lavie, Carl J.

2012-01-01

Evidence-based medicine is an important aspect of continuing medical education. This article reviews previous and current examples of conflicting topics that evidence-based medicine has clarified to allow us to provide the best possible patient care.

Creating High Reliability Teams in Healthcare through In situ Simulation Training

Directory of Open Access Journals (Sweden)

Kristi Miller RN

2011-07-01

Full Text Available The importance of teamwork on patient safety in healthcare has been well established. However, the theory and research of healthcare teams are seriously lacking in clinical application. While conventional team theory assumes that teams are stable and leadership is constant, a growing body of evidence indicates that most healthcare teams are unstable and lack constant leadership. For healthcare organizations to reduce error and ensure patient safety, the true nature of healthcare teams must be better understood. This study presents a taxonomy of healthcare teams and the determinants of high reliability in healthcare teams based on a series of studies undertaken over a five-year period (2005–2010.

Adaptation and validation of the Evidence-Based Practice Belief and Implementation scales for French-speaking Swiss nurses and allied healthcare providers.

Science.gov (United States)

Verloo, Henk; Desmedt, Mario; Morin, Diane

2017-09-01

To evaluate two psychometric properties of the French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales, namely their internal consistency and construct validity. The Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales developed by Melnyk et al. are recognised as valid, reliable instruments in English. However, no psychometric validation for their French versions existed. Secondary analysis of a cross sectional survey. Source data came from a cross-sectional descriptive study sample of 382 nurses and other allied healthcare providers. Cronbach's alpha was used to evaluate internal consistency, and principal axis factor analysis and varimax rotation were computed to determine construct validity. The French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales showed excellent reliability, with Cronbach's alphas close to the scores established by Melnyk et al.'s original versions. Principal axis factor analysis showed medium-to-high factor loading scores without obtaining collinearity. Principal axis factor analysis with varimax rotation of the 16-item Evidence-Based Practice Beliefs scale resulted in a four-factor loading structure. Principal axis factor analysis with varimax rotation of the 17-item Evidence-Based Practice Implementation scale revealed a two-factor loading structure. Further research should attempt to understand why the French Evidence-Based Practice Implementation scale showed a two-factor loading structure but Melnyk et al.'s original has only one. The French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales can both be considered valid and reliable instruments for measuring Evidence-Based Practice beliefs and implementation. The results suggest that the French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales are valid and reliable and can therefore be used to

Virtual reality-based medical training and assessment

DEFF Research Database (Denmark)

Aboulafia, Annette Løw T.; Lövquist, Erik; Shorten, George Declan

2012-01-01

The current focus on patient safety and evidence-based medical education has led to an increased interest in utilising virtual reality (VR) for medical training. The development of VR-based systems require experts from different disciplines to collaborate with shared and agreed objectives...... to develop useful and usable VR-based medical training systems. Methods: This article reports a case study of two research projects that developed and evaluated a VR-based training system for spinal anaesthesia. Results: The case study illustrates how close relationships can be established by champion...

Information-seeking Behavior During Residency Is Associated With Quality of Theoretical Learning, Academic Career Achievements, and Evidence-based Medical Practice

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Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

2015-01-01

Abstract Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3–6; range, 1–10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77–17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33–4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09–4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01–3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46–11.53); knowledge of the leading medical journals of the

Mass lesions in chronic pancreatitis: benign or malignant? An "evidence-based practice" approach.

LENUS (Irish Health Repository)

Gerstenmaier, Jan F

2012-02-01

The diagnosis of a pancreatic mass lesion in the presence of chronic pancreatitis can be extremely challenging. At the same time, a high level of certainty about the diagnosis is necessary for appropriate management planning. The aim of this study was to establish current best evidence about which imaging methods reliably differentiate a benign from a malignant lesion, and show how that evidence is best applied. A diagnostic algorithm based on Bayesian analysis is proposed.

Measuring reliability under epistemic uncertainty: Review on non-probabilistic reliability metrics

Directory of Open Access Journals (Sweden)

Kang Rui

2016-06-01

Full Text Available In this paper, a systematic review of non-probabilistic reliability metrics is conducted to assist the selection of appropriate reliability metrics to model the influence of epistemic uncertainty. Five frequently used non-probabilistic reliability metrics are critically reviewed, i.e., evidence-theory-based reliability metrics, interval-analysis-based reliability metrics, fuzzy-interval-analysis-based reliability metrics, possibility-theory-based reliability metrics (posbist reliability and uncertainty-theory-based reliability metrics (belief reliability. It is pointed out that a qualified reliability metric that is able to consider the effect of epistemic uncertainty needs to (1 compensate the conservatism in the estimations of the component-level reliability metrics caused by epistemic uncertainty, and (2 satisfy the duality axiom, otherwise it might lead to paradoxical and confusing results in engineering applications. The five commonly used non-probabilistic reliability metrics are compared in terms of these two properties, and the comparison can serve as a basis for the selection of the appropriate reliability metrics.

Evidence-based approach to the maintenance of laboratory and medical equipment in resource-poor settings.

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Malkin, Robert; Keane, Allison

2010-07-01

Much of the laboratory and medical equipment in resource-poor settings is out-of-service. The most commonly cited reasons are (1) a lack of spare parts and (2) a lack of highly trained technicians. However, there is little data to support these hypotheses, or to generate evidence-based solutions to the problem. We studied 2,849 equipment-repair requests (of which 2,529 were out-of-service medical equipment) from 60 resource-poor hospitals located in 11 nations in Africa, Europe, Asia, and Central America. Each piece of equipment was analyzed by an engineer or an engineering student and a repair was attempted using only locally available materials. If the piece was placed back into service, we assumed that the engineer's problem analysis was correct. A total of 1,821 pieces of medical equipment were placed back into service, or 72%, without requiring the use of imported spare parts. Of those pieces repaired, 1,704 were sufficiently documented to determine what knowledge was required to place the equipment back into service. We found that six domains of knowledge were required to accomplish 99% of the repairs: electrical (18%), mechanical (18%), power supply (14%), plumbing (19%), motors (5%), and installation or user training (25%). A further analysis of the domains shows that 66% of the out-of-service equipment was placed back into service using only 107 skills covering basic knowledge in each domain; far less knowledge than that required of a biomedical engineer or biomedical engineering technician. We conclude that a great majority of laboratory and medical equipment can be put back into service without importing spare parts and using only basic knowledge. Capacity building in resource-poor settings should first focus on a limited set of knowledge; a body of knowledge that we call the biomedical technician's assistant (BTA). This data set suggests that a supported BTA could place 66% of the out-of-service laboratory and medical equipment in their hospital back

The Heart of the Matter of Opinion and Evidence: The Value of Evidence-Based Medicine

Science.gov (United States)

Masvidal, Daniel; Lavie, Carl J.

2012-01-01

Evidence-based medicine is an important aspect of continuing medical education. This article reviews previous and current examples of conflicting topics that evidence-based medicine has clarified to allow us to provide the best possible patient care. PMID:22438783

Reliability of microprocessor-based relay protection devices: Myths and reality

Directory of Open Access Journals (Sweden)

Gurevich Vladimir

2009-01-01

Full Text Available The article examines four basic theses about the ostensibly extremely high reliability of microprocessor-based relay protection (MP touted by supporters of MP. Through detailed analysis based on many references it is shown that the basis of these theses are widespread myths, and actually MP reliability is lower than the reliability of electromechanical and electronic protective relays on discrete components.

[Implementation of evidence based medicine in primary care].

Science.gov (United States)

Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

2009-01-01

The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

Reliability and Validity of Survey Instruments to Measure Work-Related Fatigue in the Emergency Medical Services Setting: A Systematic Review.

Science.gov (United States)

Patterson, P Daniel; Weaver, Matthew D; Fabio, Anthony; Teasley, Ellen M; Renn, Megan L; Curtis, Brett R; Matthews, Margaret E; Kroemer, Andrew J; Xun, Xiaoshuang; Bizhanova, Zhadyra; Weiss, Patricia M; Sequeira, Denisse J; Coppler, Patrick J; Lang, Eddy S; Higgins, J Stephen

2018-02-15

This study sought to systematically search the literature to identify reliable and valid survey instruments for fatigue measurement in the Emergency Medical Services (EMS) occupational setting. A systematic review study design was used and searched six databases, including one website. The research question guiding the search was developed a priori and registered with the PROSPERO database of systematic reviews: "Are there reliable and valid instruments for measuring fatigue among EMS personnel?" (2016:CRD42016040097). The primary outcome of interest was criterion-related validity. Important outcomes of interest included reliability (e.g., internal consistency), and indicators of sensitivity and specificity. Members of the research team independently screened records from the databases. Full-text articles were evaluated by adapting the Bolster and Rourke system for categorizing findings of systematic reviews, and the rated data abstracted from the body of literature as favorable, unfavorable, mixed/inconclusive, or no impact. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used to evaluate the quality of evidence. The search strategy yielded 1,257 unique records. Thirty-four unique experimental and non-experimental studies were determined relevant following full-text review. Nineteen studies reported on the reliability and/or validity of ten different fatigue survey instruments. Eighteen different studies evaluated the reliability and/or validity of four different sleepiness survey instruments. None of the retained studies reported sensitivity or specificity. Evidence quality was rated as very low across all outcomes. In this systematic review, limited evidence of the reliability and validity of 14 different survey instruments to assess the fatigue and/or sleepiness status of EMS personnel and related shift worker groups was identified.

Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients.

Science.gov (United States)

Jørgensen, Lise Walther; Søndergaard, Kasper; Melgaard, Dorte; Warming, Susan

2017-12-01

Oropharyngeal dysphagia (OD) is prevalent among medical and geriatric patients admitted due to acute illness and it is associated with malnutrition, increased length of stay and increased mortality. A valid and reliable bedside screening test for patients at risk of OD is essential in order to detect patients in need of further assessment. The Volume-Viscosity Swallow Test (V-VST) has been shown to be a valid screening test for OD in mixed outpatient populations. However, as reliability of the test has yet to be investigated in a population of medical and geriatric patients admitted due to acute illness, we aimed to determine the interrater reliability of the V-VST in this clinical setting. Reporting in this study is in accordance with proposed guidelines for the reporting of reliability and agreement studies (GRRAS). In three Danish hospitals (CRD-BFH, CRD-GH, NDR-H) 11 skilled occupational therapists examined an unselected group of 110 patients admitted to geriatric or medical wards. In an overall agreement phase raters reached ≥80% agreement before data collection phase was commenced. The V-VST was applied to patients twice within maximum one hour by raters who administrated the test in an order based on randomization, blinded to each other's results. Agreement, Kappa values, weighed Kappa values and Kappa adjusted for bias and prevalence are reported. The interrater reliability of V-VST as screening test for OD in patients admitted to geriatric or medical wards was substantial with an overall Kappa value of 0.77 (95% CI 0.65-0.89) however interrater reliability varied among hospitals ranging from 0.37 (95% CI -0.01 to 0.41) to 0.85 (95% CI 0.75-1.00). Interrater reliability of the accompanying recommendations of volume and viscosity was moderate with a weighted kappa value of 0.55 (95% CI 0.37-0.73) for viscosity and 0.53 (95% CI 0.36-0.7) for volume. The overall prevalence of OD was 34.5%, ranging from 8% to 53.6% across hospitals. The prevalence and bias

Is Learner Self-Assessment Reliable and Valid in a Web-Based Portfolio Environment for High School Students?

Science.gov (United States)

Chang, Chi-Cheng; Liang, Chaoyun; Chen, Yi-Hui

2013-01-01

This study explored the reliability and validity of Web-based portfolio self-assessment. Participants were 72 senior high school students enrolled in a computer application course. The students created learning portfolios, viewed peers' work, and performed self-assessment on the Web-based portfolio assessment system. The results indicated: 1)…

Reliability-Based Optimization in Structural Engineering

DEFF Research Database (Denmark)

Enevoldsen, I.; Sørensen, John Dalsgaard

1994-01-01

In this paper reliability-based optimization problems in structural engineering are formulated on the basis of the classical decision theory. Several formulations are presented: Reliability-based optimal design of structural systems with component or systems reliability constraints, reliability...

Development of an evidence-based review with recommendations using an online iterative process.

Science.gov (United States)

Rudmik, Luke; Smith, Timothy L

2011-01-01

The practice of modern medicine is governed by evidence-based principles. Due to the plethora of medical literature, clinicians often rely on systematic reviews and clinical guidelines to summarize the evidence and provide best practices. Implementation of an evidence-based clinical approach can minimize variation in health care delivery and optimize the quality of patient care. This article reports a method for developing an "Evidence-based Review with Recommendations" using an online iterative process. The manuscript describes the following steps involved in this process: Clinical topic selection, Evidence-hased review assignment, Literature review and initial manuscript preparation, Iterative review process with author selection, and Manuscript finalization. The goal of this article is to improve efficiency and increase the production of evidence-based reviews while maintaining the high quality and transparency associated with the rigorous methodology utilized for clinical guideline development. With the rise of evidence-based medicine, most medical and surgical specialties have an abundance of clinical topics which would benefit from a formal evidence-based review. Although clinical guideline development is an important methodology, the associated challenges limit development to only the absolute highest priority clinical topics. As outlined in this article, the online iterative approach to the development of an Evidence-based Review with Recommendations may improve productivity without compromising the quality associated with formal guideline development methodology. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

Integration of Evidence Base into a Probabilistic Risk Assessment

Science.gov (United States)

Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

Evidences of validity and reliability of the Luria-Nebraska Test for Children

Directory of Open Access Journals (Sweden)

Ricardo Franco de Lima

2016-01-01

Full Text Available Abstract This paper aimed to verify evidences of validity and reliability of Luria-Nebraska Test for Children (TLN-C, in Portuguese. Three hundred eighty-seven students aged 6–13 years old, with learning difficulties, comprised the study. They were assessed with the Wechsler Intelligence Scale for Children (WISC-III and TLN-C; and effect of age differences, as well as accuracy rating by internal consistency were investigated. Age effects were found for all subtests and in the general score, except for receptive speech subtest, even when total IQ effect was controlled. Reliability analysis had satisfactory results (0.79. The TLN-C showed evidences of validity and reliability. Receptive speech subtest requires revision.

Inter-rater reliability of an observation-based ergonomics assessment checklist for office workers.

Science.gov (United States)

Pereira, Michelle Jessica; Straker, Leon Melville; Comans, Tracy Anne; Johnston, Venerina

2016-12-01

To establish the inter-rater reliability of an observation-based ergonomics assessment checklist for computer workers. A 37-item (38-item if a laptop was part of the workstation) comprehensive observational ergonomics assessment checklist comparable to government guidelines and up to date with empirical evidence was developed. Two trained practitioners assessed full-time office workers performing their usual computer-based work and evaluated the suitability of workstations used. Practitioners assessed each participant consecutively. The order of assessors was randomised, and the second assessor was blinded to the findings of the first. Unadjusted kappa coefficients between the raters were obtained for the overall checklist and subsections that were formed from question-items relevant to specific workstation equipment. Twenty-seven office workers were recruited. The inter-rater reliability between two trained practitioners achieved moderate to good reliability for all except one checklist component. This checklist has mostly moderate to good reliability between two trained practitioners. Practitioner Summary: This reliable ergonomics assessment checklist for computer workers was designed using accessible government guidelines and supplemented with up-to-date evidence. Employers in Queensland (Australia) can fulfil legislative requirements by using this reliable checklist to identify and subsequently address potential risk factors for work-related injury to provide a safe working environment.

Evidence-based medicine between explicit rationing, medical deontology and rights of patients.

Science.gov (United States)

Frati, P

1998-01-01

Today a "just" health policy is balanced between the problem of the allocation of scarce resources and the priority setting of services, care and cures. Despite technologies and molecular medicine, with their tendency to reach absolute prediction of disease or absence of disease and to cure with predicted efficacy, a large portion of the public refuse the results of experimental procedures and prefer to place trust in so-called alternative medicine or in drugs which are not in the official guide-lines following the principles of evidence-based medicine according to DL Sackett. Juridical problems arise between the rights of free choice of cure and social dimension of Governmental care programs, which include the maximum of benefits (i.e. effective therapies) for a pre-fixed total budget. An explicit rationing only on budgetary bases without rationalisation of medical procedures reduces the rights to care of citizens-patients. Thus, an explicit rationing-rationalisation seems to be the only procedure compatible with the interest of patients in a social security system allocating "scarce" resources.

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm.

Science.gov (United States)

Friedli, Natalie; Stanga, Zeno; Culkin, Alison; Crook, Martin; Laviano, Alessandro; Sobotka, Lubos; Kressig, Reto W; Kondrup, Jens; Mueller, Beat; Schuetz, Philipp

2018-03-01

Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search. Based on a recent qualitative systematic review on the topic, we developed clinically relevant recommendations as well as a treatment and monitoring algorithm for the clinical management of inpatients regarding RFS. With international experts, these recommendations were discussed and agreement with the recommendation was rated. Upon hospital admission, we recommend the use of specific screening criteria (i.e., low body mass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse) for risk assessment regarding the occurrence of RFS. According to the patient's individual risk for RFS, a careful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplementation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also propose criteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations with adoption of the nutritional therapy. Based on the available evidence, we developed a practical algorithm for risk assessment, treatment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimize and standardize the management of this vulnerable patient population. We encourage future quality studies to further refine these recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

Inverse Reliability Task: Artificial Neural Networks and Reliability-Based Optimization Approaches

OpenAIRE

Lehký , David; Slowik , Ondřej; Novák , Drahomír

2014-01-01

Part 7: Genetic Algorithms; International audience; The paper presents two alternative approaches to solve inverse reliability task – to determine the design parameters to achieve desired target reliabilities. The first approach is based on utilization of artificial neural networks and small-sample simulation Latin hypercube sampling. The second approach considers inverse reliability task as reliability-based optimization task using double-loop method and also small-sample simulation. Efficie...

Do medical students with A-level mathematics have a better understanding of the principles behind evidence-based medicine?

Science.gov (United States)

Ben-Shlomo, Y; Fallon, U; Sterne, J; Brookes, S

2004-12-01

With the advent of evidence-based medicine, medical students, doctors and other healthcare professionals are required to be more skilled in the interpretation and manipulation of numerical data. The authors observed that undergraduate students without A-level mathematics expressed concern as to their ability to cope with an epidemiology and biostatistics course. It was hypothesized that these anxieties reflected differences in attitudes to numerical manipulation rather than any real lack of competence. Mean exam performance scores were compared for 498 first-year medical students between 2000 and 2002 depending on whether the students did or did not have A-level mathematics. The data revealed no difference in performance. Students without mathematics A-level scored marginally worse (-1.1%, 95% CI -3.1% to 0.8%, p=0.20) but were no more likely to fail the exam (odds ratio=0.98, 95% CI 0.40 to 2.6, p=0.9). It is concluded that some students experience 'numerophobia'-- a perceived and, it is thought, disproportionate fear of numbers and simple mathematical manipulation. This may act as a psychological barrier for future evidence-based practitioners.

The effect of Web-based Braden Scale training on the reliability and precision of Braden Scale pressure ulcer risk assessments.

Science.gov (United States)

Magnan, Morris A; Maklebust, Joann

2008-01-01

To evaluate the effect of Web-based Braden Scale training on the reliability and precision of pressure ulcer risk assessments made by registered nurses (RN) working in acute care settings. Pretest-posttest, 2-group, quasi-experimental design. Five hundred Braden Scale risk assessments were made on 102 acute care patients deemed to be at various levels of risk for pressure ulceration. Assessments were made by RNs working in acute care hospitals at 3 different medical centers where the Braden Scale was in regular daily use (2 medical centers) or new to the setting (1 medical center). The Braden Scale for Predicting Pressure Sore Risk was used to guide pressure ulcer risk assessments. A Web-based version of the Detroit Medical Center Braden Scale Computerized Training Module was used to teach nurses correct use of the Braden Scale and selection of risk-based pressure ulcer prevention interventions. In the aggregate, RN generated reliable Braden Scale pressure ulcer risk assessments 65% of the time after training. The effect of Web-based Braden Scale training on reliability and precision of assessments varied according to familiarity with the scale. With training, new users of the scale made reliable assessments 84% of the time and significantly improved precision of their assessments. The reliability and precision of Braden Scale risk assessments made by its regular users was unaffected by training. Technology-assisted Braden Scale training improved both reliability and precision of risk assessments made by new users of the scale, but had virtually no effect on the reliability or precision of risk assessments made by regular users of the instrument. Further research is needed to determine best approaches for improving reliability and precision of Braden Scale assessments made by its regular users.

Deterministic versus evidence-based attitude towards clinical diagnosis.

Science.gov (United States)

Soltani, Akbar; Moayyeri, Alireza

2007-08-01

Generally, two basic classes have been proposed for scientific explanation of events. Deductive reasoning emphasizes on reaching conclusions about a hypothesis based on verification of universal laws pertinent to that hypothesis, while inductive or probabilistic reasoning explains an event by calculation of some probabilities for that event to be related to a given hypothesis. Although both types of reasoning are used in clinical practice, evidence-based medicine stresses on the advantages of the second approach for most instances in medical decision making. While 'probabilistic or evidence-based' reasoning seems to involve more mathematical formulas at the first look, this attitude is more dynamic and less imprisoned by the rigidity of mathematics comparing with 'deterministic or mathematical attitude'. In the field of medical diagnosis, appreciation of uncertainty in clinical encounters and utilization of likelihood ratio as measure of accuracy seem to be the most important characteristics of evidence-based doctors. Other characteristics include use of series of tests for refining probability, changing diagnostic thresholds considering external evidences and nature of the disease, and attention to confidence intervals to estimate uncertainty of research-derived parameters.

Relationship among Translational Medicine, Evidence-Based Medicine and Precision Medicine

OpenAIRE

Xin-en HUANG

2016-01-01

Translational medicine is a new concept in international medical field. It integrates experimental research results and clinical guidance into the optimal implementation criteria for promoting the prediction, prevention and treatment of diseases. Based on people’s higher demand for medicine and health, appearance of translational medicine changes the mode of medical research.Evidence-based medicine (EBM) refers to cautious and accurate application of the current best research evidence and com...

Practical Biostatistics A Friendly Step-by-Step Approach for Evidence-based Medicine

CERN Document Server

Suchmacher, Mendel

2012-01-01

Evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision making. It is a practice that uses statistical analysis of scientific methods and outcomes to drive further experimentation and diagnosis. The profusion of evidence-based medicine in medical practice and clinical research has produced a need for life scientists and clinical researchers to assimilate biostatistics into their work to meet efficacy and practical standards. Practical Biostatistics provides researchers, medical professionals, and students with a friendly, practica

The personalised medicine: a paradigm of evidence-based medicine

Directory of Open Access Journals (Sweden)

Dhavendra Kumar

2011-01-01

Full Text Available The practice of "evidence-based medicine" aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about the individualised patient care. The clinical genetics evolved from translational genetics research and contributes to the clinical care of patients and families through evidence-based health care in managing inherited disorders through accurate diagnosis, molecular pathology and assessing phenotypic correlations. Translational genetics and genomics research has led to the development of powerful tools for clinical diagnosis, assessing individual's genomic profile for disease prediction/prevention, high-throughput genome-wide screening for predisposition and/or protection to complex medical conditions, and discovery and development of new drugs and vaccines. Gene mapping and deciphering pathogenic mutations have helped in unravelling the basic biological mechanisms leading to new drug discovery and development. Targeted pharmacotherapy is now possible for managing the highly penetrant multi-system dominantly inherited conditions. Notable examples include rapamycin (sirolimus in suppressing the mTOR pathway associated hamartomas in dominantly inherited cancer family syndromes and angiotensin converting enzyme receptor blockers (ACE-RB in preventing aortic dilatation in Marfan syndrome and related familial arteriopathies. The translational genomic research is the essential prerequisite for developing sound evidence-based diagnostic, therapeutic and prognostic clinical protocols for the practice of personalised clinical medicine.

Analysis of fatigue reliability for high temperature and high pressure multi-stage decompression control valve

Science.gov (United States)

Yu, Long; Xu, Juanjuan; Zhang, Lifang; Xu, Xiaogang

2018-03-01

Based on stress-strength interference theory to establish the reliability mathematical model for high temperature and high pressure multi-stage decompression control valve (HMDCV), and introduced to the temperature correction coefficient for revising material fatigue limit at high temperature. Reliability of key dangerous components and fatigue sensitivity curve of each component are calculated and analyzed by the means, which are analyzed the fatigue life of control valve and combined with reliability theory of control valve model. The impact proportion of each component on the control valve system fatigue failure was obtained. The results is shown that temperature correction factor makes the theoretical calculations of reliability more accurate, prediction life expectancy of main pressure parts accords with the technical requirements, and valve body and the sleeve have obvious influence on control system reliability, the stress concentration in key part of control valve can be reduced in the design process by improving structure.

Medical marijuana patient counseling points for health care professionals based on trends in the medical uses, efficacy, and adverse effects of cannabis-based pharmaceutical drugs.

Science.gov (United States)

Parmar, Jayesh R; Forrest, Benjamin D; Freeman, Robert A

2016-01-01

The purpose of this report is to present a review of the medical uses, efficacy, and adverse effects of the three approved cannabis-based medications and ingested marijuana. A literature review was conducted utilizing key search terms: dronabinol, nabilone, nabiximols, cannabis, marijuana, smoke, efficacy, toxicity, cancer, multiple sclerosis, nausea, vomiting, appetite, pain, glaucoma, and side effects. Abstracts of the included literature were reviewed, analyzed, and organized to identify the strength of evidence in medical use, efficacy, and adverse effects of the approved cannabis-based medications and medical marijuana. A total of 68 abstracts were included for review. Dronabinol's (Marinol) most common medical uses include weight gain, chemotherapy-induced nausea and vomiting (CINV), and neuropathic pain. Nabiximol's (Sativex) most common medical uses include spasticity in multiple sclerosis (MS) and neuropathic pain. Nabilone's (Cesamet) most common medical uses include CINV and neuropathic pain. Smoked marijuana's most common medical uses include neuropathic pain and glaucoma. Orally ingested marijuana's most common medical uses include improving sleep, reducing neuropathic pain, and seizure control in MS. In general, all of these agents share similar medical uses. The reported adverse effects of the three cannabis-based medications and marijuana show a major trend in central nervous system (CNS)-related adverse effects along with cardiovascular and respiratory related adverse effects. Marijuana shares similar medical uses with the approved cannabis-based medications dronabinol (Marinol), nabiximols (Sativex), and nabilone (Cesamet), but the efficacy of marijuana for these medical uses has not been fully determined due to limited and conflicting literature. Medical marijuana also has similar adverse effects as the FDA-approved cannabis-based medications mainly consisting of CNS related adverse effects but also including cardiovascular and respiratory

Eminence-based medicine versus evidence-based medicine: level V evidence in sports medicine.

Science.gov (United States)

Tjoumakaris, Fotios P; Ganley, Theodore J; Kapur, Rahul; Kelly, John; Sennett, Brian J; Bernstein, Joseph

2011-11-01

cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.

Psiquiatria baseada em evidências Evidence-based psychiatry

Directory of Open Access Journals (Sweden)

Maurício S de Lima

2000-09-01

Full Text Available Em psiquiatria, observa-se grande variabilidade de práticas clínicas, muitas vezes desnecessária. Essas variações podem estar relacionadas à ausência de evidência científica confiável ou ao desconhecimento das evidências de boa qualidade disponíveis. A medicina baseada em evidências (MBE é uma combinação de estratégias que busca assegurar que o cuidado individual do paciente seja baseado na melhor informação disponível, a qual deve ser incorporada à prática clínica. Neste artigo, conceitos de MBE são discutidos com relação a aspectos e desafios no tratamento de pacientes com distimia, bulimia nervosa e esquizofrenia. A partir de resultados de três revisões sistemáticas recentemente publicadas, conclui-se que a prática de psiquiatria baseada em evidências acrescenta qualidade à prática psiquiátrica tradicional.The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.

[Burden of proof in medical cases--presumption of fact and prima facie evidence. II. Presumption of fact and prima facie evidence].

Science.gov (United States)

Sliwka, Marcin

2004-01-01

The aim of this paper was to present the main rules concerning the burden of proof in polish civil trials, including medical cases. The standard rules were presented with all the important exclusions such as presumption of law and fact or prima facie evidence. The author analyses the effect of these institutions on burden of proof in medical cases. The difference between presumptions of fact and prima facie evidence was analysed and explained. This paper also describes the importance of the res ipsa loquitur rule in United Kingdom and USA. This paper includes numerous High Court sentences on evidential and medical issues.

Reliability analysis framework for computer-assisted medical decision systems

International Nuclear Information System (INIS)

Habas, Piotr A.; Zurada, Jacek M.; Elmaghraby, Adel S.; Tourassi, Georgia D.

