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Sample records for structured clinical examinationsosces

  1. Clinical trial structures

    OpenAIRE

    Evans, Scott R.

    2010-01-01

    Most errors in clinical trials are a result of poor planning. Fancy statistical methods cannot rescue design flaws. Thus careful planning with clear foresight is crucial. The selection of a clinical trial design structure requires logic and creativity. Common structural designs are discussed.

  2. STRUCTURED CLINICAL EVALUATION

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    Arabela Maria Barbosa Sampaio

    2014-05-01

    Full Text Available In a world experiencing profound technological and socio-political changes in areas of knowledge and capacity, healthcare can not remain static. A new kind of professional is required, whose practice is based on ethics, scientific standards, integrity, citizenship, and health promotion, who develops skills beyond healthcare, such as decision making, communication,leadership, management, and continuing education. No single method can assess all of these elements (knowledge, skills, and attitudes, and only a combination of methods is able to produce a valid evaluation. An alternative method exists: structured clinical assessments based on observation of "to do, or how to do" that aim to complete this evaluation by focusing attention on the performance of specific skills. In order to broaden the scope of evaluation methods that have been used in health education, this article, a literature review, intends to offer readers an overview of the diverse types of structured clinical evaluation, emphasizing Objective Structured Clinical Examination, the most widely used in Brazil, with a goal of advancing opportunities for health professionals to make use of this evaluative tool.

  3. Students' perceptions regarding the objective, structured, clinical ...

    African Journals Online (AJOL)

    The nursing profession is characterised by the fact that a significant amount of time is spent on competency-related activities. The assessment of clinical competence is therefore an important issue in nursing education and the utilisation of objective structured clinical evaluation for that purpose was considered to be very ...

  4. Students' perceptions regarding the objective, structured, clinical ...

    African Journals Online (AJOL)

    2013-04-18

    Apr 18, 2013 ... execution, time allocation and student and assessor variables. The findings indicated that, as an assessment tool, the objective structured clinical evaluation approach was perceived as not being totally realistic, especially by the more senior nursing students (third-year) as compared with the first-year ...

  5. Structured Clinical Interviews and the Inferential Process.

    Science.gov (United States)

    Saigh, Philip A.

    1992-01-01

    Reviews history of psychiatric nosology and the use of interview data as a vehicle for formulating clinical inferences. Focuses on qualities of structured interviews as well as procedures for constructing these indices and methods for establishing their psychometric properties. Reviews practical and theoretical limitations relating to formal…

  6. Tetrasomy Y by structural rearrangement: clinical report.

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    DesGroseilliers, Martin; Lemyre, Emmanuelle; Dallaire, Louis; Lemieux, Nicole

    2002-09-01

    Poly-Y karyotypes, except for 47,XYY, are rare events in humans. For instance, Y chromosome tetrasomy has been reported 10 times, 2 of which were by structural rearrangement. We present a 2-year-and-4-month-old boy who was referred for cytogenetic assessment because of global psychomotor delay. The GTG- and CBG-banded karyotypes on PHA-stimulated lymphocytes showed two cell populations, one of them contained two identical isodicentric Y chromosomes, which was seen in 93% of metaphases analyzed, and a 45,X cell line (7%). This was confirmed by FISH with probes DYZ3 (recognizing the centromeric region of the Y chromosome), 91H4.5 (recognizing Yp11.2), and DYZ1 (recognizing Y heterochromatin in Yq12). The breakpoint has occurred near the telomeric end of the heterochromatic region. Therefore, the karyotype is mos 47,X,idic(Y)(q12)x2[123]/45,X[9]. This is the second time that such a karyotype has been reported. This chromosomal anomaly was formed most likely by a U-type exchange. Clinical features included speech delay, short stature, brachycephaly, large ears, bilateral epicanthal folds, hypertelorism, delayed teeth eruption, bilateral radio-ulnar synostosis, bilateral fifth finger clinodactyly, normal external genitalia, and impulsive behavior. The father had normal phenotype and karyotype. A review of the tetrasomy Y patients is presented. All patients with Y chromosome tetrasomy exhibit some degree of mental retardation, various skeletal abnormalities, and facial dysmorphism. Nevertheless, the correlation between karyotype and phenotype is not yet well defined since few cases have been reported. This clinical report will be helpful in defining the phenotypic range associated with tetrasomy Y. Copyright 2002 Wiley-Liss, Inc.

  7. Objective structured clinical examination and its impact on clinical and interpersonal skills: Follow-up study

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    Manoj Kumar Sharma; Chandra, Prabha S; Chaturvedi, S.K.

    2013-01-01

    Background: Objective structured clinical examination is being used for assessing the clinical skills as well as their knowledge for various skills. Aim: The present work assess the role of exposure to objective structured clinical examination (OSCE) based skills in enhancement of clinical and interpersonal skills at 1 year interval among mental health trainees. Materials and Methods: Fifty five mental health trainees got exposure to weekly OSCE training on various aspects of clinical work. T...

  8. Computer assisted Objective structured clinical examination versus Objective structured clinical examination in assessment of Dermatology undergraduate students

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    Richa Chaudhary

    2017-01-01

    Conclusions: Computer assisted objective structured clinical examination was found to be a valid, reliable and effective format for dermatology assessment, being rated as the preferred format by examiners.

  9. Effects of test stress during an objective structured clinical examination.

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    Zhang, Niu; Rabatsky, Ali

    2015-10-01

    The existence of test stress has been widely reported among professional students. To our knowledge, no studies exist that explore student stress response to objective structured clinical examinations. The aim of this study was to evaluate possible correlations between stress and objective structured clinical examination performance in a sample of chiropractic students. A total of 116 students completed a 2-part questionnaire to assess test stress and the physiological symptoms and signs of stress. Heart rate, systolic blood pressure, and diastolic were measured during the physical examination laboratory class within the first 3 weeks and then again just prior to their objective structured clinical examination in week 5. Statistical tests were then performed for questionnaire data, heart rate and blood pressure differences, and correlation between the objective structured clinical examination grade and symptoms and signs. Questionnaire results showed that 5.1%-22.4% of students sometimes or often felt a certain degree of stress. More than 50% had 1 or more physiological symptoms and signs of stress. The objective structured clinical examination heart rate (75.23 ± 11.20 vs 68.16 ± 8.82, p examination grades and physiological symptoms and signs and between objective structured clinical examination grades and feeling statement score. The results support our hypothesis that chiropractic students experience stress when performing the objective structured clinical examination and that high levels of stress had a negative impact on performance.

  10. Lipoprotein (a: Structure, Pathophysiology and Clinical Implications

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    Raul Cavalcante Maranhão

    2014-07-01

    Full Text Available The chemical structure of lipoprotein (a is similar to that of LDL, from which it differs due to the presence of apolipoprotein (a bound to apo B100 via one disulfide bridge. Lipoprotein (a is synthesized in the liver and its plasma concentration, which can be determined by use of monoclonal antibody-based methods, ranges from 1,000 mg/dL. Lipoprotein (a levels over 20-30 mg/dL are associated with a two-fold risk of developing coronary artery disease. Usually, black subjects have higher lipoprotein (a levels that, differently from Caucasians and Orientals, are not related to coronary artery disease. However, the risk of black subjects must be considered. Sex and age have little influence on lipoprotein (a levels. Lipoprotein (a homology with plasminogen might lead to interference with the fibrinolytic cascade, accounting for an atherogenic mechanism of that lipoprotein. Nevertheless, direct deposition of lipoprotein (a on arterial wall is also a possible mechanism, lipoprotein (a being more prone to oxidation than LDL. Most prospective studies have confirmed lipoprotein (a as a predisposing factor to atherosclerosis. Statin treatment does not lower lipoprotein (a levels, differently from niacin and ezetimibe, which tend to reduce lipoprotein (a, although confirmation of ezetimibe effects is pending. The reduction in lipoprotein (a concentrations has not been demonstrated to reduce the risk for coronary artery disease. Whenever higher lipoprotein (a concentrations are found, and in the absence of more effective and well-tolerated drugs, a more strict and vigorous control of the other coronary artery disease risk factors should be sought.

  11. Refining the structure and content of clinical genomic reports.

    Science.gov (United States)

    Dorschner, Michael O; Amendola, Laura M; Shirts, Brian H; Kiedrowski, Lesli; Salama, Joseph; Gordon, Adam S; Fullerton, Stephanie M; Tarczy-Hornoch, Peter; Byers, Peter H; Jarvik, Gail P

    2014-03-01

    To effectively articulate the results of exome and genome sequencing we refined the structure and content of molecular test reports. To communicate results of a randomized control trial aimed at the evaluation of exome sequencing for clinical medicine, we developed a structured narrative report. With feedback from genetics and non-genetics professionals, we developed separate indication-specific and incidental findings reports. Standard test report elements were supplemented with research study-specific language, which highlighted the limitations of exome sequencing and provided detailed, structured results, and interpretations. The report format we developed to communicate research results can easily be transformed for clinical use by removal of research-specific statements and disclaimers. The development of clinical reports for exome sequencing has shown that accurate and open communication between the clinician and laboratory is ideally an ongoing process to address the increasing complexity of molecular genetic testing. © 2014 Wiley Periodicals, Inc.

  12. The 'present state' examination and the structured clinical interview ...

    African Journals Online (AJOL)

    The language, cultural and reality factors found to be important in the Zulu translation of the 'present state' examination (PSE) and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) are discussed and compared with a previous translation of the PSE in Xhosa.

  13. Objective structured clinical examination (OSCE in pharmacy education - a trend

    Directory of Open Access Journals (Sweden)

    Shirwaikar A

    2015-12-01

    Full Text Available Pharmacy education has undergone a radical change as it evolves towards becoming a more patient oriented profession. With a greater emphasis on problem based teaching and competency, the Objective Structured Clinical Examination (OSCE, supported by its reliability and validity became the gold standard for the evaluation of clinical skills of undergraduate students of medicine and pharmacy worldwide. Core competency evaluation has become a mandatory and critical norm for accountability of educational objectives as the traditional testing tools cannot evaluate clinical competence. Interpersonal and communication skills, professional judgment, skills of resolution etc., may be best assessed through a well- structured OSCE in comparison to oral examinations, multiple choice tests and other methods of assessment. Though OSCEs as an objective method of evaluation offer several advantages to both students and teachers, it also has disadvantages and pitfalls in implementation. This article reviews the OSCE as a trend in pharmacy education.

  14. Social cognition in schizophrenia: factor structure, clinical and functional correlates.

    Science.gov (United States)

    Buck, Benjamin E; Healey, Kristin M; Gagen, Emily C; Roberts, David L; Penn, David L

    2016-08-01

    Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure. This study (1) examines the factor structure of social cognition in both a sample of individuals with schizophrenia-spectrum disorders and non-clinical controls and (2) explores relationships of factors to neurocognition, symptoms and functioning. A factor analysis was conducted on social cognition measures in a sample of 65 individuals with schizophrenia or schizoaffective disorder, and 50 control participants. The resulting factors were examined for their relationships to symptoms and functioning. Results suggested a two-factor structure in the schizophrenia sample (social cognition skill and hostile attributional style) and a three-factor structure in the non-clinical sample (hostile attributional style, higher-level inferential processing and lower-level cue detection). In the schizophrenia sample, the social cognition skill factor was significantly related to negative symptoms and social functioning, whereas hostile attributional style predicted positive and general psychopathology symptoms. The factor structure of social cognition in schizophrenia separates hostile attributional style and social cognition skill, and each show differential relationships to relevant clinical variables in schizophrenia.

  15. The clinical use of structural MRI in Alzheimer disease

    Science.gov (United States)

    Frisoni, Giovanni B.; Fox, Nick C.; Jack, Clifford R.; Scheltens, Philip; Thompson, Paul M.

    2010-01-01

    Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment. PMID:20139996

  16. Performance-Based Assessment of Clinical Ethics Using an Objective Structured Clinical Examination.

    Science.gov (United States)

    Singer, Peter A.; And Others

    1996-01-01

    Final-year Ontario medical students (n=88) took a 4-station objective structured clinical examination (OSCE) using standardized patients and involving decisions to forgo life-sustaining treatment. Performance was scored on a checklist of behaviors unique to each case. Results indicated that because of low reliability, the OSCE is not a feasible…

  17. [Development of an objective structured clinical examination (OSCE) for evaluating clinical competence in vascular medicine].

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    Risse, J; Busato, T; Dufrost, V; Perri, M; Zuily, S; Wahl, D

    2017-05-01

    Vascular medicine is now a clinical specialty in France. During their studies, students will acquire clinical reasoning in addition to technical skills. An Objective Structured Clinical Examination (OSCE) is considered as the gold standard for evaluating clinical competence. Our main objective was to evaluate the feasibility and acceptability of OSCE for the evaluation of students, secondarily their performance. Three representative clinical cases of the specialty were developed. The OSCE consisted of a sequence of clinical situations presented in three stations of 7minutes each. The role of the simulated patient was played by medical students. At the end of the OSCE, observers and students completed the evaluation form. We compared the performances between junior and senior vascular medicine students. Written questionnaires were used to measure OSCE satisfaction. We were able to develop and organize this examination without difficulties. Fifteen students were evaluated. All participants agreed that the clinical situations were representative of vascular medicine practice, the cases were realistic and standardized patients were convincing. The performance of senior students was statistically higher than junior students in one case. Our study demonstrates the feasibility and acceptability of the OSCE in students in vascular medicine. The small number of stations and candidates requires further studies on a larger scale to evaluate their performance. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  18. Use of an Objective Structured Clinical Examination in Clinical Nurse Specialist Education.

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    Cuevas, Heather E; Timmerman, Gayle M

    2016-01-01

    Helping patients maximize their potential using expert coaching to facilitate lifestyle change is an important practice area for clinical nurse specialists (CNSs). The purpose is to determine the usefulness of objective structured clinical examinations (OSCEs) for evaluating CNS students' coaching competencies in the context of facilitating lifestyle change. Despite the use of OSCEs to assess competencies in clinical skills (eg, performance of procedures, decision making), its potential for evaluating coaching competencies for lifestyle change has not been demonstrated. We developed 4 OSCEs dealing with coaching patients in exercise, weight loss, stress reduction, or nonpharmacologic management of hyperlipidemia. Evaluation criteria included (1) approach to the patient, (2) information gathering, (3) motivational interviewing, and (4) management (medical and behavioral strategies). Student performance ranged from highly organized with proficient coaching skills to disorganized and focused solely on clinical management and prescriptive communication. Student responses were positive. Objective structured clinical examinations were highly useful for evaluating CNS students' coaching competencies for lifestyle change. Using OSCEs early in the semester to provide students feedback on their performance and again at the end to determine improvement optimizes use of this teaching strategy.

  19. THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Rodrigo Arnold Tisot

    2016-03-01

    Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

  20. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

    Science.gov (United States)

    Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

    2014-07-01

    Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Structure of the clinical and geriatric depression: Similarities and differences

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    Novović Zdenka

    2006-01-01

    Full Text Available Studies demonstrating the uniqueness of depression in old age are numerous, but conclusions on the fact if the problems of the elderly people cause depression or if they are a part of depression are not unique. The aim of this paper is to compare the structure of depression of old people without the history of mental illness and middle-aged people treated for depression. The sample consists of 82 healthy inmates of different Homes for the Aged and 78 patients diagnosed with some sort of affective disorder. A depression has been assessed with the shorten version of the MMPI D-scale. The structure of the geriatric and clinical depression has been compared with the method of maximum likelihood, over the matrix of co-variances of answers on the items on the depression scale. The results point out to the statistically significant difference in the structure of depression of the old and clinically depressed individuals. However, half of the items of the D-scale have significant loadings on the factor of depression in both groups. The essence of the depression in both samples is made of cognitive subject matters, depressive affect, decline of motivation and a negative estimate of one's basic abilities. Symptoms concerning low self-esteem, experiencing cognitive deficit, energy and impaired physical health have been significant in describing the clinical depression, while a feeling of reduced positive stimulation and the affective liability is typical for the depression of geriatric sample. The conclusion is that, despite the differences, there is a common core of symptoms that makes the essence of depression, apart from the samples.

  2. Can disclosure of scoring rubric for basic clinical skills improve objective structured clinical examination?

    Science.gov (United States)

    Chae, Su Jin; Kim, Miran; Chang, Ki Hong

    2016-06-01

    To determine whether disclosure of scoring rubric for objective basic clinical skills can improve the scores on the objective structured clinical examination (OSCE) in medical students. Clinical performance score results of one university medical students (study group, n=345) were compared to those of another university (control group, n=1,847). Both groups took identical OSCE exam. OSCE rubric was not revealed to the study group until they were in the last 2 years of medical school. There was no significant difference between before and after disclosure of rubric. However, history taking and physical examination scores of the study group were lower than those of the control group before the disclosure of rubric. After disclosure of rubric, the scores were either unchanged or slightly increased in the control group. Trend analysis of scores demonstrated that history taking and physical examination scores after the disclosure were significantly increased in the study group for 2 years. This study revealed that disclosure of basic clinical skills rubric to medical students could enhance their clinical performance, particularly in history taking and physical examination scores.

  3. Designing and implementing the objective structured clinical examination in anesthesiology.

    Science.gov (United States)

    Hastie, Maya Jalbout; Spellman, Jessica L; Pagano, Parwane P; Hastie, Jonathan; Egan, Brian J

    2014-01-01

    Since its description in 1974, the Objective Structured Clinical Examination (OSCE) has gained popularity as an objective assessment tool of medical students, residents, and trainees. With the development of the anesthesiology residents' milestones and the preparation for the Next Accreditation System, there is an increased interest in OSCE as an evaluation tool of the six core competencies and the corresponding milestones proposed by the Accreditation Council for Graduate Medical Education.In this article the authors review the history of OSCE and its current application in medical education and in different medical and surgical specialties. They also review the use of OSCE by anesthesiology programs and certification boards in the United States and internationally. In addition, they discuss the psychometrics of test design and implementation with emphasis on reliability and validity measures as they relate to OSCE.

  4. FAIR_OSCE – Feedback structure for assessment of interactive roleplay in Objective Structured Clinical Exams

    OpenAIRE

    Brem, Beate; Richter, Cornelia Sabine; Schnabel, Kai

    2014-01-01

    Introduction Since the quality of patient portrayal of standardized patients (SPs) during an Objective Structured Clinical Exam (OSCE) has a major impact on the reliability and validity of the exam, quality control should be initiated. Literature about quality control of SPs’ performance focuses on feedback [1, 2] or completion of checklists [3, 4]. Since we did not find a published instrument meeting our needs for the assessment of patient portrayal, we developed such an instrument af...

  5. Clinical clerkships: students can structure their own learning.

    Science.gov (United States)

    Smith, Pat; Morrison, Jillian

    2006-09-01

    In clinical clerkships, student learning is often unstructured and diverse. Even when curriculum objectives are explicit, they are seldom used by students to guide their learning. Student-determined learning objectives may help students to structure their learning. This study aimed to assess whether students can use this method to meet widely differing learning needs within the general practice clerkship and considered the relationship of student objectives to overall curriculum objectives. Students allocated a 5-week clerkship in general practice from April 2000 to April 2001 were required to set and meet personal learning objectives within a supportive learning environment. They recorded the strategies they used, how well objectives were met and which curriculum objectives they met. Objectives were categorised using a hierarchical system. A total of 143 (85%) students recorded 1549 objectives. Four categories accounted for 1092 (70%) of objectives: Consultation Skills; Study of Diseases; Practical Procedures, and Therapeutics. Otherwise the range of objectives set was wide, encompassing all curriculum objectives. A total of 1043 objectives were rated as satisfactorily or highly satisfactorily met and 185 (12%) were not met at all. Strategies that students used to meet objectives included clinical experience with doctors but also with practice-based nurses. Students were able to use student-determined learning objectives to meet a diverse range of learning needs within the general practice clerkship. The objectives set reflected the breadth of curriculum objectives. This method allows students to address gaps in their knowledge in a clerkship where teaching is largely based on opportunistic contact.

  6. Using the objective structured clinical examinations in undergraduate midwifery students

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    Delavar, MA; Salmalian, H; Faramarzi, M; Pasha, H; Bakhtiari, A; Nikpour, M; Ledari, FM

    2013-01-01

    The Objective Structured Clinical Examination (OSCE) has been considered a modern type of examination for the assessment of clinical skills within nurse education, but it has been rarely applied in the teaching of midwifery. The aim of the present study was to assess the use of the OSCE as a tool to evaluate the abilities of undergraduate midwifery students and to compare the perspectives of the students regarding the OSCE and traditional examination. Fifty-two midwifery students participated in the study. The export trainer evaluated the internal consistency of the OSCE stations and it was tested by using Cronbach’s alpha. Successive groups of students completed a self-administered questionnaire immediately after the final examination. The students’ perspective regarding the traditional final examination ranked as unsatisfactory by more than two thirds of the students, while, the students’ perspective regarding the OSCE system was ranked as very satisfactory to satisfactory by more than half of the students (p=0.001). There was a significant difference in the students’ perspective between the OSCE system and the traditional final examination among the students (49.8±18.3 vs 25.3±18.1) (p=0.001). A significant difference was found in being credible (p=0.0001), consistent/reliable (p=0.001), enhances teaching level (p=0.011), and measures the course category (p=0.008) between two methods of the final examination. Around half of the students expressed their opinion that the OSCE test was a stressful assessment. Overall, students’ evaluation of the OSCE was remarkably encouraging. To this end, we recommend the consideration of the validity and reliability of the process for undergraduate midwifery students. PMID:23599825

  7. Pharmacy Student Anxiety and Success With Objective Structured Clinical Examinations.

    Science.gov (United States)

    Longyhore, Daniel S

    2017-02-25

    Objective. To evaluate whether a relationship exists between the degree of student state-anxiety and pass rates on moderate-to-high stakes objective structured clinical examinations (OSCE). Methods. Third-professional year (P3) students were assessed using the Speilberger State-Trait Anxiety Index (STAI) three weeks prior to their first moderate-to-high stakes OSCEs. Students' OSCE station pass rates, individual station analytical scores, and the overall pass rate for the class were compared with student responses on STAI surveys to measure their association. Results. Seventy-three students (100%) provided consent to participate in the research; 64 (87%) sufficiently completed the STAI survey. Degree of student state-anxiety or train-anxiety was not associated with any of the outcomes assessed in this study. Overall pass rate, individual station pass rates, and station analytical checklist scores were not inversely correlated with state- or trait-anxiety scores. Conclusions. Efforts to assist students in OSCE performance should focus on means other than reducing associated anxiety. Future research in this area should focus on what interventions beyond instruction could be put in place to help students be more successful during OSCEs.