2007-01-01

We present a technique that enhances computer-assisted decision (CAD) systems with the ability to assess the reliability of each individual decision they make. Reliability assessment is achieved by measuring the accuracy of a CAD system with known cases similar to the one in question. The proposed technique analyzes the feature space neighborhood of the query case to dynamically select an input-dependent set of known cases relevant to the query. This set is used to assess the local (query-specific) accuracy of the CAD system. The estimated local accuracy is utilized as a reliability measure of the CAD response to the query case. The underlying hypothesis of the study is that CAD decisions with higher reliability are more accurate. The above hypothesis was tested using a mammographic database of 1337 regions of interest (ROIs) with biopsy-proven ground truth (681 with masses, 656 with normal parenchyma). Three types of decision models, (i) a back-propagation neural network (BPNN), (ii) a generalized regression neural network (GRNN), and (iii) a support vector machine (SVM), were developed to detect masses based on eight morphological features automatically extracted from each ROI. The performance of all decision models was evaluated using the Receiver Operating Characteristic (ROC) analysis. The study showed that the proposed reliability measure is a strong predictor of the CAD system's case-specific accuracy. Specifically, the ROC area index for CAD predictions with high reliability was significantly better than for those with low reliability values. This result was consistent across all decision models investigated in the study. The proposed case-specific reliability analysis technique could be used to alert the CAD user when an opinion that is unlikely to be reliable is offered. The technique can be easily deployed in the clinical environment because it is applicable with a wide range of classifiers regardless of their structure and it requires neither additional

A survey study of evidence-based medicine training in US and Canadian medical schools.

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Blanco, Maria A; Capello, Carol F; Dorsch, Josephine L; Perry, Gerald; Zanetti, Mary L

2014-07-01

The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Findings can provide a starting point for discussion to develop a standardized competency framework.

Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

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Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

2016-01-01

The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

Visualization studies on evidence-based medicine domain knowledge (series 3): visualization for dissemination of evidence based medicine information.

Science.gov (United States)

Shen, Jiantong; Yao, Leye; Li, Youping; Clarke, Mike; Gan, Qi; Li, Yifei; Fan, Yi; Gou, Yongchao; Wang, Li

2011-05-01

To identify patterns in information sharing between a series of Chinese evidence based medicine (EBM) journals and the Cochrane Database of Systematic Reviews, to determine key evidence dissemination areas for EBM and to provide a scientific basis for improving the dissemination of EBM research. Data were collected on citing and cited from the Chinese Journal of Evidence-Based Medicine (CJEBM), Journal of Evidence-Based Medicine (JEBMc), Chinese Journal of Evidence Based Pediatrics (CJEBP), and the Cochrane Database of Systematic Reviews (CDSR). Relationships between citations were visualized. High-frequency key words from these sources were identified, to build a word co-occurrence matrix and to map research subjects. CDSR contains a large collection of information of relevance to EBM and its contents are widely cited across many journals, suggesting a well-developed citation environment. The content and citation of the Chinese journals have been increasing in recent years. However, their citation environments are much less developed, and there is a wide variation in the breadth and strength of their knowledge communication, with the ranking from highest to lowest being CJEBM, JEBMc and CJEBP. The content of CDSR is almost exclusively Cochrane intervention reviews examining the effects of healthcare interventions, so it's contribution to EBM is mostly in disease control and treatment. On the other hand, the Chinese journals on evidence-based medicine and practice focused more on areas such as education and research, design and quality of clinical trials, evidence based policymaking, evidence based clinical practice, tumor treatment, and pediatrics. Knowledge and findings of EBM are widely communicated and disseminated. However, citation environments and range of knowledge communication differ greatly between the journals examined in this study. This finds that Chinese EBM has focused mainly on clinical medicine, Traditional Chinese Medicine, pediatrics, tumor

Training Methods to Improve Evidence-Based Medicine Skills

Directory of Open Access Journals (Sweden)

Filiz Ozyigit

2010-06-01

Full Text Available Evidence based medicine (EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It is estimated that only 15% of medical interventions is evidence-based. Increasing demand, new technological developments, malpractice legislations, a very speed increase in knowledge and knowledge sources push the physicians forward for EBM, but at the same time increase load of physicians by giving them the responsibility to improve their skills. Clinical maneuvers are needed more, as the number of clinical trials and observational studies increase. However, many of the physicians, who are in front row of patient care do not use this increasing evidence. There are several examples related to different training methods in order to improve skills of physicians for evidence based practice. There are many training methods to improve EBM skills and these trainings might be given during medical school, during residency or as continuous trainings to the actual practitioners in the field. It is important to discuss these different training methods in our country as well and encourage dissemination of feasible and effective methods. [TAF Prev Med Bull 2010; 9(3.000: 245-254

Evaluation of mobile ad hoc network reliability using propagation-based link reliability model

International Nuclear Information System (INIS)

Padmavathy, N.; Chaturvedi, Sanjay K.

2013-01-01

A wireless mobile ad hoc network (MANET) is a collection of solely independent nodes (that can move randomly around the area of deployment) making the topology highly dynamic; nodes communicate with each other by forming a single hop/multi-hop network and maintain connectivity in decentralized manner. MANET is modelled using geometric random graphs rather than random graphs because the link existence in MANET is a function of the geometric distance between the nodes and the transmission range of the nodes. Among many factors that contribute to the MANET reliability, the reliability of these networks also depends on the robustness of the link between the mobile nodes of the network. Recently, the reliability of such networks has been evaluated for imperfect nodes (transceivers) with binary model of communication links based on the transmission range of the mobile nodes and the distance between them. However, in reality, the probability of successful communication decreases as the signal strength deteriorates due to noise, fading or interference effects even up to the nodes' transmission range. Hence, in this paper, using a propagation-based link reliability model rather than a binary-model with nodes following a known failure distribution to evaluate the network reliability (2TR m , ATR m and AoTR m ) of MANET through Monte Carlo Simulation is proposed. The method is illustrated with an application and some imperative results are also presented

The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review.

Science.gov (United States)

Downs, Stephen; Marquez, Jodie; Chiarelli, Pauline

2013-06-01

What is the intra-rater and inter-rater relative reliability of the Berg Balance Scale? What is the absolute reliability of the Berg Balance Scale? Does the absolute reliability of the Berg Balance Scale vary across the scale? Systematic review with meta-analysis of reliability studies. Any clinical population that has undergone assessment with the Berg Balance Scale. Relative intra-rater reliability, relative inter-rater reliability, and absolute reliability. Eleven studies involving 668 participants were included in the review. The relative intrarater reliability of the Berg Balance Scale was high, with a pooled estimate of 0.98 (95% CI 0.97 to 0.99). Relative inter-rater reliability was also high, with a pooled estimate of 0.97 (95% CI 0.96 to 0.98). A ceiling effect of the Berg Balance Scale was evident for some participants. In the analysis of absolute reliability, all of the relevant studies had an average score of 20 or above on the 0 to 56 point Berg Balance Scale. The absolute reliability across this part of the scale, as measured by the minimal detectable change with 95% confidence, varied between 2.8 points and 6.6 points. The Berg Balance Scale has a higher absolute reliability when close to 56 points due to the ceiling effect. We identified no data that estimated the absolute reliability of the Berg Balance Scale among participants with a mean score below 20 out of 56. The Berg Balance Scale has acceptable reliability, although it might not detect modest, clinically important changes in balance in individual subjects. The review was only able to comment on the absolute reliability of the Berg Balance Scale among people with moderately poor to normal balance. Copyright © 2013 Australian Physiotherapy Association. Published by .. All rights reserved.

Research on the Fusion of Dependent Evidence Based on Rank Correlation Coefficient

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Fengjian Shi

2017-10-01

Full Text Available In order to meet the higher accuracy and system reliability requirements, the information fusion for multi-sensor systems is an increasing concern. Dempster–Shafer evidence theory (D–S theory has been investigated for many applications in multi-sensor information fusion due to its flexibility in uncertainty modeling. However, classical evidence theory assumes that the evidence is independent of each other, which is often unrealistic. Ignoring the relationship between the evidence may lead to unreasonable fusion results, and even lead to wrong decisions. This assumption severely prevents D–S evidence theory from practical application and further development. In this paper, an innovative evidence fusion model to deal with dependent evidence based on rank correlation coefficient is proposed. The model first uses rank correlation coefficient to measure the dependence degree between different evidence. Then, total discount coefficient is obtained based on the dependence degree, which also considers the impact of the reliability of evidence. Finally, the discount evidence fusion model is presented. An example is illustrated to show the use and effectiveness of the proposed method.

Research on the Fusion of Dependent Evidence Based on Rank Correlation Coefficient.

Science.gov (United States)

Shi, Fengjian; Su, Xiaoyan; Qian, Hong; Yang, Ning; Han, Wenhua

2017-10-16

In order to meet the higher accuracy and system reliability requirements, the information fusion for multi-sensor systems is an increasing concern. Dempster-Shafer evidence theory (D-S theory) has been investigated for many applications in multi-sensor information fusion due to its flexibility in uncertainty modeling. However, classical evidence theory assumes that the evidence is independent of each other, which is often unrealistic. Ignoring the relationship between the evidence may lead to unreasonable fusion results, and even lead to wrong decisions. This assumption severely prevents D-S evidence theory from practical application and further development. In this paper, an innovative evidence fusion model to deal with dependent evidence based on rank correlation coefficient is proposed. The model first uses rank correlation coefficient to measure the dependence degree between different evidence. Then, total discount coefficient is obtained based on the dependence degree, which also considers the impact of the reliability of evidence. Finally, the discount evidence fusion model is presented. An example is illustrated to show the use and effectiveness of the proposed method.

Evidence - based medicine/practice in sports physical therapy.

Science.gov (United States)

Manske, Robert C; Lehecka, B J

2012-10-01

A push for the use of evidence-based medicine and evidence-based practice patterns has permeated most health care disciplines. The use of evidence-based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision-making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well-being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence-based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.

Ethical reflections on Evidence Based Medicine

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S. Corrao

2013-05-01

Full Text Available BACKGROUND According to Potter’s point of view, medical ethics is the science of survival, a bridge between humanistic and scientific culture. The working out of judgements on right or wrong referred to the human being are studied by this science. Methodological quality is fundamental in clinical research, and several technical issues are of paramount importance in trying to answer to the final question “what is the true, the right thing?”. We know they are essential aspects as in medical ethics as in evidence based practice. AIM OF THE STUDY The aim of this paper is to talk about relationships and implications between ethical issues and Evidence Based Medicine (EBM. DISCUSSION EBM represents a new paradigm that introduces new concepts to guide medical-decision making and health-care planning. Its principles are deeply rooted in clinical research methodology since information are derived from sound studies of strong quality. Health-care professionals have to deal with methodological concepts for critical appraisal of literature and implementation of evidences in clinical practice and healthcare planning. The central role of EBM in medical ethics is obvious, but a risk could be possible. The shift from Hippocratic point of view to community-centred one could lose sight of the centrality of the patient. CONCLUSION Both EBM principles and the needs to adequately response to economic restrictions urge a balance between individual and community ethics. All this has to represent an opportunity to place the patient at the centre of medical action considering at the same time community ethics as systemic aim, but without forgetting the risk that economic restrictions push towards veterinary ethics where herd is central and individual needs do not exist.

Reliability-based optimization of engineering structures

DEFF Research Database (Denmark)

Sørensen, John Dalsgaard

2008-01-01

The theoretical basis for reliability-based structural optimization within the framework of Bayesian statistical decision theory is briefly described. Reliability-based cost benefit problems are formulated and exemplitied with structural optimization. The basic reliability-based optimization...... problems are generalized to the following extensions: interactive optimization, inspection and repair costs, systematic reconstruction, re-assessment of existing structures. Illustrative examples are presented including a simple introductory example, a decision problem related to bridge re...

[A Study of the Evidence-Based Nursing Practice Competence of Nurses and Its Clinical Applications].

Science.gov (United States)

Hsu, Li-Ling; Hsieh, Suh-Ing; Huang, Ya-Hsuan

2015-10-01

Nurses must develop competence in evidence-based nursing in order to provide the best practice medical care to patients. Evidence-based nursing uses issue identification, data mining, and information consolidation from the related medical literature to help nurses find the best evidence. Therefore, for medical institutions to provide quality clinical care, it is necessary for nurses to develop competence in evidence-based nursing. This study aims to explore the effect of a fundamental evidence-based nursing course, as a form of educational intervention, on the development of evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, and outcome expectations of evidence-based practice in nurse participants. Further the competence of these nurses in overcoming obstacles in evidence-based nursing practice. This quasi-experimental study used a pre-post test design with a single group of participants. A convenience sample of 34 nurses from a municipal hospital in northern Taiwan received 8 hours of a fundamental evidence-based nursing course over a two-week period. Participants were asked to complete four questionnaires before and after the intervention. The questionnaires measured the participants' basic demographics, experience in mining the medical literature, evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, outcome expectations of evidence-based practice, competence in overcoming obstacles in evidence-based nursing practice, and learning satisfaction. Collected data was analyzed using paired t, Wilcoxon Signed Rank, and McNemar tests to measure the differences among participants' evidence-based nursing knowledge and practice activities before and after the workshop. The nurses demonstrated significantly higher scores from pre-test to post-test in evidence-based nursing knowledge II, self-efficacy in evidence-based nursing practice activities, and outcome expectations of evidence-based practice

Information-seeking behavior during residency is associated with quality of theoretical learning, academic career achievements, and evidence-based medical practice: a strobe-compliant article.

Science.gov (United States)

Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

2015-02-01

Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3-6; range, 1-10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77-17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33-4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09-4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01-3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46-11.53); knowledge of the leading medical journals of the specialty (OR, 3.33; 95

A G-function-based reliability-based design methodology applied to a cam roller system

International Nuclear Information System (INIS)

Wang, W.; Sui, P.; Wu, Y.T.

1996-01-01

Conventional reliability-based design optimization methods treats the reliability function as an ordinary function and applies existing mathematical programming techniques to solve the design problem. As a result, the conventional approach requires nested loops with respect to g-function, and is very time consuming. A new reliability-based design method is proposed in this paper that deals with the g-function directly instead of the reliability function. This approach has the potential of significantly reducing the number of calls for g-function calculations since it requires only one full reliability analysis in a design iteration. A cam roller system in a typical high pressure fuel injection diesel engine is designed using both the proposed and the conventional approach. The proposed method is much more efficient for this application

Impact of Loss Synchronization on Reliable High Speed Networks: A Model Based Simulation

Directory of Open Access Journals (Sweden)

Suman Kumar

2014-01-01

Full Text Available Contemporary nature of network evolution demands for simulation models which are flexible, scalable, and easily implementable. In this paper, we propose a fluid based model for performance analysis of reliable high speed networks. In particular, this paper aims to study the dynamic relationship between congestion control algorithms and queue management schemes, in order to develop a better understanding of the causal linkages between the two. We propose a loss synchronization module which is user configurable. We validate our model through simulations under controlled settings. Also, we present a performance analysis to provide insights into two important issues concerning 10 Gbps high speed networks: (i impact of bottleneck buffer size on the performance of 10 Gbps high speed network and (ii impact of level of loss synchronization on link utilization-fairness tradeoffs. The practical impact of the proposed work is to provide design guidelines along with a powerful simulation tool to protocol designers and network developers.

Adherence to evidence-based guidelines among diabetes self-management apps.

Science.gov (United States)

Breland, Jessica Y; Yeh, Vivian M; Yu, Jessica

2013-09-01

Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term "diabetes" identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs.

Implementing Evidence-Based Practices for People With Schizophrenia

Science.gov (United States)

Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

2009-01-01

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

An Evidence-based Approach to Developing a Management Strategy for Medical Contingencies on the Lunar Surface: The NASA/Haughton-Mars Project (HMP) 2006 Lunar Medical Contingency Simulation at Devon Island

Science.gov (United States)

Scheuring, R. A.; Jones, J. A.; Lee, P.; Comtois, J. M.; Chappell, S.; Rafiq, A.; Braham, S.; Hodgson, E.; Sullivan, P.; Wilkinson, N.;

Ruminant self-medication against gastrointestinal nematodes: evidence, mechanism, and origins☆

Science.gov (United States)

Villalba, Juan J.; Miller, James; Ungar, Eugene D.; Landau, Serge Y.; Glendinning, John

2014-01-01

Gastrointestinal helminths challenge ruminants in ways that reduce their fitness. In turn, ruminants have evolved physiological and behavioral adaptations that counteract this challenge. Ruminants display anorexia and avoidance behaviors, which tend to reduce the incidence of parasitism. In addition, ruminants appear to learn to self-medicate against gastrointestinal parasites by increasing consumption of plant secondary compounds with antiparasitic actions. This selective feeding improves health and fitness. Here, we review the evidence for self-medication in ruminants, propose a hypothesis to explain self-medicative behaviors (based on post-ingestive consequences), and discuss mechanisms (e.g., enhanced neophilia, social transmission) that may underlie the ontogeny and spread of self-medicative behaviors in social groups. A better understanding of the mechanisms that underlie and trigger self-medication in parasitized animals will help scientists devise innovative and more sustainable management strategies for improving ruminant health and well-being. PMID:24971486

Asymmetric Programming: A Highly Reliable Metadata Allocation Strategy for MLC NAND Flash Memory-Based Sensor Systems

Science.gov (United States)

Huang, Min; Liu, Zhaoqing; Qiao, Liyan

2014-01-01

While the NAND flash memory is widely used as the storage medium in modern sensor systems, the aggressive shrinking of process geometry and an increase in the number of bits stored in each memory cell will inevitably degrade the reliability of NAND flash memory. In particular, it's critical to enhance metadata reliability, which occupies only a small portion of the storage space, but maintains the critical information of the file system and the address translations of the storage system. Metadata damage will cause the system to crash or a large amount of data to be lost. This paper presents Asymmetric Programming, a highly reliable metadata allocation strategy for MLC NAND flash memory storage systems. Our technique exploits for the first time the property of the multi-page architecture of MLC NAND flash memory to improve the reliability of metadata. The basic idea is to keep metadata in most significant bit (MSB) pages which are more reliable than least significant bit (LSB) pages. Thus, we can achieve relatively low bit error rates for metadata. Based on this idea, we propose two strategies to optimize address mapping and garbage collection. We have implemented Asymmetric Programming on a real hardware platform. The experimental results show that Asymmetric Programming can achieve a reduction in the number of page errors of up to 99.05% with the baseline error correction scheme. PMID:25310473

Asymmetric Programming: A Highly Reliable Metadata Allocation Strategy for MLC NAND Flash Memory-Based Sensor Systems

Directory of Open Access Journals (Sweden)

Min Huang

2014-10-01

Full Text Available While the NAND flash memory is widely used as the storage medium in modern sensor systems, the aggressive shrinking of process geometry and an increase in the number of bits stored in each memory cell will inevitably degrade the reliability of NAND flash memory. In particular, it’s critical to enhance metadata reliability, which occupies only a small portion of the storage space, but maintains the critical information of the file system and the address translations of the storage system. Metadata damage will cause the system to crash or a large amount of data to be lost. This paper presents Asymmetric Programming, a highly reliable metadata allocation strategy for MLC NAND flash memory storage systems. Our technique exploits for the first time the property of the multi-page architecture of MLC NAND flash memory to improve the reliability of metadata. The basic idea is to keep metadata in most significant bit (MSB pages which are more reliable than least significant bit (LSB pages. Thus, we can achieve relatively low bit error rates for metadata. Based on this idea, we propose two strategies to optimize address mapping and garbage collection. We have implemented Asymmetric Programming on a real hardware platform. The experimental results show that Asymmetric Programming can achieve a reduction in the number of page errors of up to 99.05% with the baseline error correction scheme.

High-Reliability Health Care: Getting There from Here

Science.gov (United States)

Chassin, Mark R; Loeb, Jerod M

2013-01-01

Context Despite serious and widespread efforts to improve the quality of health care, many patients still suffer preventable harm every day. Hospitals find improvement difficult to sustain, and they suffer “project fatigue” because so many problems need attention. No hospitals or health systems have achieved consistent excellence throughout their institutions. High-reliability science is the study of organizations in industries like commercial aviation and nuclear power that operate under hazardous conditions while maintaining safety levels that are far better than those of health care. Adapting and applying the lessons of this science to health care offer the promise of enabling hospitals to reach levels of quality and safety that are comparable to those of the best high-reliability organizations. Methods We combined the Joint Commission's knowledge of health care organizations with knowledge from the published literature and from experts in high-reliability industries and leading safety scholars outside health care. We developed a conceptual and practical framework for assessing hospitals’ readiness for and progress toward high reliability. By iterative testing with hospital leaders, we refined the framework and, for each of its fourteen components, defined stages of maturity through which we believe hospitals must pass to reach high reliability. Findings We discovered that the ways that high-reliability organizations generate and maintain high levels of safety cannot be directly applied to today's hospitals. We defined a series of incremental changes that hospitals should undertake to progress toward high reliability. These changes involve the leadership's commitment to achieving zero patient harm, a fully functional culture of safety throughout the organization, and the widespread deployment of highly effective process improvement tools. Conclusions Hospitals can make substantial progress toward high reliability by undertaking several specific

Designing high availability systems DFSS and classical reliability techniques with practical real life examples

CERN Document Server

Taylor, Zachary

2014-01-01

A practical, step-by-step guide to designing world-class, high availability systems using both classical and DFSS reliability techniques Whether designing telecom, aerospace, automotive, medical, financial, or public safety systems, every engineer aims for the utmost reliability and availability in the systems he, or she, designs. But between the dream of world-class performance and reality falls the shadow of complexities that can bedevil even the most rigorous design process. While there are an array of robust predictive engineering tools, there has been no single-source guide to understan

Performance and reliability of TPE-2 device with pulsed high power source

International Nuclear Information System (INIS)

Sato, Y.; Takeda, S.; Kiyama, S.

1987-01-01

The performance and the reliability of TPE-2 device with pulsed high power sources are described. To obtain the stable high beta plasma, the reproducibility and the reliability of the pulsed power sources must be maintained. A new power crowbar system with high efficiency and the switches with low jitter time are adopted to the bank system. A monitor system which always watches the operational states of the switches is developed too, and applied for the fast rising capacitor banks of TPE-2 device. The reliable operation for the bank has been realized, based on the data of switch monitor system

Assessment of Knowledge, Attitudes and Practice of Clinical Faculty Members of Alborz University of Medical Sciences Towards Evidence Based Medicine (EBM and Its Using

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D. salehifar

2017-06-01

Full Text Available Background: Evidence based medicine (EBM is an approach to improve the quality of clinical decision making, treatment and care provided to patients. This study aimed to assess the knowledge, attitude and practice of faculty members of Alborz University of Medical Sciences about EBM. Methods: A cross sectional study was conducted in 2015 and 40 physicians participated. Data were collected by a valid and reliable structured questionnaire consisting 17 knowledge items, 8 attitude items and 12 items for practices about EBM. Using SPSS software version 19 data analyses was done. Results: From a total of 49 faculty members 40 responded the questionnaires in which 62.5% were female, the mean average age was 40.6 years and mean time of job experience was 8.1 years. About half of the respondents had participated in an EBM workshop, 10% of the participants have stated that do not know EBM and 37.5% had low knowledge, only 7.5% had adequate knowledge. Ninety percent of the respondents believed that EBM has an important role in promoting quality of care and 82% of them were interested to take part in EBM workshops. The information source for clinical practice in 70% of the participants was the text book, 55% Cochrane, and 45% clinical experience. Conclusion: Faculty members had a positive attitude toward EBM; although a vast majority of them claimed that they practice based on evidence in clinical settings, about half of them stated had not adequate knowledge about EBM. Therefore, it is necessary to keep their knowledge up to date. 

Development of a highly reliable CRT processor

International Nuclear Information System (INIS)

Shimizu, Tomoya; Saiki, Akira; Hirai, Kenji; Jota, Masayoshi; Fujii, Mikiya

1996-01-01

Although CRT processors have been employed by the main control board to reduce the operator's workload during monitoring, the control systems are still operated by hardware switches. For further advancement, direct controller operation through a display device is expected. A CRT processor providing direct controller operation must be as reliable as the hardware switches are. The authors are developing a new type of highly reliable CRT processor that enables direct controller operations. In this paper, we discuss the design principles behind a highly reliable CRT processor. The principles are defined by studies of software reliability and of the functional reliability of the monitoring and operation systems. The functional configuration of an advanced CRT processor is also addressed. (author)

The reliability of in-home measures of height and weight in large cohort studies: Evidence from Add Health

Directory of Open Access Journals (Sweden)

Jon Hussey

2015-05-01

Full Text Available Background: With the emergence of obesity as a global health issue, an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. Objective: We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health, compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES and, using both sources, provide a detailed anthropometric description of young adults in the United States. Methods: The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. Results: Short-term reliabilities of in-home measures of height, weight, waist and arm circumference - as well as derived body mass index (BMI, kg/m2 - were excellent. Prevalence of obesity (37Š vs. 29Š and central obesity (47Š vs. 38Š was higher in Add Health than in NHANES, while socio-demographic patterns of obesity and central obesity were comparable in the two studies. Conclusions: Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality.

EVIDENCE-BASED MEDICINE – II. CLINICAL USE AND CRITICS

Directory of Open Access Journals (Sweden)

Angela Čuk

2004-01-01

Full Text Available Background. Evidence-based medicine employs systematic searching, evaluation and use of current research findings as the basis for clinical decision-making. However, there are some problems and uncertainties hindering introduction and spreading of the use of the method in clinical practice. Physicians often have no time for literature searching and for use of the method in practice. For certain questions in clinical practice there are no answers in medical literature. Most of the evidences in medical literature are only available in English. Introduction of the method is hampered also by the fact that clinical decision-making is complex and does not allow procedures prescribed in advance. Rigidity and universality of decisions resulting from the evidence may appear impersonal and may affect the relationship between the physician and the patient. Trends towards evidence based medicine are followed also by big multinational pharmaceutical corporations. They carry out large and expensive clinical trials using the results for promotional purposes. In this way, they get the competitive advantage and influence the objectivity of physicians’ clinical decision-making.Conclusions. With introduction of evidence based medicine into clinical practice physicians acquire new information and use a new form of continuing education by following new developments in their field. This way, new findings from medical literature get into clinical practice faster and more efficiently. In addition, physicians get more professional satisfaction and quality in clinical practice is higher.

Reliability analysis of software based safety functions

International Nuclear Information System (INIS)

Pulkkinen, U.

1993-05-01

The methods applicable in the reliability analysis of software based safety functions are described in the report. Although the safety functions also include other components, the main emphasis in the report is on the reliability analysis of software. The check list type qualitative reliability analysis methods, such as failure mode and effects analysis (FMEA), are described, as well as the software fault tree analysis. The safety analysis based on the Petri nets is discussed. The most essential concepts and models of quantitative software reliability analysis are described. The most common software metrics and their combined use with software reliability models are discussed. The application of software reliability models in PSA is evaluated; it is observed that the recent software reliability models do not produce the estimates needed in PSA directly. As a result from the study some recommendations and conclusions are drawn. The need of formal methods in the analysis and development of software based systems, the applicability of qualitative reliability engineering methods in connection to PSA and the need to make more precise the requirements for software based systems and their analyses in the regulatory guides should be mentioned. (orig.). (46 refs., 13 figs., 1 tab.)

Judicial Understanding of the Reliability of Eyewitness Evidence: A Tale of Two Cases

Directory of Open Access Journals (Sweden)

Lirieka Meintjes-van der Walt

2016-06-01

Full Text Available One of the most significant consequences of the use of post-conviction DNA testing in the criminal justice system has been the growing recognition that eyewitness identification testimony is simply not as reliable as it was previously considered to be. In approximately 75% of DNA exonerations in the United States, mistaken eyewitness identifications were the principal cause of wrongful convictions. Notwithstanding scientific advances regarding human memory and other factors that could influence identifications by eyewitnesses, courts have not shown eagerness in utilising such scientific knowledge in reaching legal decisions. Two cases have been chosen for discussion in this article. In S v Henderson 27 A 3d 872 (NJ 2011 the New Jersey Supreme Court was the first in State and Federal jurisdictions in the US that adopted a science-based approach to the evaluation of eyewitness evidence. The other case under discussion is S v Mdlongwa 2010 2 SACR 419 (SCA, a South African Supreme Court of Appeal judgment, where the identification of the perpetrator was based on an eyewitness account and the evidence of an expert on CCTV images. In part one of this article the research findings with regard to estimator variables that were acknowledged in S v Henderson are discussed. Part two specifically scrutinizes S v Mdlongwa to determine the extent to which psychological eyewitness research findings are recognised in South Africa as having an influence on the reliability of eyewitness evidence. In Henderson the court recognised that the legal standards governing the admissibility and use of identification evidence lagged far behind the findings of numerous studies in the social sciences. The new wave introduced by S v Henderson has not gone unnoticed in other State courts in the USA. In Massachusetts, for example, the Justices of the Supreme Judicial Court convened a study group on Eyewitness Evidence and the resulting report inter alia recommended judicial

Implementation of evidence-based knowledge in general practice.

Science.gov (United States)

Le, Jette Videbæk

2017-12-01

Background Keeping up with the evidence and implementing it into the daily care for patients are fundamental prerequisites for delivering a high quality of care in general practice. However, despite many years of research into dissemination and implementation of evidence-based recommendations, significant challenges remain. In recent years, organisational factors have become widely acknowledged as vitally important for ensuring successful implementation. Further knowledge is needed to understand more about which factors affect the seeking and implementation of evidence-based knowledge in general practice. Aim The overall aim was to investigate how evidence-based knowledge is sought and implemented in general practice and to analyse associations with GP characteristics and quality of care. Three separate studies, each covering a specific part of the overall aim, were undertaken: I. To examine how GPs implement clinical practice guidelines in everyday clinical practice, and how implementation approaches differ between practices. II. To assess GPs’ information seeking behaviour with regard to the use and perceived importance of scientific medical information sources and to investigate associations with GP characteristics. III. To investigate if there are associations between specific formalised implementation activities within general practice and quality of care – exemplified by the use of spirometry testing among first-time users of medication against obstructive lung diseases. Methods The study was designed as a mixed methods study combining qualitative interviews, questionnaire and register data. Study I was a qualitative interview study that involved purposefully selected GPs representing seven different practices. The interviews were analysed using systematic text condensation, and results were used to qualify the development of a national survey of general practitioners regarding their seeking and implementation of evidence-based knowledge. This survey was

Simple and rapid preparation of [11C]DASB with high quality and reliability for routine applications

International Nuclear Information System (INIS)

Haeusler, D.; Mien, L.-K.; Nics, L.; Ungersboeck, J.; Philippe, C.; Lanzenberger, R.R.; Kletter, K.; Dudczak, R.; Mitterhauser, M.; Wadsak, W.

2009-01-01

[ 11 C]DASB combines all major prerequisites for a successful SERT-ligand, providing excellent biological properties and in-vivo behaviour. Thus, we aimed to establish a fully automated procedure for the synthesis and purification of [ 11 C]DASB with a high degree of reliability reducing the overall synthesis time while conserving high yields and purity. The optimized [ 11 C]DASB synthesis was applied in more than 60 applications with a very low failure rate (3.2%). We obtained yields up to 8.9 GBq (average 5.3±1.6 GBq). Radiochemical yields based on [ 11 C]CH 3 I, (corrected for decay) were 66.3±6.9% with a specific radioactivity (A s ) of 86.8±24.3 GBq/μmol (both at the end of synthesis, EOS). Time consumption was kept to a minimum, resulting in 43 min from end of bombardment to release of the product after quality control. Form our data, it is evident that the presented method can be implemented for routine preparations of [ 11 C]DASB with high reliability.

Reliability-based design of wind turbine blades

DEFF Research Database (Denmark)

Toft, Henrik Stensgaard; Sørensen, John Dalsgaard

2011-01-01

Reliability-based design of wind turbine blades requires identification of the important failure modes/limit states along with stochastic models for the uncertainties and methods for estimating the reliability. In the present paper it is described how reliability-based design can be applied to wi...

High-reliability health care: getting there from here.

Science.gov (United States)

Chassin, Mark R; Loeb, Jerod M

2013-09-01

Despite serious and widespread efforts to improve the quality of health care, many patients still suffer preventable harm every day. Hospitals find improvement difficult to sustain, and they suffer "project fatigue" because so many problems need attention. No hospitals or health systems have achieved consistent excellence throughout their institutions. High-reliability science is the study of organizations in industries like commercial aviation and nuclear power that operate under hazardous conditions while maintaining safety levels that are far better than those of health care. Adapting and applying the lessons of this science to health care offer the promise of enabling hospitals to reach levels of quality and safety that are comparable to those of the best high-reliability organizations. We combined the Joint Commission's knowledge of health care organizations with knowledge from the published literature and from experts in high-reliability industries and leading safety scholars outside health care. We developed a conceptual and practical framework for assessing hospitals' readiness for and progress toward high reliability. By iterative testing with hospital leaders, we refined the framework and, for each of its fourteen components, defined stages of maturity through which we believe hospitals must pass to reach high reliability. We discovered that the ways that high-reliability organizations generate and maintain high levels of safety cannot be directly applied to today's hospitals. We defined a series of incremental changes that hospitals should undertake to progress toward high reliability. These changes involve the leadership's commitment to achieving zero patient harm, a fully functional culture of safety throughout the organization, and the widespread deployment of highly effective process improvement tools. Hospitals can make substantial progress toward high reliability by undertaking several specific organizational change initiatives. Further research

Analyzing Reliability and Performance Trade-Offs of HLS-Based Designs in SRAM-Based FPGAs Under Soft Errors

Science.gov (United States)

Tambara, Lucas Antunes; Tonfat, Jorge; Santos, André; Kastensmidt, Fernanda Lima; Medina, Nilberto H.; Added, Nemitala; Aguiar, Vitor A. P.; Aguirre, Fernando; Silveira, Marcilei A. G.

2017-02-01

The increasing system complexity of FPGA-based hardware designs and shortening of time-to-market have motivated the adoption of new designing methodologies focused on addressing the current need for high-performance circuits. High-Level Synthesis (HLS) tools can generate Register Transfer Level (RTL) designs from high-level software programming languages. These tools have evolved significantly in recent years, providing optimized RTL designs, which can serve the needs of safety-critical applications that require both high performance and high reliability levels. However, a reliability evaluation of HLS-based designs under soft errors has not yet been presented. In this work, the trade-offs of different HLS-based designs in terms of reliability, resource utilization, and performance are investigated by analyzing their behavior under soft errors and comparing them to a standard processor-based implementation in an SRAM-based FPGA. Results obtained from fault injection campaigns and radiation experiments show that it is possible to increase the performance of a processor-based system up to 5,000 times by changing its architecture with a small impact in the cross section (increasing up to 8 times), and still increasing the Mean Workload Between Failures (MWBF) of the system.

Integration of evidence-based practice in bedside teaching paediatrics supported by e-learning.

Science.gov (United States)

Potomkova, Jarmila; Mihal, Vladimir; Zapletalova, Jirina; Subova, Dana

2010-03-01

Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

Evidence-based Practice of Radiology.

Science.gov (United States)

Lavelle, Lisa P; Dunne, Ruth M; Carroll, Anne G; Malone, Dermot E

2015-10-01

Current health care reform in the United States is producing a shift in radiology practice from the traditional volume-based role of performing and interpreting a large number of examinations to providing a more affordable and higher-quality service centered on patient outcomes, which is described as a value-based approach to the provision of health care services. In the 1990 s, evidence-based medicine was defined as the integration of current best evidence with clinical expertise and patient values. When these methods are applied outside internal medicine, the process is called evidence-based practice (EBP). EBP facilitates understanding, interpretation, and application of the best current evidence into radiology practice, which optimizes patient care. It has been incorporated into "Practice-based Learning and Improvement" and "Systems-based Practice," which are two of the six core resident competencies of the Accreditation Council for Graduate Medical Education and two of the 12 American Board of Radiology milestones for diagnostic radiology. Noninterpretive skills, such as systems-based practice, are also formally assessed in the "Quality and Safety" section of the American Board of Radiology Core and Certifying examinations. This article describes (a) the EBP framework, with particular focus on its relevance to the American Board of Radiology certification and maintenance of certification curricula; (b) how EBP can be integrated into a residency program; and (c) the current value and likely place of EBP in the radiology information technology infrastructure. Online supplemental material is available for this article. © RSNA, 2015.

Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study.

Science.gov (United States)

Sullivan, Jennifer L; Rivard, Peter E; Shin, Marlena H; Rosen, Amy K

2016-09-01

The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.

Reliability and validity evidence of the Assessment of Language Use in Social Contexts for Adults (ALUSCA).

Science.gov (United States)

Valente, Ana Rita S; Hall, Andreia; Alvelos, Helena; Leahy, Margaret; Jesus, Luis M T

2018-04-12

The appropriate use of language in context depends on the speaker's pragmatic language competencies. A coding system was used to develop a specific and adult-focused self-administered questionnaire to adults who stutter and adults who do not stutter, The Assessment of Language Use in Social Contexts for Adults, with three categories: precursors, basic exchanges, and extended literal/non-literal discourse. This paper presents the content validity, item analysis, reliability coefficients and evidences of construct validity of the instrument. Content validity analysis was based on a two-stage process: first, 11 pragmatic questionnaires were assessed to identify items that probe each pragmatic competency and to create the first version of the instrument; second, items were assessed qualitatively by an expert panel composed by adults who stutter and controls, and quantitatively and qualitatively by an expert panel composed by clinicians. A pilot study was conducted with five adults who stutter and five controls to analyse items and calculate reliability. Construct validity evidences were obtained using the hypothesized relationships method and factor analysis with 28 adults who stutter and 28 controls. Concerning content validity, the questionnaires assessed up to 13 pragmatic competencies. Qualitative and quantitative analysis revealed ambiguities in items construction. Disagreement between experts was solved through item modification. The pilot study showed that the instrument presented internal consistency and temporal stability. Significant differences between adults who stutter and controls and different response profiles revealed the instrument's underlying construct. The instrument is reliable and presented evidences of construct validity.

Design and reliability analysis of high-speed and continuous data recording system based on disk array

Science.gov (United States)

Jiang, Changlong; Ma, Cheng; He, Ning; Zhang, Xugang; Wang, Chongyang; Jia, Huibo

2002-12-01

In many real-time fields the sustained high-speed data recording system is required. This paper proposes a high-speed and sustained data recording system based on the complex-RAID 3+0. The system consists of Array Controller Module (ACM), String Controller Module (SCM) and Main Controller Module (MCM). ACM implemented by an FPGA chip is used to split the high-speed incoming data stream into several lower-speed streams and generate one parity code stream synchronously. It also can inversely recover the original data stream while reading. SCMs record lower-speed streams from the ACM into the SCSI disk drivers. In the SCM, the dual-page buffer technology is adopted to implement speed-matching function and satisfy the need of sustainable recording. MCM monitors the whole system, controls ACM and SCMs to realize the data stripping, reconstruction, and recovery functions. The method of how to determine the system scale is presented. At the end, two new ways Floating Parity Group (FPG) and full 2D-Parity Group (full 2D-PG) are proposed to improve the system reliability and compared with the Traditional Parity Group (TPG). This recording system can be used conveniently in many areas of data recording, storing, playback and remote backup with its high-reliability.

Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

Science.gov (United States)

O'Neil, Kevin M; Addrizzo-Harris, Doreen J

2009-03-01

Recommendations for optimizing continuing medical education (CME) effectiveness in improving physician application of knowledge and psychomotor skills are needed to guide the development of processes that effect physician change and improve patient care. The guideline panel reviewed evidence tables and a comprehensive review of the effectiveness of CME developed by The Johns Hopkins Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ Evidence Report). The panel considered studies relevant to the effect of CME on physician knowledge application and psychomotor skill development. From the 136 studies identified in the systematic review, 15 articles, 12 addressing physician application of knowledge and 3 addressing psychomotor skills, were identified and reviewed. Recommendations for optimizing CME were developed using the American College of Chest Physicians guideline grading system. The preponderance of evidence demonstrated improvement in physician application of knowledge with CME. The quality of evidence did not allow specific recommendations regarding optimal media or educational techniques or the effectiveness of CME in improving psychomotor skills. CME is effective in improving physician application of knowledge. Multiple exposures and longer durations of CME are recommended to optimize educational outcomes.

Achieving High Reliability Operations Through Multi-Program Integration

Energy Technology Data Exchange (ETDEWEB)

Holly M. Ashley; Ronald K. Farris; Robert E. Richards

2009-04-01

Over the last 20 years the Idaho National Laboratory (INL) has adopted a number of operations and safety-related programs which has each periodically taken its turn in the limelight. As new programs have come along there has been natural competition for resources, focus and commitment. In the last few years, the INL has made real progress in integrating all these programs and are starting to realize important synergies. Contributing to this integration are both collaborative individuals and an emerging shared vision and goal of the INL fully maturing in its high reliability operations. This goal is so powerful because the concept of high reliability operations (and the resulting organizations) is a masterful amalgam and orchestrator of the best of all the participating programs (i.e. conduct of operations, behavior based safety, human performance, voluntary protection, quality assurance, and integrated safety management). This paper is a brief recounting of the lessons learned, thus far, at the INL in bringing previously competing programs into harmony under the goal (umbrella) of seeking to perform regularly as a high reliability organization. In addition to a brief diagram-illustrated historical review, the authors will share the INL’s primary successes (things already effectively stopped or started) and the gaps yet to be bridged.

Development and evaluation of a simulation-based continuing medical education course: beyond lectures and credit hours.

Science.gov (United States)

Pugh, Carla M; Arafat, Fahd O; Kwan, Calvin; Cohen, Elaine R; Kurashima, Yo; Vassiliou, Melina C; Fried, Gerald M

2015-10-01

The aim of our study was to modify our previously developed laparoscopic ventral hernia (LVH) simulator to increase difficulty and then reassess validity and feasibility for using the simulator in a newly developed simulation-based continuing medical education course. Participants (N = 30) were practicing surgeons who signed up for a hands-on postgraduate laparoscopic hernia course. An LVH simulator, with prior validity evidence, was modified for the course to increase difficulty. Participants completed 1 of the 3 variations in hernia anatomy: incarcerated omentum, incarcerated bowel, and diffuse adhesions. During the procedure, course faculty and peer observers rated surgeon performance using Global Operative Assessment of Laparoscopic Skills-Incisional Hernia and Global Operative Assessment of Laparoscopic Skills rating scales with prior validity evidence. Rating scale reliability was reassessed for internal consistency. Peer and faculty raters' scores were compared. In addition, quality and completeness of the hernia repairs were rated. Internal consistency on the general skills performance (peer α = .96, faculty α = .94) and procedure-specific performance (peer α = .91, faculty α = .88) scores were high. Peers were more lenient than faculty raters on all LVH items in both the procedure-specific skills and general skills ratings. Overall, participants scored poorly on the quality and completeness of their hernia repairs (mean = 3.90/16, standard deviation = 2.72), suggesting a mismatch between course attendees and hernia difficulty and identifying a learning need. Simulation-based continuing medical education courses provide hands-on experiences that can positively affect clinical practice. Although our data appear to show a significant mismatch between clinical skill and simulator difficulty, these findings also underscore significant learning needs in the surgical community. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessment of Evidence Base from Medical Debriefs Data on Space Motion Sickness Incidence and Treatment

Science.gov (United States)

Younker, D.R.; Daniels, V.R.; Boyd, J.L.; Putcha, L.

2008-01-01

An objective of this data compilation and analysis project is to examine incidence and treatment efficacy of common patho-physiological disturbances during spaceflight. Analysis of medical debriefs data indicated that astronauts used medications to alleviate symptoms of four major ailments for which astronauts received treatment for sleep disturbances, space motion sickness (SMS), pain (headache, back pain) and sinus congestion. In the present data compilation and analysis project on SMS treatment during space missions, subject demographics (gender, age, first-time or repeat flyer), incidence and severity of SMS symptoms and subjective treatment efficacy from 317 crewmember debrief records were examined from STS-1 through STS-89. Preliminary analysis of data revealed that 50% of crew members reported SMS symptoms on at least one flight and 22% never experienced it. In addition, there were 387 medication dosing episodes reported, and promethazine was the most commonly used medication. Results of analysis of symptom check lists, medication use/efficacy and gender and flight record differences in incidence and treatment efficacy will be presented. Evidence gaps for treatment efficacy along with medication use trend analysis will be identified.

Contribution to high voltage matrix switches reliability

International Nuclear Information System (INIS)

Lausenaz, Yvan

2000-01-01

Nowadays, power electronic equipment requirements are important, concerning performances, quality and reliability. On the other hand, costs have to be reduced in order to satisfy the market rules. To provide cheap, reliability and performances, many standard components with mass production are developed. But the construction of specific products must be considered following these two different points: in one band you can produce specific components, with delay, over-cost problems and eventuality quality and reliability problems, in the other and you can use standard components in a adapted topologies. The CEA of Pierrelatte has adopted this last technique of power electronic conception for the development of these high voltage pulsed power converters. The technique consists in using standard components and to associate them in series and in parallel. The matrix constitutes high voltage macro-switch where electrical parameters are distributed between the synchronized components. This study deals with the reliability of these structures. It brings up the high reliability aspect of MOSFETs matrix associations. Thanks to several homemade test facilities, we obtained lots of data concerning the components we use. The understanding of defects propagation mechanisms in matrix structures has allowed us to put forwards the necessity of robust drive system, adapted clamping voltage protection, and careful geometrical construction. All these reliability considerations in matrix associations have notably allowed the construction of a new matrix structure regrouping all solutions insuring reliability. Reliable and robust, this product has already reaches the industrial stage. (author) [fr

Exponential Reliability Coefficient based Reputation Mechanism for isolating selfish nodes in MANETs

Directory of Open Access Journals (Sweden)

J. Sengathir

2015-07-01

Full Text Available In mobile ad hoc networks, cooperation among active mobile nodes is considered to play a vital role in reliable transmission of data. But, the selfish mobile nodes present in an ad hoc environment refuse to forward neighbouring nodes’ packet for conserving its own energy. This intentional selfish behaviour drastically reduces the degree of cooperation maintained between the mobile nodes. Hence, a need arises for devising an effective mechanism which incorporates both energy efficiency and reputation into account for mitigating selfish behaviour in MANETs. In this paper, we propose an Exponential Reliability Coefficient based reputation Mechanism (ERCRM which isolates the selfish nodes from the routing path based on Exponential Reliability Coefficient (ExRC. This reliability coefficient manipulated through exponential failure rate based on moving average method highlights the most recent past behaviour of the mobile nodes for quantifying its genuineness. From the simulation results, it is evident that, the proposed ERCRM approach outperforms the existing Packet Conservation Monitoring Algorithm (PCMA and Spilt Half Reliability Coefficient based Mathematical Model (SHRCM in terms of performance evaluation metrics such as packet delivery ratio, throughput, total overhead and control overhead. Further, this ERCRM mechanism has a successful rate of 28% in isolating the selfish nodes from the routing path. Furthermore, it also aids in framing the exponential threshold point of detection as 0.4, where a maximum number of selfish nodes are identified when compared to the existing models available in the literature.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

Science.gov (United States)

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-02-01

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

The Care and Feeding of Evidence Based Medicine

OpenAIRE

Tabrah, Frank L

2012-01-01

Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment.

High-Reliable PLC RTOS Development and RPS Structure Analysis

Energy Technology Data Exchange (ETDEWEB)

Sohn, H. S.; Song, D. Y.; Sohn, D. S.; Kim, J. H. [Enersys Co., Daejeon (Korea, Republic of)

2008-04-15

One of the KNICS objectives is to develop a platform for Nuclear Power Plant(NPP) I and C(Instrumentation and Control) system, especially plant protection system. The developed platform is POSAFE-Q and this work supports the development of POSAFE-Q with the development of high-reliable real-time operating system(RTOS) and programmable logic device(PLD) software. Another KNICS objective is to develop safety I and C systems, such as Reactor Protection System(RPS) and Engineered Safety Feature-Component Control System(ESF-CCS). This work plays an important role in the structure analysis for RPS. Validation and verification(V and V) of the safety critical software is an essential work to make digital plant protection system highly reliable and safe. Generally, the reliability and safety of software based system can be improved by strict quality assurance framework including the software development itself. In other words, through V and V, the reliability and safety of a system can be improved and the development activities like software requirement specification, software design specification, component tests, integration tests, and system tests shall be appropriately documented for V and V.

High-Reliable PLC RTOS Development and RPS Structure Analysis

International Nuclear Information System (INIS)

Sohn, H. S.; Song, D. Y.; Sohn, D. S.; Kim, J. H.

2008-04-01

One of the KNICS objectives is to develop a platform for Nuclear Power Plant(NPP) I and C(Instrumentation and Control) system, especially plant protection system. The developed platform is POSAFE-Q and this work supports the development of POSAFE-Q with the development of high-reliable real-time operating system(RTOS) and programmable logic device(PLD) software. Another KNICS objective is to develop safety I and C systems, such as Reactor Protection System(RPS) and Engineered Safety Feature-Component Control System(ESF-CCS). This work plays an important role in the structure analysis for RPS. Validation and verification(V and V) of the safety critical software is an essential work to make digital plant protection system highly reliable and safe. Generally, the reliability and safety of software based system can be improved by strict quality assurance framework including the software development itself. In other words, through V and V, the reliability and safety of a system can be improved and the development activities like software requirement specification, software design specification, component tests, integration tests, and system tests shall be appropriately documented for V and V.

Evidence-based practice of periodontics.

Science.gov (United States)

Cobb, Charles M; MacNeill, Simon R; Satheesh, Keerthana

2010-01-01

Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.

Medical Assistant-based care management for high risk patients in small primary care practices

DEFF Research Database (Denmark)

Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

2016-01-01

Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

Introducing competency-based postgraduate medical education in the Netherlands.

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Scheele, Fedde; Teunissen, Pim; Van Luijk, Scheltus; Heineman, Erik; Fluit, Lia; Mulder, Hanneke; Meininger, Abe; Wijnen-Meijer, Marjo; Glas, Gerrit; Sluiter, Henk; Hummel, Thalia

2008-01-01

Medical boards around the world face the challenge of creating competency-based postgraduate training programs. Recent legislation requires that all postgraduate medical training programmes in The Netherlands be reformed. In this article the Dutch Advisory Board for Postgraduate Curriculum Development shares some of their experiences with guiding the design of specialist training programs, based on the Canadian Medical Educational Directives for Specialists (CanMEDS). All twenty-seven Dutch Medical Specialty Societies take three steps in designing a curriculum. First they divide the entire content of a specialty into logical units, so-called 'themes'. The second step is discussing, for each theme, for which tasks trainees have to be instructed, guided, and assessed. Finally, for each task an assessment method is chosen to focus on a limited number of CanMEDS roles. This leads to a three step training cycle: (i) based on their in-training assessment and practices, trainees will gather evidence on their development in a portfolio; (ii) this evidence stimulates the trainee and the supervisor to regularly reflect on a trainee's global development regarding the CanMEDS roles as well as on the performance in specific tasks; (iii) a personal development plan structures future learning goals and strategies. The experiences in the Netherlands are in line with international developments in postgraduate medical education and with the literature on workplace-based teaching and learning.

A Systematic Review of Statistical Methods Used to Test for Reliability of Medical Instruments Measuring Continuous Variables

Directory of Open Access Journals (Sweden)

Rafdzah Zaki

2013-06-01

Full Text Available   Objective(s: Reliability measures precision or the extent to which test results can be replicated. This is the first ever systematic review to identify statistical methods used to measure reliability of equipment measuring continuous variables. This studyalso aims to highlight the inappropriate statistical method used in the reliability analysis and its implication in the medical practice.   Materials and Methods: In 2010, five electronic databases were searched between 2007 and 2009 to look for reliability studies. A total of 5,795 titles were initially identified. Only 282 titles were potentially related, and finally 42 fitted the inclusion criteria. Results: The Intra-class Correlation Coefficient (ICC is the most popular method with 25 (60% studies having used this method followed by the comparing means (8 or 19%. Out of 25 studies using the ICC, only 7 (28% reported the confidence intervals and types of ICC used. Most studies (71% also tested the agreement of instruments. Conclusion: This study finds that the Intra-class Correlation Coefficient is the most popular method used to assess the reliability of medical instruments measuring continuous outcomes. There are also inappropriate applications and interpretations of statistical methods in some studies. It is important for medical researchers to be aware of this issue, and be able to correctly perform analysis in reliability studies.

Evidence-based dentistry for planning restorative treatments: barriers and potential solutions.

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Afrashtehfar, K I; Eimar, H; Yassine, R; Abi-Nader, S; Tamimi, F

2017-11-01

Evidence-based dentistry (EBD) can help provide the best treatment option for every patient, however, its implementation in restorative dentistry is very limited. This study aimed at assessing the barriers preventing the implementation of EBD among dental undergraduate and graduate students in Montreal, and explore possible solutions to overcome these barriers. A cross-sectional survey was conducted by means of a paper format self-administrated questionnaire distributed among dental students. The survey assessed the barriers and potential solutions for implementation of an evidence-based practice. Sixty-one students completed the questionnaire. Forty-one percent of respondents found evidence-based literature to be the most reliable source of information for restorative treatment planning, however, only 16% used it. They considered that finding reliable information was difficult and they sometimes encountered conflicting information when consulting different sources. Dental students had positive attitudes towards the need for better access to evidence-based literature to assist learning and decision making in restorative treatment planning and to improve treatment outcomes. Even for dentists trained in EBD, online searching takes too much time, and even though it can provide information of better quality than personal intuition, it might not be enough to identify the best available evidence. Even though dental students are aware of the importance of EBD in restorative dentistry they rarely apply the concept, mainly due to time constraints. For this reason, implementation of EBD would probably require faster access to evidence-based knowledge. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine.

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Bensing, J

2000-01-01

Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and

Reliability-based assessment of polyethylene pipe creep lifetime

International Nuclear Information System (INIS)

Khelif, Rabia; Chateauneuf, Alaa; Chaoui, Kamel

2007-01-01

Lifetime management of underground pipelines is mandatory for safe hydrocarbon transmission and distribution systems. The use of high-density polyethylene tubes subjected to internal pressure, external loading and environmental variations requires a reliability study in order to define the service limits and the optimal operating conditions. In service, the time-dependent phenomena, especially creep, take place during the pipe lifetime, leading to significant strength reduction. In this work, the reliability-based assessment of pipe lifetime models is carried out, in order to propose a probabilistic methodology for lifetime model selection and to determine the pipe safety levels as well as the most important parameters for pipeline reliability. This study is enhanced by parametric analysis on pipe configuration, gas pressure and operating temperature

Reliability-based assessment of polyethylene pipe creep lifetime

Energy Technology Data Exchange (ETDEWEB)

Khelif, Rabia [LaMI-UBP and IFMA, Campus de Clermont-Fd, Les Cezeaux, BP 265, 63175 Aubiere Cedex (France); LR3MI, Departement de Genie Mecanique, Universite Badji Mokhtar, BP 12, Annaba 23000 (Algeria)], E-mail: rabia.khelif@ifma.fr; Chateauneuf, Alaa [LGC-University Blaise Pascal, Campus des Cezeaux, BP 206, 63174 Aubiere Cedex (France)], E-mail: alaa.chateauneuf@polytech.univ-bpclermont.fr; Chaoui, Kamel [LR3MI, Departement de Genie Mecanique, Universite Badji Mokhtar, BP 12, Annaba 23000 (Algeria)], E-mail: chaoui@univ-annaba.org

2007-12-15

Lifetime management of underground pipelines is mandatory for safe hydrocarbon transmission and distribution systems. The use of high-density polyethylene tubes subjected to internal pressure, external loading and environmental variations requires a reliability study in order to define the service limits and the optimal operating conditions. In service, the time-dependent phenomena, especially creep, take place during the pipe lifetime, leading to significant strength reduction. In this work, the reliability-based assessment of pipe lifetime models is carried out, in order to propose a probabilistic methodology for lifetime model selection and to determine the pipe safety levels as well as the most important parameters for pipeline reliability. This study is enhanced by parametric analysis on pipe configuration, gas pressure and operating temperature.

High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations.

Science.gov (United States)

Nandiwada, Deepa Rani; Kohli, Amar; McNamara, Megan; Smith, Kenneth J; Zimmer, Shanta; McNeil, Melissa; Spagnoletti, Carla; Rubio, Doris; Berlacher, Kathryn

2017-10-01

In an era when value-based care is paramount, teaching trainees to explicitly communicate the evidence behind recommendations fosters high-value care (HVC) in the consultation process. To implement an HVC consult curriculum highlighting the need for clear consult questions, evidence-based recommendations to improve consult teaching, clinical decision-making, and the educational value of consults. A pilot curriculum was implemented for residents on cardiology consult electives utilizing faculty and fellows as evidence-based medicine (EBM) coaches. The curriculum included an online module, an EBM teaching point template, EBM presentations on rounds, and "coach" feedback on notes. A total of 15 residents and 4 fellows on cardiology consults participated, and 87% (13 of 15) of residents on consults felt the curriculum was educationally valuable. A total of 80% (72 of 90) of residents on general medicine rotations responded to the survey, and 25 of 72 residents (35%) had a consult with the EBM template. General medicine teams felt the EBM teaching points affected clinical decision-making (48%, 12 of 25) and favored dissemination of the curriculum (90%, 72 of 80). Checklist-guided chart review showed a 22% improvement in evidence-based summaries behind recommendations (7 of 36 precurriculum to 70 of 146 charts postcurriculum, P  = .015). The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

Is the practice of public or private sector doctors more evidence-based? A qualitative study from Vellore, India.