  8. Neurology objective structured clinical examination reliability using generalizability theory.

    Science.gov (United States)

    Blood, Angela D; Park, Yoon Soo; Lukas, Rimas V; Brorson, James R

    2015-11-03

    This study examines factors affecting reliability, or consistency of assessment scores, from an objective structured clinical examination (OSCE) in neurology through generalizability theory (G theory). Data include assessments from a multistation OSCE taken by 194 medical students at the completion of a neurology clerkship. Facets evaluated in this study include cases, domains, and items. Domains refer to areas of skill (or constructs) that the OSCE measures. G theory is used to estimate variance components associated with each facet, derive reliability, and project the number of cases required to obtain a reliable (consistent, precise) score. Reliability using G theory is moderate (Φ coefficient = 0.61, G coefficient = 0.64). Performance is similar across cases but differs by the particular domain, such that the majority of variance is attributed to the domain. Projections in reliability estimates reveal that students need to participate in 3 OSCE cases in order to increase reliability beyond the 0.70 threshold. This novel use of G theory in evaluating an OSCE in neurology provides meaningful measurement characteristics of the assessment. Differing from prior work in other medical specialties, the cases students were randomly assigned did not influence their OSCE score; rather, scores varied in expected fashion by domain assessed. © 2015 American Academy of Neurology.

  9. Radiology as part of an objective structured clinical examination on clinical skills

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    Berk, I.A.H. van den, E-mail: i.a.h.van_den_berk@lumc.nl [Department of Radiology, Leiden University Medical Centre, Postbus 9600, 2300 RC Leiden (Netherlands); Ridder, J.M.M. van de, E-mail: J.M.M.vandeRidder@umcutrecht.nl [School of Medical Sciences, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Schaik, J.P.J. van, E-mail: J.P.J.vanSchaik@umcutrecht.nl [Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100 E01-132, 3584 CX Utrecht (Netherlands)

    2011-06-15

    Introduction: An objective structured clinical examination (OSCE) assessess clinical competence in a standardised and context related manner. Compared with written tests, OSCE's are more susceptible to reliability errors because of the use of multiple cases and multiple examiners. In the pre-clinical phase of the medical curriculum of the University Medical Centre Utrecht, an OSCE is organised as a medical consult. We evaluated the radiology station. Method: Four questions were formulated: {center_dot}What is the internal consistency of the items of the radiology station? {center_dot}How do the scores on the radiology station compare with the scores on the test excluding radiology? {center_dot}How do different cases differ in scores? {center_dot}What are the differences in score between the examiners? We analysed the OSCE results of second year medical students in 2004. Results: Two hundred and sixty-five students were examined in the OSCE in 2004. Ninty-three Students were examined in the radiology station. Cronbach's alpha coefficient for the radiology station was 0.92. The average score for the radiology station was 3.8 (0.87). The average score for the test without radiology was 3.9 (0.32). The range of the average scores for the six different cases was 0.5 (3.6-4.1). The range of the average scores for the five examiners was 1.0 (3.3-4.3). Conclusion: The internal consistency of the items in the radiology station is good. The average score for the radiology station is similar to that of the other stations. The range of the scores between the different cases was relatively small. The range of the scores between the different examiners was clearly larger.

  10. [Ibogaine - structure, influence on human body, clinical relevance].

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    Zdrojewicz, Zygmunt; Kuszczak, Bartłomiej; Olszak, Natalia

    2016-07-29

    Ibogaine is a natural chemical compound, which belongs to the indole alkaloid family. It can be naturally found within the root bark of african plant Tabernanthe iboga. Ibogaine plays a significant role among tribal cultures. Ibogaine, in small amount, causes reduction of hunger, thirst and exhaustion. In bigger amount, however, it can cause intensive visions. Other effects include reduction or complete disappearance of absitnence symptoms visible in people addicted to the nicotine, alcohol, methamphetamine, cocaine or opioids, what has been scientifically proven after the tests on animals and small groups of people. After oral application, 80% of ibogaine is subjected to the Odemethylation into noribogaine; main catalyzing enzyme is cytochrome CYP2D6. Research suggests, that ibogaine acts in many places within central nervous system. NMDA receptors seem to play main role in its anti-addiction properties. It is important to mention the side effects of the compound, which are cardiotoxicity and neurotoxicity, what makes it harder to use its beneficial properties. Because of this, Ibogaine is included among the dangerous substance. However, there are a few clinics in the world which specializes in the use of the compound in order to interrupt the sypmtoms acute opioid withdrawal syndrome as well as a substance benficial in curing other addictions. There is more hope with synthetic derivatives of ibogaine, which although are less toxic still keep their anti-addiction properties. The aim is to collect the available knowledge related to the structure and effects on human body of alkaloid Tabernanthe iboga and consider the possibility of commercial medical use. © 2016 MEDPRESS.

  11. Factor Structure of the Adolescent Clinical Sexual Behavior Inventory

    Science.gov (United States)

    Wherry, Jeffrey N.; Berres, Ashley K.; Sim, Leslie; Friedrich, William N.

    2009-01-01

    The primary goal of this study was to determine if the Adolescent Clinical Sexual Behavior Inventory-Self-Report conformed to the five-factor scale format that was initially used with a clinical sample that included adolescents referred for sexual abuse evaluations. Participants were 141 teenagers, ages 12-19 (M = 15.11, SD = 1.4), and their…

  12. The structure of clinical translation: efficiency, information, and ethics.

    Science.gov (United States)

    Kimmelman, Jonathan; London, Alex John

    2015-01-01

    The so-called drug pipeline is not really about drugs and not much like a pipeline. It is really about the production and dissemination of information, and it is much more like a web. The misunderstanding leads to a poor understanding of what's wrong with clinical translation and how it can be improved.

  13. Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination.

    Science.gov (United States)

    Urteaga, Elizabeth M; Attridge, Rebecca L; Tovar, John M; Witte, Amy P

    2015-10-25

    Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

  14. Clinical skills training and structured internship orientation of ...

    African Journals Online (AJOL)

    Unfortunately many of the newly qualify medical doctors do not get placement years after graduation and many start the internship positions with little or no knowledge about the goals of the training, organizational structure, decorum, expected roles and responsibilities and expected outcome of the internship. In this study ...

  15. Perceptions of postgraduate trainees on the impact of objective structured clinical examinations on their study behavior and clinical practice.

    Science.gov (United States)

    Opoka, Robert O; Kiguli, Sarah; Ssemata, Andrew S; Govaerts, Marjan; Driessen, Erik W

    2015-01-01

    The objective structured clinical examination (OSCE) is a commonly used method of assessing clinical competence at various levels, including at the postgraduate level. How the OSCE impacts on learning in higher education is poorly described. In this study, we evaluated the perceptions of postgraduate trainees regarding the impact of the OSCE on their study and clinical behavior. We employed an explorative qualitative research design by conducting focus group discussions with 41 pediatric postgraduate trainees at the College of Health Science, Makerere University. A semi-structured tool was used to obtain the views and experiences of the trainees. Transcripts from the discussion were analyzed in an iterative manner using thematic content analysis. The trainees reported the OSCEs as a fair and appropriate tool for assessing clinical competency at the postgraduate level. However, they noted that whereas OSCEs assess a broad range of skills and competencies relevant to their training, there were areas that they did not adequately assess. In particular, OSCEs did not adequately assess in-depth clinical knowledge or detailed history-taking skills. Overall, the majority of the trainees reported that the OSCEs inspired them to study widely and improve their procedural and communication skills. OSCEs are a useful tool for assessing clinical competencies in postgraduate education. However, the perceived limitations in their ability to assess complex skills raises concerns about their use as a standalone mode of assessment at the postgraduate level. Future studies should evaluate how use of OSCEs in combination with other assessment tools impacts on learning.

  16. Unravelling the Mystery Between Structure and Sustained Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Edward Keystone

    2016-07-01

    Full Text Available Targeted biologics have revolutionised the treatment and outlook of patients with inflammatory joint diseases. The combination of high-cost long-term therapy straining healthcare systems with impending expiry of key biologics patents has led to heightened interest in the development of biosimilars. The expanding landscape of biosimilars has triggered, in healthcare providers, the need to explore the option to non-medically switch stable patients from costly reference products to less expensive alternatives. Currently, there are many unknowns surrounding the effects of non-medical switching on patient outcomes and cost-effectiveness. Prof Edward Keystone opened the symposium by discussing the constantly evolving landscape of biologics, highlighting that their high cost is becoming an increasing challenge and has created the issue of non-medical switching. Dr Leigh Revers provided a background to the structural and functional relationships of biologic therapies, stressing the need for careful control of the manufacturing processes of these large and complex molecules. Prof Keystone presented the long-term data currently available for anti-tumour necrosis factor (anti-TNF agents and examined how sustainability of response can be influenced by multiple factors. Prof Thomas Dörner concluded the symposium by stressing the importance of the prescribing doctor being in control of which biologics their patients receive to ensure effective pharmacovigilance. The challenge of non-medical switching was discussed along with the potential trial designs that could help to determine if biologics and biosimilars could be interchangeable.

  17. Bone morphogenetic proteins: from structure to clinical use

    Directory of Open Access Journals (Sweden)

    Granjeiro J.M.

    2005-01-01

    Full Text Available Bone morphogenetic proteins (BMPs are multi-functional growth factors belonging to the transforming growth factor ß superfamily. Family members are expressed during limb development, endochondral ossification, early fracture, and cartilage repair. The activity of BMPs was first identified in the 1960s but the proteins responsible for bone induction were unknown until the purification and cloning of human BMPs in the 1980s. To date, about 15 BMP family members have been identified and characterized. The signal triggered by BMPs is transduced through serine/threonine kinase receptors, type I and II subtypes. Three type I receptors have been shown to bind BMP ligands, namely: type IA and IB BMP receptors and type IA activin receptors. BMPs seem to be involved in the regulation of cell proliferation, survival, differentiation and apoptosis, but their hallmark is their ability to induce bone, cartilage, ligament, and tendon formation at both heterotopic and orthotopic sites. This suggests that, in the future, they may play a major role in the treatment of bone diseases. Several animal studies have illustrated the potential of BMPs to enhance spinal fusion, repair critical-size defects, accelerate union, and heal articular cartilage lesions. Difficulties in producing and purifying BMPs from bone tissue have prompted the attempts made by several laboratories, including ours, to express these proteins in the recombinant form in heterologous systems. This review focuses on BMP structure, molecular mechanisms of action and significance and potential applications in medical, dental and veterinary practice for the treatment of cartilage and bone-related diseases.

  18. A Four- and Five-Factor Structural Model for Wechsler Tests: Does It Really Matter Clinically?

    Science.gov (United States)

    Schwartz, David M.

    2013-01-01

    The purpose of this commentary is to focus on the clinical utility of the four- and five-factor structural models for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). It provides a discussion of important considerations when evaluating the clinical utility of the…

  19. The Reliability, Validity, and Usefulness of the Objective Structured Clinical Examination (OSCE) in Dental Education

    Science.gov (United States)

    Graham, Roseanna

    2010-01-01

    This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this…

  20. Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

    Science.gov (United States)

    Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

    2009-01-01

    A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

  1. The Reliability, Validity, and Evaluation of the Objective Structured Clinical Examination in Podiatry (Chiropody).

    Science.gov (United States)

    Woodburn, Jim; Sutcliffe, Nick

    1996-01-01

    The Objective Structured Clinical Examination (OSCE), initially developed for undergraduate medical education, has been adapted for assessment of clinical skills in podiatry students. A 12-month pilot study found the test had relatively low levels of reliability, high construct and criterion validity, and good stability of performance over time.…

  2. FACULTY AND STUDENT PERCEPTIONS ON THE INTRODUCTION OF OBJECTIVE STRUCTURED CLINICAL EXAMINATION IN AN UNDERGRADUATE PHYSIOTHERAPY COURSE: A PILOT STUDY

    OpenAIRE

    Mullai Dhinakaran; Jugesh Chattwal; Dheeraj K.V

    2015-01-01

    Background: The clinical education methods in undergraduate physiotherapy training are well integrated but the methodology of the clinical skill assessment still remains subjective. Due to lack of objective clinical assessment, competency in clinical skills becomes compromised. Aim and Objectives: To introduce Objective Structured Clinical Examination to Physiotherapy faculty, students and determine the perception of Physiotherapy faculty and students about OSCE method of clinical assess...

  3. Assessing nursing clinical skills competence through objective structured clinical examination (OSCE) for open distance learning students in Open University Malaysia.

    Science.gov (United States)

    Oranye, Nelson Ositadimma; Ahmad, Che'an; Ahmad, Nora; Bakar, Rosnida Abu

    2012-06-01

    The objective structured clinical skills examination (OSCE) has over the years emerged as a method of evaluating clinical skills in most medical and allied professions. Although its validity and objectivity has evoked so much debate in the literature, little has been written about its application in non-traditional education systems such as in distance learning. This study examined clinical skills competence among practising nursing students who were enrolled in a distance learning programme. The study examined the effect of work and years of nursing practice on nurses' clinical skills competence. This study used observational design whereby nursing students' clinical skills were observed and scored in five OSCE stations. Two instruments were used for the data collection - A self-administered questionnaire on the students' bio-demographic data, and a check list on the clinical skills which the examiners rated on a four point scale. The findings revealed that 14% of the nurses had level four competence, which indicated that they could perform the tasks correctly and complete. However, 12% failed the OSCE, even though they had more than 10 years experience in nursing and post basic qualifications. Inter-rater reliability was 0.92 for the five examiners. Factor analysis indicated that five participant factors accounted for 74.1% of the variations in clinical skills performance. An OSCE is a necessary assessment tool that should be continuously applied in nursing education, regardless of the mode of the education program, the student's years of experience or his/her clinical placement. This study validates the need for OSCE in both the design of tertiary nursing degree programs and the assessment of nurses' clinical competency level.

  4. Clinical judgment development using structured classroom reflective practice: a qualitative study.

    Science.gov (United States)

    Glynn, Donna M

    2012-03-01

    This qualitative study examined the incorporation of "reflection-on-action" in a structured reflective classroom format as defined by Tanner's Clinical Judgment Model on the development of perceived clinical judgment and clinical confidence in Bachelor of Science nursing students. The qualitative results described the students' perceptions of the benefit of the intervention on their development of clinical judgment and clinical confidence. This research was an important contribution to the debate regarding the benefit of structured reflection in a classroom setting. By using reflection in the classroom, nurse educators may influence the education-practice gap and incorporate new pedagogies to strengthen the educational preparedness of nursing students to provide high-quality, competent, compassionate care to patients and their families. Copyright 2012, SLACK Incorporated.

  5. Exploring the structure and organization of information within nursing clinical handovers.

    Science.gov (United States)

    Johnson, Maree; Jefferies, Diana; Nicholls, Daniel

    2012-10-01

    Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress. © 2012 Wiley Publishing Asia Pty Ltd.

  6. Clinical skills assessment: limitations to the introduction of an "OSCE" (Objective Structured Clinical Examination in a traditional Brazilian medical school

    Directory of Open Access Journals (Sweden)

    Luiz Ernesto de Almeida Troncon

    Full Text Available CONTEXT: Assessment of clinical skills has a central role in medical education and the selection of suitable methods is highly relevant. The OSCE (Objective Structured Clinical Examination is now established as one of the most valid, reliable and effective tests for the assessment of clinical skills. OBJECTIVE: To describe student and faculty perceptions of an OSCE introduced in a traditional Brazilian medical school. TYPE OF STUDY: Descriptive, semi-quantitative study. SETTING: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. PARTICIPANTS: 258 junior medical students finishing an introductory course on basic clinical skills and six faculty members deeply involved with the OSCE administration. PROCEDURES: Over a period of three consecutive years, student perceptions on the examination were evaluated using a structured questionnaire containing several five-point scales; faculty members' opinions were collected using a structured questionnaire plus a personal interview. MAIN MEASUREMENTS: Student satisfaction or dissatisfaction with aspects of OSCE administration and positive or negative opinions from faculty members. RESULTS: Students were comfortable with cases and tasks, but nearly half (48% of them criticized organizational aspects of the OSCE. Substantial proportions of students reported difficulties with both time management (70% and stress control (70%. Improvement of several aspects of exams reduced criticism of organization to a minority (5% of students, but the proportions of students reporting difficulties with time management (40% and stress control (75% during the exam remained virtually unchanged. Faculty members acknowledged the accuracy of the OSCE, but criticized its limitations for assessing the integrated approach to patients and complained that the examination was remarkably time and effort-consuming. The educational impact of the OSCE was felt to be limited, since other faculty members did not respond to

  7. Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.

    Science.gov (United States)

    Bourgois, Philippe; Holmes, Seth M; Sue, Kim; Quesada, James

    2017-03-01

    The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

  8. Educational efficacy of objective structured clinical examination on clinical training of traditional Chinese medicine - A qualitative study.

    Science.gov (United States)

    Chen, Ying-Ling; Hou, Mark C; Lin, Su-Ching; Tung, Yi-Jung

    2015-08-01

    We propose applying objective structured clinical examinations (OSCEs) and discuss the educational efficacy of such examinations regarding the clinical competence of traditional Chinese medicine (TCM) practitioners. TCM OSCEs were implemented for evaluation and instruction from 2011 to 2013. Trainees received feedback from clinician-educators and standardized patients. Trainees' survey data were extracted from post-OSCE questionnaires and interviews to analyze TCM OSCEs. Five TCM OSCEs were administered, and the educational backgrounds of the 37 participants were analyzed. According to analysis of the questionnaires, all trainees agreed OSCEs were beneficial. In interviews, trainees expressed appreciation for the direct, real-time feedback during the OSCE and felt it closely resembled actual clinical work. However, the simulation models of OSCEs must be upgraded. OSCEs can be used in evaluating, teaching, and certifying TCM clinical competencies to improve the quality of TCM practices. The patient-centered training aspect of TCM OSCEs is particularly helpful for participants. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Louis Frederick Small

    2013-04-01

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

  10. Flipping the Objective Structured Clinical Examination: A Teaching Innovation in Graduate Nursing Education.

    Science.gov (United States)

    Day, Cristi; Barker, Connie; Bell, Eva; Sefcik, Elizabeth; Flournoy, Deborah

    Objective evaluation of distance-based family nurse practitioner (FNP) students can be challenging. One FNP program piloted a teaching innovation, the video-enhanced objective structured clinical examination (VE-OSCE) or "flip" of the traditional face-to-face OSCE, to assess student clinical performance in a controlled online environment using a teleconferencing platform. This project sought to assess the VE-OSCE design, implementation, and ability to identify FNP student learning needs.

  11. Factors shaping e-feedback utilization following electronic Objective Structured Clinical Examinations.

    Science.gov (United States)

    Ashby, Samantha E; Snodgrass, Suzanne H; Rivett, Darren A; Russell, Trevor

    2016-09-01

    The development of student-practitioners' practical clinical skills is essential in health professional education. Objective Structured Clinical Examinations are central to the assessment of students performing clinical procedures on simulated patients (actors). While feedback is considered core to learning providing timely, individualised student OSCE feedback is difficult. This study explored the perceptions of students about the multiple factors which shape the utility of e-feedback following an electronic Objective Structured Clinical Examinations, which utilized iPad and specialised software. The e-feedback was trialled in four courses within occupational therapy and physiotherapy pre-professional programs with a cohort of 204 students. Evaluation of student perceptions about feedback was collected using two surveys and eight focus groups. This data showed three factors shaped perceptions of the utility of e- Objective Structured Clinical Examinations feedback: 1) timely accessibility within one day of the assessment, 2) feedback demonstrating examiners' academic literacy and 3) feedback orientated to ways of improving future performance of clinical skills. The study found training in the provision of feedback using IPads and software is needed for examiners to ensure e-feedback meets students' needs for specific, future-oriented e-feedback and institutional requirements for justification of grades. © 2016 John Wiley & Sons Australia, Ltd.

  12. The clinical instructor role in nursing education: a structured literature review.

    Science.gov (United States)

    Dahlke, Sherry; Baumbusch, Jennifer; Affleck, Frances; Kwon, Jae-Young

    2012-12-01

    A structured literature review was conducted to understand clinical instructors' perceptions of their role and the factors that facilitate and constrain their teaching in undergraduate nursing programs. The literature published in English between 2000 and 2011 was searched, and data were extracted from 15 articles that met the inclusion criteria. The analysis identified four themes-characteristics of the role, characteristics of effective clinical teaching, influence of the clinical context on the role, and influence of the academic context on the role. Clinical instructors are portrayed as needing to be good educators, as well as excellent clinicians. However, they often lack formal education and professional development opportunities related to the role and must draw on their individual personal and professional experiences to guide their teaching to meet the demands of both the clinical and academic contexts in which they simultaneously work. Copyright 2012, SLACK Incorporated.

  13. The structure of mental health research: networks of influence among psychiatry and clinical psychology journals.

    Science.gov (United States)

    Haslam, N; Lusher, D

    2011-12-01

    Psychiatry and clinical psychology are the two dominant disciplines in mental health research, but the structure of scientific influence and information flow within and between them has never been mapped. Citations among 96 of the highest impact psychiatry and clinical psychology journals were examined, based on 10 052 articles published in 2008. Network analysis explored patterns of influence between journal clusters. Psychiatry journals tended to have greater influence than clinical psychology journals, and their influence was asymmetrical: clinical psychology journals cited psychiatry journals at a much higher rate than the reverse. Eight journal clusters were found, most dominated by a single discipline. Their citation network revealed an influential central cluster of 'core psychiatry' journals that had close affinities with a 'psychopharmacology' cluster. A group of 'core clinical psychology' journals was linked to a 'behavior therapy' cluster but both were subordinate to psychiatry journals. Clinical psychology journals were less integrated than psychiatry journals, and 'health psychology/behavioral medicine' and 'neuropsychology' clusters were relatively peripheral to the network. Scientific publication in the mental health field is largely organized along disciplinary lines, and is to some degree hierarchical, with clinical psychology journals tending to be structurally subordinate to psychiatry journals.

  14. An Objective Structured Clinical Exam to Assess Semiology Skills of Medical Students.

    Science.gov (United States)

    Pereira, Vitor Hugo; Morgado, Pedro; Gonçalves, Mónica; Costa, Liliana; Sousa, Nuno; Cerqueira, João José

    2016-12-30

    Mastery of history taking and physical exam skills is a key competence of medical students. Objective Structured Clinical Examinations are the gold standard to assess these competencies, but their implementation in Portugal is poorly documented. We describe the implementation and our seven years experience with a high-stakes Objective Structured Clinical Examination to assess these skills in the School of Medicine, University of Minho. Our Objective Structured Clinical Examination is in place since 2010 and has been subject to continuous improvements, including the adoption of a standard setting procedure and an increase in the number of stations. Grades in our exam are well distributed and discriminate among students. History taking grades are lower and have remained stable throughout the years while physical examination scores have risen. The exam is reliable, with internal consistency above 0.45 and a G-coefficient of 0.74. It is also feasible, with a total testing time of approximately 20 hours for 140 students, and the involvement of 18 standardized patients and 18 faculty assessors. More importantly, it was able to engage the students, who recognize its importance. The most important validity criterion of our, and any Objective Structured Clinical Examination, would be predictive validity,the ability to predict the performance of students in the clinical context. Our approach to a high-stakes Objective Structured Clinical Examination shows that it is feasible, reliable, valid and fair and can be implemented with success in the Portuguese setting.

  15. MMPI-A Scale-Level Factor Structure: Replication in a Clinical Sample.

    Science.gov (United States)

    Archer, Robert P.; Krishnamurthy, Radhika

    1997-01-01

    The scale-level factor structure of the adolescent form of the Minnesota Multiphasic Personality Inventory (MMPI-A) was examined in a clinical sample of 358 adolescents receiving psychiatric services. Nine factors accounted for 75.6% of total variance in scale and subscale raw scores. Findings support use of the MMPI-A for assessment of…

  16. Competency-Based Training: Objective Structured Clinical Exercises (OSCE) in Marriage and Family Therapy

    Science.gov (United States)

    Miller, John K.

    2010-01-01

    The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical "Examination" (OSCE) is widely used in the medical profession to assess…

  17. structured clinical examInatIon IntervIew In and the Zulu

    African Journals Online (AJOL)

    1991-01-19

    Jan 19, 1991 ... The language, cu"ural and reality factors found to be impor- tant in the Zulu translation of the 'present state' examination. (PSE) and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID) are dis- cussed and compared with a previous translation of the PSE.

  18. Eating disorder examination: Factor structure and norms in a clinical female pediatric eating disorder sample.

    Science.gov (United States)

    O'Brien, Amy; Watson, Hunna J; Hoiles, Kimberley J; Egan, Sarah J; Anderson, Rebecca A; Hamilton, Matthew J; Shu, Chloe; McCormack, Julie

    2016-01-01

    The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist. The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%). The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score. The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years. © 2015 Wiley Periodicals, Inc.

  19. Diagnosing migraine in research and clinical settings: The validation of the Structured Migraine Interview (SMI)

    Science.gov (United States)

    2010-01-01

    Background Migraine is a common disorder that is highly co-morbid with psychopathological conditions such as depression and anxiety. Despite the extensive research and availability of treatment, migraine remains under-recognised and undertreated. The aim of this study was to design a short and practical screening tool to identify migraine for clinical and research purposes. Methods The structured migraine interview (SMI) based on the International Classification of Headache Disorders (ICHD) criteria was used in a clinical setting of headache sufferers and compared to clinical diagnosis by headache specialist. In addition to the validating characteristics of the interview different methods of administration were also tested. Results The SMI has high sensitivity (0.87) and modest specificity (0.58) when compared to headache specialist's clinical diagnosis. Conclusions Our study demonstrated that a structured interview based on the ICHD criteria is a useful and valid tool to identify migraine in research settings and to a limited extent in clinical settings, and could be used in studies on large samples where clinical interviews are less practical. PMID:20074361

  20. A systematic approach for using DICOM structured reports in clinical processes: focus on breast cancer.

    Science.gov (United States)

    Medina García, Rosana; Torres Serrano, Erik; Segrelles Quilis, J Damian; Blanquer Espert, Ignacio; Martí Bonmatí, Luis; Almenar Cubells, Daniel

    2015-04-01

    This paper describes a methodology for redesigning the clinical processes to manage diagnosis, follow-up, and response to treatment episodes of breast cancer. This methodology includes three fundamental elements: (1) identification of similar and contrasting cases that may be of clinical relevance based upon a target study, (2) codification of reports with standard medical terminologies, and (3) linking and indexing the structured reports obtained with different techniques in a common system. The combination of these elements should lead to improvements in the clinical management of breast cancer patients. The motivation for this work is the adaptation of the clinical processes for breast cancer created by the Valencian Community health authorities to the new techniques available for data processing. To achieve this adaptation, it was necessary to design nine Digital Imaging and Communications in Medicine (DICOM) structured report templates: six diagnosis templates and three summary templates that combine reports from clinical episodes. A prototype system is also described that links the lesion to the reports. Preliminary tests of the prototype have shown that the interoperability among the report templates allows correlating parameters from different reports. Further work is in progress to improve the methodology in order that it can be applied to clinical practice.

  1. Avatar-mediated home safety assessments: piloting a virtual objective structured clinical examination station.

    Science.gov (United States)

    Andrade, Allen D; Cifuentes, Pedro; Oliveira, Marcelo C; Anam, Ramanakumar; Roos, Bernard A; Ruiz, Jorge G

    2011-12-01

    Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows. We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's "home visit" was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist. The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as "excellent." Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house. The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting.

  2. Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics

    DEFF Research Database (Denmark)

    Qvist, Ina; Hendriks, Jeroen M L; Møller, Dorthe S

    2016-01-01

    provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study......-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death. METHODS: All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist....... Outcome measures were adjudicated by the same principles in both cohorts. RESULTS: A total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found...

  3. Using TOSCE (Team Objective Structured Clinical Examination in the second national medical sciences olympiad in Iran

    Directory of Open Access Journals (Sweden)

    Mitra Amini

    2012-01-01

    Full Text Available Introduction: Second National Medical Sciences Olympiad was done in Shiraz in August 2010 with aim of indentifying scientifically talented individuals, motivating students and orienting extracurricular activities. This Olympiad was done in 3 areas, basic sciences, clinical sciences and management. In clinical sciences, we used TOSCE (Team Objective Structured Clinical Examination. In this article we report the details of this exam and participants′ satisfaction. Materials and Methods: This Olympiad in Clinical Medical Sciences was held in 2 levels: Individual and team. In the team stage, 9 teams from 9 universities participated. We used TOSCE for measuring clinical competency of teams. Each team consisted of 3 students. We designed 12 stations based on emergency medicine in medical and surgical fields. The time considered for each station was 15 min, after doing this exam the view of students was measured using a valid and reliable questionnaire. Results: Most of the students believed that TOSCE was a useful examination for measuring competency. More than 50% of students reported that success in this exam needs clinical competency, team work and problem solving ability. Nearly, half (48.1% of students believed that 15 min is not enough for each station and they need more time. Conclusion: The results of this study showed that this kind of exam is useful for measuring clinical competency from students′ viewpoint .

  4. The Structure of Clinical Consultation: A Case of Non-Native Speakers of English as Participants

    Science.gov (United States)

    Bagheri, H.; Ibrahim, N. A.; Habil, H.

    2015-01-01

    Background: In many parts of the world, patients may find it difficult to visit doctors who share the same language and culture due to the intermingling of people and international recruitment of doctors among many other reasons. In these multilingual multicultural settings (MMSs), doctor-patient interactions face new communication challenges. This study aims to identify the structure of clinical consultation and its phases in an MMS where both doctors and patients are non-native speakers (NNSs) of English. Method: This study takes on a discourse analytic approach to examine the structure of clinical consultation as an activity type. 25 clinical consultation sessions between non-native speakers of English in a public healthcare centre in Malaysia were audio-recorded. Findings and Discussion: The results show that there are some deviations from the mainstream structure of clinical consultations although, in general, the pattern is compatible with previous studies. Deviations are particularly marked in the opening and closing phases of consultation. Conclusion: In almost all interactions, there is a straightforward manner of beginning medical consultations. The absence of greetings may have naturally reduced the length of talk. Hence, by directly entering medical talks, the doctors voice their concern on the curing aspects of the consultation rather than its caring facets. The preference of curing priority to caring is more goal-oriented and in alignment with the consultation as an activity type. PMID:25560336

  5. Assessing the Objective Structured Clinical Examination: Saudi family medicine undergraduate medical students' perceptions of the tool.

    Science.gov (United States)

    Raheel, Hafsa; Naeem, Naghma

    2013-10-01

    To assess the perception and opinion of the medical students about Obejective Structured Clinical Examination. The descriptive study was conducted at King Saud University College of Medicine, Riyadh, Saudi Arabia, from March to May 2010. Total population sampling, which is a type of purposive sampling technique, was used. A structured pre-tested questionnaire was circulated among the undergraduate medical students doing Family Medicine clerkship immediately at the end of Objective Structured Clinical Examination. Of the 97 questionnaires distributed, 95 (98%) were received. A number of positive aspects of the OSCE exam were identified by students such as 63 (66%) felt that it provided practical and useful experience; 63 (66%) perceived as having a positive impact on student learning; 62 (65%) stated it is a standardised exam; 53 (56%) felt that it should be used more often in undergraduate assessment; 54 (57%) stated that it evaluated a wide variety of clinical skills; 50 (53%) stated that the format allowed students to compensate for deficiency in some areas; 49 (52%) were of the opinion that the exam was fair; 45 (47%) preferred it over other forms of assessment; 39 (41%) perceived exam scores to be truly reflective of competence in clinical skills; and 34 (35%) felt that the format minimises chances of failure. Also, 46 (48% found it to be stressful, and 38 (40%) found it not easy. Overall, the Objective Structured Clinical Examination was perceived very positively and welcomed by the undergraduate family medicine students. Certain negative perceptions such as stress and difficulty were also highlighted, which could be managed through better orientation and preparation of the students.

  6. Creative Curriculum: The Experience of Writing and Teaching Formative Objective Structured Clinical Examinations (FOSCEs).

    Science.gov (United States)

    Harrod, Tom P; Gomes, Alexandra W

    2017-01-01

    The launch of the revised medical school curriculum in fall 2014 provided new opportunities for librarians to collaborate with clinical faculty. As a result of past informatics instruction embedded in the first-year curriculum, librarians were invited to expand this content as part of a new Formative Objective Structured Clinical Examination (FOSCE) initiative. This article describes the stages of this project from writing and teaching the FOSCE informatics cases to improvements which were made after the first year. A description of the overall curriculum and information about lessons learned in each of these stages is included.

  7. Transforming clinical dictation into structured notes in an ambulatory care practice.

    Science.gov (United States)

    Ollendieck, Michael; Chueh, Henry

    2004-01-01

    Structured clinical encounter notes offer many advantages compared to free text notes. However, cost and other issues limit their widespread use. At our institution, the electronic medical record (EMR) used by an Internal Medicine practice was designed years ago to utilize structured data. This paper describes a technique to improve the process by which structured notes are dictated and transcribed. We outsourced transcription services and then passed the files through parsing software to structure the data to the granularity required for our database. Software was built to handle all aspects of the process including file validation, parsing, and review. During our pilot project, more than 10,000 notes were parsed, reviewed and uploaded into the EMR.

  8. The reliability, validity, and usefulness of the Objective Structured Clinical Examination (OSCE) in dental education

    Science.gov (United States)

    Graham, Roseanna

    This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this study included CDM's class of 2010 which consisted of 78 students. The overall reliability of the examination was measured via calculation of Cronbach's alpha. Content validity was examined through evaluation of the OSCE by three experienced clinical faculty members. Predictive validity was evaluated by correlating student grades on the OSCE to future clinical performance as measured by number of clinical points achieved during the third year of training. Student perceptions regarding the educational usefulness of the examination were evaluated through a 12-question Liken-type survey and focus group interviews analyzed using a phenomenological approach. Findings of the study indicated the OSCE was a highly reliable examination (alpha=0.86) with high content validity and a moderately high correlation to future clinical performance (r=.614, pstudent perceptions of the educational usefulness of the OSCE were positive as based on their responses to a 5-point Likert scale (1=strongly disagree and 5=strongly agree). They reported that the exam required the ability to think critically and problem-solve (4.0 +/- 0.85), assessed clinically relevant skills (4.59 +/- 0.69), helped identify clinical weaknesses (4.16 +/- 0.90), and was a learning experience (4.58 +/- 0.84). Findings from the qualitative portion of the study identified four main themes including the student perception that the OSCE is a unique assessment experience that required integration and application of knowledge. Recommendations for the use of the OSCE to improve clinical teaching and the implications of this study relating to the expanded use of the OSCE in

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

    Science.gov (United States)

    McKenzie, Carly T

    2016-05-01

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

  10. The Relationship of Clinical Nurses' Perceptions of Structural and Psychological Empowerment and Engagement on Their Unit.

    Science.gov (United States)

    DiNapoli, Jean Marie; O'Flaherty, Deirdre; Musil, Carol; Clavelle, Joanne T; Fitzpatrick, Joyce J

    2016-02-01

    The purpose of this study was to describe relationships between structural empowerment, psychological empowerment, and engagement among clinical nurses. Empowerment and engagement are key drivers of retention and quality in healthcare. Creating an empowering culture and an engaged staff supports initiatives that are essential for positive work environments. A survey of 280 nurses in a national conference was conducted using the Conditions of Work Effectiveness, Psychological Empowerment Instrument, and the Utrecht Work Engagement Scale. Pearson correlation coefficients and multiple regression analysis were used to determine relationships between demographic data and study variables. Overall, nurses had high perceptions of structural empowerment and psychological empowerment and were moderately engaged. Also, significant positive relationships were found between the key study variables. Results show positive correlations between empowerment and perceived engagement among clinical nurses.

  11. Use of Portable Digital Devices to Analyze Autonomic Stress Response in Psychology Objective Structured Clinical Examination.

    Science.gov (United States)

    Beltrán-Velasco, Ana Isabel; Bellido-Esteban, Alberto; Ruisoto-Palomera, Pablo; Clemente-Suárez, Vicente Javier

    2018-01-12

    The aim of the present study was to explore changes in the autonomic stress response of Psychology students in a Psychology Objective Structured Clinical Examination (OSCE) and their relationship with OSCE performance. Variables of autonomic modulation by the analysis of heart rate variability in temporal, frequency and non-linear domains, subjective perception of distress strait and academic performance were measured before and after the two different evaluations that composed the OSCE. A psychology objective structured clinical examination composed by two different evaluation scenarios produced a large anxiety anticipatory response, a habituation response in the first of the evaluation scenarios and a in the entire evaluation, and a no habituation response in the second evaluation scenario. Autonomic modulation parameters do not correlate with academic performance of students.

  12. 3D protein-structure-oriented discovery of clinical relation across chronic lymphocytic leukemia patients

    DEFF Research Database (Denmark)

    Mochament, Konstantinos; Agathangelidis, Andreas; Polychronidou, Eleftheria

    2017-01-01

    Chronic lymphocytic leukemia (CLL) is the most common adult leukemia with still unclear etiology. Indications of antigenic pressure have been hinted, using sequence and structure-based reasoning. The accuracy of such approaches, and in particular of the ones derived from 3D models obtained from t....... The proposed methodology achieved an efficient and highly informative grouping of CLL patients in accordance to their biological and clinical properties....

  13. Significance of Objective Structured Clinical Examinations to Plastic Surgery Residency Training.

    Science.gov (United States)

    Simmons, Brian J; Zoghbi, Yasmina; Askari, Morad; Birnbach, David J; Shekhter, Ilya; Thaller, Seth R

    2017-09-01

    Objective structured clinical examinations (OSCEs) have proven to be a powerful tool. They possess more than a 30-year track record in assessing the competency of medical students, residents, and fellows. Objective structured clinical examinations have been used successfully in a variety of medical specialties, including surgery. They have recently found their way into the subspecialty of plastic surgery. This article uses a systematic review of the available literature on OSCEs and their recent use in plastic surgery. It incorporates survey results assessing program directors' views on the use of OSCEs. Approximately 40% of programs surveyed use OSCEs to assess the Accreditation Council for Graduate Medical Education core competencies. We found that 40% use OSCEs to evaluate specific plastic surgery milestones. Objective structured clinical examinations are usually performed annually. They cost anywhere between $100 and more than $1000 per resident. Four milestones giving residents the most difficulties on OSCEs were congenital anomalies, noncancer breast surgery, breast reconstruction, and practice-based learning and improvement. It was determined that challenges with milestones were due to lack of adequate general knowledge and surgical ward patient care, as well as deficits in professionalism and system-based problems. Programs were able to remediate weakness found by OSCEs using a variety of methods. Objective structured clinical examinations offer a unique tool to objectively assess the proficiency of residents in key areas of the Accreditation Council for Graduate Medical Education core competencies. In addition, they can be used to assess the specific milestones that plastic surgery residents must meet. This allows programs to identify and improve identified areas of weakness.

  14. An Audit of the Medical Students’ Perceptions regarding Objective Structured Clinical Examination

    OpenAIRE

    Abidullah Khan; Maimoona Ayub; Zakir Shah

    2016-01-01

    Objective. To record the perceptions of the final year MBBS students of Khyber Medical College (KMC) Peshawar regarding Objective Structured Clinical Examination (OSCE) conducted in the year 2016. Materials and Methods. This study was conducted in April 2016 which is in fact a reaudit of our similar survey done back in 2015. A total of 250 final year MBBS students participated by filling in a validated and pretested questionnaire already used by Russel et al. and Khan et al. in similar but se...

  15. The Assessment of Undergraduate Medical Students’ Satisfaction Levels With the Objective Structured Clinical Examination

    OpenAIRE

    Khosravi Khorashad, Ahmad; Salari, Somayyeh; Baharvahdat, Humain; Hejazi, Sepideh; Lari, Shiva M; Salari, Maasoomeh; Mazloomi, Maryam; Shahrzad M.Lari

    2014-01-01

    Background: The objective structured clinical examination (OSCE) has been introduced as an efficient method for the assessment of medical students. Objectives: The aim of the present study was to determine the satisfaction level of undergraduate medical students of internal medicine department with the OSCE. Materials and Methods: This was a descriptive cross-sectional study, performed on all available undergraduate students at the end of their internal medicine training period in Mashhad Uni...

  16. [Global aphasia. The clinical picture and a consideration of the neurolinguistic structure (author's transl)].

    Science.gov (United States)

    Stachowiak, F J; Huber, W; Kerschensteiner, M; Poeck, K; Weniger, D

    1977-01-13

    Global aphasia is described as a unitary syndrome which is characterized by a severe impairment of all linguistic capabilities. Speech production is extremely limited and consists of stereotyped phrases, recurring utterances or a few isolated words which are usually neologistically distorted. The patients are unable to express their thoughts in a situationally adequate manner. Language comprehension is restricted to simple questions and commands. A clinical description of the syndrome is given and the neurolinguistic structure of the disorders is discussed.

  17. Structures of Care in the Clinics of the HIV Research Network

    OpenAIRE

    Yehia, Baligh R.; Gebo, Kelly A.; Hicks, Perrin B.; Korthuis, P. Todd; Moore, Richard D.; Ridore, Michelande; Mathews, William Christopher

    2008-01-01

    As the HIV epidemic has evolved to become a chronic, treatable condition the focus of HIV care has shifted from the inpatient to the outpatient arena. The optimal structure of HIV care in the outpatient setting is unknown. Using the HIV Research Network (HIVRN), a federally sponsored consortium of 21 sites that provide care to HIV-infected individuals, this study attempted to: (1) document key features of the organization of care in HIVRN adult clinics and (2) estimate variability among clini...