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Akinyemi, Oluwaseun O; Martineau, Tim; Tharyan, Prathap

2015-06-01

The literature on the use of evidence-based practice is sparse, both in the public and private sectors in middle-and low-income countries, and the present literature shows that physician understanding and use of evidence-based practice is poor. The study aimed to explore the perception of medical practitioners in the private for-profit, private not-for-profit and government sectors in Vellore, India, on evidence-based practice, in order to explain the factors affecting the use of evidence-based practice among the practitioners and to inform local policy and management decisions for improvement in quality of care. Qualitative methodology was employed in the study. Sixteen in-depth and two key informant interviews were carried out with medical practitioners selected by purposive sampling in the private for-profit, private not-for-profit and government sectors. The interviews explored participants' knowledge of evidence-based practice, factors affecting its use and possible ways of improving the use of evidence-based practice among physicians in all the health sectors. Data from the in-depth and key informant interviews were analyzed with the NVIVO (version 8) software package using the framework approach. Although most practitioners interviewed have heard of evidence-based practice, knowledge about evidence-based practice seems inadequate. However, doctors in the private not-for-profit sector seem to be more familiar with the concept of evidence-based practice. Also, practitioners in the private not-for profit sector appear to use medical evidence more in their practices compared to government practitioners or doctors in the private for-profit sector. Perceived factors affecting physician use of evidence-based practice include lack of personal time for literature appraisal as a result of high case load, weak regulatory system, pressure from patients, caregivers and pharmaceutical companies, as well as financial considerations. Opinions of the respondents are that use

Simple and rapid preparation of [{sup 11}C]DASB with high quality and reliability for routine applications

Energy Technology Data Exchange (ETDEWEB)

Haeusler, D.; Mien, L.-K. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, A-1090 Vienna (Austria); Nics, L. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Nutritional Sciences, University of Vienna, A-1090 Vienna (Austria); Ungersboeck, J. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Inorganic Chemistry, University of Vienna, A-1090 Vienna (Austria); Philippe, C. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, A-1090 Vienna (Austria); Lanzenberger, R.R. [Department of Psychiatry and Psychotherapy, Medical University of Vienna, A-1090 Vienna (Austria); Kletter, K.; Dudczak, R. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Mitterhauser, M. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, A-1090 Vienna (Austria); Hospital Pharmacy of the General Hospital of Vienna, A-1090 Vienna (Austria); Wadsak, W. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Inorganic Chemistry, University of Vienna, A-1090 Vienna (Austria)], E-mail: wolfgang.wadsak@meduniwien.ac.at

2009-09-15

[{sup 11}C]DASB combines all major prerequisites for a successful SERT-ligand, providing excellent biological properties and in-vivo behaviour. Thus, we aimed to establish a fully automated procedure for the synthesis and purification of [{sup 11}C]DASB with a high degree of reliability reducing the overall synthesis time while conserving high yields and purity. The optimized [{sup 11}C]DASB synthesis was applied in more than 60 applications with a very low failure rate (3.2%). We obtained yields up to 8.9 GBq (average 5.3{+-}1.6 GBq). Radiochemical yields based on [{sup 11}C]CH{sub 3}I, (corrected for decay) were 66.3{+-}6.9% with a specific radioactivity (A{sub s}) of 86.8{+-}24.3 GBq/{mu}mol (both at the end of synthesis, EOS). Time consumption was kept to a minimum, resulting in 43 min from end of bombardment to release of the product after quality control. Form our data, it is evident that the presented method can be implemented for routine preparations of [{sup 11}C]DASB with high reliability.

Utilization of Evidence-Based Secondary Prevention Medications at the Time of Discharge in Patients with Acute Coronary Syndrome (ACS) in Qatar.

Science.gov (United States)

El-Hajj, Maguy S; Saad, Ahned; Al-Suwaidi, Jassim; Al-Marridi, Wafa Z; Elkhalifa, Dana H; Mohamed, Alaa A; Mahfoud, Ziyad R

2016-01-01

In Qatar, ACS (Acute Coronary Syndrome) has become the leading cause of morbidity and mortality. Guidelines recommend that ACS patients should receive indefinite treatment with antiplatelets, β-blockers, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and statins. The study objectives were to assess the use of evidence-based secondary prevention medication at discharge among ACS patients in Qatar and to determine the clinical and demographic characteristics associated with the use of these medications. A retrospective medical record review was conducted at the Heart Hospital in Qatar. A random sample of 1068 ACS patients was selected. Patient characteristics were summarized. Prevalence of medications at discharge were computed for each medication as well as for medication combinations. Multiple logistic regression was used to detect patient variables that were associated with the outcomes. A p≤0.05 was considered significant. -Percentage of ACS patients discharged on each of the following medications: antiplatelets (aspirin, clopidogrel), β-blockers, ACEI or ARBs and statins and on the combination of these medications-Association between the use of these medications and patient characteristics. In total, 1064 records were reviewed. The majority were males (85.3%) and about 1 in 5 (18.7%) were Qatari. At discharge, patients were prescribed the following: aspirin (96.0%), clopidogrel (92.0%), β-blockers (90.6%) and statins (97.7%). ACEI and ARBs were prescribed to 63.5 and 11.3%, respectively. The concurrent 4 medications (aspirin or clopidogrel, statins or other lowering cholesterol medication, β-blockers and ACEI or ARB) were prescribed to 773 patients (77.8%; 95% confidence interval: 75.2-80.4%). Being overweight or obese, and having PCI (percutaneous coronary intervention) or hypertension were associated with higher prescription of the concurrent medications. Those with diabetes had a 52% increase in the odds of

Medical School Librarians Need More Training to Support their Involvement in Evidence Based Medicine Curricula

Directory of Open Access Journals (Sweden)

Aislinn Conway

2016-04-01

Full Text Available Objective – To describe the self-perceived role of librarians in developing evidence based medicine (EBM curricula and identify their current and desired level of training to support these activities. Design – Multi-institutional qualitative study. Setting – Nine medical schools in Canada and the United States of America. Subjects – Nine librarians identified by medical school faculty as central to the provision of EBM training for medical students at their institution. Methods – The researchers designed a semi-structured interview schedule based on a review of the literature and their own experiences as librarians teaching EBM. The topics covered were; librarians’ perceptions of their roles in relation to the curriculum, the training required to enable them to undertake these roles, and their professional development needs. The interviews were conducted by telephone and then audio-recorded and transcribed verbatim. The authors present five main themes; curricular design, curricular deployment, curricular assessment, educational training, and professional development. Profiles were developed for each participant based on the latter two themes and from this information common characteristics were identified. Main Results – The participants described the importance of collaboration with faculty and student bodies when designing a curriculum. Information literacy instruction and specifically literature searching and forming a research question were taught by all of the participants to facilitate curricular deployment. Some of the librarians were involved or partly involved in curricular assessment activities such as formulating exam questions or providing feedback on assignments. Educational training of participants varied from informal observation to formal workshops offered by higher education institutions. All librarians indicated a willingness to partake in professional development focused on teaching and EBM. The subjects�

Promoting evidence-based practice in pharmacies.

Science.gov (United States)

Toklu, Hale Zerrin

2015-01-01

Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive "medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community." Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs.

Intellectual wellness in medical university teachers: Gender based comparison.

Science.gov (United States)

Syed, Sadiqa; Rehman, Rehana; Hussain, Mehwish; Shaikh, Saifullah

2017-05-01

A cross section, questionnaire based study was carried out from January 2012 till December 2014 to compare intellectual wellness (IW) awareness on the basis of gender in teachers of basic sciences at medical universities of Karachi, Pakistan. Data was collected from 3 public and 5 private medical universities of Karachi, Pakistan. Questionnaire was tailored from "Wellness Wheel" and responses were aggregated for eight questions in the dimension of IW to obtain aggregate IW score. Reliability of the questionnaire was measured using Cronbach's alpha. The average intellectual score was 24.99 ± 3.93 with a minimum score of 8 and maximum 32.The frequency of keeping informed about research updates was significantly higher in males (p = 0.043) that emphasized significantly better IW awareness of male medical teachers involved in teaching of medical sciences in both public and private medical universities of Pakistan.

Hijacked evidence-based medicine: stay the course and throw the pirates overboard.

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Ioannidis, John P A

2017-04-01

The article discusses a number of criticisms that have been raised against evidence-based medicine, such as focusing on benefits and ignoring adverse events; being interested in averages and ignoring the wide variability in individual risks and responsiveness; ignoring clinician-patient interaction and clinical judgement; leading to some sort of reductionism; and falling prey to corruption from conflicts of interest. I argue that none of these deficiencies are necessarily inherent to evidence-based medicine. In fact, work in evidence-based medicine has contributed a lot towards minimizing these deficiencies in medical research and medical care. However, evidence-based medicine is paying the price of its success: having become more widely recognized, it is manipulated and misused to support subverted or perverted agendas that are hijacking its reputation value. Sometimes the conflicts behind these agendas are so strong that one worries about whether the hijacking of evidence-based medicine is reversible. Nevertheless, evidence-based medicine is a valuable conceptual toolkit and it is worth to try to remove the biases of the pirates who have hijacked its ship. Copyright © 2017 Elsevier Inc. All rights reserved.

The role of hypnotherapy in evidence-based clinical practice.

Science.gov (United States)

Griffiths, M J

2017-05-01

The purpose of this review was to discuss the place of hypnotherapy in a modern medical world dominated by so-called evidence-based clinical practice. Hypnosis is an easily learned technique that is a valuable adjuvant to many medical, dental and psychological interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Evidence-based hypnotherapy for depression.

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Alladin, Assen

2010-04-01

Cognitive hypnotherapy (CH) is a comprehensive evidence-based hypnotherapy for clinical depression. This article describes the major components of CH, which integrate hypnosis with cognitive-behavior therapy as the latter provides an effective host theory for the assimilation of empirically supported treatment techniques derived from various theoretical models of psychotherapy and psychopathology. CH meets criteria for an assimilative model of psychotherapy, which is considered to be an efficacious model of psychotherapy integration. The major components of CH for depression are described in sufficient detail to allow replication, verification, and validation of the techniques delineated. CH for depression provides a template that clinicians and investigators can utilize to study the additive effects of hypnosis in the management of other psychological or medical disorders. Evidence-based hypnotherapy and research are encouraged; such a movement is necessary if clinical hypnosis is to integrate into mainstream psychotherapy.

Reliability and Validity Evidence of Multiple Balance Assessments in Athletes With a Concussion

Science.gov (United States)

Murray, Nicholas; Salvatore, Anthony; Powell, Douglas; Reed-Jones, Rebecca

2014-01-01

Context: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. Objective: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Data Sources: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. Data Extraction: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. Data Synthesis: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. Conclusions: The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for

Reliability and validity evidence of multiple balance assessments in athletes with a concussion.

Science.gov (United States)

Murray, Nicholas; Salvatore, Anthony; Powell, Douglas; Reed-Jones, Rebecca

2014-01-01

An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for assessing balance in athletes with concussions.

Evidence and evidence gaps in tinnitus therapy

Science.gov (United States)

Hesse, Gerhard

2016-01-01

A nearly endless number of procedures has been tried and in particular sold for the treatment of tinnitus, unfortunately they have not been evaluated appropriately in an evidence-based way. A causal therapy, omitting the tinnitus still does not exist, actually it cannot exist because of the various mechanisms of its origin. However or perhaps because of that, medical interventions appear and reappear like fashion trends that can never be proven by stable and reliable treatment success. This contribution will discuss and acknowledge all current therapeutic procedures and the existing or non-existing evidence will be assessed. Beside external evidence, the term of evidence also encompasses the internal evidence, i.e. the experience of the treating physician and the patient’s needs shall be included. While there is no evidence for nearly all direct procedures that intend modulating or stimulating either the cochlea or specific cervical regions such as the auditory cortex, there are therapeutic procedures that are acknowledged in clinical practice and have achieved at least a certain degree of evidence and generate measurable effect sizes. Those are in particular habituation therapy and psychotherapeutic measures, especially if they are combined with concrete measures for improved audio perception (hearing aids, CI, hearing therapies). PMID:28025604

Pharmaceutical counseling: Between evidence-based medicine and profits.

Science.gov (United States)

Egorova, S N; Akhmetova, T

2015-01-01

pharmaceutical counseling standards: Article 1.1 "Code of Ethics of the pharmaceutical worker of Russia" states: "The main task of the professional activity of the pharmaceutical worker - protection of human health", Article 1.3 states that a pharmaceutical worker must take professional decisions solely in the interests of a patient [1]. However, the pharmacy is a trade organization, thus as a retailer the pharmacy is directly interested in making profits and increasing sales of pharmaceutical products, including non-prescription medicines. Moreover, while the clinical medicine is monitored for unjustified prescribing and measures are being taken to prevent polypharmacy, for a pharmacist the growing sales of over-the-counter drugs, active promotion of dietary supplements, homeopathic medicines, medical devices, and, consequently, an increase of financial indicators (particularly "average purchase size") - all are characteristics of success [2].Rational use of over-the-counter medicines requires introduction of pharmaceutical counseling standards (pharmaceutical care) according to symptoms - major reasons to visit a pharmacy as part of responsible self-medication (cold, sore throat, headache, diarrhea, etc.). Standards of pharmaceutical counseling should be objective, reliable and up-to-date and contain recommendations for the rational use of over-the-counter drugs as well as indications requiring treatment to the doctor. Standardization of pharmaceutical counseling in terms of Evidence-based Pharmacy would enhance the efficiency, safety and cost-effectiveness of over-the-counter medicines.Currently, the lack of clinical component in the higher pharmaceutical education and the lack of approved standards of pharmaceutical counseling lead to the introduction of cross-selling technologies (which are broadly applied in other areas of trade, for example, the offer of a boot-polish during the sale of shoes) to the pharmaceutical practice [2, 3]. However, drugs belong to a special group

Evidence-based medicine and epistemological imperialism: narrowing the divide between evidence and illness.

Science.gov (United States)

Crowther, Helen; Lipworth, Wendy; Kerridge, Ian

2011-10-01

Evidence-based medicine (EBM) has been rapidly and widely adopted because it claims to provide a method for determining the safety and efficacy of medical therapies and public health interventions more generally. However, as others have noted, EBM may be riven through with cultural bias, both in the generation of evidence and in its translation. We suggest that technological and scientific advances in medicine accentuate and entrench these cultural biases, to the extent that they may invalidate the evidence we have about disease and its treatment. This creates a significant ethical, epistemological and ontological challenge for medicine. © 2011 Blackwell Publishing Ltd.

High reliability low jitter 80 kV pulse generator

International Nuclear Information System (INIS)

Savage, Mark Edward; Stoltzfus, Brian Scott

2009-01-01

Switching can be considered to be the essence of pulsed power. Time accurate switch/trigger systems with low inductance are useful in many applications. This article describes a unique switch geometry coupled with a low-inductance capacitive energy store. The system provides a fast-rising high voltage pulse into a low impedance load. It can be challenging to generate high voltage (more than 50 kilovolts) into impedances less than 10 (Omega), from a low voltage control signal with a fast rise time and high temporal accuracy. The required power amplification is large, and is usually accomplished with multiple stages. The multiple stages can adversely affect the temporal accuracy and the reliability of the system. In the present application, a highly reliable and low jitter trigger generator was required for the Z pulsed-power facility [M. E. Savage, L. F. Bennett, D. E. Bliss, W. T. Clark, R. S. Coats,J. M. Elizondo, K. R. LeChien, H. C. Harjes, J. M. Lehr, J. E. Maenchen, D. H. McDaniel, M. F. Pasik, T. D. Pointon, A. C. Owen, D. B. Seidel, D. L. Smith, B. S. Stoltzfus, K.W. Struve, W.A. Stygar, L.K. Warne, and J. R. Woodworth, 2007 IEEE Pulsed Power Conference, Albuquerque, NM (IEEE, Piscataway, NJ, 2007), p. 979]. The large investment in each Z experiment demands low prefire probability and low jitter simultaneously. The system described here is based on a 100 kV DC-charged high-pressure spark gap, triggered with an ultraviolet laser. The system uses a single optical path for simultaneously triggering two parallel switches, allowing lower inductance and electrode erosion with a simple optical system. Performance of the system includes 6 ns output rise time into 5.6 (Omega), 550 ps one-sigma jitter measured from the 5 V trigger to the high voltage output, and misfire probability less than 10 -4 . The design of the system and some key measurements will be shown in the paper. We will discuss the design goals related to high reliability and low jitter. While

The modern surgeon and competency assessment: are the workplace-based assessments evidence-based?

Science.gov (United States)

Torsney, K M; Cocker, D M; Slesser, A A P

2015-03-01

The assessment of higher surgical training has changed in the last decade or two, with a greater emphasis on work-based assessments (WBAs) to prove competency. The aim of this study was to determine the evidence underpinning the use and number of WBAs in surgical training. In July 2013, a systematic electronic literature review was undertaken using PubMed (Medline), Embase, Google Scholar and the Cochrane library. A total of 27 studies met the inclusion criteria of which 25 were observational studies and only five assessed WBAs in a surgical setting. Validity and feasibility in surgical training were assessed in two studies, respectively, with the results suggesting that WBAs maybe neither feasible nor valid in surgical training. The number required to achieve reliability in surgical training was demonstrated to be three in two separate studies. The evidence for the reliability, feasibility and validity of WBAs in other non-surgical fields was conflicting. There is a paucity of evidence supporting the use of WBAs as a tool to determine competency in surgical training, and as such, they should only have a limited role in training until more evidence is available. There appears to be no justification or evidence underpinning the use of a specific number of WBAs to determine surgical competency.

20 CFR 416.993 - Medical evidence in continuing disability review cases.

Science.gov (United States)

2010-04-01

... evidence. Before deciding that your disability has ended, we will develop a complete medical history... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Medical evidence in continuing disability... SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Continuing Or...

Medical Science Liaisons in Real-World Evidence Studies: Experience of AstraZeneca Russia.

Science.gov (United States)

Suvorov, Nikolay; Karaseva, Vera; Stukalina, Ekaterina; Sanay, Elkhan; Petrakovskaya, Vera; Bulatov, Vladimir

2018-01-01

There is no doubt that real-world evidence studies have the potential to improve and accelerate the development and delivery of safe and cost-effective innovative medicines to patients as well as influence the way we approach health and health care. Real-world evidence studies are a great challenge in terms of development and conduct, so there should be a good collaboration between the study team and clinical sites at all times, resulting eventually in timely and efficient enrollment. Engaging the sites and key external experts as early as possible during feasibility and routine visits, as well as highlighting the science rationale behind AstraZeneca's portfolio at investigator meetings and during medical science liaison (MSL) interactions, can create a positive impact on physician perception of a particular study and prioritization of patient recruitment in such studies. Therefore, we would like to underline the important role of MSLs in the risk-based monitoring setting of real-world evidence studies, with special attention to the studies with complicated patient profiles, tough timelines, and/or seasonal factors. This approach will be used further for other real world evidence projects of AstraZeneca Russia MC to ensure timelines and budget deliverables are met for the generation of high-quality evidence and eventually better health care for all of us.

4: A STUDY ON THE RATE OF INFORMATION LITERACY OF FACULTY MEMBERS AND PHD STUDENTS OF FACULTY OF NURSING AND MIDWIFERY, TABRIZ UNIVERSITY OF MEDICAL SCIENCES, BASED ON SUCCESSFUL EVIDENCE HEALTHCARE

Science.gov (United States)

Razmkhah, Maryam; Moghadam, Hadi Sharif; Ziaei, Soraya; Zarea, Vahideh; Narimani, Mohammad Reza

2017-01-01

Background and aims Evidence based care is an approach to clinical problem-solving in which merging the results of several studies and information on specialty clinical care as well as patients' wishes and values leads to effective decision making, to avoid seeking frequent care facilitating the patient cares, empowering healthcare workers, maintaining and improving the health of patients and the families. Results of the conducted studies suggest that using such an approach requires information literacy skills. Therefore, the present study aimed to assess information literacy of the faculty members and PhD students of Nursing and Midwifery School of Tabriz University of Medical Sciences about evidence based care. Methods In this cross-sectional survey 53 PhD students and faculty members were selected using census sampling method. Data gathering tool was a researcher-made questionnaire. This inventory was developed regarding valid scientific literature on information literacy and evidence-based care with 68 items and 5 standards of literacy prepared within some steps. After confirming the validity, its reliability was concluded by Cranach's Alpha (0.89). Data was analyzed using SPSS/22. Results Average information literacy skill level for faculty members and students related to evidence-based care and information literacy standards was higher than the average index, except for “information exchange” standard (50±10). The highest and lowest mean scores in evidence based care were for, respectively, questions formation (respectively, 96.18±18.6.17 and 48.51±14.69) and evaluation results (respectively 95.56±6.66 and 45.94±14.08). For information literacy standards there were calculated for (respectively) finding information as the highest score for (respectively, 95.56±6.66 and 72.44±13.62) and the lowest for information exchange (respectively, 74.19±11.83 and 48.51±11.35). Conclusion According to the results of this study and also regarding to this

Reliability and Failure in NASA Missions: Blunders, Normal Accidents, High Reliability, Bad Luck

Science.gov (United States)

Jones, Harry W.

2015-01-01

NASA emphasizes crew safety and system reliability but several unfortunate failures have occurred. The Apollo 1 fire was mistakenly unanticipated. After that tragedy, the Apollo program gave much more attention to safety. The Challenger accident revealed that NASA had neglected safety and that management underestimated the high risk of shuttle. Probabilistic Risk Assessment was adopted to provide more accurate failure probabilities for shuttle and other missions. NASA's "faster, better, cheaper" initiative and government procurement reform led to deliberately dismantling traditional reliability engineering. The Columbia tragedy and Mars mission failures followed. Failures can be attributed to blunders, normal accidents, or bad luck. Achieving high reliability is difficult but possible.

High volume medical web sites.

Science.gov (United States)

Elliott, B; Elliott, G

2000-01-01

In 1998, 22 million individuals reported surfing the web for medical information, and this number will increase to over 30 million by 2000. Fifteen of the highest volume medical web sites are described in this paper. Sponsorship and/or ownership of the fifteen sites varied. The government sponsors one, and some are the products of well-known educational institutions. One site is supported by a consumer health organization, and the American Medical Association was in the top 15. However, the most common owners are commercial, for-profit businesses. Attributes of the ideal site were categorized, and include a robust privacy and disclosure statement with an emphasis on education and an appropriate role for advertising. The covering of Complementary and Alternative Medicine (CAM) should be in a balanced and unbiased manner. There has to be an emphasis on knowledge based evidence as opposed to testimonials, and sources should be timely and reviewed. Bibliographies of authors need to be available. Hyperlinking to other web resources is valuable, as even the largest of sites cannot come close to covering all of medicine.

Self-reported use of evidence-based medicine and smoking ...

African Journals Online (AJOL)

Self-reported use of evidence-based medicine and smoking cessation 6 - 9 months after acute coronary syndrome: A single-centre perspective. ... questionnaire detailing current medication use, reasons for non-adherence and smoking status.

High reliability EPI-base radiation hardened power transistor

International Nuclear Information System (INIS)

Clark, L.E.; Saltich, J.L.

1978-01-01

A high-voltage power transistor is described which is able to withstand fluences as high as 3 x 10 14 neutrons per square centimeter and still be able to operate satisfactorily. The collector may be made essentially half as thick and twice as heavily doped as normally and its base is made in two regions which together are essentially four times as thick as the normal power transistor base region. The base region has a heavily doped upper region and a lower region intermediate the upper heavily doped region and the collector. The doping in the intermediate region is as close to intrinsic as possible, in any event less than about 3 x 10 15 impurities per cubic centimeter. The second base region has small width in comparison to the first base region, the ratio of the first to the second being at least about 5 to 1. The base region having the upper heavily doped region and the intermediate or lower low doped region contributes to the higher breakdown voltage which the transistor is able to withstand. The high doping of the collector region essentially lowers that portion of the breakdown voltage achieved by the collector region. Accordingly, it is necessary to transfer certain of this breakdown capability to the base region and this is achieved by using the upper region of heavily doped and an intermediate or lower region of low doping

First evidence on the validity and reliability of the Safety Organizing Scale-Nursing Home version (SOS-NH).

Science.gov (United States)

Ausserhofer, Dietmar; Anderson, Ruth A; Colón-Emeric, Cathleen; Schwendimann, René

2013-08-01

The Safety Organizing Scale is a valid and reliable measure on safety behaviors and practices in hospitals. This study aimed to explore the psychometric properties of the Safety Organizing Scale-Nursing Home version (SOS-NH). In a cross-sectional analysis of staff survey data, we examined validity and reliability of the 9-item Safety SOS-NH using American Educational Research Association guidelines. This substudy of a larger trial used baseline survey data collected from staff members (n = 627) in a variety of work roles in 13 nursing homes (NHs) in North Carolina and Virginia. Psychometric evaluation of the SOS-NH revealed good response patterns with low average of missing values across all items (3.05%). Analyses of the SOS-NH's internal structure (eg, comparative fit indices = 0.929, standardized root mean square error of approximation = 0.045) and consistency (composite reliability = 0.94) suggested its 1-dimensionality. Significant between-facility variability, intraclass correlations, within-group agreement, and design effect confirmed appropriateness of the SOS-NH for measurement at the NH level, justifying data aggregation. The SOS-NH showed discriminate validity from one related concept: communication openness. Initial evidence regarding validity and reliability of the SOS-NH supports its utility in measuring safety behaviors and practices among a wide range of NH staff members, including those with low literacy. Further psychometric evaluation should focus on testing concurrent and criterion validity, using resident outcome measures (eg, patient fall rates). Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.

Developing evidence-based dentistry skills: how to interpret randomized clinical trials and systematic reviews.

Science.gov (United States)

Kiriakou, Juliana; Pandis, Nikolaos; Madianos, Phoebus; Polychronopoulou, Argy

2014-10-30

Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted.

Reliability-Based Decision Fusion in Multimodal Biometric Verification Systems

Directory of Open Access Journals (Sweden)

Kryszczuk Krzysztof

2007-01-01

Full Text Available We present a methodology of reliability estimation in the multimodal biometric verification scenario. Reliability estimation has shown to be an efficient and accurate way of predicting and correcting erroneous classification decisions in both unimodal (speech, face, online signature and multimodal (speech and face systems. While the initial research results indicate the high potential of the proposed methodology, the performance of the reliability estimation in a multimodal setting has not been sufficiently studied or evaluated. In this paper, we demonstrate the advantages of using the unimodal reliability information in order to perform an efficient biometric fusion of two modalities. We further show the presented method to be superior to state-of-the-art multimodal decision-level fusion schemes. The experimental evaluation presented in this paper is based on the popular benchmarking bimodal BANCA database.

Structural reliability analysis based on the cokriging technique

International Nuclear Information System (INIS)

Zhao Wei; Wang Wei; Dai Hongzhe; Xue Guofeng

2010-01-01

Approximation methods are widely used in structural reliability analysis because they are simple to create and provide explicit functional relationships between the responses and variables in stead of the implicit limit state function. Recently, the kriging method which is a semi-parameter interpolation technique that can be used for deterministic optimization and structural reliability has gained popularity. However, to fully exploit the kriging method, especially in high-dimensional problems, a large number of sample points should be generated to fill the design space and this can be very expensive and even impractical in practical engineering analysis. Therefore, in this paper, a new method-the cokriging method, which is an extension of kriging, is proposed to calculate the structural reliability. cokriging approximation incorporates secondary information such as the values of the gradients of the function being approximated. This paper explores the use of the cokriging method for structural reliability problems by comparing it with the Kriging method based on some numerical examples. The results indicate that the cokriging procedure described in this work can generate approximation models to improve on the accuracy and efficiency for structural reliability problems and is a viable alternative to the kriging.

[Burden of proof in medical cases--presumption of fact and prima facie evidence. 1. Burden of proof].

Science.gov (United States)

Sliwka, Marcin

2004-01-01

The aim of this paper was to present the main rules concerning the burden of proof in polish civil trials, including medical cases. This paper also describes the subject of evidence were presented and explained. The court influence on evidence procedure was also analysed. The effect of the institution of informed consent on burden of proof in polish civil law is also described. This paper includes numerous High Court sentences on evidential and medical issues.