  18. Analysis on influencing factors of clinical teachers’ job satisfaction by structural equation model

    Directory of Open Access Journals (Sweden)

    Haiyi Jia

    2017-02-01

    Full Text Available [Research objective] Analyze the influencing factors of clinical teachers’ job satisfaction. [Research method] The ERG theory was used as the framework to design the questionnaires. Data were analyzed by structural equation model for investigating the influencing factors. [Research result] The modified model shows that factors of existence needs and growth needs have direct influence on the job satisfaction of clinical teachers, the influence coefficients are 0.540 and 0.380. The three influencing factors have positive effects on each other, and the correlation coefficients are 0.620, 0.400 and 0.330 respectively. [Research conclusion] Relevant departments should take active measures to improve job satisfaction of clinical teachers from two aspects: existence needs and growth needs, and to improve their work enthusiasm and teaching quality.

  19. Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics

    DEFF Research Database (Denmark)

    Qvist, Ina; Hendriks, Jeroen M L; Møller, Dorthe S

    2016-01-01

    OBJECTIVE: A previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led......, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death. METHODS: All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist....... The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23). CONCLUSIONS: Structured, nurse-led, hospital...

  20. [Hypolipidemic agents drug interactions: approach to establish and assess its clinical significance. Structured review].

    Science.gov (United States)

    Franco, D; Henao, Y; Monsalve, M; Gutiérrez, F; Hincapie, J; Amariles, P

    2013-01-01

    To carry out a structures review of drug interactions of hypolipidemic drugs and to assess their clinical relevance. Structured review of drug interactions of hypolipidemic drugs in humans through PubMed/Medline of published articles, without language restrictions and with full text access until June 30th of 2012. The following Mesh terms were used: Drug Interactions, Lipid Regulating Agents, Herb-Drug Interactions, Food-Drug Interactions y Hypolipidemic Agents (Pharmacological Action). The information was completed with those articles considered to be relevant. Finally, a method was used to assess the clinical relevance of the interaction, based on the likelihood of occurrence and the severity of the effect of the interaction. 849 publications were gathered, of which 243 references were selected, among which 189 interactions were identified. Thirty-three of them were considered of very high risk (level 1) and 42 of high risk (level 2), basically associated to increased risk for rhabdomyolisis. Enzymatic inhibition of CYP450 was the most common mechanism for these interactions. Of the interactions identified in patients on hypolipidemic drugs, 60.3% (128/189) are clinically relevant (very high or high risk), mainly associated to the occurrence of rhabdomyolisis. Most of these interactions are attributed to simultaneous use of CYP3A4 inhibitors. Therefore, statins metabolized through CYP3A4 (simvastatin, lovastatin and atorvastatin) are the ones with the highest number of clinically relevant interactions. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

  1. Structural connectomics of anxious arousal in early adolescence: Translating clinical and ethological findings

    Directory of Open Access Journals (Sweden)

    Paul B. Sharp

    2017-01-01

    Full Text Available Etiological explanations of clinical anxiety can be advanced through understanding the neural mechanisms associated with anxiety in youth prior to the emergence of psychopathology. In this vein, the present study sought to investigate how trait anxiety is related to features of the structural connectome in early adolescence. 40 adolescents (21 female, mean age = 13.49 years underwent a diffusion-weighted imaging scan. We hypothesized that the strength of several a priori defined structural connections would vary with anxious arousal based on previous work in human clinical neuroscience and adult rodent optogenetics. First, connection strength of caudate to rostral middle frontal gyrus was predicted to be anticorrelated with anxious arousal, predicated on extant work in clinically-diagnosed adolescents. Second, connection strength of amygdala to rostral anterior cingulate and to medial orbital frontal cortex would be positively and negatively correlated with anxious arousal, respectively, predicated on rodent optogenetics showing the former pathway is anxiogenic and the latter is anxiolytic. We also predicted that levels of anxiety would not vary with measures of global network topology, based on reported null findings. Results support that anxiety in early adolescence is associated with (1 the clinical biomarker connecting caudate to frontal cortex, and (2 the anxiogenic pathway connecting amygdala to rostral anterior cingulate, both in left but not right hemisphere. Findings support that in early adolescence, anxious arousal may be related to mechanisms that increase anxiogenesis, and not in a deficit in regulatory mechanisms that support anxiolysis.

  2. Differences in the internal structure of hallucinatory experiences between clinical and nonclinical populations.

    Science.gov (United States)

    Chang, Jae Seung; Kim, Yeni; Kim, Se Hyun; Hwang, Samuel; Kim, Jayoun; Chung, In-Won; Kim, Yong Sik; Jung, Hee-Yeon

    2015-03-30

    We investigated differential patterns of hallucinatory experiences between nonclinical and clinical samples. A total of 223 nonclinical individuals (108 females) and 111 subjects with schizophrenia (54 females) completed the Launay-Slade Hallucination Scale-Revised (LSHS-R) and Perceptual Aberration Scale (PAS). The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was used for the nonclinical group, and the Positive and Negative Syndrome Scale (PANSS) hallucination item was used for the clinical group. Cronbach's alpha values showed good internal consistency for the LSHS-R. In the two groups, significant associations were found between LSHS-R and PAS scores. Two factors were extracted through a principal component analysis (PCA) in the nonclinical group, and three factors were identified in the clinical group. The results of a hierarchical cluster analysis (HCA) revealed that a perception-cognition dimension was clear cluster discriminating element for the nonclinical group, whereas alterations in perception-cognition dimension were characteristic in cluster structure of the clinical group. Our findings suggest that the nature of hallucinatory experiences may differ qualitatively between a nonclinical population and subjects with schizophrenia. Perceptual or cognitive aberrations may add a psychopathologic dimension to hallucinatory experiences. Exploring the internal structure of hallucinatory experiences may provide explanatory insight into these experiences in the general population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Comparison of traditional and Objective Structured Clinical Examination (OSCE) exams in terms of clinical skills assessment and attitudes of dental students of Qazvin dental school

    OpenAIRE

    S Basir shabestari; I Shirinbak; Sefidi, F; R Sarchami

    2014-01-01

    Introduction: A practical exam is important for evaluation of university students but there is not any satisfaction of traditional exams among clinical teachers. There are limited studies done for modification of traditional exams. This study aimed to compare the traditional and Objective Structured Clinical Examination (OSCE) exams in term of clinical skills and satisfaction among dental students. Methods: Evaluation of thirty dental students was done with OSCE and traditional exams. A st...

  4. Structures of care in the clinics of the HIV Research Network.

    Science.gov (United States)

    Yehia, Baligh R; Gebo, Kelly A; Hicks, Perrin B; Korthuis, P Todd; Moore, Richard D; Ridore, Michelande; Mathews, William Christopher

    2008-12-01

    As the HIV epidemic has evolved to become a chronic, treatable condition the focus of HIV care has shifted from the inpatient to the outpatient arena. The optimal structure of HIV care in the outpatient setting is unknown. Using the HIV Research Network (HIVRN), a federally sponsored consortium of 21 sites that provide care to HIV-infected individuals, this study attempted to: (1) document key features of the organization of care in HIVRN adult clinics and (2) estimate variability among clinics in these parameters. A cross-sectional survey of adult clinic directors regarding patient volume, follow-up care, provider characteristics, acute patient care issues, wait times, patient safety procedures, and prophylaxis practices was conducted from July to December 2007. All 15 adult HIVRN clinic sites responded: 9 academic and 6 community-based. The results demonstrate variability in key practice parameters. Median (range) of selected practice characteristics were: (1) annual patient panel size, 1300 (355-5600); (2) appointment no-show rate, 28% (8%-40%); (3) annual loss to follow-up, 15% (5%-25%); (4) wait time for new appointments, 5 days (0.5-22.5), and follow-up appointment, 8 days (0-30). The majority of clinics had an internal mechanism to handle acute patient care issues and provide a number of onsite consultative services. Nurse practitioners and physician assistants were highly utilized. These data will facilitate improvements in chronic care management of persons living with HIV.

  5. The Associations Between Clerkship Objective Structured Clinical Examination (OSCE) Grades and Subsequent Performance.

    Science.gov (United States)

    Dong, Ting; Zahn, Christopher; Saguil, Aaron; Swygert, Kimberly A; Yoon, Michelle; Servey, Jessica; Durning, Steven

    2017-01-01

    Construct: We investigated the extent of the associations between medical students' clinical competency measured by performance in Objective Structured Clinical Examinations (OSCE) during Obstetrics/Gynecology and Family Medicine clerkships and later performance in both undergraduate and graduate medical education. There is a relative dearth of studies on the correlations between undergraduate OSCE scores and future exam performance within either undergraduate or graduate medical education and almost none on linking these simulated encounters to eventual patient care. Of the research studies that do correlate clerkship OSCE scores with future performance, these often have a small sample size and/or include only 1 clerkship. Students in USU graduating classes of 2007 through 2011 participated in the study. We investigated correlations between clerkship OSCE grades with United States Medical Licensing Examination Step 2 Clinical Knowledge, Clinical Skills, and Step 3 Exams scores as well as Postgraduate Year 1 program director's evaluation scores on Medical Expertise and Professionalism. We also conducted contingency table analysis to examine the associations between poor performance on clerkship OSCEs with failing Step 3 and receiving poor program director ratings. The correlation coefficients were weak between the clerkship OSCE grades and the outcomes. The strongest correlations existed between the clerkship OSCE grades and the Step 2 CS Integrated Clinical Encounter component score, Step 2 Clinical Skills, and Step 3 scores. Contingency table associations between poor performances on both clerkships OSCEs and poor Postgraduate Year 1 Program Director ratings were significant. The results of this study provide additional but limited validity evidence for the use of OSCEs during clinical clerkships given their associations with subsequent performance measures.

  6. The Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID): first psychometric evaluation in a Dutch sample of clinically referred youths

    NARCIS (Netherlands)

    Roelofs, J.; Muris, P.; Braet, C.; Arntz, A.; Beelen, I.

    2015-01-01

    The Structured Clinical Interview for DSM-IV Childhood Disorders (Kid-SCID) is a semi-structured interview for the classification of psychiatric disorders in children and adolescents. This study presents a first evaluation of the psychometric properties of the Kid-SCID in a Dutch sample of children

  7. Validity and reliability of the Structured Clinical Interview for Depersonalization–Derealization Spectrum (SCI-DER)

    Science.gov (United States)

    Mula, Marco; Pini, Stefano; Calugi, Simona; Preve, Matteo; Masini, Matteo; Giovannini, Ilaria; Conversano, Ciro; Rucci, Paola; Cassano, Giovanni B

    2008-01-01

    This study evaluates the validity and reliability of a new instrument developed to assess symptoms of depersonalization: the Structured Clinical Interview for the Depersonalization-Derealization Spectrum (SCI-DER). The instrument is based on a spectrum model that emphasizes soft-signs, sub-threshold syndromes as well as clinical and subsyndromal manifestations. Items of the interview include, in addition to DSM-IV criteria for depersonalization, a number of features derived from clinical experience and from a review of phenomenological descriptions. Study participants included 258 consecutive patients with mood and anxiety disorders, 16.7% bipolar I disorder, 18.6% bipolar II disorder, 32.9% major depression, 22.1% panic disorder, 4.7% obsessive compulsive disorder, and 1.5% generalized anxiety disorder; 2.7% patients were also diagnosed with depersonalization disorder. A comparison group of 42 unselected controls was enrolled at the same site. The SCI-DER showed excellent reliability and good concurrent validity with the Dissociative Experiences Scale. It significantly discriminated subjects with any diagnosis of mood and anxiety disorders from controls and subjects with depersonalization disorder from controls. The hypothesized structure of the instrument was confirmed empirically. PMID:19183789

  8. Validity and reliability of the Structured Clinical Interview for Depersonalization–Derealization Spectrum (SCI-DER

    Directory of Open Access Journals (Sweden)

    Marco Mula

    2008-08-01

    Full Text Available Marco Mula, Stefano Pini, Simona Calugi, Matteo Preve, Matteo Masini, Ilaria Giovannini, Ciro Conversano, Paola Rucci, Giovanni B CassanoDepartment of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, ItalyAbstract: This study evaluates the validity and reliability of a new instrument developed to assess symptoms of depersonalization: the Structured Clinical Interview for the Depersonalization-Derealization Spectrum (SCI-DER. The instrument is based on a spectrum model that emphasizes soft-signs, sub-threshold syndromes as well as clinical and subsyndromal manifestations. Items of the interview include, in addition to DSM-IV criteria for depersonalization, a number of features derived from clinical experience and from a review of phenomenological descriptions. Study participants included 258 consecutive patients with mood and anxiety disorders, 16.7% bipolar I disorder, 18.6% bipolar II disorder, 32.9% major depression, 22.1% panic disorder, 4.7% obsessive compulsive disorder, and 1.5% generalized anxiety disorder; 2.7% patients were also diagnosed with depersonalization disorder. A comparison group of 42 unselected controls was enrolled at the same site. The SCI-DER showed excellent reliability and good concurrent validity with the Dissociative Experiences Scale. It significantly discriminated subjects with any diagnosis of mood and anxiety disorders from controls and subjects with depersonalization disorder from controls. The hypothesized structure of the instrument was confirmed empirically.Keywords: depersonalization, derealization, mood disorders, anxiety disorders

  9. Molecular and clinical characteristics of 26 cases with structural Y chromosome aberrations.

    Science.gov (United States)

    Kim, J-W; Park, S-Y; Ryu, H-M; Lee, D-E; Lee, B-Y; Kim, S-Y; Park, Y-S; Lee, H-S; Seo, J-T

    2012-01-01

    Structural abnormalities include various types of translocations, inversions, deletions, duplications and isochromosomes. Structural abnormalities of the Y chromosome are estimated to affect less than 1% of the newborn male population and are particularly hazardous for male reproductive function. The objective of this study was to characterize a group of patients with structural abnormalities of the Y chromosome. All patients who visited our laboratory between 2007 and 2010 underwent cytogenetic investigations. Among these, we detected 26 patients with structural abnormalities of the Y chromosome. To confirm the structural Y chromosome alterations, we used special bandings, FISH and multiplex PCR to detect Y chromosome microdeletions. Of the 26 patients presented here, 11 had an isodicentric Y chromosome, 7 had an inversion, 3 had a translocation, 2 had a derivative, 2 had a Yqs and 1 had a deletion. Sixteen were diagnosed with azoospermia, 8 as normal fertile males and 1 as a man who was unable to donate semen due to mental retardation. One of the patients having 45,X/46,X,idic(Y) was reported to be phenotypically female with primary amenorrhea and without uterus. Deletions of the AZFbc region were correlated with the sperm concentration (p Y chromosome aberrations may be clinically important for genetic counseling and assisted reproductive technology treatment. Copyright © 2012 S. Karger AG, Basel.

  10. Assessment of Semi-Structured Clinical Interview for Mobile Phone Addiction Disorder.

    Science.gov (United States)

    Alavi, Seyyed Salman; Mohammadi, Mohammad Reza; Jannatifard, Fereshteh; Mohammadi Kalhori, Soroush; Sepahbodi, Ghazal; BabaReisi, Mohammad; Sajedi, Sahar; Farshchi, Mojtaba; KhodaKarami, Rasul; Hatami Kasvaee, Vahid

    2016-04-01

    The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) classified mobile phone addiction disorder under "impulse control disorder not elsewhere classified". This study surveyed the diagnostic criteria of DSM-IV-TR for the diagnosis of mobile phone addiction in correspondence with Iranian society and culture. Two hundred fifty students of Tehran universities were entered into this descriptive-analytical and cross-sectional study. Quota sampling method was used. At first, semi- structured clinical interview (based on DSM-IV-TR) was performed for all the cases, and another specialist reevaluated the interviews. Data were analyzed using content validity, inter-scorer reliability (Kappa coefficient) and test-retest via SPSS18 software. The content validity of the semi- structured clinical interview matched the DSM-IV-TR criteria for behavioral addiction. Moreover, their content was appropriate, and two items, including "SMS pathological use" and "High monthly cost of using the mobile phone" were added to promote its validity. Internal reliability (Kappa) and test-retest reliability were 0.55 and r = 0.4 (p<0. 01) respectively. The results of this study revealed that semi- structured diagnostic criteria of DSM-IV-TR are valid and reliable for diagnosing mobile phone addiction, and this instrument is an effective tool to diagnose this disorder.

  11. The cancer precision medicine knowledge base for structured clinical-grade mutations and interpretations.

    Science.gov (United States)

    Huang, Linda; Fernandes, Helen; Zia, Hamid; Tavassoli, Peyman; Rennert, Hanna; Pisapia, David; Imielinski, Marcin; Sboner, Andrea; Rubin, Mark A; Kluk, Michael; Elemento, Olivier

    2017-05-01

    This paper describes the Precision Medicine Knowledge Base (PMKB; https://pmkb.weill.cornell.edu ), an interactive online application for collaborative editing, maintenance, and sharing of structured clinical-grade cancer mutation interpretations. PMKB was built using the Ruby on Rails Web application framework. Leveraging existing standards such as the Human Genome Variation Society variant description format, we implemented a data model that links variants to tumor-specific and tissue-specific interpretations. Key features of PMKB include support for all major variant types, standardized authentication, distinct user roles including high-level approvers, and detailed activity history. A REpresentational State Transfer (REST) application-programming interface (API) was implemented to query the PMKB programmatically. At the time of writing, PMKB contains 457 variant descriptions with 281 clinical-grade interpretations. The EGFR, BRAF, KRAS, and KIT genes are associated with the largest numbers of interpretable variants. PMKB's interpretations have been used in over 1500 AmpliSeq tests and 750 whole-exome sequencing tests. The interpretations are accessed either directly via the Web interface or programmatically via the existing API. An accurate and up-to-date knowledge base of genomic alterations of clinical significance is critical to the success of precision medicine programs. The open-access, programmatically accessible PMKB represents an important attempt at creating such a resource in the field of oncology. The PMKB was designed to help collect and maintain clinical-grade mutation interpretations and facilitate reporting for clinical cancer genomic testing. The PMKB was also designed to enable the creation of clinical cancer genomics automated reporting pipelines via an API.

  12. Shoulder Structure and Function Following the Modified Latarjet Procedure: A Clinical and Radiological Review

    Science.gov (United States)

    Garewal, Devinder; Evans, Mathew; Taylor, David; Hoy, Gregory A.; Barwood, Shane; Connell, David

    2013-01-01

    Background To evaluate the clinical and radiological outcomes of the modified Latarjet procedure for traumatic, antero-inferior glenohumeral joint instability. Methods Case series were used with a mean follow-up of 21.3 months for clinical and radiological review and 47.2 months for recurrent instability. Shoulder function was evaluated by clinical examination and validated shoulder scales: Western Ontario Shoulder Stability Index (WOSI), Melbourne Instability Shoulder Score (MISS) and l'Insalata Shoulder Questionnaire. Shoulder structure was evaluated by computed tomography. Results Thirty-two cases were enrolled (mean age 27.0 years). One patient reported a redislocation during the follow-up period. Clinical examination revealed that the median external rotation (at 0° and 90° abduction) was reduced on the operative side by 7.5° (p 0.05). Radiological evaluation revealed a mean (SD) pre-operative glenoid surface area loss of 169.5 (48.5) mm2 reconstituted surgically by a bone block of 225.4 (73.8) mm2. Subscapularis muscle bulk was reduced on the operative side, above the level of the muscle split (p Latarjet procedure reliably restores lost glenoid surface area, shoulder stability, strength and function. A small loss of external rotation is expected and related to altered subscapularis anatomy. PMID:27582905

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

    Science.gov (United States)

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

    2012-01-01

    Objectives. To compare pharmacy students’ performance on an objective structured clinical examination (OSCE) to their performance on a written examination for the assessment of problem-based learning (PBL); and to determine students’ and faculty members’ perceptions of OSCEs for PBL evaluations. Design. Four OSCEs were added to the written examination to assess 4 PBL cases in a third-year pharmacotherapy course. OSCE scores were compared to written examination scores. Faculty members evaluated student performance. Assessment. OSCE performance did not correlate with the written-examination scores. Most students (≥ 75%) agreed that OSCEs reflected their learning from PBL and measured knowledge, communication, and clinical skills. A majority of faculty members (≥75%) agreed that OSCEs should be part of PBL assessment. Conclusions. Addition of an OSCE to written examinations was valued and provided a more comprehensive assessment of the PBL experience. PMID:22544961

  14. Development and internal structure investigation of the Dimensional Clinical Personality Inventory

    Directory of Open Access Journals (Sweden)

    Lucas de Francisco Carvalho

    2015-06-01

    Full Text Available This study aimed to develop a dimensional instrument to assess personality disorders based on Millon's theoretical perspective and on DSM-IV-TR diagnoses criteria, and seek validity evidence based on internal structure and reliability indexes of the factors. In order to do that, a self-report test composed of 215 items, the Dimensional Clinical Personality Inventory (DCPI was developed and applied to 561 respondents aged between 18 and 90 years (M = 28,8; SD = 11.4, with 51.8% females. Exploratory factor analysis and verification of reliability were performed using Cronbach's alpha. Data provided validity evidence based on internal structure of the instrument according to the theory of Millon and DSM-IV-TR.

  15. Preprocessing structured clinical data for predictive modeling and decision support. A roadmap to tackle the challenges.

    Science.gov (United States)

    Ferrão, José Carlos; Oliveira, Mónica Duarte; Janela, Filipe; Martins, Henrique M G

    2016-12-07

    EHR systems have high potential to improve healthcare delivery and management. Although structured EHR data generates information in machine-readable formats, their use for decision support still poses technical challenges for researchers due to the need to preprocess and convert data into a matrix format. During our research, we observed that clinical informatics literature does not provide guidance for researchers on how to build this matrix while avoiding potential pitfalls. This article aims to provide researchers a roadmap of the main technical challenges of preprocessing structured EHR data and possible strategies to overcome them. Along standard data processing stages - extracting database entries, defining features, processing data, assessing feature values and integrating data elements, within an EDPAI framework -, we identified the main challenges faced by researchers and reflect on how to address those challenges based on lessons learned from our research experience and on best practices from related literature. We highlight the main potential sources of error, present strategies to approach those challenges and discuss implications of these strategies. Following the EDPAI framework, researchers face five key challenges: (1) gathering and integrating data, (2) identifying and handling different feature types, (3) combining features to handle redundancy and granularity, (4) addressing data missingness, and (5) handling multiple feature values. Strategies to address these challenges include: cross-checking identifiers for robust data retrieval and integration; applying clinical knowledge in identifying feature types, in addressing redundancy and granularity, and in accommodating multiple feature values; and investigating missing patterns adequately. This article contributes to literature by providing a roadmap to inform structured EHR data preprocessing. It may advise researchers on potential pitfalls and implications of methodological decisions in

  16. Structural-functional relationships between eye orbital imaging biomarkers and clinical visual assessments

    Science.gov (United States)

    Yao, Xiuya; Chaganti, Shikha; Nabar, Kunal P.; Nelson, Katrina; Plassard, Andrew; Harrigan, Rob L.; Mawn, Louise A.; Landman, Bennett A.

    2017-02-01

    Eye diseases and visual impairment affect millions of Americans and induce billions of dollars in annual economic burdens. Expounding upon existing knowledge of eye diseases could lead to improved treatment and disease prevention. This research investigated the relationship between structural metrics of the eye orbit and visual function measurements in a cohort of 470 patients from a retrospective study of ophthalmology records for patients (with thyroid eye disease, orbital inflammation, optic nerve edema, glaucoma, intrinsic optic nerve disease), clinical imaging, and visual function assessments. Orbital magnetic resonance imaging (MRI) and computed tomography (CT) images were retrieved and labeled in 3D using multi-atlas label fusion. Based on the 3D structures, both traditional radiology measures (e.g., Barrett index, volumetric crowding index, optic nerve length) and novel volumetric metrics were computed. Using stepwise regression, the associations between structural metrics and visual field scores (visual acuity, functional acuity, visual field, functional field, and functional vision) were assessed. Across all models, the explained variance was reasonable (R2 0.1-0.2) but highly significant (p < 0.001). Instead of analyzing a specific pathology, this study aimed to analyze data across a variety of pathologies. This approach yielded a general model for the connection between orbital structural imaging biomarkers and visual function.

  17. Students' concerns about the pre-internship objective structured clinical examination in medical education.

    Science.gov (United States)

    Labaf, Ali; Eftekhar, Hasan; Majlesi, Fereshteh; Anvari, Pasha; Sheybaee-Moghaddam, Farshad; Jan, Delnavaz; Jamali, Arsia

    2014-01-01

    Despite several studies on implementation, reliability and validity of the Objective Structured Clinical Examination (OSCE), the perceptions of examinees toward this evaluation tool remain unclear. The aim of the current study was to assess students' perceptions of the OSCE. All students in their final year of studies, who participated in the pre-internship OSCE in September 2010, were included in the study. A 16-item questionnaire was designed to assess: Characteristics of respondents; organization, content and structure of the OSCE; and perceptions of validity, reliability and rating of the OSCE with respect to other assessment methods. Questionnaires were administered immediately after all students had finished the OSCE and before leaving the examination venue. Response rate was 86.2%, with 77% of the students indicating the OSCE as a useful learning experience. A majority of the students (62%) agreed that a wide range of clinical skills was covered in this exam. However, 66% had concerns about the wide coverage of knowledge assessed. A total of 81% of students did not prefer the OSCE to multiple choice question exams and 88% found the OSCE intimidating and more stressful than other forms of assessment. Our study demonstrates that although the majority of students believe in the reliability and validity of the OSCE, they have concerns about it and report poor acceptance of the OSCE. Further studies are necessary to assess the important concerns of the students and the effectiveness of interventions in improving the acceptability of the OSCE.

  18. Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

    Science.gov (United States)

    Langenau, Erik; Kachur, Elizabeth; Horber, Dot

    2014-07-01

    Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Evaluation of perceived and actual competency in a family medicine objective structured clinical examination.

    Science.gov (United States)

    Graves, Lisa; Lalla, Leonora; Young, Meredith

    2017-04-01

    To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. McGill University in Montreal, Que. All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). A total of 140 (83%) of the third-year clinical clerks participated. Participating in an OSCE decreased learners' ratings of perceived competence (pre-OSCE score = 4.9, post-OSCE score = 4.7; F1,3192 = 4.2; P  .08 for all), nor did ratings of station-relevant competence (before and after) (r .09 for all). Ratings of competence before and after the OSCE were correlated for individual students (r > 0.40 and P medicine. However, this discordance is an important consideration for the development of competency-based curricula. Copyright© the College of Family Physicians of Canada.

  20. Population structure of clinical Vibrio parahaemolyticus from 17 coastal countries, determined through multilocus sequence analysis.

    Science.gov (United States)

    Han, Dongsheng; Tang, Hui; Lu, Jun; Wang, Guangzhou; Zhou, Lin; Min, Lingfeng; Han, Chongxu

    2014-01-01

    Vibrio parahaemolyticus is a leading cause of food-borne gastroenteritis worldwide. Although this bacterium has been the subject of much research, the population structure of clinical strains from worldwide collections remains largely undescribed, and the recorded outbreaks of V. parahaemolyticus gastroenteritis highlight the need for the subtyping of this species. We present a broad phylogenetic analysis of 490 clinical V. parahaemolyticus isolates from 17 coastal countries through multilocus sequence analysis (MLST). The 490 tested isolates fell into 161 sequence types (STs). The eBURST algorithm revealed that the 161 clinically relevant STs belonged to 8 clonal complexes, 11 doublets, and 94 singletons, showing a high level of genetic diversity. CC3 was found to be a global epidemic clone of V. parahaemolyticus, and ST-3 was the only ST with an international distribution. recA was observed to be evolving more rapidly, exhibiting the highest degree of nucleotide diversity (0.028) and the largest number of polymorphic nucleotide sites (177). We also found that the high variability of recA was an important cause of differences between the results of the eBURST and ME tree analyses, suggesting that recA has a much greater influence on the apparent evolutionary classification of V. parahaemolyticus based on the current MLST scheme. In conclusion, it is evident that a high degree of genetic diversity within the V. parahaemolyticus population and multiple sequence types are contributing to the burden of disease around the world. MLST, with a fully extractable database, is a powerful system for analysis of the clonal relationships of strains at a global scale. With the addition of more strains, the pubMLST database will provide more detailed and accurate information, which will be conducive to our future research on the population structure of V. parahaemolyticus.

  1. Data integration of structured and unstructured sources for assigning clinical codes to patient stays.

    Science.gov (United States)

    Scheurwegs, Elyne; Luyckx, Kim; Luyten, Léon; Daelemans, Walter; Van den Bulcke, Tim

    2016-04-01

    Enormous amounts of healthcare data are becoming increasingly accessible through the large-scale adoption of electronic health records. In this work, structured and unstructured (textual) data are combined to assign clinical diagnostic and procedural codes (specifically ICD-9-CM) to patient stays. We investigate whether integrating these heterogeneous data types improves prediction strength compared to using the data types in isolation. Two separate data integration approaches were evaluated. Early data integration combines features of several sources within a single model, and late data integration learns a separate model per data source and combines these predictions with a meta-learner. This is evaluated on data sources and clinical codes from a broad set of medical specialties. When compared with the best individual prediction source, late data integration leads to improvements in predictive power (eg, overall F-measure increased from 30.6% to 38.3% for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes), while early data integration is less consistent. The predictive strength strongly differs between medical specialties, both for ICD-9-CM diagnostic and procedural codes. Structured data provides complementary information to unstructured data (and vice versa) for predicting ICD-9-CM codes. This can be captured most effectively by the proposed late data integration approach. We demonstrated that models using multiple electronic health record data sources systematically outperform models using data sources in isolation in the task of predicting ICD-9-CM codes over a broad range of medical specialties. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Locating relevant patient information in electronic health record data using representations of clinical concepts and database structures.

    Science.gov (United States)

    Pan, Xuequn; Cimino, James J

    2014-01-01

    Clinicians and clinical researchers often seek information in electronic health records (EHRs) that are relevant to some concept of interest, such as a disease or finding. The heterogeneous nature of EHRs can complicate retrieval, risking incomplete results. We frame this problem as the presence of two gaps: 1) a gap between clinical concepts and their representations in EHR data and 2) a gap between data representations and their locations within EHR data structures. We bridge these gaps with a knowledge structure that comprises relationships among clinical concepts (including concepts of interest and concepts that may be instantiated in EHR data) and relationships between clinical concepts and the database structures. We make use of available knowledge resources to develop a reproducible, scalable process for creating a knowledge base that can support automated query expansion from a clinical concept to all relevant EHR data.

  3. [Structured patient handovers in perioperative medicine : Rationale and implementation in clinical practice].

    Science.gov (United States)

    Merkel, M J; von Dossow, V; Zwißler, B

    2017-06-01

    Clear and consistent communication is pivotal for well-functioning teamwork, in operating theatres as well as intensive care units. However, patient handovers significantly vary between specialties and locations. If communication is not well structured, it might increase the risk for mishaps and malpractice. Therefore, implementing structured handover protocols is pivotal. The perioperative setting is a high-risk environment that is prone to communication failures due to operational design (frequent change of shift due to working time restrictions) and a high work load and multitasking (operating room management, short surgery times, concurrent emergencies). Hence teamwork in the operating room and intensive care unit requires clear and consistent communication. In the perioperative setting, the patient is transferred several times: from the ward to operating room, to recovery, intermediate care/intensive care unit and back to normal ward. This necessitates multiple handovers. Since 2005, the World Health Organization (WHO) requests a structured handover concept that processes all relevant information in a predefined order. The SBAR concept (situation, background, assessment, recommendation) is an intuitive communication concept that can improve quality of patient handovers. This underlines the clinical relevance of a structured handover concept that leads to improved outcomes for every patient.In this review, basic measures for a clear and consistent communication are presented. These are pivotal for an effective teamwork and for ensuing patient safety. Furthermore, we will focus on possibilities to implement structured approaches but also on potential barriers of implementation. Communication failure among different health care providers can be identified more easily and hopefully can be eliminated.

  4. Analysis of the level of general clinical skills of physician assistant students using an objective structured clinical examination

    NARCIS (Netherlands)

    Vught, A.J. van; Hettinga, A.M.; Denessen, E.J.P.G.; Gerhardus, M.J.T.; Bouwmans, G.A.M.; Brink, G.T. van den; Postma, C.T.

    2015-01-01

    RATIONALE, AIMS AND OBJECTIVES: The physician assistant (PA) is trained to perform clinical tasks traditionally performed by medical doctors (MDs). Previous research showed no difference in the level of clinical skills of PAs compared with MDs in a specific niche, that is the specialty in which they

  5. Disorder recognition in clinical texts using multi-label structured SVM.

    Science.gov (United States)

    Lin, Wutao; Ji, Donghong; Lu, Yanan

    2017-01-31

    Information extraction in clinical texts enables medical workers to find out problems of patients faster as well as makes intelligent diagnosis possible in the future. There has been a lot of work about disorder mention recognition in clinical narratives. But recognition of some more complicated disorder mentions like overlapping ones is still an open issue. This paper proposes a multi-label structured Support Vector Machine (SVM) based method for disorder mention recognition. We present a multi-label scheme which could be used in complicated entity recognition tasks. We performed three sets of experiments to evaluate our model. Our best F1-Score on the 2013 Conference and Labs of the Evaluation Forum data set is 0.7343. There are six types of labels in our multi-label scheme, all of which are represented by 24-bit binary numbers. The binary digits of each label contain information about different disorder mentions. Our multi-label method can recognize not only disorder mentions in the form of contiguous or discontiguous words but also mentions whose spans overlap with each other. The experiments indicate that our multi-label structured SVM model outperforms the condition random field (CRF) model for this disorder mention recognition task. The experiments show that our multi-label scheme surpasses the baseline. Especially for overlapping disorder mentions, the F1-Score of our multi-label scheme is 0.1428 higher than the baseline BIOHD1234 scheme. This multi-label structured SVM based approach is demonstrated to work well with this disorder recognition task. The novel multi-label scheme we presented is superior to the baseline and it can be used in other models to solve various types of complicated entity recognition tasks as well.

  6. Assessment of Semi-Structured Clinical Interview for Mobile ‎Phone ‎Addiction Disorder

    Directory of Open Access Journals (Sweden)

    Seyyed Salman Alavi

    2016-06-01

    Full Text Available Objective: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR classified mobile phone addiction disorder under ‎‎"impulse control disorder not elsewhere classified". This study surveyed the ‎diagnostic criteria of DSM-IV-TR for the diagnosis of mobile phone ‎addiction in correspondence with Iranian society and culture.‎Method: Two hundred fifty students of Tehran universities were entered into this ‎descriptive-analytical and cross-sectional study. Quota sampling method ‎was used. At first, semi- structured clinical interview (based on DSM-IV-‎TR was performed for all the cases, and another specialist re-evaluated the ‎interviews. Data were analyzed using content validity, inter-scorer reliability (Kappa coefficient and test-retest via SPSS18 software.Results: The content validity of the semi- structured clinical interview matched the ‎DSM –IV-TR criteria for behavioral addiction. Moreover, their content was ‎appropriate, and two items, including "SMS pathological use" and "High ‎monthly cost of using the mobile phone” were added to promote its validity. ‎Internal reliability (Kappa and test –retest reliability were 0.55 and r = 0.4 ‎‎(p<0. 01 respectively.‎Conclusion: The results of this study revealed that semi- structured diagnostic criteria of ‎DSM-IV-TR are valid and reliable for diagnosing mobile phone addiction, ‎and this instrument is an effective tool to diagnose this disorder.‎

  7. Structured internship orientation programme for undergraduate students: easy transition to clinical work.

    Science.gov (United States)

    Goel, Ashish; Venkat, R; Kumar, A; Adkoli, B V; Sood, Rita

    2010-01-01

    Internship is a phase of training when a new graduate is expected to acquire skills under supervision, so that he/she may become capable of functioning independently. Often, new graduates go through this period without a clear aim. We conducted an orientation programme before fresh graduates started their 1-year internship to familiarize them with their clinical tasks and their role in the community. Interns were invited to participate in a one-and-a-half day programme conducted by faculty members and administrators that included interactive lectures, structured panel discussions, group discussions and role plays. The participants provided feedback using a structured questionnaire and during informal group discussions. They were also evaluated by a pre-test and post-test questionnaire. Of the 41 interns who attended the programme on day 1 and the 28 who completed it on day 2, 19 completed the post-test questionnaire. The post-test score (median 14.5; range 10-18) represented a significant improvement over the pre-test score (median 13, range 3-16). All participants felt that the workshop was successful in achieving its objectives. A brief and structured orientation programme before internship offers a practical means of making the transition of new graduates from students to practising doctors smoother.

  8. The Structure of Pathological Gambling among Korean Gamblers: A Cluster and Factor Analysis of Clinical and Demographic Characteristics

    Science.gov (United States)

    Lee, Tae Kyung; LaBrie, Richard A.; Grant, Jon E.; Kim, Suck Won; Shaffer, Howard J.

    2008-01-01

    This paper reports the underlying structure of the demographic and clinical characteristics of level 3 (i.e., pathological) Korean casino gamblers. The participants reported their gambling behavior and clinical characteristics known to be associated with gambling problems (e.g., alcohol use problems, eating disorders, depression, anxiety, and…

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

    Directory of Open Access Journals (Sweden)

    Pandya J

    2010-01-01

    Full Text Available Background: Postgraduate specialities require a combination of knowledge and clinical skills. The internship year is less structured. Clinical and practical skills that are picked up during training are not well regulated and the impact is not assessed. In this study, we assessed knowledge and skills using objective structured clinical examination (OSCE. Aim: To evaluate the clinical skills of new first-year surgical residents using orientation programme and OSCE as a tool for assessment. Settings and Design: Observational study. Materials and Methods: Twenty new first-year surgical residents (10 each in 2008 and 2009 participated in a detailed structured orientation programme conducted over a period of 7 days. Clinically important topics and skills expected at this level (e.g., suturing, wound care etc. were covered. The programme was preceded by an OSCE to test pre-programme knowledge (the "pre-test". The questions were validated by senior department staff. A post-programme OSCE (the "post-test" helped to evaluate the change in clinical skill level brought about by the orientation programme. Statistical Analysis: Wilcoxson matched-pairs signed-ranks test. Results: Passing performance was achieved by all participants in both pre- and post-tests. Following the orientation programme, significant improvement was seen in tasks testing the psychomotor and cognitive domains. (P = 0.0001 and P = 0.0401, respectively. Overall reliability of the OSCE was found to be 0.7026 (Cronbach′s coefficient alpha. Conclusions: This study highlighted the lacunae in current internship training, especially for skill-based tasks. There is a need for universal inclusion of structured orientation programmes in the training of first-year residents. OSCE is a reliable, valid and effective method for the assessment of clinical skills.

  10. Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis.

    Science.gov (United States)

    Wiegant, K; van Roermund, P M; Intema, F; Cotofana, S; Eckstein, F; Mastbergen, S C; Lafeber, F P J G

    2013-11-01

    Treatment of severe osteoarthritis (OA) in relatively young patients is challenging. Although successful, total knee prosthesis has a limited lifespan, with the risk of revision surgery, especially in active young patients. Knee joint distraction (KJD) provides clinical benefit and tissue structure modification at 1-year follow-up. The present study evaluates whether this benefit is preserved during the second year of follow-up. Patients included in this study presented with end-stage knee OA and an indication for total knee replacement (TKR); they were less than 60 years old with a VAS pain ≥60 mm (n = 20). KJD was applied for 2 months (range 54-64 days) and clinical parameters assessed using the WOMAC questionnaire and VAS pain score. Changes in cartilage structure were measured using quantitative MRI, radiography, and biochemical analyses of collagen type II turnover (ELISA). Average follow-up was 24 (range 23-25) months. Clinical improvement compared with baseline (BL) was observed at 2-year follow-up: WOMAC improved by 74% (P MRI (2.35 mm (95%CI, 2.06-2.65) at BL) was significantly greater at 2-year follow-up (2.78 mm (2.50-3.09); P = 0.03). Radiographic minimum joint space width (JSW) (1.1 mm (0.5-1.7) at BL) was significantly increased at 2-year follow-up as well (1.7 mm (1.1-2.3); P = 0.03). The denuded area of subchondral bone visualized by MRI (22% (95%CI, 12.5-31.5) at BL) was significantly decreased at 2-year follow-up (8% (3.6-12.2); P = 0.004). The ratio of collagen type II synthesis over breakdown was increased at 2-year follow-up (P = 0.07). Clinical improvement by KJD treatment is sustained for at least 2 years. Cartilage repair is still present after 2 years (MRI) and the newly formed tissue continues to be mechanically resilient as shown by an increased JSW under weight-bearing conditions. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  11. Development of an Objective Structured Clinical Examination For Assessment of Clinical Skills in an Emergency Medicine Clerkship

    Directory of Open Access Journals (Sweden)

    Sharon Bord

    2015-10-01

    Full Text Available Assessment of medical students in their emergency medicine (EM clerkship is often based on clinical shift evaluations and written examinations. Clinical evaluations offer some insight into students’ ability to apply knowledge to clinical problems, but are notoriously unreliable, with score variance that may be driven as much by error as by actual student performance.1-6 Clinical evaluations are also limited by the unpredictability of pathology in emergency department (ED patients, and by patient safety considerations that prevent students from independently managing patients, especially those with high-acuity conditions. Additionally, there is evidence that the basic skills of history and physical exam are rarely observed by faculty members, and the feedback they receive on these domains is limited.7-9 These factors hinder EM educators in their effort to objectively assess students’ progress relative to clerkship objectives, particularly those that pertain to emergent care.