Reliability Based Optimization of Structural Systems

DEFF Research Database (Denmark)

Sørensen, John Dalsgaard

1987-01-01

The optimization problem to design structural systems such that the reliability is satisfactory during the whole lifetime of the structure is considered in this paper. Some of the quantities modelling the loads and the strength of the structure are modelled as random variables. The reliability...... is estimated using first. order reliability methods ( FORM ). The design problem is formulated as the optimization problem to minimize a given cost function such that the reliability of the single elements satisfies given requirements or such that the systems reliability satisfies a given requirement....... For these optimization problems it is described how a sensitivity analysis can be performed. Next, new optimization procedures to solve the optimization problems are presented. Two of these procedures solve the system reliability based optimization problem sequentially using quasi-analytical derivatives. Finally...

Task-Based Modeling of a 5k Ultra-High-Resolution Medical Imaging System for Digital Breast Tomosynthesis.

Science.gov (United States)

Zhao, Chumin; Kanicki, Jerzy

2017-09-01

High-resolution, low-noise X-ray detectors based on CMOS active pixel sensor (APS) technology have demonstrated superior imaging performance for digital breast tomosynthesis (DBT). This paper presents a task-based model for a high-resolution medical imaging system to evaluate its ability to detect simulated microcalcifications and masses as lesions for breast cancer. A 3-D cascaded system analysis for a 50- [Formula: see text] pixel pitch CMOS APS X-ray detector was integrated with an object task function, a medical imaging display model, and the human eye contrast sensitivity function to calculate the detectability index and area under the ROC curve (AUC). It was demonstrated that the display pixel pitch and zoom factor should be optimized to improve the AUC for detecting small microcalcifications. In addition, detector electronic noise of smaller than 300 e - and a high display maximum luminance (>1000 cd/cm 2 ) are desirable to distinguish microcalcifications of [Formula: see text] in size. For low contrast mass detection, a medical imaging display with a minimum of 12-bit gray levels is recommended to realize accurate luminance levels. A wide projection angle range of greater than ±30° in combination with the image gray level magnification could improve the mass detectability especially when the anatomical background noise is high. On the other hand, a narrower projection angle range below ±20° can improve the small, high contrast object detection. Due to the low mass contrast and luminance, the ambient luminance should be controlled below 5 cd/ [Formula: see text]. Task-based modeling provides important firsthand imaging performance of the high-resolution CMOS-based medical imaging system that is still at early stage development for DBT. The modeling results could guide the prototype design and clinical studies in the future.

Civil Litigation in the UK: сontemporary issues to ensure evidential reliability

Directory of Open Access Journals (Sweden)

Koch Hugh

2016-06-01

Full Text Available The system for assessing appropriate damages for individuals who have suffered a personal injury, caused by another person or persons is well established in the UK. A claimant, for example, who has been in a road accident, work accident, medical accident or negligent action can make a claim for his/her physical and psychological injuries, time off work and future disability, provided it is proven that another person(s is responsible. The system involves obtaining, medical-legal evidence on the diagnosis, causation, treatment and prognosis of any injuries, physical or psychological. One key aspect of this covers the crucial issue of evidential reliability. This paper explains the key questions facing lawyers and experts alike in the UK; fundamental postulates or beliefs about evidence; ways to improve reliability; the relevance of pre-event history and improving evidential reliability via Part 35 questioning. The UK, along with the USA, has the most advanced and developed system of personal injury litigation process.

Reliability of a science admission test (HAM-Nat) at Hamburg medical school.

Science.gov (United States)

Hissbach, Johanna; Klusmann, Dietrich; Hampe, Wolfgang

2011-01-01

The University Hospital in Hamburg (UKE) started to develop a test of knowledge in natural sciences for admission to medical school in 2005 (Hamburger Auswahlverfahren für Medizinische Studiengänge, Naturwissenschaftsteil, HAM-Nat). This study is a step towards establishing the HAM-Nat. We are investigating parallel forms reliability, the effect of a crash course in chemistry on test results, and correlations of HAM-Nat test results with a test of scientific reasoning (similar to a subtest of the "Test for Medical Studies", TMS). 316 first-year students participated in the study in 2007. They completed different versions of the HAM-Nat test which consisted of items that had already been used (HN2006) and new items (HN2007). Four weeks later half of the participants were tested on the HN2007 version of the HAM-Nat again, while the other half completed the test of scientific reasoning. Within this four week interval students were offered a five day chemistry course. Parallel forms reliability for four different test versions ranged from r(tt)=.53 to r(tt)=.67. The retest reliabilities of the HN2007 halves were r(tt)=.54 and r(tt )=.61. Correlations of the two HAM-Nat versions with the test of scientific reasoning were r=.34 und r=.21. The crash course in chemistry had no effect on HAM-Nat scores. The results suggest that further versions of the test of natural sciences will not easily conform to the standards of internal consistency, parallel-forms reliability and retest reliability. Much care has to be taken in order to assemble items which could be used interchangeably for the construction of new test versions. The test of scientific reasoning and the HAM-Nat are tapping different constructs. Participation in a chemistry course did not improve students' achievement, probably because the content of the course was not coordinated with the test and many students lacked of motivation to do well in the second test.

Medical tourism: A snapshot of evidence on treatment abroad.

Science.gov (United States)

Lunt, Neil; Horsfall, Daniel; Hanefeld, Johanna

2016-06-01

The scoping review focuses on medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include: cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF; and organ and tissue transplantation. The review assesses the emerging focus of research evidence post-2010. The narrative review traverses discussion on medical tourism definitions and flows, consumer choice, clinical quality and outcomes, and health systems implications. Attention is drawn to gaps in the research evidence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Reliability of a Computerized Neurocognitive Test in Baseline Concussion Testing of High School Athletes.

Science.gov (United States)

MacDonald, James; Duerson, Drew

2015-07-01

Baseline assessments using computerized neurocognitive tests are frequently used in the management of sport-related concussions. Such testing is often done on an annual basis in a community setting. Reliability is a fundamental test characteristic that should be established for such tests. Our study examined the test-retest reliability of a computerized neurocognitive test in high school athletes over 1 year. Repeated measures design. Two American high schools. High school athletes (N = 117) participating in American football or soccer during the 2011-2012 and 2012-2013 academic years. All study participants completed 2 baseline computerized neurocognitive tests taken 1 year apart at their respective schools. The test measures performance on 4 cognitive tasks: identification speed (Attention), detection speed (Processing Speed), one card learning accuracy (Learning), and one back speed (Working Memory). Reliability was assessed by measuring the intraclass correlation coefficient (ICC) between the repeated measures of the 4 cognitive tasks. Pearson and Spearman correlation coefficients were calculated as a secondary outcome measure. The measure for identification speed performed best (ICC = 0.672; 95% confidence interval, 0.559-0.760) and the measure for one card learning accuracy performed worst (ICC = 0.401; 95% confidence interval, 0.237-0.542). All tests had marginal or low reliability. In a population of high school athletes, computerized neurocognitive testing performed in a community setting demonstrated low to marginal test-retest reliability on baseline assessments 1 year apart. Further investigation should focus on (1) improving the reliability of individual tasks tested, (2) controlling for external factors that might affect test performance, and (3) identifying the ideal time interval to repeat baseline testing in high school athletes. Computerized neurocognitive tests are used frequently in high school athletes, often within a model of baseline testing

Survey of industry methods for producing highly reliable software

International Nuclear Information System (INIS)

Lawrence, J.D.; Persons, W.L.

1994-11-01

The Nuclear Reactor Regulation Office of the US Nuclear Regulatory Commission is charged with assessing the safety of new instrument and control designs for nuclear power plants which may use computer-based reactor protection systems. Lawrence Livermore National Laboratory has evaluated the latest techniques in software reliability for measurement, estimation, error detection, and prediction that can be used during the software life cycle as a means of risk assessment for reactor protection systems. One aspect of this task has been a survey of the software industry to collect information to help identify the design factors used to improve the reliability and safety of software. The intent was to discover what practices really work in industry and what design factors are used by industry to achieve highly reliable software. The results of the survey are documented in this report. Three companies participated in the survey: Computer Sciences Corporation, International Business Machines (Federal Systems Company), and TRW. Discussions were also held with NASA Software Engineering Lab/University of Maryland/CSC, and the AIAA Software Reliability Project

[Value-based cancer care. From traditional evidence-based decision making to balanced decision making within frameworks of shared values].

Science.gov (United States)

Palazzo, Salvatore; Filice, Aldo; Mastroianni, Candida; Biamonte, Rosalbino; Conforti, Serafino; Liguori, Virginia; Turano, Salvatore; De Simone, Rosanna; Rovito, Antonio; Manfredi, Caterina; Minardi, Stefano; Vilardo, Emmanuelle; Loizzo, Monica; Oriolo, Carmela

2016-04-01

Clinical decision making in oncology is based so far on the evidence of efficacy from high-quality clinical research. Data collection and analysis from experimental studies provide valuable insight into response rates and progression-free or overall survival. Data processing generates valuable information for medical professionals involved in cancer patient care, enabling them to make objective and unbiased choices. The increased attention of many scientific associations toward a more rational resource consumption in clinical decision making is mirrored in the Choosing Wisely campaign against the overuse or misuse of exams and procedures of little or no benefit for the patient. This cultural movement has been actively promoting care solutions based on the concept of "value". As a result, the value-based decision-making process for cancer care should not be dissociated from economic sustainability and from ethics of the affordability, also given the growing average cost of the most recent cancer drugs. In support of this orientation, the National Comprehensive Cancer Network (NCCN) has developed innovative and "complex" guidelines based on values, defined as "evidence blocks", with the aim of assisting the medical community in making overall sustainable choices.

Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.

Science.gov (United States)

Issenberg, S Barry; McGaghie, William C; Petrusa, Emil R; Lee Gordon, David; Scalese, Ross J

2005-01-01

simulations facilitate learning under the right conditions. These include the following: providing feedback--51 (47%) journal articles reported that educational feedback is the most important feature of simulation-based medical education; repetitive practice--43 (39%) journal articles identified repetitive practice as a key feature involving the use of high-fidelity simulations in medical education; curriculum integration--27 (25%) journal articles cited integration of simulation-based exercises into the standard medical school or postgraduate educational curriculum as an essential feature of their effective use; range of difficulty level--15 (14%) journal articles address the importance of the range of task difficulty level as an important variable in simulation-based medical education; multiple learning strategies--11 (10%) journal articles identified the adaptability of high-fidelity simulations to multiple learning strategies as an important factor in their educational effectiveness; capture clinical variation--11 (10%) journal articles cited simulators that capture a wide variety of clinical conditions as more useful than those with a narrow range; controlled environment--10 (9%) journal articles emphasized the importance of using high-fidelity simulations in a controlled environment where learners can make, detect and correct errors without adverse consequences; individualized learning--10 (9%) journal articles highlighted the importance of having reproducible, standardized educational experiences where learners are active participants, not passive bystanders; defined outcomes--seven (6%) journal articles cited the importance of having clearly stated goals with tangible outcome measures that will more likely lead to learners mastering skills; simulator validity--four (3%) journal articles provided evidence for the direct correlation of simulation validity with effective learning. While research in this field needs improvement in terms of rigor and quality, high

Management of the infertile couple: an evidence-based protocol

Directory of Open Access Journals (Sweden)

Kamel Remah M

2010-03-01

Full Text Available Abstract Background Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. Objectives The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. Methods A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG, American Society for Reproductive Medicine (ASRM, Canadian Fertility and Andrology Society (CFAS, and Royal College of Obstetricians and Gynaecologists (RCOG. Results A simple guide for the clinicians to manage the infertile couples. Conclusions The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.

The Healthcare Improvement Scotland evidence note rapid review process: providing timely, reliable evidence to inform imperative decisions on healthcare.

Science.gov (United States)

McIntosh, Heather M; Calvert, Julie; Macpherson, Karen J; Thompson, Lorna

2016-06-01

Rapid review has become widely adopted by health technology assessment agencies in response to demand for evidence-based information to support imperative decisions. Concern about the credibility of rapid reviews and the reliability of their findings has prompted a call for wider publication of their methods. In publishing this overview of the accredited rapid review process developed by Healthcare Improvement Scotland, we aim to raise awareness of our methods and advance the discourse on best practice. Healthcare Improvement Scotland produces rapid reviews called evidence notes using a process that has achieved external accreditation through the National Institute for Health and Care Excellence. Key components include a structured approach to topic selection, initial scoping, considered stakeholder involvement, streamlined systematic review, internal quality assurance, external peer review and updating. The process was introduced in 2010 and continues to be refined over time in response to user feedback and operational experience. Decision-makers value the responsiveness of the process and perceive it as being a credible source of unbiased evidence-based information supporting advice for NHSScotland. Many agencies undertaking rapid reviews are striving to balance efficiency with methodological rigour. We agree that there is a need for methodological guidance and that it should be informed by better understanding of current approaches and the consequences of different approaches to streamlining systematic review methods. Greater transparency in the reporting of rapid review methods is essential to enable that to happen.

Expanding the domains of attitudes towards evidence-based practice: the evidence based practice attitude scale-50.

Science.gov (United States)

Aarons, Gregory A; Cafri, Guy; Lugo, Lindsay; Sawitzky, Angelina

2012-09-01

Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.

The role of high cycle fatigue (HCF) onset in Francis runner reliability

International Nuclear Information System (INIS)

Gagnon, M; Tahan, S A; Bocher, P; Thibault, D

2012-01-01

High Cycle Fatigue (HCF) plays an important role in Francis runner reliability. This paper presents a model in which reliability is defined as the probability of not exceeding a threshold above which HCF contributes to crack propagation. In the context of combined Low Cycle Fatigue (LCF) and HCF loading, the Kitagawa diagram is used as the limit state threshold for reliability. The reliability problem is solved using First-Order Reliability Methods (FORM). A study case is proposed using in situ measured strains and operational data. All the parameters of the reliability problem are based either on observed data or on typical design specifications. From the results obtained, we observed that the uncertainty around the defect size and the HCF stress range play an important role in reliability. At the same time, we observed that expected values for the LCF stress range and the number of LCF cycles have a significant influence on life assessment, but the uncertainty around these values could be neglected in the reliability assessment.

Linking research to practice: the rise of evidence-based health sciences librarianship.

Science.gov (United States)

Marshall, Joanne Gard

2014-01-01

The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. FOUR SOURCES OF EVIDENCE ARE USED TO EXAMINE THE RISE OF EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.

Linking research to practice: the rise of evidence-based health sciences librarianship*

Science.gov (United States)

Marshall, Joanne Gard

2014-01-01

Purpose: The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work. Methods: Four sources of evidence are used to examine the rise of EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement. Results: These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice. Implications: Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services. PMID:24415915

Perceived barriers to completing an e-learning program on evidence-based medicine.

Science.gov (United States)

Gagnon, Marie-Pierre; Légaré, France; Labrecque, Michel; Frémont, Pierre; Cauchon, Michel; Desmartis, Marie

2007-01-01

The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs. A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation.

Interrater reliability of the Volume-Viscosity Swallow Test; screening for dysphagia among hospitalized elderly medical patients

DEFF Research Database (Denmark)

Jørgensen, Lise Walther; Søndergaard, Kasper; Melgaard, Dorte

2017-01-01

Background: Oropharyngeal dysphagia (OD) is prevalent among medical and geriatric patients admitted due to acute illness and it is associated with malnutrition, increased length of stay and increased mortality. A valid and reliable bedside screening test for patients at risk of OD is essential...... in order to detect patients in need of further assessment. The Volume-Viscosity Swallow Test (V-VST) has been shown to be a valid screening test for OD in mixed outpatient populations. However, as reliability of the test has yet to be investigated in a population of medical and geriatric patients admitted...... skilled occupational therapists examined an unselected group of 110 patients admitted to geriatric or medical wards. In an overall agreement phase raters reached ≥80% agreement before data collection phase was commenced. The V-VST was applied to patients twice within maximum one hour by raters who...

[Evidence-based medicine: modern scientific methods for determining usefulness].

Science.gov (United States)

Schmidt, J G

1999-01-01

For quite some time, clinical epidemiology has introduced the art of critical appraisal of evidence as well as the methods of how to design sound clinical studies and trials. Almost unnoticed by most medical institutions a new hierarchy of evidence has emerged which puts well thought out trials, able to document unbiased treatment benefit in terms of patient suffering, above pathophysiological theory. Many controlled trials have shown, in the meantime, that the control of laboratory or other kind of pathologies and the correction of anatomical abnormalities do not necessarily mean a benefit for the patient. Concepts relating to this dissection of evidence include: Surrogate fallacy ("cosmetics" of laboratory results or ligament or cartilage "cosmetics" in surgery), confounding (spurious causal relationships), selection bias (comparison with selected groups) as well as lead-time bias (mistaking earlier diagnosis as increase of survival), length bias (overlooking differences in the aggressiveness of diseases as determinants of disease stage distributions) and overdiagnosis bias (mistaking the increasing detection of clinically silent pathologies as improvement of prognosis). Moreover, absolute instead of relative risk reduction needs to be used to measure patient benefit. The incorporation of decision-analysis and of the concepts or clinical epidemiology will improve the efficiency and quality of medicine much more effectively than the sole focus on technical medical performance. Evidence based medicine is the systematic and critical appraisal of medical interventions, based on the understanding how to avoid the fallacies and biases mentioned.

Patterns and predictors of evidence-based medication continuation among hospitalized heart failure patients (from Get With the Guidelines-Heart Failure).

Science.gov (United States)

Krantz, Mori J; Ambardekar, Amrut V; Kaltenbach, Lisa; Hernandez, Adrian F; Heidenreich, Paul A; Fonarow, Gregg C

2011-06-15

Hospitalized patients with heart failure and decreased ejection fraction are at substantial risk for mortality and rehospitalization, yet no acute therapies are proven to decrease this risk. Therefore, in-hospital use of medications proved to decrease long-term mortality is a critical strategy to improve outcomes. Although endorsed in guidelines, predictors of initiation and continuation of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β blockers, and aldosterone antagonists have not been well studied. We assessed noncontraindicated use patterns for the 3 medications using the Get With the Guidelines-Heart Failure (GWTG-HF) registry from February 2009 through March 2010. Medication continuation was defined as treatment on admission and discharge. Multivariable logistic regression using generalized estimating equations was used to determine factors associated with discharge use. In total 9,474 patients were enrolled during the study period. Of those treated before hospitalization, overall continuation rates were 88.5% for ACE inhibitors/ARBs, 91.6% for β blockers, and 71.9% for aldosterone-antagonists. Of patients untreated before admission, 87.4% had ACE inhibitors/ARBs and 90.1% had β blocker initiated during hospitalization or at discharge, whereas only 25.2% were started on an aldosterone antagonist. In multivariate analysis, admission therapy was most strongly associated with discharge use (adjusted odds ratios 7.4, 6.0, and 20.9 for ACE inhibitors/ARBs, β blockers, and aldosterone antagonists, respectively). Western region, younger age, and academic affiliation were also associated with higher discharge use. Although ACE inhibitor/ARB and β-blocker continuation rates were high, aldosterone antagonist use was lower despite potential eligibility. In conclusion, being admitted on evidence-based medications is the most powerful, independent predictor of discharge use. Copyright © 2011 Elsevier Inc. All rights reserved.

Teaching Evidence-Based Medicine More Effectively

Directory of Open Access Journals (Sweden)

Zinat Nadia Hatmi

2010-10-01

Full Text Available Evidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P

Computer-based literature search in medical institutions in India

Directory of Open Access Journals (Sweden)

Kalita Jayantee

2007-01-01

Full Text Available Aim: To study the use of computer-based literature search and its application in clinical training and patient care as a surrogate marker of evidence-based medicine. Materials and Methods: A questionnaire comprising of questions on purpose (presentation, patient management, research, realm (site accessed, nature and frequency of search, effect, infrastructure, formal training in computer based literature search and suggestions for further improvement were sent to residents and faculty of a Postgraduate Medical Institute (PGI and a Medical College. The responses were compared amongst different subgroups of respondents. Results: Out of 300 subjects approached 194 responded; of whom 103 were from PGI and 91 from Medical College. There were 97 specialty residents, 58 super-specialty residents and 39 faculty members. Computer-based literature search was done at least once a month by 89% though there was marked variability in frequency and extent. The motivation for computer-based literature search was for presentation in 90%, research in 65% and patient management in 60.3%. The benefit of search was acknowledged in learning and teaching by 80%, research by 65% and patient care by 64.4% of respondents. Formal training in computer based literature search was received by 41% of whom 80% were residents. Residents from PGI did more frequent and more extensive computer-based literature search, which was attributed to better infrastructure and training. Conclusion: Training and infrastructure both are crucial for computer-based literature search, which may translate into evidence based medicine.

Portfolio assessment during medical internships: How to obtain a reliable and feasible assessment procedure?

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Michels, Nele R M; Driessen, Erik W; Muijtjens, Arno M M; Van Gaal, Luc F; Bossaert, Leo L; De Winter, Benedicte Y

2009-12-01

A portfolio is used to mentor and assess students' clinical performance at the workplace. However, students and raters often perceive the portfolio as a time-consuming instrument. In this study, we investigated whether assessment during medical internship by a portfolio can combine reliability and feasibility. The domain-oriented reliability of 61 double-rated portfolios was measured, using a generalisability analysis with portfolio tasks and raters as sources of variation in measuring the performance of a student. We obtained reliability (Phi coefficient) of 0.87 with this internship portfolio containing 15 double-rated tasks. The generalisability analysis showed that an acceptable level of reliability (Phi = 0.80) was maintained when the amount of portfolio tasks was decreased to 13 or 9 using one and two raters, respectively. Our study shows that a portfolio can be a reliable method for the assessment of workplace learning. The possibility of reducing the amount of tasks or raters while maintaining a sufficient level of reliability suggests an increase in feasibility of portfolio use for both students and raters.

The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students' Hospital Admission Notes.

Science.gov (United States)

Baker, Elizabeth A; Ledford, Cynthia H; Fogg, Louis; Way, David P; Park, Yoon Soo

2015-01-01

Construct: Clinical skills are used in the care of patients, including reporting, diagnostic reasoning, and decision-making skills. Written comprehensive new patient admission notes (H&Ps) are a ubiquitous part of student education but are underutilized in the assessment of clinical skills. The interpretive summary, differential diagnosis, explanation of reasoning, and alternatives (IDEA) assessment tool was developed to assess students' clinical skills using written comprehensive new patient admission notes. The validity evidence for assessment of clinical skills using clinical documentation following authentic patient encounters has not been well documented. Diagnostic justification tools and postencounter notes are described in the literature (1,2) but are based on standardized patient encounters. To our knowledge, the IDEA assessment tool is the first published tool that uses medical students' H&Ps to rate students' clinical skills. The IDEA assessment tool is a 15-item instrument that asks evaluators to rate students' reporting, diagnostic reasoning, and decision-making skills based on medical students' new patient admission notes. This study presents validity evidence in support of the IDEA assessment tool using Messick's unified framework, including content (theoretical framework), response process (interrater reliability), internal structure (factor analysis and internal-consistency reliability), and relationship to other variables. Validity evidence is based on results from four studies conducted between 2010 and 2013. First, the factor analysis (2010, n = 216) yielded a three-factor solution, measuring patient story, IDEA, and completeness, with reliabilities of .79, .88, and .79, respectively. Second, an initial interrater reliability study (2010) involving two raters demonstrated fair to moderate consensus (κ = .21-.56, ρ =.42-.79). Third, a second interrater reliability study (2011) with 22 trained raters also demonstrated fair to moderate agreement

[Glocalization: the outlook for Taiwan evidence based health care].

Science.gov (United States)

Chen, Chiehfeng

2014-12-01

Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.

A Brazilian Portuguese Survey of School Climate: Evidence of Validity and Reliability

Science.gov (United States)

Bear, George G.; Holst, Bruna; Lisboa, Carolina; Chen, Dandan; Yang, Chunyan; Chen, Fang Fang

2016-01-01

This study presents evidence of the validity and reliability of scores for the newly developed Brazilian Portuguese version of the Delaware School Climate Survey-Student (Brazilian DSCS-S). The sample consisted of 378 students, grades 5 through 9, attending four private and three public schools in southern Brazil. Confirmatory factor analyses…

Informing web-based communication curricula in veterinary education: a systematic review of web-based methods used for teaching and assessing clinical communication in medical education.

Science.gov (United States)

Artemiou, Elpida; Adams, Cindy L; Toews, Lorraine; Violato, Claudio; Coe, Jason B

2014-01-01

We determined the Web-based configurations that are applied to teach medical and veterinary communication skills, evaluated their effectiveness, and suggested future educational directions for Web-based communication teaching in veterinary education. We performed a systematic search of CAB Abstracts, MEDLINE, Scopus, and ERIC limited to articles published in English between 2000 and 2012. The review focused on medical or veterinary undergraduate to clinical- or residency-level students. We selected studies for which the study population was randomized to the Web-based learning (WBL) intervention with a post-test comparison with another WBL or non-WBL method and that reported at least one empirical outcome. Two independent reviewers completed relevancy screening, data extraction, and synthesis of results using Kirkpatrick and Kirkpatrick's framework. The search retrieved 1,583 articles, and 10 met the final inclusion criteria. We identified no published articles on Web based communication platforms in veterinary medicine; however, publications summarized from human medicine demonstrated that WBL provides a potentially reliable and valid approach for teaching and assessing communication skills. Student feedback on the use of virtual patients for teaching clinical communication skills has been positive,though evidence has suggested that practice with virtual patients prompted lower relation-building responses.Empirical outcomes indicate that WBL is a viable method for expanding the approach to teaching history taking and possibly to additional tasks of the veterinary medical interview.

The reliability of assigning individuals to cognitive states using the Mini Mental-State Examination: a population-based prospective cohort study

OpenAIRE

Marioni, Riccardo E.; Chatfield, Mark; Brayne, Carol; Matthews, Fiona E.; Med Res Council

2011-01-01

Abstract Background Previous investigations of test re-test reliability of the Mini-Mental State Examination (MMSE) have used correlations and statistics such as Cronbach's α to assess consistency. In practice, the MMSE is usually used to group individuals into cognitive states. The reliability of this grouping (state based approach) has not been fully explored. Methods MMSE data were collected on a subset of 2,275 older participants (≥ 65 years) from the population-based Medical Research Cou...

Pharmacologic management of neuropathic pain: Evidence-based recommendations

DEFF Research Database (Denmark)

Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav

2007-01-01

Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered...... and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second......, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs...

Highly-reliable laser diodes and modules for spaceborne applications

Science.gov (United States)

Deichsel, E.

2017-11-01

Laser applications become more and more interesting in contemporary missions such as earth observations or optical communication in space. One of these applications is light detection and ranging (LIDAR), which comprises huge scientific potential in future missions. The Nd:YAG solid-state laser of such a LIDAR system is optically pumped using 808nm emitting pump sources based on semiconductor laser-diodes in quasi-continuous wave (qcw) operation. Therefore reliable and efficient laser diodes with increased output powers are an important requirement for a spaceborne LIDAR-system. In the past, many tests were performed regarding the performance and life-time of such laser-diodes. There were also studies for spaceborne applications, but a test with long operation times at high powers and statistical relevance is pending. Other applications, such as science packages (e.g. Raman-spectroscopy) on planetary rovers require also reliable high-power light sources. Typically fiber-coupled laser diode modules are used for such applications. Besides high reliability and life-time, designs compatible to the harsh environmental conditions must be taken in account. Mechanical loads, such as shock or strong vibration are expected due to take-off or landing procedures. Many temperature cycles with high change rates and differences must be taken in account due to sun-shadow effects in planetary orbits. Cosmic radiation has strong impact on optical components and must also be taken in account. Last, a hermetic sealing must be considered, since vacuum can have disadvantageous effects on optoelectronics components.

Educating physicians in evidence based medicine: current practices and curricular strategies

NARCIS (Netherlands)

Maggio, L.A.

2015-01-01

Evidence based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM is an expectation of professional healthcare and requisite component in many medical school curricula. Yet, despite

High power klystrons for efficient reliable high power amplifiers

Science.gov (United States)

Levin, M.

1980-11-01

This report covers the design of reliable high efficiency, high power klystrons which may be used in both existing and proposed troposcatter radio systems. High Power (10 kW) klystron designs were generated in C-band (4.4 GHz to 5.0 GHz), S-band (2.5 GHz to 2.7 GHz), and L-band or UHF frequencies (755 MHz to 985 MHz). The tubes were designed for power supply compatibility and use with a vapor/liquid phase heat exchanger. Four (4) S-band tubes were developed in the course of this program along with two (2) matching focusing solenoids and two (2) heat exchangers. These tubes use five (5) tuners with counters which are attached to the focusing solenoids. A reliability mathematical model of the tube and heat exchanger system was also generated.