  12. How Do Emergency Medicine Residency Programs Structure Their Clinical Competency Committees? A Survey.

    Science.gov (United States)

    Doty, Christopher I; Roppolo, Lynn P; Asher, Shellie; Seamon, Jason P; Bhat, Rahul; Taft, Stephanie; Graham, Autumn; Willis, James

    2015-11-01

    The Accreditation Council for Graduate Medical Education (ACGME) recently has mandated the formation of a clinical competency committee (CCC) to evaluate residents across the newly defined milestone continuum. The ACGME has been nonproscriptive of how these CCCs are to be structured in order to provide flexibility to the programs. No best practices for the formation of CCCs currently exist. We seek to determine common structures of CCCs recently formed in the Council of Emergency Medicine Residency Directors (CORD) member programs and identify unique structures that have been developed. In this descriptive study, an 18-question survey was distributed via the CORD listserv in the late fall of 2013. Each member program was asked questions about the structure of its CCC. These responses were analyzed with simple descriptive statistics. A total of 116 of the 160 programs responded, giving a 73% response rate. Of responders, most (71.6%) CCCs are chaired by the associate or assistant program director, while a small number (14.7%) are chaired by a core faculty member. Program directors (PDs) chair 12.1% of CCCs. Most CCCs are attended by the PD (85.3%) and selected core faculty members (78.5%), leaving the remaining committees attended by any core faculty. Voting members of the CCC consist of the residency leadership either with the PD (53.9%) or without the PD (36.5%) as a voting member. CCCs have an average attendance of 7.4 members with a range of three to 15 members. Of respondents, 53.1% of CCCs meet quarterly while 37% meet monthly. The majority of programs (76.4%) report a system to match residents with a faculty mentor or advisor. Of respondents, 36% include the resident's faculty mentor or advisor to discuss a particular resident. Milestone summaries (determination of level for each milestone) are the primary focus of discussion (93.8%), utilizing multiple sources of information. The substantial variability and diversity found in our CORD survey of CCC structure

  13. The factor structure of anxiety and depressive disorders in a sample of clinic-referred adolescents.

    Science.gov (United States)

    Gomez, Rapson; Vance, Alasdair; Gomez, Rashika Miranjani

    2014-02-01

    The current study used confirmatory factor analysis (CFA) to examine the factor structure of anxiety and depressive disorders in a sample of clinic-referred adolescents, aged between 12 and 18 years, for diagnoses based on parent (N = 655; male = 441) and adolescent (N = 626; male = 417) interviews. Three models were examined: a 1-factor model, with all anxiety and depressive disorders in a single factor; a DSM-based 2-factor model, with anxiety disorders in one factor, and depressive disorders in another factor; and an alternate 2-factor model, with fear related anxiety disorders in one factor, and other anxiety and depressive disorders in another factor. The findings indicated support for all three models. Also, ADHD and ODD/CD were associated with only the shared variances between the latent factors in the 2-factor models, and not their unique variance. The implications of the findings for taxonomy, comorbidity, and clinical practice are discussed.

  14. Reliability analysis of the objective structured clinical examination using generalizability theory.

    Science.gov (United States)

    Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

    2016-01-01

    The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

  15. An Audit of the Medical Students’ Perceptions regarding Objective Structured Clinical Examination

    Directory of Open Access Journals (Sweden)

    Abidullah Khan

    2016-01-01

    Full Text Available Objective. To record the perceptions of the final year MBBS students of Khyber Medical College (KMC Peshawar regarding Objective Structured Clinical Examination (OSCE conducted in the year 2016. Materials and Methods. This study was conducted in April 2016 which is in fact a reaudit of our similar survey done back in 2015. A total of 250 final year MBBS students participated by filling in a validated and pretested questionnaire already used by Russel et al. and Khan et al. in similar but separate studies including questions regarding exam content, quality of performance, OSCE validity and reliability, and so forth. The data was analyzed using SPSS version 20. Results. The study group comprised 160 (64% males and 90 (36% females. 220 (88% stated that exam was fair and comprehensive; 94% believed OSCE was more stressful and mentally tougher. 96% of the students considered OSCE as valid and reliable and 87% were happy with its use in clinical competence assessment. Conclusion. Majority of students declared their final year OSCE as fair, comprehensive, standardized, less biased, and reliable format of examination but believed it was more stressful and mentally tougher than traditional examination methods.

  16. Expanding the role of objectively structured clinical examinations in nephrology training.

    Science.gov (United States)

    Prince, Lisa K; Abbott, Kevin C; Green, Felicidad; Little, Dustin; Nee, Robert; Oliver, James D; Bohen, Erin M; Yuan, Christina M

    2014-06-01

    Objectively structured clinical examinations (OSCEs) are widely used in medical education, but we know of none described that are specifically for nephrology fellowship training. OSCEs use simulation to educate and evaluate. We describe a technically simple, multidisciplinary, low-cost OSCE developed by our program that contains both examination and training features and focuses on management and clinical knowledge of rare hemodialysis emergencies. The emergencies tested are venous air embolism, blood leak, dialysis membrane reaction, and hemolysis. Fifteen fellows have participated in the OSCE as examinees and/or preceptors since June 2010. All have passed the exercise. Thirteen responded to an anonymous survey in July 2013 that inquired about their confidence in managing each of the 4 tested emergencies pre- and post-OSCE. Fellows were significantly more confident in their ability to respond to the emergencies after the OSCE. Those who subsequently saw such an emergency reported that the OSCE experience was somewhat or very helpful in managing the event. The OSCE tested and trained fellows in the recognition and management of rare hemodialysis emergencies. OSCEs and simulation generally deserve greater use in nephrology subspecialty training; however, collaboration between training programs would be necessary to validate such exercises. Published by Elsevier Inc.

  17. Valuing structured professional judgment: predictive validity, decision-making, and the clinical-actuarial conflict.

    Science.gov (United States)

    Falzer, Paul R

    2013-01-01

    Structured professional judgment (SPJ) has received considerable attention as an alternative to unstructured clinical judgment and actuarial assessment, and as a means of resolving their ongoing conflict. However, predictive validity studies have typically relied on receiver operating characteristic (ROC) analysis, the same technique commonly used to validate actuarial assessment tools. This paper presents SPJ as distinct from both unstructured clinical judgment and actuarial assessment. A key distinguishing feature of SPJ is the contribution of modifiable factors, either dynamic or protective, to summary risk ratings. With modifiable factors, the summary rating scheme serves as a prognostic model rather than a classification procedure. However, prognostic models require more extensive and thorough predictive validity testing than can be provided by ROC analysis. It is proposed that validation should include calibration and reclassification techniques, as well as additional measures of discrimination. Several techniques and measures are described and illustrated. The paper concludes by tracing the limitations of ROC analysis to its philosophical foundation and its origin as a statistical theory of decision-making. This foundation inhibits the performance of crucial tasks, such as determining the sufficiency of a risk assessment and examining the evidentiary value of statistical findings. The paper closes by noting a current effort to establish a viable and complementary relationship between SPJ and decision-making theory. Copyright © 2013 John Wiley & Sons, Ltd.

  18. Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training.

    Science.gov (United States)

    Griesser, Michael J; Beran, Matthew C; Flanigan, David C; Quackenbush, Michael; Van Hoff, Corey; Bishop, Julie Y

    2012-01-01

    While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. Prospective, uncontrolled, observational. A major Midwestern tertiary referral center and academic medical center. The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. An objective structured clinical exam to measure intrinsic CanMEDS roles.

    Science.gov (United States)

    Kassam, Aliya; Cowan, Michèle; Donnon, Tyrone

    2016-01-01

    The CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE) is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise. We developed the CanMEDS In-Training Exam (CITE), a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary) and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA) was used to investigate differences between year of residency, sex, and the type of residency program. In total, 63 residents participated in the CITE; 40 residents (63%) were from internal medicine programs, whereas the remaining 23 (37%) were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, pmedical education.

  20. Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services.

    Directory of Open Access Journals (Sweden)

    Kine Johansen

    Full Text Available This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.

  1. [The objective structured clinical evaluation of teaching in anaesthesiology and resuscitation].

    Science.gov (United States)

    Echevarría Moreno, M; Prieto Vera, C; Martín Tellería, A; Neira Reina, F; Martín, J S; Fernández Jurado, M L; Luis Navarro, J C; Ortega Garcia, J L; Alarcón Martínez, L; López-Cuervo Derqui, R

    2012-03-01

    To find out the acquirement of professional competencies of Anaesthesiology and Resuscitation medical residents at the end of their training period using the Objective Structured Clinical Evaluation (OCSE) tool. Six competency components to evalúate were defined as follows: clinical interview (communication), technical ability and relationship abilities (leadership, decision making, work in a team), diagnostic assessment, therapeutic management, and medical records. Different methodologies were determined depending on the knowledge and skills to evaluate. Twelve clinical cases were developed that were performed in 12 stations. A total of 107 Ítems, specified within the stations, evaluated the competency components. A total of 43 residents were invited to participate in the last 4 months of their training in hospitals in Andalusia and Extremadura. A total of 33 residents participated. The overall mean of the classifications obtained in the 12 stations was 64.2 out of a maximum of 100. The medical residents demonstrated higher competency in obstetrics, paediatric anaesthesia, and that associated with difficult airway. The main competency gaps were detected in the area of one-day surgery, chronic pain, and literature management, in which approximately half passed the test. We believe that training evaluations, such as the OCSE, help in determining the skill levels of the medical resident, making it easier to continually improve the training of the future anaesthesiologist. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España.. All rights reserved.

  2. Neural structure and social dysfunction in individuals at clinical high risk for psychosis.

    Science.gov (United States)

    Lincoln, Sarah Hope; Hooker, Christine I'Lee

    2014-12-30

    Individuals at a clinical high risk (CHR) for psychosis have gray matter volume (GMV) abnormalities that are similar to, though less severe than, those in individuals with schizophrenia. Less GMV in schizophrenia is related to worse social cognition and social functioning, but the relationship between GMV and social functioning in CHR individuals has yet to be investigated. The aim of this study was to (1) investigate differences in GMV between healthy controls (HC) and CHR individuals, and (2) evaluate the relationship between GMV and social functioning in these two groups. Participants comprised 22 CHR and 21 HC individuals who completed a structural magnetic resonance imaging (MRI) scan as well as self-reported and interviewer-rated measures of social functioning. Processing and analysis of structural images were completed using voxel based morphometry (VBM). Results showed that the CHR group had less GMV in the left postcentral gyrus, bilateral parahippocampual gyri, and left anterior cingulate cortex. Reduced GMV in the postcentral gyrus and the anterior cingulate was related to self-reported social impairment across the whole group. This study has implications for the neurobiological basis of social dysfunction present before the onset of psychosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Measuring Professional Behaviour in Canadian Physical Therapy Students' Objective Structured Clinical Examinations: An Environmental Scan

    Science.gov (United States)

    Ellerton, Cindy; Evans, Cathy

    2015-01-01

    ABSTRACT Purpose: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. Method: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. Results: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). Conclusions: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes. PMID:25931656

  4. Evaluation of objective structured clinical examination for advanced orthodontic education 12 years after introduction.

    Science.gov (United States)

    Fields, Henry W; Kim, Do-Gyoon; Jeon, Minjeong; Firestone, Allen R; Sun, Zongyang; Shanker, Shiva; Mercado, Ana M; Deguchi, Toru; Vig, Katherine W L

    2017-05-01

    Advanced education programs in orthodontics must ensure student competency in clinical skills. An objective structure clinical examination has been used in 1 program for over a decade. The results were analyzed cross-sectionally and longitudinally to provide insights regarding the achievement of competency, student growth, question difficulty, question discrimination, and question predictive ability. In this study, we analyzed 218 (82 first-year, 68 second-year, and 68 third-year classes) scores of each station from 85 orthodontic students. The grades originated from 13 stations and were collected anonymously for 12 consecutive years during the first 2 decades of the 2000s. The stations tested knowledge and skills regarding dental relationships, analyzing a cephalometric tracing, performing a diagnostic skill, identifying cephalometric points, bracket placement, placing first-order and second-order bends, forming a loop, placing accentuated third-order bends, identifying problems and planning mixed dentition treatment, identifying problems and planning adolescent dentition treatment, identifying problems and planning nongrowing skeletal treatment, superimposing cephalometric tracings, and interpreting cephalometric superimpositions. Results were evaluated using multivariate analysis of variance, chi-square tests, and latent growth analysis. The multivariate analysis of variance showed that all stations except 3 (analyzing a cephalometric tracing, forming a loop, and identifying cephalometric points) had significantly lower mean scores for the first-year student class than the second- and third-year classes (P 0.108). The chi-square analysis of the distribution of the number of noncompetent item responses decreased from the first to the second years (P <0.0003), from the second to the third years (P <0.0042), and from the first to the third years (P <0.00003). The latent growth analysis showed a wide range of difficulty and discrimination between questions. It

  5. Medical students' perception of objective structured clinical examination: a feedback for process improvement.

    Science.gov (United States)

    Nasir, Abdulrasheed A; Yusuf, Ayodeji S; Abdur-Rahman, Lukman O; Babalola, Olasunkanmi M; Adeyeye, Ademola A; Popoola, Ademola A; Adeniran, James O

    2014-01-01

    Medical educators have always been desirous of the best methods for formative and summative evaluation of trainees. The Objective Structured Clinical Examination (OSCE) is an approach for student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent, and structured manner with close attention to the objectivity of the process. Though popular in most medical schools globally, its use in Nigeria medical schools appears limited. This study was conceived to explore students' perception about the acceptability of OSCE process and to provide feedback to be used to improve the assessment technique. A cross-sectional survey was conducted on final-year medical students, who participated in the final MBBS surgery examination in June 2011. A 19-item self-administered structured questionnaire was employed to obtain relevant data on demographics of respondents and questions evaluating the OSCE stations in terms of the quality of instructions and organization, learning opportunities, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared with other formats. Students' responses were based on a 5-point Likert scales ranging from strongly disagree to strongly agree. The data were analyzed using SPSS, version 15 (SPSS, Inc, Chicago, IL). The study took place at the University of Ilorin, College of Health Science. A total of 187 final-year medical students were enrolled in to the survey. Of 187 eligible students, 151 completed the self-administered questionnaire representing 80.7% response rate. A total of 61 (40.4%) students felt that it was easy to understand written instructions at the OSCE stations. In total, 106 (70.2%) students felt that the time allocated to each station was adequate. A total of 89 (58.9%) students agreed that the OSCE accurately measured their knowledge and skill, and 85 (56.3%) reported that OSCE enhanced their communication skill. Of the respondents, 80 (53

  6. Proposing a clinical quantification framework of macro-linguistic structures in aphasic narratives

    Directory of Open Access Journals (Sweden)

    Anthony Pak Hin Kong

    2014-03-01

    Full Text Available Background Analysis of aphasic narratives can be a challenge for clinicians. Previous studies have mainly employed measures that categorized speech samples at the word level. They included quantification of the use and misuse of different word classes, presence and absence of narrative contents and errors, paraphasias, and perseverations, as well as morphological structures and errors within a narrative. In other words, a great amount of research has been conducted in the aphasiology literature focusing on micro-linguistic structures of oral narratives. Aspects of macro- linguistic structures, such as the analysis of content information by a speaker, consistency of using cohesive devices to present information within a narrative, and order of presenting information necessary to form a coherent discourse, have not been extensively investigated. The current investigation proposes a clinical analytic system to target three aspects of macro-linguistic structures in narratives among speakers with aphasia. Specifically, (1 the presence of search events (i.e., the mentioning of key events that allow the listener to understand; Capilouto, Wright, &Wagovich, 2006 within a narrative, (2 the sequence of the mentioned events, and (3 the informativeness (i.e., the fulfillment of lexical items that allow the user to understand what the event is detailing of the event contents, were focused in the proposed framework. Method Ten controls transcripts from were selected from the AphasiaBank (MacWhinney, Fromm, Forbes, & Holland, 2011. Three narrative tasks, including sequential picture description of ‘Refused Umbrella’, procedural narrative of making a ‘Peanut Butter and Jelly Sandwich’, and telling of ‘Cinderella’ story, were used to establish normative data for the basis of analysis. Specifically, the Search Events (e and Informative Words (i used by at least 70% of the speakers were listed for each genre. The sequential order of mentioning the

  7. Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population.

    Science.gov (United States)

    Qvist, Ina; Hendriks, Jeroen M L; Møller, Dorthe S; Albertsen, Andi E; Mogensen, Helle M; Oddershede, Gitte D; Odgaard, Annette; Mortensen, Leif Spange; Johnsen, Søren Paaske; Frost, Lars

    2016-01-01

    A previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death. All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated by the same principles in both cohorts. A total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found. The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23). Structured, nurse-led, hospital-based AF care appears to be effective, and patient outcomes in an actual, hospital-based, structured AF care are as least as good as those in trial settings.

  8. The objective structured clinical examination: can physician-examiners participate from a distance?

    Science.gov (United States)

    Chan, James; Humphrey-Murto, Susan; Pugh, Debra M; Su, Charles; Wood, Timothy

    2014-04-01

    Currently, a 'pedagogical gap' exists in distributed medical education in that distance educators teach medical students but typically do not have the opportunity to assess them in large-scale examinations such as the objective structured clinical examination (OSCE). We developed a remote examiner OSCE (reOSCE) that was integrated into a traditional OSCE to establish whether remote examination technology may be used to bridge this gap. The purpose of this study was to explore whether remote physician-examiners can replace on-site physician-examiners in an OSCE, and to determine the feasibility of this new examination method. Forty Year 3 medical students were randomised into six reOSCE stations that were incorporated into two tracks of a 10-station traditional OSCE. For the reOSCE stations, student performance was assessed by both a local examiner (LE) in the room and a remote examiner (RE) who viewed the OSCE encounters from a distance. The primary endpoint was the correlation of scores between LEs and REs across all reOSCE stations. The secondary endpoint was a post-OSCE survey of both REs and students. Statistically significant correlations were found between LE and RE checklist scores for history taking (r = 0.64-r = 0.80), physical examination (r = 0.41-r = 0.54), and management stations (r = 0.78). Correlations between LE and RE global ratings were more varied (r = 0.21-r = 0.77). Correlations on three of the six stations reached significance. Qualitative analysis of feedback from REs and students showed high acceptance of the reOSCE despite technological issues. This preliminary study demonstrated that OSCE ratings by LEs and REs were reasonably comparable when using checklists. Remote examination may be a feasible and acceptable way of assessing students' clinical skills, but further validity evidence will be required before it can be recommended for use in high-stakes examinations. © 2014 John Wiley & Sons Ltd.

  9. Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.

    Science.gov (United States)

    Posner, Glenn; Naik, Viren; Bidlake, Erin; Nakajima, Amy; Sohmer, Benjamin; Arab, Abeer; Varpio, Lara

    2012-04-01

    The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE. Sixteen obstetrics and gynaecology residents participated in this mixed methods study. Prior to disclosing the complication in an SP encounter, residents were randomized either to receive a written description of an adverse event, or to experience a mannequin simulation of an adverse event. Mean OSCE scores from blinded examiners were compared in each group. Focus group discussions elicited residents' reflections on the experience of disclosing the adverse event. The mean score was 16.6/23 ± 2.9 (range 10 to 20) for the traditional OSCE group and 16.9/23 ± 1.7 (range 15 to 20) for the simulation group. Analysis of the focus group data revealed several themes, such as the type of context the residents desired, the emotional involvement they felt, and their insights about their experience of the simulation scenario or with the SP. The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.

  10. An objective structured clinical exam to measure intrinsic CanMEDS roles

    Directory of Open Access Journals (Sweden)

    Aliya Kassam

    2016-09-01

    Full Text Available Background: The CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise. Method: We developed the CanMEDS In-Training Exam (CITE, a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA was used to investigate differences between year of residency, sex, and the type of residency program. Results: In total, 63 residents participated in the CITE; 40 residents (63% were from internal medicine programs, whereas the remaining 23 (37% were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, p<0.05. Noninternal medicine residents scored higher in terms of the Professional competency overall, whereas internal medicine residents scored significantly higher in the Collaborator competency overall. Discussion: The OSCE checklists developed for the assessment of intrinsic CanMEDS roles were functional, but the specific items within stations required more uniformity to be used between stations. More generic types of checklists may also improve correlations across stations. Conclusion: An OSCE measuring intrinsic competence is feasible; however, further development of our cases and checklists is needed. We provide a model of how to develop an OSCE to measure intrinsic CanMEDS roles that educators may adopt as

  11. HIV-1 Protease with 20 Mutations Exhibits Extreme Resistance to Clinical Inhibitors through Coordinated Structural Rearrangements

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    Agniswamy, Johnson; Shen, Chen-Hsiang; Aniana, Annie; Sayer, Jane M.; Louis, John M.; Weber, Irene T. (GSU); (NIH)

    2012-06-28

    The escape mutant of HIV-1 protease (PR) containing 20 mutations (PR20) undergoes efficient polyprotein processing even in the presence of clinical protease inhibitors (PIs). PR20 shows >3 orders of magnitude decreased affinity for PIs darunavir (DRV) and saquinavir (SQV) relative to PR. Crystal structures of PR20 crystallized with yttrium, substrate analogue p2-NC, DRV, and SQV reveal three distinct conformations of the flexible flaps and diminished interactions with inhibitors through the combination of multiple mutations. PR20 with yttrium at the active site exhibits widely separated flaps lacking the usual intersubunit contacts seen in other inhibitor-free dimers. Mutations of residues 35-37 in the hinge loop eliminate interactions and perturb the flap conformation. Crystals of PR20/p2-NC contain one uninhibited dimer with one very open flap and one closed flap and a second inhibitor-bound dimer in the closed form showing six fewer hydrogen bonds with the substrate analogue relative to wild-type PR. PR20 complexes with PIs exhibit expanded S2/S2' pockets and fewer PI interactions arising from coordinated effects of mutations throughout the structure, in agreement with the strikingly reduced affinity. In particular, insertion of the large aromatic side chains of L10F and L33F alters intersubunit interactions and widens the PI binding site through a network of hydrophobic contacts. The two very open conformations of PR20 as well as the expanded binding site of the inhibitor-bound closed form suggest possible approaches for modifying inhibitors to target extreme drug-resistant HIV.

  12. The Objective Structured Clinical Examination (OSCE) as a strategy for assessing clinical competence in midwifery education in Ireland: a critical review.