An accurate and efficient reliability-based design optimization using the second order reliability method and improved stability transformation method

Science.gov (United States)

Meng, Zeng; Yang, Dixiong; Zhou, Huanlin; Yu, Bo

2018-05-01

The first order reliability method has been extensively adopted for reliability-based design optimization (RBDO), but it shows inaccuracy in calculating the failure probability with highly nonlinear performance functions. Thus, the second order reliability method is required to evaluate the reliability accurately. However, its application for RBDO is quite challenge owing to the expensive computational cost incurred by the repeated reliability evaluation and Hessian calculation of probabilistic constraints. In this article, a new improved stability transformation method is proposed to search the most probable point efficiently, and the Hessian matrix is calculated by the symmetric rank-one update. The computational capability of the proposed method is illustrated and compared to the existing RBDO approaches through three mathematical and two engineering examples. The comparison results indicate that the proposed method is very efficient and accurate, providing an alternative tool for RBDO of engineering structures.

Effect of an evidence-based answering service on GPs and their patients : a pilot study

NARCIS (Netherlands)

Verhoeven, A.A.; Schuling, J.

2004-01-01

OBJECTIVES: For general practitioners (GPs), an important obstacle to practising evidence-based medicine is lack of time. An evidence-based answering service was developed that took over searching and appraisal of medical evidence from the GPs. GPs sent in questions, and the informationist

Non-evidence-based policy: how effective is China's new cooperative medical scheme in reducing medical impoverishment?

Science.gov (United States)

Yip, Winnie; Hsiao, William C

2009-01-01

In recent years, many lower to middle income countries have looked to insurance as a means to protect their populations from medical impoverishment. In 2003, the Chinese government initiated the New Cooperative Medical System (NCMS), a government-run voluntary insurance program for its rural population. The prevailing model of NCMS combines medical savings accounts with high-deductible catastrophic hospital insurance (MSA/Catastrophic). To assess the effectiveness of this approach in reducing medical impoverishment, we used household survey data from 2006 linked to claims records of health expenditures to simulate the effect of MSA/Catastrophic on reducing the share of individuals falling below the poverty line (headcount), and the amount by which household resources fall short of the poverty line (poverty gap) due to medical expenses. We compared the effects of MSA/Catastrophic to Rural Mutual Health Care (RMHC), an experimental model that provides first dollar coverage for primary care, hospital services and drugs with a similar premium but a lower ceiling. Our results show that RMHC is more effective at reducing medical impoverishment than NCMS. Under the internationally accepted poverty line of US$1.08 per person per day, the MSA/Catastrophic models would reduce the poverty headcount by 3.5-3.9% and the average poverty gap by 11.8-16.4%, compared with reductions of 6.1-6.8% and 15-18.5% under the RMHC model. The primary reason for this is that NCMS does not address a major cause of medical impoverishment: expensive outpatient services for chronic conditions. As such, health policymakers need first to examine the disease profile and health expenditure pattern of a population before they can direct resources to where they will be most effective. As chronic diseases impose a growing share of the burden on the population in developing countries, it is not necessarily true that insurance coverage focusing on expensive hospital care alone is the most effective at

Making generic tutorials content specific: recycling evidence-based practice (EBP) tutorials for two disciplines.

Science.gov (United States)

Jeffery, Keven M; Maggio, Lauren; Blanchard, Mary

2009-01-01

Librarians at the Boston University Medical Center constructed two interactive online tutorials, "Introduction to EBM" and "Formulating a Clinical Question (PICO)," for a Family Medicine Clerkship and then quickly repurposed the existing tutorials to support an Evidence-based Dentistry course. Adobe's ColdFusion software was used to populate the tutorials with course-specific content based on the URL used to enter each tutorial, and a MySQL database was used to collect student input. Student responses were viewable immediately by course faculty on a password-protected Web site. The tutorials ensured that all students received the same baseline training and allowed librarians to tailor a subsequent library skills workshop to student tutorial answers. The tutorials were well-received by the medical and dental schools and have been added to mandatory first-year Evidence-based Medicine (EBM) and Evidence-based Dentistry (EBD) courses, meaning that every medical and dental student at BUMC will be expected to complete these tutorials.

Lessons Learned from A System-Wide Evidence-Based Practice Program Implementation

Science.gov (United States)

2017-04-25

incorporating scientific evidence, clinical expertise and the patient’s values and preferences to provide quality healthcare . Despite growing...MEMORANDUM FOR ST DEPARTMENT OF THE AIR FORCE 59TH MEDICAL WING (AETC) JOINT BASE SAN ANTONIO - LACKLAND TEXAS ATTN: LT COL JACQUELINE KILLIAN...FROM: 59 MDW/SGVU SUBJECT: Professional Presentation Approval 14 FEB 2017 1. Your paper, entitled Lesson Learned From A System-Wide Evidence- Based

From evidence-based to evidence-reflected practice

DEFF Research Database (Denmark)

Lystbæk, Christian Tang

“Knowledge” is of the utmost significance for professional practice and learning. Today, though, the established knowledge base is changing in all areas of the labour market (Alvesson, 2004). Work and society are dominated by commitment to demands for high levels of demonstrable accountability......, cost-efficiency and measurable quality. Thus, today, evidence-based practice has become an expectation and fashion, often used to emphasize the grounding of practice in research based knowledge that provides measurable evidence for best practice. But at the same time, there is a growing distrust...... of the supremacy of this kind of knowledge, and traditional monopolies of knowledge are challenged (Gabbay & May, 2010). In the literature, there is an on-going debate about professional knowledge enacted in diverse settings. This debate presents a wide range of epistemological terminologies and typologies, which...

The value of self-medication: summary of existing evidence.

Science.gov (United States)

Noone, Joshua; Blanchette, Christopher M

2018-02-01

The aim of this review was to identify the international evidence that is currently available on the economic value of self-care through responsible self-medication, in terms of the measures related to access to treatment, time, and productivity. A targeted literature search was conducted for 1990-2016, including data gathered from members of the World Self-Medication Industry and searches on PubMed, EBSCOHost, and Google Scholar. Specific searches of individual drug classes known to be switched to non-prescription status in this period were also conducted. A total of 71 articles were identified, of which 17 (11 modeling studies, six retrospective analyses) were included in the review. Evidence from modeling studies and retrospective analyses of grouped data across a range of common conditions for which non-prescription medications are available in different countries/regions showed that the use of non-prescription products for the treatment of common conditions or for symptom management (e.g. allergies, chronic pain, migraine, vaginitis, gastrointestinal symptoms, or common cold symptoms) had considerable value to patients, payers, and employers alike in terms of cost savings and improved productivity. Potential benefits of self-medication were also identified in preventative healthcare strategies, such as those for cardiovascular health and osteoporosis. This review was limited by a targeted, but non-systematic approach to literature retrieval, as well as the inclusion of unpublished reports/white papers and patient self-reported data. The evidence identified in this literature review shows that responsible, appropriate self-medication with non-prescription products can provide significant economic benefits for patients, employers, and healthcare systems worldwide.

Translation, cross-cultural adaption and measurement properties of the evidence-based practice profile

OpenAIRE

Titlestad, Kristine Berg; Snibsoer, Anne Kristin; Stromme, Hilde; Nortvedt, Monica Wammen; Graverholt, Birgitte; Espehaug, Birgitte

2017-01-01

Background The evidence-based practice profile (EBP2) questionnaire assesses students? self-reported knowledge, behaviour and attitudes related to evidence-based practice. The aim of this study was to translate and cross-culturally adapt EBP2 into Norwegian and to evaluate the reliability, validity and responsiveness of the Norwegian version. Methods EBP2 was translated and cross-culturally adapted using recommended methodology. Face validity and feasibility were evaluated in a pilot on bache...

Knowledge and Attitudes of Oman Medical Specialty Board Residents towards Evidence-Based Medicine

Directory of Open Access Journals (Sweden)

Aiman Al Wahaibi

2014-05-01

Full Text Available Objective: This study aims to evaluate the knowledge and attitudes of Oman Medical Specialty Board (OMSB residents towards Evidence-Based Medicine (EBM. Methods: This cross sectional study was conducted on all OMSB residents through a self-administered online questionnaire between October 2012 and March 2013. An electronic survey was designed to identify and determine residents' knowledge and attitudes toward the use of EBM. Results: The survey was completed by 93 (21% OMSB residents, 76 (82% of whom took part in continuing education courses and 50 (54% belonged to professional practice-oriented organizations. On average, the residents were reportedly involved in patient care for approximately 70% (Standard Deviation [SD] 17% of their time, while 14% (SD 12% participated in research activities. The results showed that 53 respondents (57% were competent users of medical search engines compared to 23 residents (25% who rated their skills as neutral. Sixteen percent of the respondents strongly agreed and 46% only agreed that the facility supports the use of current research in practice. Fourteen percent strongly agreed and fifty-three percent only agreed that the foundation of EBM is part of OMSB academic preparation. On the other hand, 17% of the respondents thought that insufficient time is always a barrier against EBM, while another 27% perceived insufficient time as a usual barrier. The lack of information resources was reported to always be a barrier in 11% of the respondents while 32% thought that it usually acts as a barrier. Conclusion: Time constraints and skills in EBM were found to be the two major obstacles. This study was, however, limited by the low response rate of the survey; thus larger studies with a previously validated questionnaire should be conducted in the future.

Dynamic reliability of digital-based transmitters

Energy Technology Data Exchange (ETDEWEB)

Brissaud, Florent, E-mail: florent.brissaud.2007@utt.f [Institut National de l' Environnement Industriel et des Risques (INERIS), Parc Technologique Alata, BP 2, 60550 Verneuil-en-Halatte (France) and Universite de Technologie de Troyes - UTT, Institut Charles Delaunay - ICD and UMR CNRS 6279 STMR, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France); Smidts, Carol [Ohio State University (OSU), Nuclear Engineering Program, Department of Mechanical Engineering, Scott Laboratory, 201 W 19th Ave, Columbus OH 43210 (United States); Barros, Anne; Berenguer, Christophe [Universite de Technologie de Troyes (UTT), Institut Charles Delaunay (ICD) and UMR CNRS 6279 STMR, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)

2011-07-15

Dynamic reliability explicitly handles the interactions between the stochastic behaviour of system components and the deterministic behaviour of process variables. While dynamic reliability provides a more efficient and realistic way to perform probabilistic risk assessment than 'static' approaches, its industrial level applications are still limited. Factors contributing to this situation are the inherent complexity of the theory and the lack of a generic platform. More recently the increased use of digital-based systems has also introduced additional modelling challenges related to specific interactions between system components. Typical examples are the 'intelligent transmitters' which are able to exchange information, and to perform internal data processing and advanced functionalities. To make a contribution to solving these challenges, the mathematical framework of dynamic reliability is extended to handle the data and information which are processed and exchanged between systems components. Stochastic deviations that may affect system properties are also introduced to enhance the modelling of failures. A formalized Petri net approach is then presented to perform the corresponding reliability analyses using numerical methods. Following this formalism, a versatile model for the dynamic reliability modelling of digital-based transmitters is proposed. Finally the framework's flexibility and effectiveness is demonstrated on a substantial case study involving a simplified model of a nuclear fast reactor.

Evidence-based decision making in health care settings: from theory to practice.

Science.gov (United States)

Kohn, Melanie Kazman; Berta, Whitney; Langley, Ann; Davis, David

2011-01-01

The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

Reliability-based sensitivity of mechanical components with arbitrary distribution parameters

International Nuclear Information System (INIS)

Zhang, Yi Min; Yang, Zhou; Wen, Bang Chun; He, Xiang Dong; Liu, Qiaoling

2010-01-01

This paper presents a reliability-based sensitivity method for mechanical components with arbitrary distribution parameters. Techniques from the perturbation method, the Edgeworth series, the reliability-based design theory, and the sensitivity analysis approach were employed directly to calculate the reliability-based sensitivity of mechanical components on the condition that the first four moments of the original random variables are known. The reliability-based sensitivity information of the mechanical components can be accurately and quickly obtained using a practical computer program. The effects of the design parameters on the reliability of mechanical components were studied. The method presented in this paper provides the theoretic basis for the reliability-based design of mechanical components

The accuracy of self-reported medical history: a preliminary analysis of the promise of internet-based research in Inflammatory Bowel Diseases.

Science.gov (United States)

Kelstrup, Anne Mette; Juillerat, Pascal; Korzenik, Joshua

2014-05-01

Internet-based surveys provide a potentially important tool for Inflammatory Bowel Disease (IBD) research. The advantages include low cost, large numbers of participants, rapid study completion and less extensive infrastructure than traditional methods. The aim was to determine the accuracy of patient self-reporting in internet-based IBD research and identify predictors of greater reliability. 197 patients from a tertiary care center answered an online survey concerning personal medical history and an evaluation of disease specific knowledge. Self-reported medical details were compared with data abstracted from medical records. Agreement was assessed by kappa (κ) statistics. Participants responded correctly with excellent agreement (κ=0.96-0.97) on subtype of IBD and history of surgery. The agreement was also excellent for colectomy (κ=0.88) and small bowel resection (κ=0.91), moderate for abscesses and fistulas (κ=0.60 and 0.63), but poor regarding partial colectomy (κ=0.39). Time since last colonoscopy was self-reported with better agreement (κ=0.84) than disease activity. For disease location/extent, moderate agreements at κ=69% and 64% were observed for patients with Crohn's disease and ulcerative colitis, respectively. Subjects who scored higher than the average in the IBD knowledge assessment were significantly more accurate about disease location than their complementary group (74% vs. 59%, p=0.02). This study demonstrates that IBD patients accurately report their medical history regarding type of disease and surgical procedures. More detailed medical information is less reliably reported. Disease knowledge assessment may help in identifying the most accurate individuals and could therefore serve as validity criteria. Internet-based surveys are feasible with high reliability about basic disease features only. However, the participants in this study were engaged at a tertiary center, which potentially leads to a bias and compromises generalization to

Structural hybrid reliability index and its convergent solving method based on random–fuzzy–interval reliability model

Directory of Open Access Journals (Sweden)

Hai An

2016-08-01

Full Text Available Aiming to resolve the problems of a variety of uncertainty variables that coexist in the engineering structure reliability analysis, a new hybrid reliability index to evaluate structural hybrid reliability, based on the random–fuzzy–interval model, is proposed in this article. The convergent solving method is also presented. First, the truncated probability reliability model, the fuzzy random reliability model, and the non-probabilistic interval reliability model are introduced. Then, the new hybrid reliability index definition is presented based on the random–fuzzy–interval model. Furthermore, the calculation flowchart of the hybrid reliability index is presented and it is solved using the modified limit-step length iterative algorithm, which ensures convergence. And the validity of convergent algorithm for the hybrid reliability model is verified through the calculation examples in literature. In the end, a numerical example is demonstrated to show that the hybrid reliability index is applicable for the wear reliability assessment of mechanisms, where truncated random variables, fuzzy random variables, and interval variables coexist. The demonstration also shows the good convergence of the iterative algorithm proposed in this article.

High Bit-Depth Medical Image Compression With HEVC.

Science.gov (United States)

Parikh, Saurin S; Ruiz, Damian; Kalva, Hari; Fernandez-Escribano, Gerardo; Adzic, Velibor

2018-03-01

Efficient storing and retrieval of medical images has direct impact on reducing costs and improving access in cloud-based health care services. JPEG 2000 is currently the commonly used compression format for medical images shared using the DICOM standard. However, new formats such as high efficiency video coding (HEVC) can provide better compression efficiency compared to JPEG 2000. Furthermore, JPEG 2000 is not suitable for efficiently storing image series and 3-D imagery. Using HEVC, a single format can support all forms of medical images. This paper presents the use of HEVC for diagnostically acceptable medical image compression, focusing on compression efficiency compared to JPEG 2000. Diagnostically acceptable lossy compression and complexity of high bit-depth medical image compression are studied. Based on an established medically acceptable compression range for JPEG 2000, this paper establishes acceptable HEVC compression range for medical imaging applications. Experimental results show that using HEVC can increase the compression performance, compared to JPEG 2000, by over 54%. Along with this, a new method for reducing computational complexity of HEVC encoding for medical images is proposed. Results show that HEVC intra encoding complexity can be reduced by over 55% with negligible increase in file size.

Promoting evidence-based practice in pharmacies

Directory of Open Access Journals (Sweden)

Toklu HZ

2015-09-01

Full Text Available Hale Zerrin Toklu Department of Pharmacology and Therapeutics, College of Medicine, University of Florida, Gainesville, FL, USA Abstract: Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive “medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.” Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs. Keywords: pharmacist, rational use of medicine, pharmacotherapy, pharmaceutical, outcome

Validity and reliability of instruments aimed at measuring Evidence-Based Practice in Physical Therapy: a systematic review of the literature.

Science.gov (United States)

Fernández-Domínguez, Juan Carlos; Sesé-Abad, Albert; Morales-Asencio, Jose Miguel; Oliva-Pascual-Vaca, Angel; Salinas-Bueno, Iosune; de Pedro-Gómez, Joan Ernest

2014-12-01

Our goal is to compile and analyse the characteristics - especially validity and reliability - of all the existing international tools that have been used to measure evidence-based clinical practice in physiotherapy. A systematic review conducted with data from exclusively quantitative-type studies synthesized in narrative format. An in-depth search of the literature was conducted in two phases: initial, structured, electronic search of databases and also journals with summarized evidence; followed by a residual-directed search in the bibliographical references of the main articles found in the primary search procedure. The studies included were assigned to members of the research team who acted as peer reviewers. Relevant information was extracted from each of the selected articles using a template that included the general characteristics of the instrument as well as an analysis of the quality of the validation processes carried out, by following the criteria of Terwee. Twenty-four instruments were found to comply with the review screening criteria; however, in all cases, they were found to be limited as regards the 'constructs' included. Besides, they can all be seen to be lacking as regards comprehensiveness associated to the validation process of the psychometric tests used. It seems that what constitutes a rigorously developed assessment instrument for EBP in physical therapy continues to be a challenge. © 2014 John Wiley & Sons, Ltd.

Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review.

Science.gov (United States)

Woodman, J P; Moore, N R

2012-01-01

Complementary medicine and alternative approaches to chronic and intractable health conditions are increasingly being used, and require critical evaluation. The aim of this review was to systematically evaluate available evidence for the effectiveness and safety of instruction in the Alexander Technique in health-related conditions. PUBMED, EMBASE, PSYCHINFO, ISI Web-of-Knowledge, AMED, CINHAL-plus, Cochrane library and Evidence-based Medicine Reviews were searched to July 2011. Inclusion criteria were prospective studies evaluating Alexander Technique instruction (individual lessons or group delivery) as an intervention for any medical indication/health-related condition. Studies were categorised and data extracted on study population, randomisation method, nature of intervention and control, practitioner characteristics, validity and reliability of outcome measures, completeness of follow-up and statistical analyses.   Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. One well-designed, well-conducted RCT demonstrated that, compared with usual GP care, Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. The results were broadly supported by a smaller, earlier RCT in chronic back pain. The third RCT, a small, well-designed, well-conducted study in individuals with Parkinson's disease, showed a sustained increased ability to carry out everyday activities following Alexander lessons, compared with usual care. The 15 non-RCT studies are also reviewed. Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the

Changing the culture of medical training: An important step toward the implementation of competency-based medical education.

Science.gov (United States)

Ferguson, Peter C; Caverzagie, Kelly J; Nousiainen, Markku T; Snell, Linda

2017-06-01

The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education. At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic. There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME. The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.

The judgement process in evidence-based medicine and health technology assessment

OpenAIRE

Kelly, Michael P; Moore, Tessa A

2011-01-01

This article describes the judgements used to interpret evidence in evidence-based medicine (EBM) and health technology assessment (HTA). It outlines the methods and processes of EBM and HTA. Respectively, EBM and HTA are approaches to medical clinical decision making and efficient allocation of scarce health resources. At the heart of both is a concern to review and synthesise evidence, especially evidence derived from randomised controlled trials (RCTs) of clinical effectiveness. The driver...

The effect of Web-based Braden Scale training on the reliability of Braden subscale ratings.

Science.gov (United States)

Magnan, Morris A; Maklebust, JoAnn

2009-01-01

The primary purpose of this study was to evaluate the effect of Web-based Braden Scale training on the reliability of Braden Scale subscale ratings made by nurses working in acute care hospitals. A secondary purpose was to describe the distribution of reliable Braden subscale ratings before and after Web-based Braden Scale training. Secondary analysis of data from a recently completed quasi-experimental, pretest-posttest, interrater reliability study. A convenience sample of RNs working at 3 Michigan medical centers voluntarily participated in the study. RN participants included nurses who used the Braden Scale regularly at their place of employment ("regular users") as well as nurses who did not use the Braden Scale at their place of employment ("new users"). Using a pretest-posttest, quasi-experimental design, pretest interrater reliability data were collected to identify the percentage of nurses making reliable Braden subscale assessments. Nurses then completed a Web-based Braden Scale training module after which posttest interrater reliability data were collected. The reliability of nurses' Braden subscale ratings was determined by examining the level of agreement/disagreement between ratings made by an RN and an "expert" rating the same patient. In total, 381 RN-to-expert dyads were available for analysis. During both the pretest and posttest periods, the percentage of reliable subscale ratings was highest for the activity subscale, lowest for the moisture subscale, and second lowest for the nutrition subscale. With Web-based Braden Scale training, the percentage of reliable Braden subscale ratings made by new users increased for all 6 subscales with statistically significant improvements in the percentage of reliable assessments made on 3 subscales: sensory-perception, moisture, and mobility. Training had virtually no effect on the percentage of reliable subscale ratings made by regular users of the Braden Scale. With Web-based Braden Scale training the

An evidence-based approach to the creation of normative data: base rates of impaired scores within a brief neuropsychological battery argue for age corrections, but against corrections for medical conditions.

Science.gov (United States)

O'Connell, Megan E; Tuokko, Holly; Voll, Stacey; Simard, Martine; Griffith, Lauren E; Taler, Vanessa; Wolfson, Christina; Kirkland, Susan; Raina, Parminder

We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery. We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores. Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.

Interactive Reliability-Based Optimal Design

DEFF Research Database (Denmark)

Sørensen, John Dalsgaard; Thoft-Christensen, Palle; Siemaszko, A.

1994-01-01

Interactive design/optimization of large, complex structural systems is considered. The objective function is assumed to model the expected costs. The constraints are reliability-based and/or related to deterministic code requirements. Solution of this optimization problem is divided in four main...... tasks, namely finite element analyses, sensitivity analyses, reliability analyses and application of an optimization algorithm. In the paper it is shown how these four tasks can be linked effectively and how existing information on design variables, Lagrange multipliers and the Hessian matrix can...

Improving medication adherence: a framework for community pharmacy-based interventions

Directory of Open Access Journals (Sweden)

Pringle J

2015-11-01

Full Text Available Janice Pringle,1 Kim C Coley2 1Program Evaluation and Research Unit, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA; 2Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA Abstract: Evidence supports that patient medication adherence is suboptimal with patients typically taking less than half of their prescribed doses. Medication nonadherence is associated with poor health outcomes and higher downstream health care costs. Results of studies evaluating pharmacist-led models in a community pharmacy setting and their impact on medication adherence have been mixed. Community pharmacists are ideally situated to provide medication adherence interventions, and effective strategies for how they can consistently improve patient medication adherence are necessary. This article suggests a framework to use in the community pharmacy setting that will significantly improve patient adherence and provides a strategy for how to apply this framework to develop and test new medication adherence innovations. The proposed framework is composed of the following elements: 1 defining the program's pharmacy service vision, 2 using evidence-based, patient-centered communication and intervention strategies, 3 using specific implementation approaches that ensure fidelity, and 4 applying continuous evaluation strategies. Within this framework, pharmacist interventions should include those services that capitalize on their specific skill sets. It is also essential that the organization's leadership effectively communicates the pharmacy service vision. Medication adherence strategies that are evidence-based and individualized to each patient's adherence problems are most desirable. Ideally, interventions would be delivered repeatedly over time and adjusted when patient's adherence circumstances change. Motivational interviewing principles are particularly well

Prophylactic antibiotics in vesicoureteric reflux: Evidence-based analysis

Directory of Open Access Journals (Sweden)

M S Ansari

2009-01-01

Full Text Available Objectives: The aim of this review was to systematically examine the available evidence for the effectiveness of prophylactic antibiotics in cases of vesicoureteric reflux (VUR. Materials and Methods: We searched the relevant data on medical management of VUR and the date of last search was June 2008. The search included both randomized controlled trials as well as the nonrandomized trials and the data sources were; MEDLINE, online peer reviewed journals, Cochrane database and abstracts from conference proceedings. Results: Barring few most of the studies published on medical management were nonrandomized. Besides being small in number many of these studies were of poor-quality and poorly designed eventually failing in giving a reliable answer in this regard. Few of the studies suggest that the children with low grade VUR might do well even without antibiotic prophylaxis. Conclusions : In the absence of properly designed, randomized controlled trials and long-term follow-up the question of antibiotic prophylaxis in cases of VUR remains unanswered in large part of it. Whether to give prophylactic antibiotics or not would ultimately need a shared decision-making involving both the treating physician and the parents assessing both the risks and the benefits.

The History of Evidence-Based Practice in Nursing Education and Practice.

Science.gov (United States)

Mackey, April; Bassendowski, Sandra

Beginning with Florence Nightingale in the 1800s and evolving again within the medical community, evidence-based practice continues to advance along with the nursing discipline. Evidence-based practice is foundational to undergraduate and graduate nursing education and is a way for the nursing discipline to minimize the theory to practice gap. This article discusses the concept of evidence-based practice from a historical perspective as it relates to nursing in the educational and practice domains. The concept evidence-based practice is defined, and the similarities and differences to evidence-based medicine are discussed. It is crucial that registered nurses be proactive in their quest for research knowledge, so the gap between theory and practice continues to close. Utilizing nursing best practice guidelines, reviewing and implementing applicable research evidence, and taking advantage of technological advances are all ways in which nursing can move forward as a well-informed discipline. Copyright © 2016 Elsevier Inc. All rights reserved.

ADDIS: A decision support system for evidence-based medicine

NARCIS (Netherlands)

G. van Valkenhoef (Gert); T. Tervonen (Tommi); T. Zwinkels (Tijs); B. de Brock (Bert); H.L. Hillege (Hans)

2013-01-01

textabstractClinical trials are the main source of information for the efficacy and safety evaluation of medical treatments. Although they are of pivotal importance in evidence-based medicine, there is a lack of usable information systems providing data-analysis and decision support capabilities for

NLM Evidence-based Information at Your Fingertips - NBNA

Energy Technology Data Exchange (ETDEWEB)

Womble, R.

2010-08-06

The workshop titled, National Library of Medicine: Evidence-based Information At Your Fingertips, is a computer training class designed to meet the needs of nurses who require access to information on specific medical topics and on the adverse health effects of exposure to hazardous substances. The Specialized Information Services Division of the National Library of Medicine (NLM) is sponsoring this workshop for the National Black Nurses Association to increase the awareness of health professionals of the availability and value of the free NLM medical, environmental health, and toxicology databases.

Structural hybrid reliability index and its convergent solving method based on random–fuzzy–interval reliability model

OpenAIRE

Hai An; Ling Zhou; Hui Sun

2016-01-01

Aiming to resolve the problems of a variety of uncertainty variables that coexist in the engineering structure reliability analysis, a new hybrid reliability index to evaluate structural hybrid reliability, based on the random–fuzzy–interval model, is proposed in this article. The convergent solving method is also presented. First, the truncated probability reliability model, the fuzzy random reliability model, and the non-probabilistic interval reliability model are introduced. Then, the new...

Methodology for developing evidence-based clinical imaging guidelines: Joint recommendations by Korea society of radiology and national evidence-based healthcare collaborating agency

Energy Technology Data Exchange (ETDEWEB)

Choi, Sol Ji; Jo, Ae Jeong; Choi, Jin A [Div. for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul (Korea, Republic of); and others

2017-01-15

This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.

Methodology for developing evidence-based clinical imaging guidelines: Joint recommendations by Korea society of radiology and national evidence-based healthcare collaborating agency

International Nuclear Information System (INIS)

Choi, Sol Ji; Jo, Ae Jeong; Choi, Jin A

2017-01-01

This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure

Medical application and clinical validation for reliable and trustworthy physiological monitoring using functional textiles: experience from the HeartCycle and MyHeart project.