    Science.gov (United States)

    Smith, Valerie; Muldoon, Kathryn; Biesty, Linda

    2012-09-01

    In Ireland, to register as a midwife, all student midwives must be deemed competent to practice with the assessment of competence an essential component of midwifery education. A variety of assessment strategies, including observed practice, clinical interviews, portfolios of reflection, the Objective Structured Clinical Examination (OSCE) and written examination papers, are utilised to assess midwifery students' clinical competence. In this paper, a critical review of the OSCE as a strategy for assessing clinical competence in one third level institution in Ireland is offered. Although utilised for assessing competence across a range of areas (e.g. obstetric emergencies and pharmacology/drug administration), the use of the OSCE for assessing midwifery students' competence in lactation and infant feeding practices, as an example for this paper, is described. The advantages, disadvantages, validity and reliability of the OSCE, as an assessment strategy, are critically explored. Recognising that no single assessment strategy can provide all the information required to assess something as complex as clinical performance, the OSCE, when viewed alongside other forms of assessment, and with relevance to the topic under examination, may be considered a valuable strategy for enhancing the assessment of students' clinical competence, and for embracing diversity within midwifery education and training. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Saudi Internal Medicine Residents׳ Perceptions of the Objective Structured Clinical Examination as a Formative Assessment Tool

    Directory of Open Access Journals (Sweden)

    Salwa Alaidarous

    2016-12-01

    Full Text Available The Saudi Commission for Health Specialties first implemented the Objective Structured Clinical Examinations (OSCE as part of the final year Internal Medicine clerkship exam during the 2007–2008 academic year. This study evaluated Internal Medicine residents׳ overall perceptions of the OSCE as a formative assessment tool. It focused on residents׳ perceptions of the OSCE stations׳ attributes, determined the acceptability of the process, and provided feedback to enhance further development of the assessment tool. The main objective was to assess Internal Medicine resident test-takers׳ perceptions and acceptance of the OSCE, and to identify its strengths and weaknesses through their feedback. Sixty six residents were involved in the studied administered on November 8th 2012 at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Overall, resident׳s evaluation of the OSCE was favorable and encouraging. To this end, we recommend that formative assessment opportunities using the OSCE for providing feedback to students should be included in the curriculum, and continuing refinement and localized adaptation of OSCEs in use should be pursued by course directors and assessment personnel.

  14. The Assessment of Undergraduate Medical Students’ Satisfaction Levels With the Objective Structured Clinical Examination

    Science.gov (United States)

    Khosravi Khorashad, Ahmad; Salari, Somayyeh; Baharvahdat, Humain; Hejazi, Sepideh; Lari, Shiva M; Salari, Maasoomeh; Mazloomi, Maryam; Lari, Shahrzad M

    2014-01-01

    Background: The objective structured clinical examination (OSCE) has been introduced as an efficient method for the assessment of medical students. Objectives: The aim of the present study was to determine the satisfaction level of undergraduate medical students of internal medicine department with the OSCE. Materials and Methods: This was a descriptive cross-sectional study, performed on all available undergraduate students at the end of their internal medicine training period in Mashhad University of Medical Sciences. The students responded to 15 multiple-choice questions with confirmed validity and reliability. Results: The majority of the students (94.5%) had a positive attitude toward the OSCE and mentioned that the OSCE format was a more appropriate type of exam than other methods of testing; however, 79.1% thought that the OSCE format was stressful. In addition, the participants’ sex had no effect on their level of satisfaction with the examination. Likewise, there was no significant correlation between their level of satisfaction and their age, marital status, or lack of previous experience with this type of exam. Conclusions: If the exam standards are met and a uniform dispersion of the scientific content is maintained, the OSCE method of assessment can be recommended as an efficient and applicable method for assessing medical students. PMID:25389474

  15. The assessment of undergraduate medical students' satisfaction levels with the objective structured clinical examination.

    Science.gov (United States)

    Khosravi Khorashad, Ahmad; Salari, Somayyeh; Baharvahdat, Humain; Hejazi, Sepideh; Lari, Shiva M; Salari, Maasoomeh; Mazloomi, Maryam; Lari, Shahrzad M

    2014-08-01

    The objective structured clinical examination (OSCE) has been introduced as an efficient method for the assessment of medical students. The aim of the present study was to determine the satisfaction level of undergraduate medical students of internal medicine department with the OSCE. This was a descriptive cross-sectional study, performed on all available undergraduate students at the end of their internal medicine training period in Mashhad University of Medical Sciences. The students responded to 15 multiple-choice questions with confirmed validity and reliability. The majority of the students (94.5%) had a positive attitude toward the OSCE and mentioned that the OSCE format was a more appropriate type of exam than other methods of testing; however, 79.1% thought that the OSCE format was stressful. In addition, the participants' sex had no effect on their level of satisfaction with the examination. Likewise, there was no significant correlation between their level of satisfaction and their age, marital status, or lack of previous experience with this type of exam. If the exam standards are met and a uniform dispersion of the scientific content is maintained, the OSCE method of assessment can be recommended as an efficient and applicable method for assessing medical students.

  16. Approach to the notice of insanity. Symptom - mental health and clinical structures. Psychology and psychoanalysis

    Directory of Open Access Journals (Sweden)

    Jorge Enrique Chacón-Afanador

    2017-09-01

    Full Text Available The present work of reflection proposes the approach of the concepts of clinical structures and mental health, starting from the position of psychoanalysis and the question is asked if it is possible to think the madness within them. To do this, it starts from an approach to training and symptom in psychoanalysis and psychology, pointing out the importance of differentiating the psychic from the organic, as well as the psychic from the mental. In this sense, the concept of mental health proposed by WHO is addressed and the place of psychology and psychoanalysis in this concept is questioned. In the same way a reflection is made around the questions: Is it possible to speak of madness in the XXI century, when psychiatry has tried to eradicate this term? To talk about crazy again is to return to a debate that has somehow been left out of the scientific debate? Is it possible to think nowadays the importance of elaborating a nosography that includes Insanity?

  17. Factors associated with medical student test anxiety in objective structured clinical examinations: a preliminary study.

    Science.gov (United States)

    Kim, Kyong-Jee

    2016-12-29

    To investigate attributes of medical students associated with their test anxiety on Objective Structured Clinical Examinations (OSCEs). A cross-sectional study using a self-administered questionnaire was conducted of all Year 3 and 4 students at a private medical school in South Korea in 2014. This 53-item questionnaire consisted of factors pertaining to test anxiety on the OSCE identified from a review of relevant literature, which included students' motivational beliefs and achievement emotions, perceived values of the OSCE, and attitude and orientation towards patients. Participants' test anxiety levels were measured using the Korean Achievement Emotions Questionnaire. Participants rated their responses using a five-point Likert-type scale. Univariate analysis was performed to examine relationships between the variables. A total of 94 students completed the questionnaire (a 93% response rate). No differences in the participants' test anxiety scores were observed across genders, entry-levels, or years in medical school. Participants' test anxiety on the OSCE showed moderate association with their class-related achievement emotions (i.e., anxiety and boredom), where r = 0.46 and 0.32, p study found some non-cognitive factors related to medical students' test anxiety on the OSCE. These findings have implications for developing effective educational interventions for helping students cope with such a stress by enhancing our understanding of the various factors that influence their test anxiety in OSCEs.

  18. Musculoskeletal ultrasound objective structured clinical examination: an assessment of the test.

    Science.gov (United States)

    Kissin, Eugene Y; Grayson, Peter C; Cannella, Amy C; Demarco, Paul J; Evangelisto, Amy; Goyal, Janak; Al Haj, Rany; Higgs, Jay; Malone, Daniel G; Nishio, Midori J; Tabechian, Darren; Kaeley, Gurjit S

    2014-01-01

    To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS). A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert faculty (controls). Participants were unaware of joint health (5 diseased/4 healthy). Faculty assessors (n = 9) graded image quality with predefined checklists and a 0-5 global rating, blinded to who performed the study. Interrater reliability, correlation between a written multiple choice question examination (MCQ) and OSCE performance, and comparison of fellow OSCE results with those of the faculty were measured to determine OSCE reliability, concurrent validity, and construct validity. Assessors' interrater reliability was good (intraclass correlation coefficient [ICC] 0.7). Score reliability was good in the normal wrist and ankle stations (ICC 0.7) and moderate in the abnormal wrist and ankle stations (ICC 0.4). MCQ grades significantly correlated with OSCE grades (r = 0.52, P skill. Normal joint assessment stations are more reliable than abnormal joint assessment stations and better discriminate poorly performing fellows from faculty. Therefore, MSUS OSCE with normal joints can be used for the assessment of MSUS skill competency. Copyright © 2014 by the American College of Rheumatology.

  19. Influence of standardized patient body habitus on undergraduate student performance in an Objective Structured Clinical Examination.

    Science.gov (United States)

    Yazbeck-Karam, Vanda; Aoun Bahous, Sola; Faour, Wissam; Khairallah, Maya; Asmar, Nadia

    2014-03-01

    Previous studies have shown that the standardized patient's (SP) gender may affect student performance in an Objective Structured Clinical Examination (OSCE). The aim of this study is to investigate the influence of the SPs' body habitus on students' performance in an OSCE counseling station. Four equally trained female SPs, with either a normal or an obese BMI participated in an OSCE counseling station for cardiovascular risk factors. Ninety-two, second year medical students were randomly assigned to one of the SPs. Station scores were compared and student behavior and opinion regarding the influence of their SP's body habitus on their performance was assessed. There was no difference in mean exam scores for students interacting with SPs with a normal BMI versus increased BMI (14.9 ± 2.2 versus 14.01 ± 2.2/20 respectively, p = 0.06). Additionally, almost all students gave advice about healthy diets (93.5% versus 95.7%) with no specificity regarding the BMI of the SP. The body habitus of the SP did not significantly affect students' performance in an undergraduate OSCE about cardiovascular risk factors, suggesting that students at that level may primarily focus on gaining points the diagnostic checklist without considering SPs as real patients.

  20. An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents.

    Science.gov (United States)

    Mangold, Karen A; Jeffers, Justin M; Burns, Rebekah A; Trainor, Jennifer L; Unti, Sharon M; Eppich, Walter; Adler, Mark D

    2015-09-01

    Residency programs are developing new methods to assess resident competence and to improve the quality of formative assessment and feedback to trainees. Simulation is a valuable tool for giving formative feedback to residents. To develop an objective structured clinical examination (OSCE) to improve formative assessment of senior pediatrics residents. We developed a multistation examination using various simulation formats to assess the skills of senior pediatrics residents in communication and acute resuscitation. We measured several logistical factors (staffing and program costs) to determine the feasibility of such a program. Thirty-one residents participated in the assessment program over a 3-month period. Residents received formative feedback comparing their performance to both a standard task checklist and to peers' performance. The program required 16 faculty members per session, and had a cost of $624 per resident. A concentrated assessment program using simulation can be a valuable tool to assess residents' skills in communication and acute resuscitation and provide directed formative feedback. However, such a program requires considerable financial and staffing resources.

  1. Using standardised patients in an objective structured clinical examination as a patient safety tool.

    Science.gov (United States)

    Battles, J B; Wilkinson, S L; Lee, S J

    2004-10-01

    Standardised patients (SPs) are a powerful form of simulation that has now become commonplace in training and assessment in medical education throughout the world. Standardised patients are individuals, with or without actual disease, who have been trained to portray a medical case in a consistent manner. They are now the gold standard for measuring the competence of physicians and other health professionals, and the quality of their practice. A common way in which SPs are used in performance assessment has been as part of an objective structured clinical examination (OSCE). The use of an SP based OSCE can be a powerful tool in measuring continued competence in human reliability and skill performance where such skills are a critical attribute to maintaining patient safety. This article will describe how an OSCE could be used as a patient safety tool based on cases derived from actual events related to postdonation information in the blood collection process. The OSCE was developed as a competency examination for health history takers. Postdonation information events in the blood collection process account for the majority of errors reported to the US Food and Drug Administration. SP based assessment is an important patient safety tool that could be applied to a variety of patient safety settings and situations, and should be considered an important weapon in the war on medical error and patient harm.

  2. [Clinical efficacy of structured institution-based teaching programme combined with family rehabilitation training in treatment of childhood autism].

    Science.gov (United States)

    Liu, Chao; Lu, Bin; Zhang, Yu; Xu, Chuan-Guo; Peng, Feng-Xiang; Ma, Li-Fang; Liu, Li-Li; Nie, Wen-Ying

    2015-12-01

    To investigate the clinical efficacy of a structured institution-based teaching programme combined with family rehabilitation training in the treatment of childhood autism. One hundred children with autism were divided into a combination therapy group (n=50) and a control group (n=50). The children in the control group received a structured institution-based teaching programme, and the children in the combination therapy group received a family rehabilitation training besides the structured institution-based teaching programme. Comparisons were made between the two groups by the Autism Behavior Checklist (ABC) score, Autism Treatment Evaluation Checklist (ATEC) score, and Chinese version of Psychoeducational Profile (C-PEP) sore. After 12-months training, each dimension score and total score of ABC in the combination therapy group were all significantly lower than those in the control group (Pautism, structured institution-based teaching programme combined with family rehabilitation training is worthy of clinical promotion and application.

  3. Clinical relevance of drug-drug interactions : a structured assessment procedure.

    NARCIS (Netherlands)

    Roon, E.N. van; Flikweert, S.; Comte, M. le; Langendijk, P.N.; Kwee-Zuiderwijk, W.J.; Smits, P.; Brouwers, J.R.B.J.

    2005-01-01

    INTRODUCTION: Computerised drug interaction surveillance systems (CIS) may be helpful in detecting clinically significant drug interactions. Experience with CIS reveals that they often yield alerts with questionable clinical significance, fail to provide relevant information on risk factors for the

  4. Clinical relevance of drug-drug interactions - A structured assessment procedure

    NARCIS (Netherlands)

    van Roon, EN; Flikweert, S; le Comte, M; Langendijk, PNJ; Kwee-Zuiderwijk, WJM; Smits, P; Brouwers, JRBJ

    2005-01-01

    Introduction: Computerised drug interaction surveillance systems (CIS) may be helpful in detecting clinically significant drug interactions. Experience with CIS C, reveals that they often yield alerts with questionable clinical significance, fail to provide relevant information on risk factors for

  5. Validity of early MRI structural damage end points and potential impact on clinical trial design in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Baker, Joshua F; Conaghan, Philip G; Emery, Paul

    2016-01-01

    OBJECTIVE: To evaluate the construct validity of the rheumatoid arthritis MRI score (RAMRIS) erosion evaluation as structural damage end point and to assess the potential impact of incorporation in clinical trials. METHODS: In a randomised trial of early methotrexate-naïve RA (GO-BEFORE), RAMRIS ...

  6. Exploration of Nursing Faculty Members' Lived Experiences of Objective Structured Clinical Examination (OSCE) in Undergraduate Nursing Education

    Science.gov (United States)

    Obizoba, Cordelia O.

    2014-01-01

    The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…

  7. Associations between delusion proneness and personality structure in non-clinical participants : Comparison between young and elderly samples

    NARCIS (Netherlands)

    Laroi, F.; Van der Linden, M.; DeFruyt, F.; Van Os, J.; Aleman, A.

    2006-01-01

    Background: Few studies have explored the prevalence of delusions in the non-clinical, elderly population. In addition, the association between personality structure and delusions remains poorly investigated. The aims of the present study were, first, to explore the relation between age and the

  8. Effects of a structured medication review by geriatrician and clinical pharmacologist on appropriateness of pharmacotherapy of frail elderly inpatients

    NARCIS (Netherlands)

    Van Dijk, K.N.; Van Asselt, D.Z.B.; Vogel, D.; Van Der Hooft, C.S.; Van Roon, E.N.; Brouwers, J.R.B.J.

    2009-01-01

    Objective To study the results of a structured medication review of geriatric inpatients by both geriatrician and hospital pharmacist/clinical pharmacologist. Methods Patients who were present at the geriatric ward were eligible for a review of their medication and medical problems using a screening

  9. A Review of the Factor Structure of the Sixteen Personality Factor Questionnaire and the Clinical Analysis Questionnaire.

    Science.gov (United States)

    Boyle, Gregory J.

    1990-01-01

    Research relating to the factor structure of the Sixteen Personality Factor Questionnaire (16PF) and the Clinical Analysis Questionnaire is reviewed. Different opinions about the factors measured by the 16PF are discussed. Focusing on the second-order factor level could eliminate problems with the instruments' reliability. (SLD)

  10. Sequential Objective Structured Clinical Examination based on item response theory in Iran

    Directory of Open Access Journals (Sweden)

    Sara Mortaz Hejri

    2017-09-01

    Full Text Available Purpose In a sequential objective structured clinical examination (OSCE, all students initially take a short screening OSCE. Examinees who pass are excused from further testing, but an additional OSCE is administered to the remaining examinees. Previous investigations of sequential OSCE were based on classical test theory. We aimed to design and evaluate screening OSCEs based on item response theory (IRT. Methods We carried out a retrospective observational study. At each station of a 10-station OSCE, the students’ performance was graded on a Likert-type scale. Since the data were polytomous, the difficulty parameters, discrimination parameters, and students’ ability were calculated using a graded response model. To design several screening OSCEs, we identified the 5 most difficult stations and the 5 most discriminative ones. For each test, 5, 4, or 3 stations were selected. Normal and stringent cut-scores were defined for each test. We compared the results of each of the 12 screening OSCEs to the main OSCE and calculated the positive and negative predictive values (PPV and NPV, as well as the exam cost. Results A total of 253 students (95.1% passed the main OSCE, while 72.6% to 94.4% of examinees passed the screening tests. The PPV values ranged from 0.98 to 1.00, and the NPV values ranged from 0.18 to 0.59. Two tests effectively predicted the results of the main exam, resulting in financial savings of 34% to 40%. Conclusion If stations with the highest IRT-based discrimination values and stringent cut-scores are utilized in the screening test, sequential OSCE can be an efficient and convenient way to conduct an OSCE.

  11. Interfacial behavior and structural properties of a clinical lung surfactant from porcine source.

    Science.gov (United States)

    Blanco, Odalys; Cruz, Antonio; Ospina, Olga L; López-Rodriguez, Elena; Vázquez, Luis; Pérez-Gil, Jesús

    2012-11-01

    Surfacen® is a clinical surfactant preparation of porcine origin, partly depleted of cholesterol, which is widely used in Cuba to treat pre-term babies at risk or already suffering neonatal respiratory distress. In the present study we have characterized the interfacial behavior of Surfacen in several in vitro functional models, including spreading and compression-expansion cycling isotherms in surface balances and in a captive bubble surfactometer, in comparison with the functional properties of whole native surfactant purified from porcine lungs and its reconstituted organic extract, the material from which Surfacen is derived. Surfacen exhibited similar properties to native porcine surfactant or its organic extract to efficiently form stable surface active films at the air-liquid interface, able to consistently reach surface tensions below 5mN/m upon repetitive compression-expansion cycling. Surfacen films, however, showed a substantially larger and stable compression-driven segregation of condensed lipid phases than exhibited by films formed by native surfactant or its organic extract. In spite of structural differences observed at microscopic level, Surfacen membranes showed a similar thermotropic behavior to membranes from native surfactant or its organic extract, characterized by calorimetry or fluorescence spectroscopy of samples doped with the Laurdan probe. On the other hand, analysis by atomic force microscopy of films formed by Surfacen or by the organic extract of native porcine surfactant revealed a similar network of interconnected condensed nanostructures, suggesting that the organization of the films at the submicroscopic level is the essential feature to support the proper stability and mechanical properties permitting the interfacial surfactant films to facilitate the work of breathing. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Biofilm Morphotypes and Population Structure among Staphylococcus epidermidis from Commensal and Clinical Samples.

    Directory of Open Access Journals (Sweden)

    Llinos G Harris

    Full Text Available Bacterial species comprise related genotypes that can display divergent phenotypes with important clinical implications. Staphylococcus epidermidis is a common cause of nosocomial infections and, critical to its pathogenesis, is its ability to adhere and form biofilms on surfaces, thereby moderating the effect of the host's immune response and antibiotics. Commensal S. epidermidis populations are thought to differ from those associated with disease in factors involved in adhesion and biofilm accumulation. We quantified the differences in biofilm formation in 98 S. epidermidis isolates from various sources, and investigated population structure based on ribosomal multilocus typing (rMLST and the presence/absence of genes involved in adhesion and biofilm formation. All isolates were able to adhere and form biofilms in in vitro growth assays and confocal microscopy allowed classification into 5 biofilm morphotypes based on their thickness, biovolume and roughness. Phylogenetic reconstruction grouped isolates into three separate clades, with the isolates in the main disease associated clade displaying diversity in morphotype. Of the biofilm morphology characteristics, only biofilm thickness had a significant association with clade distribution. The distribution of some known adhesion-associated genes (aap and sesE among isolates showed a significant association with the species clonal frame. These data challenge the assumption that biofilm-associated genes, such as those on the ica operon, are genetic markers for less invasive S. epidermidis isolates, and suggest that phenotypic characteristics, such as adhesion and biofilm formation, are not fixed by clonal descent but are influenced by the presence of various genes that are mobile among lineages.

  13. The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills.

    Science.gov (United States)

    Browne, C; Norton, S; Nolan, J M; Whelan, C; Sullivan, J F; Quinlan, M; Sheikh, M; Mc Dermott, T E D; Lynch, T H; Manecksha, R P

    2018-02-01

    Undergraduate training in core urology skills is lacking in many Irish training programmes. Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies. A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course. Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2. This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

  14. [Structural Equation Modeling of Quality of Work Life in Clinical Nurses based on the Culture-Work-Health Model].