Science.gov (United States)

Reiter, Harald; Muehlsteff, Jens; Sipilä, Auli

2011-01-01

Functional textiles are seen as promising technology to enable healthcare services and medical care outside hospitals due to their ability to integrate textile-based sensing and monitoring technologies into the daily life. In the past much effort has been spent onto basic functional textile research already showing that reliable monitoring solutions can be realized. The challenge remains to find and develop suited medical application and to fulfil the boundary conditions for medical endorsement and exploitation. The HeartCycle vest described in this abstract will serve as an example for a functional textile carefully developed according to the requirements of a specific medical application, its clinical validation, the related certification aspects and the next improvement steps towards exploitation.

The reliability assessment of the electromagnetic valve of high-speed electric multiple units braking system based on two-parameter exponential distribution

Directory of Open Access Journals (Sweden)

Jianwei Yang

2016-06-01

Full Text Available In order to solve the reliability assessment of braking system component of high-speed electric multiple units, this article, based on two-parameter exponential distribution, provides the maximum likelihood estimation and Bayes estimation under a type-I life test. First of all, we evaluate the failure probability value according to the classical estimation method and then obtain the maximum likelihood estimation of parameters of two-parameter exponential distribution by performing and using the modified likelihood function. On the other hand, based on Bayesian theory, this article also selects the beta and gamma distributions as the prior distribution, combines with the modified maximum likelihood function, and innovatively applies a Markov chain Monte Carlo algorithm to parameters assessment based on Bayes estimation method for two-parameter exponential distribution, so that two reliability mathematical models of the electromagnetic valve are obtained. Finally, through type-I life test, the failure rates according to maximum likelihood estimation and Bayes estimation method based on Markov chain Monte Carlo algorithm are, respectively, 2.650 × 10−5 and 3.037 × 10−5. Compared with the failure rate of a electromagnetic valve 3.005 × 10−5, it proves that the Bayes method can use a Markov chain Monte Carlo algorithm to estimate reliability for two-parameter exponential distribution and Bayes estimation is more closer to the value of electromagnetic valve. So, by fully integrating multi-source, Bayes estimation method can preferably modify and precisely estimate the parameters, which can provide a certain theoretical basis for the safety operation of high-speed electric multiple units.

Evidence-Based Management of Anticoagulant Therapy

Science.gov (United States)

Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.

2012-01-01

Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259

The effects of problem-based learning during medical school on physician competency: a systematic review.

Science.gov (United States)

Koh, Gerald Choon-Huat; Khoo, Hoon Eng; Wong, Mee Lian; Koh, David

2008-01-01

Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed. Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate). Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.

Evaluation of a Nutrition Care Process-based audit instrument, the Diet-NCP-Audit, for documentation of dietetic care in medical records.

Science.gov (United States)

Lövestam, Elin; Orrevall, Ylva; Koochek, Afsaneh; Karlström, Brita; Andersson, Agneta

2014-06-01

Adequate documentation in medical records is important for high-quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four-step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0-1 or 0-2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet-NCP-Audit. Firstly, the content validity of the Diet-NCP-Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter-rater agreement with Krippendorff's α = 0.65-0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra-rater reliability test-retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic

Evidence-based Medicine Search: a customizable federated search engine.

Science.gov (United States)

Bracke, Paul J; Howse, David K; Keim, Samuel M

2008-04-01

This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center.

Barriers to evidence-based medicine: a systematic review.

Science.gov (United States)

Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber

2014-12-01

Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.

Teaching evidence-based medicine more effectively.

Science.gov (United States)

Hatmi, Zinat Nadia; Tahvildari, Sousan; Dabiran, Soheila; Soheili, Suraya; Sabouri Kashani, Ahmad; Raznahan, Maedeh

2010-01-01

Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

The Structure of Medical Decisions

DEFF Research Database (Denmark)

Austin, Laurel C.; Reventlow, Susanne; Sandøe, Peter

2013-01-01

) an individual for a population-based intervention. Analysis of these situations facilitates examination of intuitive probabilistic reasoning. Drawing on evidence in related literature, we discuss some implications of decision-makers imposing the wrong structure or probabilistic reasoning when making medical......Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible......, but not certain, future symptomatic conditions. Other preventive decisions include whether or not to accept population-based intervention, such as vaccination. Using decision trees, we model the normative structures and associated uncertainties that underlie five medical decision situations, each of which...

High reliability low jitter 80 kV pulse generator

Directory of Open Access Journals (Sweden)

M. E. Savage

2009-08-01

Full Text Available Switching can be considered to be the essence of pulsed power. Time accurate switch/trigger systems with low inductance are useful in many applications. This article describes a unique switch geometry coupled with a low-inductance capacitive energy store. The system provides a fast-rising high voltage pulse into a low impedance load. It can be challenging to generate high voltage (more than 50 kilovolts into impedances less than 10  Ω, from a low voltage control signal with a fast rise time and high temporal accuracy. The required power amplification is large, and is usually accomplished with multiple stages. The multiple stages can adversely affect the temporal accuracy and the reliability of the system. In the present application, a highly reliable and low jitter trigger generator was required for the Z pulsed-power facility [M. E. Savage, L. F. Bennett, D. E. Bliss, W. T. Clark, R. S. Coats,J. M. Elizondo, K. R. LeChien, H. C. Harjes, J. M. Lehr, J. E. Maenchen, D. H. McDaniel, M. F. Pasik, T. D. Pointon, A. C. Owen, D. B. Seidel, D. L. Smith, B. S. Stoltzfus, K. W. Struve, W. A. Stygar, L. K. Warne, and J. R. Woodworth, 2007 IEEE Pulsed Power Conference, Albuquerque, NM (IEEE, Piscataway, NJ, 2007, p. 979]. The large investment in each Z experiment demands low prefire probability and low jitter simultaneously. The system described here is based on a 100 kV DC-charged high-pressure spark gap, triggered with an ultraviolet laser. The system uses a single optical path for simultaneously triggering two parallel switches, allowing lower inductance and electrode erosion with a simple optical system. Performance of the system includes 6 ns output rise time into 5.6  Ω, 550 ps one-sigma jitter measured from the 5 V trigger to the high voltage output, and misfire probability less than 10^{-4}. The design of the system and some key measurements will be shown in the paper. We will discuss the

Reliability data bases: the current picture

International Nuclear Information System (INIS)

Fragola, J.R.

1985-01-01

The paper addresses specific advances in nuclear power plant reliability data base development, a critical review of a select set of relevant data bases and suggested future data bases and suggested future data development needs required for risk assessment techniques to reach full potential

Rapid Evidence Assessment of the Literature (REAL(©)): streamlining the systematic review process and creating utility for evidence-based health care.

Science.gov (United States)

Crawford, Cindy; Boyd, Courtney; Jain, Shamini; Khorsan, Raheleh; Jonas, Wayne

2015-11-02

Systematic reviews (SRs) are widely recognized as the best means of synthesizing clinical research. However, traditional approaches can be costly and time-consuming and can be subject to selection and judgment bias. It can also be difficult to interpret the results of a SR in a meaningful way in order to make research recommendations, clinical or policy decisions, or practice guidelines. Samueli Institute has developed the Rapid Evidence Assessment of the Literature (REAL) SR process to address these issues. REAL provides up-to-date, rigorous, high quality SR information on health care practices, products, or programs in a streamlined, efficient and reliable manner. This process is a component of the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™) program developed by Samueli Institute, which aims at answering the question of "What works?" in health care. The REAL process (1) tailors a standardized search strategy to a specific and relevant research question developed with various stakeholders to survey the available literature; (2) evaluates the quantity and quality of the literature using structured tools and rulebooks to ensure objectivity, reliability and reproducibility of reviewer ratings in an independent fashion and; (3) obtains formalized, balanced input from trained subject matter experts on the implications of the evidence for future research and current practice. Online tools and quality assurance processes are utilized for each step of the review to ensure a rapid, rigorous, reliable, transparent and reproducible SR process. The REAL is a rapid SR process developed to streamline and aid in the rigorous and reliable evaluation and review of claims in health care in order to make evidence-based, informed decisions, and has been used by a variety of organizations aiming to gain insight into "what works" in health care. Using the REAL system allows for the facilitation of recommendations on appropriate next steps in policy, funding

Training and Maintaining System-Wide Reliability in Outcome Management.

Science.gov (United States)

Barwick, Melanie A; Urajnik, Diana J; Moore, Julia E

2014-01-01

The Child and Adolescent Functional Assessment Scale (CAFAS) is widely used for outcome management, for providing real time client and program level data, and the monitoring of evidence-based practices. Methods of reliability training and the assessment of rater drift are critical for service decision-making within organizations and systems of care. We assessed two approaches for CAFAS training: external technical assistance and internal technical assistance. To this end, we sampled 315 practitioners trained by external technical assistance approach from 2,344 Ontario practitioners who had achieved reliability on the CAFAS. To assess the internal technical assistance approach as a reliable alternative training method, 140 practitioners trained internally were selected from the same pool of certified raters. Reliabilities were high for both practitioners trained by external technical assistance and internal technical assistance approaches (.909-.995, .915-.997, respectively). 1 and 3-year estimates showed some drift on several scales. High and consistent reliabilities over time and training method has implications for CAFAS training of behavioral health care practitioners, and the maintenance of CAFAS as a global outcome management tool in systems of care.

Reliability Based Ship Structural Design

DEFF Research Database (Denmark)

Dogliani, M.; Østergaard, C.; Parmentier, G.

1996-01-01

This paper deals with the development of different methods that allow the reliability-based design of ship structures to be transferred from the area of research to the systematic application in current design. It summarises the achievements of a three-year collaborative research project dealing...... with developments of models of load effects and of structural collapse adopted in reliability formulations which aim at calibrating partial safety factors for ship structural design. New probabilistic models of still-water load effects are developed both for tankers and for containerships. New results are presented...... structure of several tankers and containerships. The results of the reliability analysis were the basis for the definition of a target safety level which was used to asses the partial safety factors suitable for in a new design rules format to be adopted in modern ship structural design. Finally...

Item Analysis to Improve Reliability for an Internal Medicine Undergraduate OSCE

Science.gov (United States)

Auewarakul, Chirayu; Downing, Steven M.; Praditsuwan, Rungnirand; Jaturatamrong, Uapong

2005-01-01

Utilization of objective structured clinical examinations (OSCEs) for final assessment of medical students in Internal Medicine requires a representative sample of OSCE stations. The reliability and generalizability of OSCE scores provides validity evidence for OSCE scores and supports its contribution to the final clinical grade of medical…

Design of piezoelectric transducer layer with electromagnetic shielding and high connection reliability

Science.gov (United States)

Qiu, Lei; Yuan, Shenfang; Shi, Xiaoling; Huang, Tianxiang

2012-07-01

Piezoelectric transducer (PZT) and Lamb wave based structural health monitoring (SHM) method have been widely studied for on-line SHM of high-performance structures. To monitor large-scale structures, a dense PZTs array is required. In order to improve the placement efficiency and reduce the wire burden of the PZTs array, the concept of the piezoelectric transducers layer (PSL) was proposed. The PSL consists of PZTs, a flexible interlayer with printed wires and signal input/output interface. For on-line SHM on real aircraft structures, there are two main issues on electromagnetic interference and connection reliability of the PSL. To address the issues, an electromagnetic shielding design method of the PSL to reduce spatial electromagnetic noise and crosstalk is proposed and a combined welding-cementation process based connection reliability design method is proposed to enhance the connection reliability between the PZTs and the flexible interlayer. Two experiments on electromagnetic interference suppression are performed to validate the shielding design of the PSL. The experimental results show that the amplitudes of the spatial electromagnetic noise and crosstalk output from the shielded PSL developed by this paper are - 15 dB and - 25 dB lower than those of the ordinary PSL, respectively. Other two experiments on temperature durability ( - 55 °C-80 °C ) and strength durability (160-1600μɛ, one million load cycles) are applied to the PSL to validate the connection reliability. The low repeatability errors (less than 3% and less than 5%, respectively) indicate that the developed PSL is of high connection reliability and long fatigue life.

What is nature capable of? Evidence, ontology and speculative medical humanities.

Science.gov (United States)

Savransky, Martin; Rosengarten, Marsha

2016-09-01

Expanding on the recent call for a 'critical medical humanities' to intervene in questions of the ontology of health, this article develops a what we call a 'speculative' orientation to such interventions in relation to some of the ontological commitments on which contemporary biomedical cultures rest. We argue that crucial to this task is an approach to ontology that treats it not as a question of first principles, but as a matter of the consequences of the images of nature that contemporary biomedical research practices espouse when they make claims to evidence, as well as the possible consequences of imagining different worlds in which health and disease processes partake. By attending to the implicit ontological assumptions involved in the method par excellence of biomedical research, namely the randomised controlled trial (RCT), we argue that the mechanistic ontology that tacitly informs evidence-based biomedical research simultaneously authorises a series of problematic consequences for understanding and intervening practically in the concrete realities of health. As a response, we develop an alternative ontological proposition that regards processes of health and disease as always situated achievements. We show that, without disqualifying RCT-based evidence, such a situated ontology enables one to resist the reduction of the realities of health and disease to biomedicine's current forms of explanation. In so doing, we call for medical humanities scholars to actively engage in the speculative question of what nature may be capable of. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Evidence of Reliability and Validity for a Children’s Auditory Continuous Performance Test

Directory of Open Access Journals (Sweden)

Michael J. Lasee

2013-11-01

Full Text Available Continuous Performance Tests (CPTs are commonly utilized clinical measures of attention and response inhibition. While there have been many studies of CPTs that utilize a visual format, there is considerably less research employing auditory CPTs. The current study provides initial reliability and validity evidence for the Auditory Vigilance Screening Measure (AVSM, a newly developed CPT. Participants included 105 five- to nine-year-old children selected from two rural Midwestern school districts. Reliability data for the AVSM was collected through retesting of 42 participants. Validity was evaluated through correlation of AVSM scales with subscales from the ADHD Rating Scale–IV. Test–retest reliability coefficients ranged from .62 to .74 for AVSM subscales. A significant (r = .31 correlation was obtained between the AVSM Impulsivity Scale and teacher ratings of inattention. Limitations and implications for future study are discussed.

Evidence-based management.

Science.gov (United States)

Pfeffer, Jeffrey; Sutton, Robert I

2006-01-01

For the most part, managers looking to cure their organizational ills rely on obsolete knowledge they picked up in school, long-standing but never proven traditions, patterns gleaned from experience, methods they happen to be skilled in applying, and information from vendors. They could learn a thing or two from practitioners of evidence-based medicine, a movement that has taken the medical establishment by storm over the past decade. A growing number of physicians are eschewing the usual, flawed resources and are instead identifying, disseminating, and applying research that is soundly conducted and clinically relevant. It's time for managers to do the same. The challenge is, quite simply, to ground decisions in the latest and best knowledge of what actually works. In some ways, that's more difficult to do in business than in medicine. The evidence is weaker in business; almost anyone can (and many people do) claim to be a management expert; and a motley crew of sources--Shakespeare, Billy Graham,Jack Welch, Attila the Hunare used to generate management advice. Still, it makes sense that when managers act on better logic and strong evidence, their companies will beat the competition. Like medicine, management is learned through practice and experience. Yet managers (like doctors) can practice their craft more effectively if they relentlessly seek new knowledge and insight, from both inside and outside their companies, so they can keep updating their assumptions, skills, and knowledge.

Implementation of checklists in health care; learning from high-reliability organisations

Directory of Open Access Journals (Sweden)

Lossius Hans

2011-10-01

Full Text Available Abstract Background Checklists are common in some medical fields, including surgery, intensive care and emergency medicine. They can be an effective tool to improve care processes and reduce mortality and morbidity. Despite the seemingly rapid acceptance and dissemination of the checklist, there are few studies describing the actual process of developing and implementing such tools in health care. The aim of this study is to explore the experiences from checklist development and implementation in a group of non-medical, high reliability organisations (HROs. Method A qualitative study based on key informant interviews and field visits followed by a Delphi approach. Eight informants, each with 10-30 years of checklist experience, were recruited from six different HROs. Results The interviews generated 84 assertions and recommendations for checklist implementation. To achieve checklist acceptance and compliance, there must be a predefined need for which a checklist is considered a well suited solution. The end-users ("sharp-end" are the key stakeholders throughout the development and implementation process. Proximity and ownership must be assured through a thorough and wise process. All informants underlined the importance of short, self-developed, and operationally-suited checklists. Simulation is a valuable and widely used method for training, revision, and validation. Conclusion Checklists have been a cornerstone of safety management in HROs for nearly a century, and are becoming increasingly popular in medicine. Acceptance and compliance are crucial for checklist implementation in health care. Experiences from HROs may provide valuable input to checklist implementation in healthcare.

An integrated reliability-based design optimization of offshore towers

International Nuclear Information System (INIS)

Karadeniz, Halil; Togan, Vedat; Vrouwenvelder, Ton

2009-01-01

After recognizing the uncertainty in the parameters such as material, loading, geometry and so on in contrast with the conventional optimization, the reliability-based design optimization (RBDO) concept has become more meaningful to perform an economical design implementation, which includes a reliability analysis and an optimization algorithm. RBDO procedures include structural analysis, reliability analysis and sensitivity analysis both for optimization and for reliability. The efficiency of the RBDO system depends on the mentioned numerical algorithms. In this work, an integrated algorithms system is proposed to implement the RBDO of the offshore towers, which are subjected to the extreme wave loading. The numerical strategies interacting with each other to fulfill the RBDO of towers are as follows: (a) a structural analysis program, SAPOS, (b) an optimization program, SQP and (c) a reliability analysis program based on FORM. A demonstration of an example tripod tower under the reliability constraints based on limit states of the critical stress, buckling and the natural frequency is presented.

An integrated reliability-based design optimization of offshore towers

Energy Technology Data Exchange (ETDEWEB)

Karadeniz, Halil [Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft (Netherlands)], E-mail: h.karadeniz@tudelft.nl; Togan, Vedat [Department of Civil Engineering, Karadeniz Technical University, Trabzon (Turkey); Vrouwenvelder, Ton [Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft (Netherlands)

2009-10-15

After recognizing the uncertainty in the parameters such as material, loading, geometry and so on in contrast with the conventional optimization, the reliability-based design optimization (RBDO) concept has become more meaningful to perform an economical design implementation, which includes a reliability analysis and an optimization algorithm. RBDO procedures include structural analysis, reliability analysis and sensitivity analysis both for optimization and for reliability. The efficiency of the RBDO system depends on the mentioned numerical algorithms. In this work, an integrated algorithms system is proposed to implement the RBDO of the offshore towers, which are subjected to the extreme wave loading. The numerical strategies interacting with each other to fulfill the RBDO of towers are as follows: (a) a structural analysis program, SAPOS, (b) an optimization program, SQP and (c) a reliability analysis program based on FORM. A demonstration of an example tripod tower under the reliability constraints based on limit states of the critical stress, buckling and the natural frequency is presented.

Test-retest reliability and responsiveness of the Barthel Index-based Supplementary Scales in patients with stroke.

Science.gov (United States)

Lee, Ya-Chen; Yu, Wan-Hui; Hsueh, I-Ping; Chen, Sheng-Shiung; Hsieh, Ching-Lin

2017-10-01

A lack of evidence on the test-retest reliability and responsiveness limits the utility of the BI-based Supplementary Scales (BI-SS) in both clinical and research settings. To examine the test-retest reliability and responsiveness of the BI-based Supplementary Scales (BI-SS) in patients with stroke. A repeated-assessments design (1 week apart) was used to examine the test-retest reliability of the BI-SS. For the responsiveness study, the participants were assessed with the BI-SS and BI (treated as an external criterion) at admission to and discharge from rehabilitation wards. Seven outpatient rehabilitation units and one inpatient rehabilitation unit. Outpatients with chronic stroke. Eighty-four outpatients with chronic stroke participated in the test-retest reliability study. Fifty-seven inpatients completed baseline and follow-up assessments in the responsiveness study. For the test-retest reliability study, the values of the intra-class correlation coefficient and the overall percentage of minimal detectable change for the Ability Scale and Self-perceived Difficulty Scale were 0.97, 12.8%, and 0.78, 35.8%, respectively. For the responsiveness study, the standardized effect size and standardized response mean (representing internal responsiveness) of the Ability Scale and Self-perceived Difficulty Scale were 1.17 and 1.56, and 0.78 and 0.89, respectively. Regarding external responsiveness, the change in score of the Ability Scale had significant and moderate association with that of the BI (r=0.61, Ptest-retest reliability and sufficient responsiveness for patients with stroke. However, the Self-perceived Difficulty Scale of the BI-SS has substantial random measurement error and insufficient external responsiveness, which may affect its utility in clinical settings. The findings of this study provide empirical evidence of psychometric properties of the BI-SS for assessing ability and self-perceived difficulty of ADL in patients with stroke.

Distance walked and run as improved metrics over time-based energy estimation in epidemiological studies and prevention; evidence from medication use.

Directory of Open Access Journals (Sweden)

Paul T Williams

Full Text Available The guideline physical activity levels are prescribed in terms of time, frequency, and intensity (e.g., 30 minutes brisk walking, five days a week or its energy equivalence and assume that different activities may be combined to meet targeted goals (exchangeability premise. Habitual runners and walkers may quantify exercise in terms of distance (km/day, and for them, the relationship between activity dose and health benefits may be better assessed in terms of distance rather than time. Analyses were therefore performed to test: 1 whether time-based or distance-based estimates of energy expenditure provide the best metric for relating running and walking to hypertensive, high cholesterol, and diabetes medication use (conditions known to be diminished by exercise, and 2 the exchangeability premise.Logistic regression analyses of medication use (dependent variable vs. metabolic equivalent hours per day (METhr/d of running, walking and other exercise (independent variables using cross-sectional data from the National Runners' (17,201 male, 16,173 female and Walkers' Health Studies (3,434 male, 12,384 female.Estimated METhr/d of running and walking activity were 38% and 31% greater, respectively, when calculated from self-reported time than distance in men, and 43% and 37% greater in women, respectively. Percent reductions in the odds for hypertension and high cholesterol medication use per METhr/d run or per METhr/d walked were ≥ 2-fold greater when estimated from reported distance (km/wk than from time (hr/wk. The per METhr/d odds reduction was significantly greater for the distance- than the time-based estimate for hypertension (runners: P<10(-5 for males and P=0.003 for females; walkers: P=0.03 for males and P<10(-4 for females, high cholesterol medication use in runners (P<10(-4 for males and P=0.02 for females and male walkers (P=0.01 for males and P=0.08 for females and for diabetes medication use in male runners (P<10(-3.Although causality

A Learning Object Approach To Evidence based learning

OpenAIRE

Zabin Visram; Bruce Elson; Patricia Reynolds

2005-01-01

This paper describes the philosophy, development and framework of the body of elements formulated to provide an approach to evidence-based learning sustained by Learning Objects and web based technology Due to the demands for continuous improvement in the delivery of healthcare and in the continuous endeavour to improve the quality of life, there is a continuous need for practitioner's to update their knowledge by accomplishing accredited courses. The rapid advances in medical science has mea...

Column Grid Array Rework for High Reliability

Science.gov (United States)

Mehta, Atul C.; Bodie, Charles C.

2008-01-01

Due to requirements for reduced size and weight, use of grid array packages in space applications has become common place. To meet the requirement of high reliability and high number of I/Os, ceramic column grid array packages (CCGA) were selected for major electronic components used in next MARS Rover mission (specifically high density Field Programmable Gate Arrays). ABSTRACT The probability of removal and replacement of these devices on the actual flight printed wiring board assemblies is deemed to be very high because of last minute discoveries in final test which will dictate changes in the firmware. The questions and challenges presented to the manufacturing organizations engaged in the production of high reliability electronic assemblies are, Is the reliability of the PWBA adversely affected by rework (removal and replacement) of the CGA package? and How many times can we rework the same board without destroying a pad or degrading the lifetime of the assembly? To answer these questions, the most complex printed wiring board assembly used by the project was chosen to be used as the test vehicle, the PWB was modified to provide a daisy chain pattern, and a number of bare PWB s were acquired to this modified design. Non-functional 624 pin CGA packages with internal daisy chained matching the pattern on the PWB were procured. The combination of the modified PWB and the daisy chained packages enables continuity measurements of every soldered contact during subsequent testing and thermal cycling. Several test vehicles boards were assembled, reworked and then thermal cycled to assess the reliability of the solder joints and board material including pads and traces near the CGA. The details of rework process and results of thermal cycling are presented in this paper.

Reliability-Based Optimization of Series Systems of Parallel Systems

DEFF Research Database (Denmark)

Enevoldsen, I.; Sørensen, John Dalsgaard

1993-01-01

Reliability-based design of structural systems is considered. In particular, systems where the reliability model is a series system of parallel systems are treated. A sensitivity analysis for this class of problems is presented. Optimization problems with series systems of parallel systems...... optimization of series systems of parallel systems, but it is also efficient in reliability-based optimization of series systems in general....

Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview.

Science.gov (United States)

Burt, Jenni; Abel, Gary; Elmore, Natasha; Campbell, John; Roland, Martin; Benson, John; Silverman, Jonathan

2014-03-06

To investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor-patient consultation, based on the Calgary-Cambridge guide to the medical interview), in simulated patient consultations. Multiple ratings of simulated general practitioner (GP)-patient consultations by trained GP evaluators. UK primary care. 21 GPs and six trained GP evaluators. GCRS score. 6 GP raters used GCRS to rate randomly assigned video recordings of GP consultations with simulated patients. Each of the 42 consultations was rated separately by four raters. We considered whether a fixed difference between scores had the same meaning at all levels of performance. We then examined the reliability of GCRS using mixed linear regression models. We augmented our regression model to also examine whether there were systematic biases between the scores given by different raters and to look for possible order effects. Assessing the communication quality of individual consultations, GCRS achieved a reliability of 0.73 (95% CI 0.44 to 0.79) for two raters, 0.80 (0.54 to 0.85) for three and 0.85 (0.61 to 0.88) for four. We found an average difference of 1.65 (on a 0-10 scale) in the scores given by the least and most generous raters: adjusting for this evaluator bias increased reliability to 0.78 (0.53 to 0.83) for two raters; 0.85 (0.63 to 0.88) for three and 0.88 (0.69 to 0.91) for four. There were considerable order effects, with later consultations (after 15-20 ratings) receiving, on average, scores more than one point higher on a 0-10 scale. GCRS shows good reliability with three raters assessing each consultation. We are currently developing the scale further by assessing a large sample of real-world consultations.

Evidence-based practice guidelines in OHS: are they agree-able?

Science.gov (United States)

Hulshof, Carel; Hoenen, John

2007-01-01

The purpose of this study was to evaluate the acceptance, validity, reliability and feasibility of the AGREE (Appraisal of Guidelines and REsearch and Evaluation) instrument to assess the quality of evidence-based practice guidelines for occupational physicians. In total, 6 practice guidelines of the Netherlands Society of Occupational Medicine (NVAB) were appraised by 20 occupational health professionals and experts in guideline development or implementation. Although appraisers often disagreed on individual item scores, the internal consistency and interrater reliability for most domains was sufficient. The AGREE criteria were in general considered relevant and no major suggestions for additional items for use in the context of occupational health were brought up. The domain scores for the individual guidelines show a wide variety: 'applicability' had on average the lowest mean score (53%) while 'scope and purpose' had the highest one (87%). Low scores indicate where improvements are possible and necessary, e.g. by providing more information about the development. Key experts in occupational health report that AGREE is a relevant and easy to use instrument to evaluate quality aspects and the included criteria provide a good framework to develop or update evidence-based practice guidelines in the field of occupational health.

Evidence-based medicine and prejudice-based medicine: the case of homeopathy

Directory of Open Access Journals (Sweden)

Nelson Filice de Barros

2014-11-01

Full Text Available In recent decades an important social movement related to Complementary and Alternative Medicine has been identified worldwide. In Brazil, although homeopathy was recognized as a specialist medical area in 1980, few medical schools offer courses related to it. In a previous study, 176 resident doctors at the University of Campinas Medical School were interviewed and 86 (49% rejected homeopathy as a subject in the core medical curriculum. Thus, this qualitative study was conducted to understand their reasons for refusing. 20 residents from 15 different specialist areas were interviewed. Very few of them admitted to a lack of knowledge for making a judgment about homeopathy; none of them made a conscientious objection to it; and the majority demonstrated prejudice, affirming that there is not enough scientific evidence to support homeopathy, defending their position based on personal opinion, limited clinical practice and on information circulated in the mass media. Finally, resident doctors’ prejudices against homeopathy can be extended to practices other than allopathic medicine.

Management systems for high reliability organizations. Integration and effectiveness; Managementsysteme fuer Hochzuverlaessigkeitsorganisationen. Integration und Wirksamkeit

Energy Technology Data Exchange (ETDEWEB)

Mayer, Michael

2015-03-09

The scope of the thesis is the development of a method for improvement of efficient integrated management systems for high reliability organizations (HRO). A comprehensive analysis of severe accident prevention is performed. Severe accident management, mitigation measures and business continuity management are not included. High reliability organizations are complex and potentially dynamic organization forms that can be inherently dangerous like nuclear power plants, offshore platforms, chemical facilities, large ships or large aircrafts. A recursive generic management system model (RGM) was development based on the following factors: systemic and cybernetic Asepcts; integration of different management fields, high decision quality, integration of efficient methods of safety and risk analysis, integration of human reliability aspects, effectiveness evaluation and improvement.

The Use of Collaboration to Implement Evidence-Based Safe Practices

OpenAIRE

Clarke, John R.

2013-01-01

The Pennsylvania Patient Safety Authority receives over 235,000 reports of medical error per year. Near miss and serious event reports of common and interesting problems are analysed to identify best practices for preventing harmful errors. Dissemination of this evidence-based information in the peer-reviewed Pennsylvania Patient Safety Advisory and presentations to medical staffs are not sufficient for adoption of best practices. Adoption of best practices has required working with instituti...

Leading change: evidence-based transition.

Science.gov (United States)

Lewis, Brennan; Allen, Stephanie

2015-01-01

The purpose of this article was to provide a framework for evidence-based transition of patient populations within an acute care pediatric institution. Transition within a hospital is foreseeable, given the ever-changing needs of the patients within an evolving healthcare system. These changes include moving patient populations because of expansion, renovation, or cohorting similar patient diagnoses to provide care across a continuum. Over the past 1 to 2 years, Children's Health Children's Medical Center Dallas has experienced a wide variety of transition. To provide a smooth transition for patients and families into new care areas resulting in a healthy work environment for all team members. The planning phase for patient population moves, and transition should address key aspects to include physical location and care flow, supplies and equipment, staffing model and human resources (HR), education and orientation, change process and integrating teams, and family preparation. It is imperative to consider these aspects in order for transitions within a healthcare system to be successful. During a time of such transitions, the clinical nurse specialist (CNS) is a highly valuable team member offering a unique perspective and methodological approach, which is central to the new initiative's overall success. The themes addressed in this article on evidence-based transition are organized according to the CNS spheres of influence: system/organization, patient/family, and nursing. An evidence-based transition plan was developed and implemented successfully with the support from the CNS for 3 patient populations. Organizational leadership gained an increased awareness of the CNS role at the conclusion of each successful transition. The CNS plays a pivotal role as clinical experts and proponents of evidence-based practice and effects change in the system/organization, nursing, and patient/family spheres of influence. While transitions can be a source of stress for leaders

Psychometric properties of a test in evidence based practice: the Spanish version of the Fresno test

Directory of Open Access Journals (Sweden)

Jiménez-Villa Josep

2010-06-01

Full Text Available Abstract Background Validated instruments are needed to evaluate the programmatic impact of Evidence Based Practice (EBP training and to document the competence of individual trainees. This study aimed to translate the Fresno test into Spanish and subsequently validate it, in order to ensure the equivalence of the Spanish version against the original English version. Methods Before and after study performed between October 2007 and June 2008. Three groups of participants: (a Mentors of family medicine residents (expert group (n = 56; (b Family medicine physicians (intermediate experience group (n = 17; (c Family medicine residents (novice group (n = 202; Medical residents attended an EBP course, and two sets of the test were administered before and after the course. The Fresno test is a performance based measure for use in medical education that assesses EBP skills. The outcome measures were: inter-rater and intra-rater reliability, internal consistency, item analyses, construct validity, feasibility of administration, and responsiveness. Results Inter-rater correlations were 0.95 and 0.85 in the pre-test and the post-test respectively. The overall intra-rater reliability was 0.71 and 0.81 in the pre-test and post-test questionnaire, respectively. Cronbach's alpha was 0.88 and 0.77, respectively. 152 residents (75.2% returned both sets of the questionnaire. The observed effect size for the residents was 1.77 (CI 95%: 1.57-1.95, the standardised response mean was 1.65 (CI 95%:1.47-1.82. Conclusions The Spanish version of the Fresno test is a useful tool in assessing the knowledge and skills of EBP in Spanish-speaking residents of Family Medicine.

Critical gaps in the medical knowledge base of eating disorders.

Science.gov (United States)

Gibson, Dennis; Drabkin, Anne; Krantz, Mori J; Mascolo, Margherita; Rosen, Elissa; Sachs, Katherine; Welles, Christine; Mehler, Philip S

2018-04-21

Eating disorders are unique in that they inherently have much medical comorbidity both as a part of restricting-type eating disorders and those characterized by purging behaviors. Over the last three decades, remarkable progress has been made in the understanding and treatment of the medical complications of eating disorders. Yet, unfortunately, there is much research that is sorely needed to bridge the gap between current medical knowledge and more effective and evidence-based medical treatment knowledge. These gaps exist in many different clinical areas including cardiology, electrolytes, gastrointestinal and bone disease. In this paper, we discuss some of the knowledge gap areas, which if bridged would help develop more effective medical intervention for this population of patients.

Evidence-based guidelines, time-based health outcomes, and the Matthew effect

NARCIS (Netherlands)

M.L.E. Essink-Bot (Marie-Louise); M.E. Kruijshaar (Michelle); J.J.M. Barendregt (Jan); L.G.A. Bonneux (Luc)

2007-01-01

textabstractBackground: Cardiovascular risk management guidelines are 'risk based'; health economists' practice is 'time based'. The 'medical' risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model

Evidence-based guidelines, time-based health outcomes, and the Matthew effect

NARCIS (Netherlands)

Essink-Bot, Marie-Louise; Kruijshaar, Michelle E.; Barendregt, Jan J.; Bonneux, Luc G. A.

2007-01-01

BACKGROUND: Cardiovascular risk management guidelines are 'risk based'; health economists' practice is 'time based'. The 'medical' risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model maximises

Design of Accelerated Reliability Test for CNC Motorized Spindle Based on Vibration Signal

Directory of Open Access Journals (Sweden)

Chen Chao

2016-01-01

Full Text Available Motorized spindle is the key functional component of CNC machining centers which is a mechatronics system with long life and high reliability. The reliability test cycle of motorized spindle is too long and infeasible. This paper proposes a new accelerated test for reliability evaluation of motorized spindle. By field reliability test, authors collect and calculate the load data including rotational speed, cutting force and torque. Load spectrum distribution law is analyzed. And authors design a test platform to apply the load spectrum. A new method to define the fuzzy acceleration factor based on the vibration signal is proposed. Then the whole test plan of accelerated reliability test is done.

Evidence-based medicine in rapidly changing technologies

DEFF Research Database (Denmark)

Schroeder, Torben Veith

2008-01-01

Evidence-based medicine (EBM) is not a randomised controlled trial (RCT), but EBM seeks to apply evidence gained from scientific methods - which could be RCT - to daily medical practice. Any surgical treatment reflects a certain development technically as well as skills based. The procedure may....... Special considerations should be given in rapidly developing fields. If started too early the resulting comparison will likely turn out to be irrelevant because the new technology is not fully developed, not mastered or the device may have undergone major modifications rendering the results obsolete....... On the other hand, if started too late there is a chance that data may be lost because the technology has already been introduced into the daily clinics and physicians may be unwilling to recruit patients. Or the opposite, that the technique may have been rejected without a proper trial. In this situation...

Evaluating the spoken English proficiency of graduates of foreign medical schools.

Science.gov (United States)

Boulet, J R; van Zanten, M; McKinley, D W; Gary, N E

2001-08-01

The purpose of this study was to gather additional evidence for the validity and reliability of spoken English proficiency ratings provided by trained standardized patients (SPs) in high-stakes clinical skills examination. Over 2500 candidates who took the Educational Commission for Foreign Medical Graduates' (ECFMG) Clinical Skills Assessment (CSA) were studied. The CSA consists of 10 or 11 timed clinical encounters. Standardized patients evaluate spoken English proficiency and interpersonal skills in every encounter. Generalizability theory was used to estimate the consistency of spoken English ratings. Validity coefficients were calculated by correlating summary English ratings with CSA scores and other external criterion measures. Mean spoken English ratings were also compared by various candidate background variables. The reliability of the spoken English ratings, based on 10 independent evaluations, was high. The magnitudes of the associated variance components indicated that the evaluation of a candidate's spoken English proficiency is unlikely to be affected by the choice of cases or SPs used in a given assessment. Proficiency in spoken English was related to native language (English versus other) and scores from the Test of English as a Foreign Language (TOEFL). The pattern of the relationships, both within assessment components and with external criterion measures, suggests that valid measures of spoken English proficiency are obtained. This result, combined with the high reproducibility of the ratings over encounters and SPs, supports the use of trained SPs to measure spoken English skills in a simulated medical environment.

Delivering high performance BWR fuel reliably

International Nuclear Information System (INIS)

Schardt, J.F.

1998-01-01

Utilities are under intense pressure to reduce their production costs in order to compete in the increasingly deregulated marketplace. They need fuel, which can deliver high performance to meet demanding operating strategies. GE's latest BWR fuel design, GE14, provides that high performance capability. GE's product introduction process assures that this performance will be delivered reliably, with little risk to the utility. (author)

Highly reliable electro-hydraulic control system

International Nuclear Information System (INIS)

Mande, Morima; Hiyama, Hiroshi; Takahashi, Makoto

1984-01-01

The unscheduled shutdown of nuclear power stations disturbs power system, and exerts large influence on power generation cost due to the lowering of capacity ratio; therefore, high reliability is required for the control system of nuclear power stations. Toshiba Corp. has exerted effort to improve the reliability of the control system of power stations, and in this report, the electro-hydraulic control system for the turbines of nuclear power stations is described. The main functions of the electro-hydraulic control system are the control of main steam pressure with steam regulation valves and turbine bypass valves, the control of turbine speed and load, the prevention of turbine overspeed, the protection of turbines and so on. The system is composed of pressure sensors and a speed sensor, the control board containing the electronic circuits for control computation and protective sequence, the oil cylinders, servo valves and opening detectors of the valves for control, a high pressure oil hydraulic machine and piping, the operating panel and so on. The main features are the adoption of tripling intermediate value selection method, the multiplying of protection sensors and the adoption of 2 out of 3 trip logic, the multiplying of power sources, the improvement of the reliability of electronic circuit hardware and oil hydraulic system. (Kako, I.)

High-cost users of medical care

OpenAIRE

Garfinkel, Steven A.; Riley, Gerald F.; Iannacchione, Vincent G.

1988-01-01

Based on data from the National Medical Care Utilization and Expenditure Survey, the 10 percent of the noninstitutionalized U.S. population that incurred the highest medical care charges was responsible for 75 percent of all incurred charges. Health status was the strongest predictor of high-cost use, followed by economic factors. Persons 65 years of age or over incurred far higher costs than younger persons and had higher out-of-pocket costs, absolutely and as a percentage of income, althoug...

Medical Ethnobotany in Europe: From Field Ethnography to a More Culturally Sensitive Evidence-Based CAM?

Directory of Open Access Journals (Sweden)

Cassandra L. Quave

2012-01-01

Full Text Available European folk medicine has a long and vibrant history, enriched with the various documented uses of local and imported plants and plant products that are often unique to specific cultures or environments. In this paper, we consider the medicoethnobotanical field studies conducted in Europe over the past two decades. We contend that these studies represent an important foundation for understanding local small-scale uses of CAM natural products and allow us to assess the potential for expansion of these into the global market. Moreover, we discuss how field studies of this nature can provide useful information to the allopathic medical community as they seek to reconcile existing and emerging CAM therapies with conventional biomedicine. This is of great importance not only for phytopharmacovigilance and managing risk of herb-drug interactions in mainstream patients that use CAM, but also for educating the medical community about ethnomedical systems and practices so that they can better serve growing migrant populations. Across Europe, the general status of this traditional medical knowledge is at risk due to acculturation trends and the urgency to document and conserve this knowledge is evident in the majority of the studies reviewed.

Medical Ethnobotany in Europe: From Field Ethnography to a More Culturally Sensitive Evidence-Based CAM?

Science.gov (United States)

Quave, Cassandra L.; Pardo-de-Santayana, Manuel; Pieroni, Andrea

2012-01-01

European folk medicine has a long and vibrant history, enriched with the various documented uses of local and imported plants and plant products that are often unique to specific cultures or environments. In this paper, we consider the medicoethnobotanical field studies conducted in Europe over the past two decades. We contend that these studies represent an important foundation for understanding local small-scale uses of CAM natural products and allow us to assess the potential for expansion of these into the global market. Moreover, we discuss how field studies of this nature can provide useful information to the allopathic medical community as they seek to reconcile existing and emerging CAM therapies with conventional biomedicine. This is of great importance not only for phytopharmacovigilance and managing risk of herb-drug interactions in mainstream patients that use CAM, but also for educating the medical community about ethnomedical systems and practices so that they can better serve growing migrant populations. Across Europe, the general status of this traditional medical knowledge is at risk due to acculturation trends and the urgency to document and conserve this knowledge is evident in the majority of the studies reviewed. PMID:22899952

Judicial Decision-Making and Juvenile Offenders: Effects of Medical Evidence and Victim Age.

Science.gov (United States)

Falligant, John Michael; Fix, Rebecca L; Alexander, Apryl A

2017-01-01

A growing body of evidence suggests that jurors place greater weight on DNA or other types of forensic evidence than non-forensic evidence (Cole & Dioso-Villa, 2009). For cases involving child sexual abuse, certain types of evidence, including forensic medical evidence, may be viewed as more important or indicative of abuse than other types of evidence, such as victim statements or disclosure. The present study evaluated perceptions of juvenile offenders and victim credibility across four vignettes that systematically manipulated variables related to victim age and physical indicators of abuse. A sample of 636 participants read vignettes and answered questions pertaining to the vignette. Participants also provided demographic information and responded to a series of items assessing participants' judicial decision-making strategies and outcomes. Broadly, the presence of medical evidence significantly influenced participants' decision-making across a variety of variables, including verdict outcome, verdict confidence, confidence that the victim was truthful, and determinations involving sex offender registration and notification requirements. The influence of medical evidence and victim age on perceptions and sentencing of juvenile sex offenders across these and additional outcome variables will be discussed.

Reliability Assessment and Reliability-Based Inspection and Maintenance of Offshore Wind Turbines

DEFF Research Database (Denmark)

Ramírez, José G. Rangel; Sørensen, John Dalsgaard

2009-01-01

Probabilistic methodologies represent an important tool to identify the suitable strategy to inspect and deal with the deterioration in structures such as offshore wind turbines (OWT). Reliability based methods such as Risk Based Inspection (RBI) planning may represent a proper methodology to opt...

High-performance control system for a heavy-ion medical accelerator

Energy Technology Data Exchange (ETDEWEB)

Lancaster, H.D.; Magyary, S.B.; Sah, R.C.

1983-03-01

A high performance control system is being designed as part of a heavy ion medical accelerator. The accelerator will be a synchrotron dedicated to clinical and other biomedical uses of heavy ions, and it will deliver fully stripped ions at energies up to 800 MeV/nucleon. A key element in the design of an accelerator which will operate in a hospital environment is to provide a high performance control system. This control system will provide accelerator modeling to facilitate changes in operating mode, provide automatic beam tuning to simplify accelerator operations, and provide diagnostics to enhance reliability. The control system being designed utilizes many microcomputers operating in parallel to collect and transmit data; complex numerical computations are performed by a powerful minicomputer. In order to provide the maximum operational flexibility, the Medical Accelerator control system will be capable of dealing with pulse-to-pulse changes in beam energy and ion species.

High-performance control system for a heavy-ion medical accelerator

International Nuclear Information System (INIS)

Lancaster, H.D.; Magyary, S.B.; Sah, R.C.

1983-03-01

A high performance control system is being designed as part of a heavy ion medical accelerator. The accelerator will be a synchrotron dedicated to clinical and other biomedical uses of heavy ions, and it will deliver fully stripped ions at energies up to 800 MeV/nucleon. A key element in the design of an accelerator which will operate in a hospital environment is to provide a high performance control system. This control system will provide accelerator modeling to facilitate changes in operating mode, provide automatic beam tuning to simplify accelerator operations, and provide diagnostics to enhance reliability. The control system being designed utilizes many microcomputers operating in parallel to collect and transmit data; complex numerical computations are performed by a powerful minicomputer. In order to provide the maximum operational flexibility, the Medical Accelerator control system will be capable of dealing with pulse-to-pulse changes in beam energy and ion species

Medical terminology in online patient-patient communication: evidence of high health literacy?

Science.gov (United States)

Fage-Butler, Antoinette M; Nisbeth Jensen, Matilde

2016-06-01

Health communication research and guidelines often recommend that medical terminology be avoided when communicating with patients due to their limited understanding of medical terms. However, growing numbers of e-patients use the Internet to equip themselves with specialized biomedical knowledge that is couched in medical terms, which they then share on participatory media, such as online patient forums. Given possible discrepancies between preconceptions about the kind of language that patients can understand and the terms they may actually know and use, the purpose of this paper was to investigate medical terminology used by patients in online patient forums. Using data from online patient-patient communication where patients communicate with each other without expert moderation or intervention, we coded two data samples from two online patient forums dedicated to thyroid issues. Previous definitions of medical terms (dichotomized into technical and semi-technical) proved too rudimentary to encapsulate the types of medical terms the patients used. Therefore, using an inductive approach, we developed an analytical framework consisting of five categories of medical terms: dictionary-defined medical terms, co-text-defined medical terms, medical initialisms, medication brand names and colloquial technical terms. The patients in our data set used many medical terms from all of these categories. Our findings suggest the value of a situated, condition-specific approach to health literacy that recognizes the vertical kind of knowledge that patients with chronic diseases may have. We make cautious recommendations for clinical practice, arguing for an adaptive approach to medical terminology use with patients. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

Science.gov (United States)

Gambrill, E

1999-03-01

Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

Teaching Evidence-Based Medicine More Effectively

Directory of Open Access Journals (Sweden)

Zinat Nadia Hatmi

2010-09-01

Full Text Available "nEvidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84. Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conclusions: Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

Design of piezoelectric transducer layer with electromagnetic shielding and high connection reliability

International Nuclear Information System (INIS)

Qiu, Lei; Yuan, Shenfang; Shi, Xiaoling; Huang, Tianxiang

2012-01-01

Piezoelectric transducer (PZT) and Lamb wave based structural health monitoring (SHM) method have been widely studied for on-line SHM of high-performance structures. To monitor large-scale structures, a dense PZTs array is required. In order to improve the placement efficiency and reduce the wire burden of the PZTs array, the concept of the piezoelectric transducers layer (PSL) was proposed. The PSL consists of PZTs, a flexible interlayer with printed wires and signal input/output interface. For on-line SHM on real aircraft structures, there are two main issues on electromagnetic interference and connection reliability of the PSL. To address the issues, an electromagnetic shielding design method of the PSL to reduce spatial electromagnetic noise and crosstalk is proposed and a combined welding–cementation process based connection reliability design method is proposed to enhance the connection reliability between the PZTs and the flexible interlayer. Two experiments on electromagnetic interference suppression are performed to validate the shielding design of the PSL. The experimental results show that the amplitudes of the spatial electromagnetic noise and crosstalk output from the shielded PSL developed by this paper are − 15 dB and − 25 dB lower than those of the ordinary PSL, respectively. Other two experiments on temperature durability ( − 55 °C–80 °C ) and strength durability (160–1600με, one million load cycles) are applied to the PSL to validate the connection reliability. The low repeatability errors (less than 3% and less than 5%, respectively) indicate that the developed PSL is of high connection reliability and long fatigue life. (paper)

Evidence-based radiography

International Nuclear Information System (INIS)

Hafslund, Bjorg; Clare, Judith; Graverholt, Birgitte; Wammen Nortvedt, Monica

2008-01-01

Evidence-based practice (EBP) offers the integration of the best research evidence with clinical knowledge and expertise and patient values. EBP is a well known term in health care. This paper discusses the implementation of EBP into radiography and introduces the term evidence-based radiography. Evidence-based radiography is radiography informed and based on the combination of clinical expertise and the best available research-based evidence, patient preferences and resources available. In Norway, EBP in radiography is being debated and radiographers are discussing the challenges of implementing EBP in both academic and clinical practice. This discussion paper explains why EBP needs to be a basis for a radiography curriculum and a part of radiographers' practice. We argue that Norwegian radiographers must increase participation in research and developing practice within their specific radiographic domain

Component fragility data base for reliability and probability studies

International Nuclear Information System (INIS)

Bandyopadhyay, K.; Hofmayer, C.; Kassier, M.; Pepper, S.

1989-01-01

Safety-related equipment in a nuclear plant plays a vital role in its proper operation and control, and failure of such equipment due to an earthquake may pose a risk to the safe operation of the plant. Therefore, in order to assess the overall reliability of a plant, the reliability of performance of the equipment should be studied first. The success of a reliability or a probability study depends to a great extent on the data base. To meet this demand, Brookhaven National Laboratory (BNL) has formed a test data base relating the seismic capacity of equipment specimens to the earthquake levels. Subsequently, the test data have been analyzed for use in reliability and probability studies. This paper describes the data base and discusses the analysis methods. The final results that can be directly used in plant reliability and probability studies are also presented in this paper

A Secure ECC-based RFID Mutual Authentication Protocol to Enhance Patient Medication Safety.

Science.gov (United States)

Jin, Chunhua; Xu, Chunxiang; Zhang, Xiaojun; Li, Fagen

2016-01-01

Patient medication safety is an important issue in patient medication systems. In order to prevent medication errors, integrating Radio Frequency Identification (RFID) technology into automated patient medication systems is required in hospitals. Based on RFID technology, such systems can provide medical evidence for patients' prescriptions and medicine doses, etc. Due to the mutual authentication between the medication server and the tag, RFID authentication scheme is the best choice for automated patient medication systems. In this paper, we present a RFID mutual authentication scheme based on elliptic curve cryptography (ECC) to enhance patient medication safety. Our scheme can achieve security requirements and overcome various attacks existing in other schemes. In addition, our scheme has better performance in terms of computational cost and communication overhead. Therefore, the proposed scheme is well suitable for patient medication systems.

Reliability and Validity of the Telephone-Based eHealth Literacy Scale Among Older Adults: Cross-Sectional Survey.

Science.gov (United States)

Stellefson, Michael; Paige, Samantha R; Tennant, Bethany; Alber, Julia M; Chaney, Beth H; Chaney, Don; Grossman, Suzanne

2017-10-26

Only a handful of studies have examined reliability and validity evidence of scores produced by the 8-item eHealth literacy Scale (eHEALS) among older adults. Older adults are generally more comfortable responding to survey items when asked by a real person rather than by completing self-administered paper-and-pencil or online questionnaires. However, no studies have explored the psychometrics of this scale when administered to older adults over the telephone. The objective of our study was to examine the reliability and internal structure of eHEALS data collected from older adults aged 50 years or older responding to items over the telephone. Respondents (N=283) completed eHEALS as part of a cross-sectional landline telephone survey. Exploratory structural equation modeling (E-SEM) analyses examined model fit of eHEALS scores with 1-, 2-, and 3-factor structures. Subsequent analyses based on the partial credit model explored the internal structure of eHEALS data. Compared with 1- and 2-factor models, the 3-factor eHEALS structure showed the best global E-SEM model fit indices (root mean square error of approximation=.07; comparative fit index=1.0; Tucker-Lewis index=1.0). Nonetheless, the 3 factors were highly correlated (r range .36 to .65). Item analyses revealed that eHEALS items 2 through 5 were overfit to a minor degree (mean square infit/outfit values information for respondents at similar points on the latent continuum. Test information curves suggested that eHEALS may capture more information about older adults at the higher end of the latent continuum (ie, those with high eHealth literacy) than at the lower end of the continuum (ie, those with low eHealth literacy). Item reliability (value=.92) and item separation (value=11.31) estimates indicated that eHEALS responses were reliable and stable. Results support administering eHEALS over the telephone when surveying older adults regarding their use of the Internet for health information. eHEALS scores best

Design and reliability, availability, maintainability, and safety analysis of a high availability quadruple vital computer system

Institute of Scientific and Technical Information of China (English)

Ping TAN; Wei-ting HE; Jia LIN; Hong-ming ZHAO; Jian CHU

2011-01-01

With the development of high-speed railways in China,more than 2000 high-speed trains will be put into use.Safety and efficiency of railway transportation is increasingly important.We have designed a high availability quadruple vital computer (HAQVC) system based on the analysis of the architecture of the traditional double 2-out-of-2 system and 2-out-of-3 system.The HAQVC system is a system with high availability and safety,with prominent characteristics such as fire-new internal architecture,high efficiency,reliable data interaction mechanism,and operation state change mechanism.The hardware of the vital CPU is based on ARM7 with the real-time embedded safe operation system (ES-OS).The Markov modeling method is designed to evaluate the reliability,availability,maintainability,and safety (RAMS) of the system.In this paper,we demonstrate that the HAQVC system is more reliable than the all voting triple modular redundancy (AVTMR) system and double 2-out-of-2 system.Thus,the design can be used for a specific application system,such as an airplane or high-speed railway system.

Frequency of Testing for Dyslipidemia: An Evidence-Based Analysis

Science.gov (United States)

2014-01-01

Background Dyslipidemias include high levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides and low levels of high-density lipoprotein (HDL) cholesterol. Dyslipidemia is a risk factor for cardiovascular disease, which is a major contributor to mortality in Canada. Approximately 23% of the 2009/11 Canadian Health Measures Survey (CHMS) participants had a high level of LDL cholesterol, with prevalence increasing with age, and approximately 15% had a total cholesterol to HDL ratio above the threshold. Objectives To evaluate the frequency of lipid testing in adults not diagnosed with dyslipidemia and in adults on treatment for dyslipidemia. Research Methods A systematic review of the literature set out to identify randomized controlled trials (RCTs), systematic reviews, health technology assessments (HTAs), and observational studies published between January 1, 2000, and November 29, 2012, that evaluated the frequency of testing for dyslipidemia in the 2 populations. Results Two observational studies assessed the frequency of lipid testing, 1 in individuals not on lipid-lowering medications and 1 in treated individuals. Both studies were based on previously collected data intended for a different objective and, therefore, no conclusions could be reached about the frequency of testing at intervals other than the ones used in the original studies. Given this limitation and generalizability issues, the quality of evidence was considered very low. No evidence for the frequency of lipid testing was identified in the 2 HTAs included. Canadian and international guidelines recommend testing for dyslipidemia in individuals at an increased risk for cardiovascular disease. The frequency of testing recommended is based on expert consensus. Conclusions Conclusions on the frequency of lipid testing could not be made based on the 2 observational studies. Current guidelines recommend lipid testing in adults with increased cardiovascular risk, with

Application of Metric-based Software Reliability Analysis to Example Software

International Nuclear Information System (INIS)

Kim, Man Cheol; Smidts, Carol

2008-07-01

The software reliability of TELLERFAST ATM software is analyzed by using two metric-based software reliability analysis methods, a state transition diagram-based method and a test coverage-based method. The procedures for the software reliability analysis by using the two methods and the analysis results are provided in this report. It is found that the two methods have a relation of complementary cooperation, and therefore further researches on combining the two methods to reflect the benefit of the complementary cooperative effect to the software reliability analysis are recommended

High reliability fuel in the US

International Nuclear Information System (INIS)

Neuhold, R.J.; Leggett, R.D.; Walters, L.C.; Matthews, R.B.

1986-05-01

The fuels development program of the United States is described for liquid metal reactors (LMR's). The experience base, status and future potential are discussed for the three systems - oxide, metal and carbide - that have proved to have high reliability. Information is presented showing burnup capability of the oxide fuel system in a large core, e.g., FFTF, to be 150 MWd/kgM with today's technology with the potential for a capability as high as 300 MWd/kgM. Data provided for the metal fuel system show 8 at. % being routinely achieved as the EBR-II driver fuel with good potential for extending this to 15 at. % since special test pins have already exceeded this burnup level. The data included for the carbide fuel system are from pin and assembly irradiations in EBR-II and FFTF, respectively. Burnup to 12 at. % appears readily achievable with burnups to 20 at. % being demonstrated in a few pins. Efforts continue on all three systems with the bulk of the activity on metal and oxide

Delivering high performance BWR fuel reliably

Energy Technology Data Exchange (ETDEWEB)

Schardt, J.F. [GE Nuclear Energy, Wilmington, NC (United States)

1998-07-01

Utilities are under intense pressure to reduce their production costs in order to compete in the increasingly deregulated marketplace. They need fuel, which can deliver high performance to meet demanding operating strategies. GE's latest BWR fuel design, GE14, provides that high performance capability. GE's product introduction process assures that this performance will be delivered reliably, with little risk to the utility. (author)