    Science.gov (United States)

    Kim, Miji; Ryu, Eunjung

    2015-12-01

    The purpose of this study was to construct and test a structural equation model of quality of work life for clinical nurses based on Peterson and Wilson's Culture-Work-Health model (CWHM). A structured questionnaire was completed by 523 clinical nurses to analyze the relationships between concepts of CWHM-organizational culture, social support, employee health, organizational health, and quality of work life. Among these conceptual variables of CWHM, employee health was measured by perceived health status, and organizational health was measured by presenteeism. SPSS21.0 and AMOS 21.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting quality of work life among clinical nurses. The goodness-of-fit statistics of the final modified hypothetical model are as follows: χ²=586.03, χ²/df=4.19, GFI=.89, AGFI=.85, CFI=.91, TLI=.90, NFI=.89, and RMSEA=.08. The results revealed that organizational culture, social support, organizational health, and employee health accounted for 69% of clinical nurses' quality of work life. The major findings of this study indicate that it is essential to create a positive organizational culture and provide adequate organizational support to maintain a balance between the health of clinical nurses and the organization. Further repeated and expanded studies are needed to explore the multidimensional aspects of clinical nurses' quality of work life in Korea, including various factors, such as work environment, work stress, and burnout.

  15. Topic maps for exploring nosological, lexical, semantic and HL7 structures for clinical data.

    Science.gov (United States)

    Paterson, Grace I; Grant, Andrew M; Soroka, Steven D

    2008-12-01

    A topic map is implemented for learning about clinical data associated with a hospital stay for patients diagnosed with chronic kidney disease, diabetes and hypertension. The question posed is: how might a topic map help bridge perspectival differences among communities of practice and help make commensurable the different classifications they use? The knowledge layer of the topic map was generated from existing ontological relationships in nosological, lexical, semantic and HL7 boundary objects. Discharge summaries, patient charts and clinical data warehouse entries rectified the clinical knowledge used in practice. These clinical data were normalized to HL7 Clinical Document Architecture (CDA) markup standard and stored in the Clinical Document Repository. Each CDA entry was given a subject identifier and linked with the topic map. The ability of topic maps to function as the infostructure ;glue' is assessed using dimensions of semantic interoperability and commensurability.

  16. Clinical and anatomical heterogeneity in autistic spectrum disorder: a structural MRI study.

    LENUS (Irish Health Repository)

    Toal, F

    2010-07-01

    Autistic spectrum disorder (ASD) is characterized by stereotyped\\/obsessional behaviours and social and communicative deficits. However, there is significant variability in the clinical phenotype; for example, people with autism exhibit language delay whereas those with Asperger syndrome do not. It remains unclear whether localized differences in brain anatomy are associated with variation in the clinical phenotype.

  17. Structures' validation profiles in Transmission of Imaging and Data (TRIAD) for automated National Clinical Trials Network (NCTN) clinical trial digital data quality assurance.

    Science.gov (United States)

    Giaddui, Tawfik; Yu, Jialu; Manfredi, Denise; Linnemann, Nancy; Hunter, Joanne; O'Meara, Elizabeth; Galvin, James; Bialecki, Brian; Xiao, Ying

    2016-01-01

    Transmission of Imaging and Data (TRIAD) is a standard-based system built by the American College of Radiology to provide the seamless exchange of images and data for accreditation of clinical trials and registries. Scripts of structures' names validation profiles created in TRIAD are used in the automated submission process. It is essential for users to understand the logistics of these scripts for successful submission of radiation therapy cases with less iteration. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  18. Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.

    Science.gov (United States)

    Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet; Rubin, Susan; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, Payal; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M

    2017-01-01

    Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy. We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort. We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

  19. Study of psychiatric comorbidity in patients with headache using a short structured clinical interview in a rural neurology clinic in Western India

    Directory of Open Access Journals (Sweden)

    Soaham Dilip Desai

    2014-01-01

    Full Text Available Background: Psychiatric disorders are common in patients attending neurology clinics with headache. Evaluation of psychiatric comorbidity in patients with headache is often missed in the busy neurology clinics. Aims: To assess the prevalence of Axis-I DSM-IV psychiatric disorders in patients with primary headache disorders in a rural-based tertiary neurology clinic in Western India. Settings and Design : A cross-sectional observation survey was conducting assessing all patients with migraine, tension-type headache and chronic daily headache attending the Neurology Clinic of Shree Krishna Hospital, a rural medical teaching hospital in Karamsad, in Gujarat in Western India. Materials and Methods: A total of 101 consecutive consenting adults with headache were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I., a structured diagnostic clinical interview to assess prevalence of Axis-I DSM-IV psychiatric disorders. Statistical Analysis: Descriptive statistics were calculated using SPSS software version 16 and a binomial regression model was used to study the relationship of psychiatric co-morbidity with patient-related factors. Results: 49 out of 101 (48.5% patients with headache suffered from depressive disorders (dysthymia or depression or suicidality, 18 out of 101 patients with headache (17.90% suffered from anxiety related disorders (generalized anxiety disorder or agoraphobia or social phobia or panic disorder. Conclusions: Axis-I psychiatric disorders are a significant comorbidity among patients with headache disorders. M.I.N.I. can be used as a short, less time consuming instrument to assess all patients with headache disorders.

  20. Logic structure of clinical judgment and its relation to medical and psychiatric semiology.

    Science.gov (United States)

    Rejón Altable, Carlos

    2012-01-01

    The logical nature of clinical judgment has been conceptualized in different ways, but a clear connection between the features of clinical judgment and those of semiology is still lacking. The characteristics of clinical judgment, medical semiology, and psychiatric semiology are described. Connections between them are drawn. Clinical judgment is described as an abductive inference. Abductive inferences are especially useful to balance universal and singular information. In psychiatric semiology, due to some specific features, a careful balance between the information present in descriptive definitions and the information absent from the definition but present in singular symptoms is needed. The main types of out-of-definition information are reviewed. The implications of the results for diagnosis and research are drawn. Copyright © 2012 S. Karger AG, Basel.

  1. The value of structured data elements from electronic health records for identifying subjects for primary care clinical trials.

    Science.gov (United States)

    Ateya, Mohammad B; Delaney, Brendan C; Speedie, Stuart M

    2016-01-11

    An increasing number of clinical trials are conducted in primary care settings. Making better use of existing data in the electronic health records to identify eligible subjects can improve efficiency of such studies. Our study aims to quantify the proportion of eligibility criteria that can be addressed with data in electronic health records and to compare the content of eligibility criteria in primary care with previous work. Eligibility criteria were extracted from primary care studies downloaded from the UK Clinical Research Network Study Portfolio. Criteria were broken into elemental statements. Two expert independent raters classified each statement based on whether or not structured data items in the electronic health record can be used to determine if the statement was true for a specific patient. Disagreements in classification were discussed until 100 % agreement was reached. Statements were also classified based on content and the percentages of each category were compared to two similar studies reported in the literature. Eligibility criteria were retrieved from 228 studies and decomposed into 2619 criteria elemental statements. 74 % of the criteria elemental statements were considered likely associated with structured data in an electronic health record. 79 % of the studies had at least 60 % of their criteria statements addressable with structured data likely to be present in an electronic health record. Based on clinical content, most frequent categories were: "disease, symptom, and sign", "therapy or surgery", and "medication" (36 %, 13 %, and 10 % of total criteria statements respectively). We also identified new criteria categories related to provider and caregiver attributes (2.6 % and 1 % of total criteria statements respectively). Electronic health records readily contain much of the data needed to assess patients' eligibility for clinical trials enrollment. Eligibility criteria content categories identified by our study can be

  2. Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP care in Mississippi.

    Directory of Open Access Journals (Sweden)

    Trisha Arnold

    Full Text Available Pre-exposure prophylaxis (PrEP is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23 participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1 structural factors such as cost and access to financial assistance for medications and clinical services; 2 social factors such as stigma and relationship status; 3 behavioral factors including sexual risk behaviors; and 4 clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.

  3. Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi.

    Science.gov (United States)

    Arnold, Trisha; Brinkley-Rubinstein, Lauren; Chan, Philip A; Perez-Brumer, Amaya; Bologna, Estefany S; Beauchamps, Laura; Johnson, Kendra; Mena, Leandro; Nunn, Amy

    2017-01-01

    Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.

  4. Preparing and conducting objective structured clinical examination for oman medical specialty board r1-r4 residents.

    Science.gov (United States)

    Al Sinawi, Hamed; Al Sharbati, Marwan; Obaid, Yousif; Viernes, Nonna

    2012-05-01

    The Objective Structured Clinical Examination (OSCE) has been a common tool of assessment in both undergraduate and postgraduate medicine, and has been reported to have both higher reliability and validity over the oral exam. In addition, another advantage is that it reduces luck by standardizing both examiners and patients. This article describes our experience in organizing and conducting an OSCE for Oman Medical Specialty Board residents in Psychiatry.

  5. Preparing and Conducting Objective Structured Clinical Examination for Oman Medical Specialty Board R1-R4 Residents

    Directory of Open Access Journals (Sweden)

    Hamed Al Sinawi

    2012-05-01

    Full Text Available The Objective Structured Clinical Examination (OSCE has been a common tool of assessment in both undergraduate and postgraduate medicine, and has been reported to have both higher reliability and validity over the oral exam. In addition, another advantage is that it reduces luck by standardizing both examiners and patients. This article describes our experience in organizing and conducting an OSCE for Oman Medical Specialty Board residents in Psychiatry.

  6. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder.

    Science.gov (United States)

    Bateman, Anthony; Fonagy, Peter

    2009-12-01

    This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder. Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-month intervals, were analyzed using mixed effects logistic regressions for binary data, Poisson regression models for count data, and mixed effects linear growth curve models for self-report variables. Substantial improvements were observed in both conditions across all outcome variables. Patients randomly assigned to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization. Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.

  7. Functional neuroimaging correlates of thinking flexibility and knowledge structure in memory: Exploring the relationships between clinical reasoning and diagnostic thinking.

    Science.gov (United States)

    Durning, Steven J; Costanzo, Michelle E; Beckman, Thomas J; Artino, Anthony R; Roy, Michael J; van der Vleuten, Cees; Holmboe, Eric S; Lipner, Rebecca S; Schuwirth, Lambert

    2016-06-01

    Diagnostic reasoning involves the thinking steps up to and including arrival at a diagnosis. Dual process theory posits that a physician's thinking is based on both non-analytic or fast, subconscious thinking and analytic thinking that is slower, more conscious, effortful and characterized by comparing and contrasting alternatives. Expertise in clinical reasoning may relate to the two dimensions measured by the diagnostic thinking inventory (DTI): memory structure and flexibility in thinking. Explored the functional magnetic resonance imaging (fMRI) correlates of these two aspects of the DTI: memory structure and flexibility of thinking. Participants answered and reflected upon multiple-choice questions (MCQs) during fMRI. A DTI was completed shortly after the scan. The brain processes associated with the two dimensions of the DTI were correlated with fMRI phases - assessing flexibility in thinking during analytical clinical reasoning, memory structure during non-analytical clinical reasoning and the total DTI during both non-analytical and analytical reasoning in experienced physicians. Each DTI component was associated with distinct functional neuroanatomic activation patterns, particularly in the prefrontal cortex. Our findings support diagnostic thinking conceptual models and indicate mechanisms through which cognitive demands may induce functional adaptation within the prefrontal cortex. This provides additional objective validity evidence for the use of the DTI in medical education and practice settings.

  8. Effects of Job Burnout and Emotional Labor on Objective Structured Clinical Examination Performance Among Interns and Residents in Taiwan.

    Science.gov (United States)

    Wang, Chen-Yu; Chen, Jen-De; Wang, Chih-Hung; Wang, Jong-Yi; Tai, Chih-Jaan; Hsieh, Tsu-Yi; Chen, Der-Yuan

    2017-01-01

    Medical education faces challenges concerning job burnout and emotional labor among junior physicians, which poses a potential threat to the quality of medical care. Although studies have investigated job burnout and emotional labor among physicians, empirical research on the association between job burnout, emotional labor, and clinical performance is lacking. This study investigated the effects of job burnout and emotional labor on clinical performance by using the objective structured clinical examination (OSCE) scores of interns and residents. Specifically, this cross-sectional study utilized the Maslach Burnout Inventory and the Emotional Labor Questionnaire as measurement instruments. A total of 225 interns and residents in central Taiwan answered structured questionnaires before beginning their OSCE. The major statistical analysis method employed was logistic regression. After adjustment for covariates, first-year residents were less likely than other residents to obtain high OSCE scores. The odds of high OSCE performance among interns and residents with high interaction component scores in emotional labor were significantly higher than those with low interaction scores. A high score in the interaction dimension of emotional labor was associated with strong clinical performance. The findings suggest that interventions which motivate positive attitudes and increase interpersonal interaction skills among physicians should receive higher priority.

  9. Clinical Updates in Women's Health Care Summary: Structural Heart Disease: Primary and Preventive Care Review.

    Science.gov (United States)

    Frisoli, Tiberio; Voeltz, Michele Doughty

    2017-03-01

    Reproductive-aged women with structural heart disease who become pregnant as well as postreproductive-aged women with this condition represent a significant proportion of patients seen by obstetrician- gynecologists. Usually, their conditions are complex, and a basic knowledge of the anatomy and physiology of the heart is required. Additionally, understanding the effect of pregnancy on women with structural heart disease is critically important to optimizing maternal and fetal outcomes. This monograph addresses the pathophysiology, signs and symptoms, screening and diagnosis, basic management, and suggested counseling for an obstetric-gynecologic patient with structural heart disease.

  10. Structural deterioration of finger joints with ultrasonographic synovitis in rheumatoid arthritis patients with clinical low disease activity.

    Science.gov (United States)

    Fukae, Jun; Isobe, Masato; Kitano, Akemi; Henmi, Mihoko; Sakamoto, Fumihiko; Narita, Akihiro; Ito, Takeya; Mitsuzaki, Akio; Shimizu, Masato; Tanimura, Kazuhide; Matsuhashi, Megumi; Kamishima, Tamotsu; Atsumi, Tatsuya; Koike, Takao

    2014-09-01

    In this study we investigated the relationship between synovial vascularity (SV) and structural alteration of finger joints in patients with RA and long-term sustained clinical low disease activity (CLDA). RA patients with CLDA of >2 years (minimum 1 year of CLDA for study entry plus 1 year of observation) were analysed. Quantitative SV values were sequentially measured in each finger joint using power Doppler ultrasonography (0, 8, 20 and 52 weeks). Radiological progression of local finger joints was evaluated according to the Genant-modified Sharp score (0-52 weeks). Of the 25 patients enrolled, 15 patients were finally analysed after excluding 10 patients who failed to maintain CLDA during the observational period. Changes in radiological progression of MCP and PIP joints with positive SV were significantly greater than those in joints with negative SV. Joint space narrowing (JSN) was strongly related to structural alteration of finger joints. In joints with positive SV, changes in structural alteration did not relate to total SV values, which reflect total exposure to inflammation in an observational period. Even in patients with a long period of CLDA, finger joints with positive SV showed structural alteration, especially in the progression of JSN. University Hospital Medical Information Network Clinical Trials Registry, http://www.umin.ac.jp/ctr/, UMIN000007305. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Guidelines for the Identification of the Mandibular Vital Structures: Practical Clinical Applications of Anatomy and Radiological Examination Methods

    Directory of Open Access Journals (Sweden)

    Hom-Lay Wang

    2010-04-01

    Full Text Available Objectives: The purpose of this article was to review the current available clinical techniques and to recommend the most appropriate imaging modalities for the identification of mandibular vital structures when planning for oral implants.Material and Methods: The literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, mandibular incisive canal, mental foramen, anterior loop of the mental nerve, radiography, dental implants. The search was restricted to English language articles, published from January 1976 to January 2010.Results: In total 111 literature sources were obtained and reviewed. The peculiarities of the clinical anatomy of mandibular canal, mandibular incisive canal, mental foramen and anterior loop of mental nerve were discussed. Radiological diagnostic methods currently available for the identification of the mandibular vital structures when planning for oral implants were presented. Guidelines for the identification of the mandibular vital structures in dental implantology were made.Conclusions: The proposed guideline provides clinicians a tool in proper identifying the important mandibular vital structures thus minimizing the potential complications during implant surgery.

  12. Clinical and anatomical heterogeneity in autistic spectrum disorder: a structural MRI study

    NARCIS (Netherlands)

    Toal, F.; Daly, E. M.; Page, L.; Deeley, Q.; Hallahan, B.; Bloemen, O.; Cutter, W. J.; Brammer, M. J.; Curran, S.; Robertson, D.; Murphy, C.; Murphy, K. C.; Murphy, D. G. M.

    2010-01-01

    Autistic spectrum disorder (ASD) is characterized by stereotyped/obsessional behaviours and social and communicative deficits. However, there is significant variability in the clinical phenotype; for example, people with autism exhibit language delay whereas those with Asperger syndrome do not. It

  13. A Marginal Structural Model Analysis for Loneliness: Implications for Intervention Trials and Clinical Practice

    Science.gov (United States)

    VanderWeele, Tyler J.; Hawkley, Louise C.; Thisted, Ronald A.; Cacioppo, John T.

    2011-01-01

    Objective: Clinical scientists, policymakers, and individuals must make decisions concerning effective interventions that address health-related issues. We use longitudinal data on loneliness and depressive symptoms and a new class of causal models to illustrate how empirical evidence can be used to inform intervention trial design and clinical…

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    The objective of this prospective cross-sectional study is to describe the clinical otorhinolaryngological manifestations of granulomatosis with polyangiitis (Wegener's) (GPA) in a prospective cohort. All patients suffering from GPA seen in a tertiary centre between March 2007 and November 2008 had...

  15. Advanced echocardiography and clinical surrogates to risk stratify and manage patients with structural heart disease

    NARCIS (Netherlands)

    Debonnaire, Philippe Jean Marc Rita

    2016-01-01

    Part I focuses on the potential role of 3-dimensional echocardiography. At first a clinical risk score model for prediction of outcome in patients undergoing TAVI is presented (Chapter 2). Second the role of 3D-echocardiography is explored in depth in patients with mitral valve disease. Different

  16. Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis.

    Science.gov (United States)

    K, Anbarasi; K, Kasim Mohamed; Vijayaraghavan, Phagalvarthy; Kandaswamy, Deivanayagam

    2016-12-01

    To design and implement flipped clinical training for undergraduate dental students in removable complete denture treatment and predict its effectiveness by comparing the assessment results of students trained by flipped and traditional methods. Flipped training was designed by shifting the learning from clinics to learning center (phase I) and by preserving the practice in clinics (phase II). In phase I, student-faculty interactive session was arranged to recap prior knowledge. This is followed by a display of audio synchronized video demonstration of the procedure in a repeatable way and subsequent display of possible errors that may occur in treatment with guidelines to overcome such errors. In phase II, live demonstration of the procedure was given. Students were asked to treat three patients under instructor's supervision. The summative assessment was conducted by applying the same checklist criterion and rubric scoring used for the traditional method. Assessment results of three batches of students trained by flipped method (study group) and three traditionally trained previous batches (control group) were taken for comparison by chi-square test. The sum of traditionally trained three batch students who prepared acceptable dentures (score: 2 and 3) and unacceptable dentures (score: 1) was compared with the same of flipped trained three batch students revealed that the number of students who demonstrated competency by preparing acceptable dentures was higher for flipped training (χ 2 =30.996 with pflipped training in enhancing students competency and hence recommended for training various clinical procedures.

  17. The Need for Open-access, Structured Data in Clinical Brain Research

    Directory of Open Access Journals (Sweden)

    Adomas Bunevicius

    2015-01-01

    Full Text Available Neurological and psychiatric disorders are considered major public health problems associated with a significant number of suffering patients and an enormous socioeconomic burden to societies. Therefore, significant research funds have been allocated towards improving outcomes of patients suffering from brain disorders. In recent years, researchers have been facing a constantly growing world-wide pressure to make their datasets freely and readily available to other researchers and the public. The major goal of this movement is to allow re-use of already collected data in order to facilitate medical progress. There are numerous ways that clinical neuroscience researchers and research organizations commonly employ to make their databases available. Institutional databases and publicly available research and clinical data repositories and registries are the most com-mon ways to share data among researchers and organizations in order to facilitate collaboration. In addition, numerous traditional neuroscience peer reviewed journals have implemented various data sharing policies. Furthermore, a few traditional clinical neuroscience peer review journals have recently started accepting dataset papers. Finally, there is a constantly growing number of database journals which accept clinical neuroscience research datasets for publication. Potential for improving of citation metrics is among the important advantages for authors considering publishing their databases in dataset journals.

  18. Availability of Structured and Unstructured Clinical Data for Comparative Effectiveness Research and Quality Improvement: A Multisite Assessment

    Science.gov (United States)

    Capurro, Daniel; PhD, Meliha Yetisgen; van Eaton, Erik; Black, Robert; Tarczy-Hornoch, Peter

    2014-01-01

    Introduction: A key attribute of a learning health care system is the ability to collect and analyze routinely collected clinical data in order to quickly generate new clinical evidence, and to monitor the quality of the care provided. To achieve this vision, clinical data must be easy to extract and stored in computer readable formats. We conducted this study across multiple organizations to assess the availability of such data specifically for comparative effectiveness research (CER) and quality improvement (QI) on surgical procedures. Setting: This study was conducted in the context of the data needed for the already established Surgical Care and Outcomes Assessment Program (SCOAP), a clinician-led, performance benchmarking, and QI registry for surgical and interventional procedures in Washington State. Methods: We selected six hospitals, managed by two Health Information Technology (HIT) groups, and assessed the ease of automated extraction of the data required to complete the SCOAP data collection forms. Each data element was classified as easy, moderate, or complex to extract. Results: Overall, a significant proportion of the data required to automatically complete the SCOAP forms was not stored in structured computer-readable formats, with more than 75 percent of all data elements being classified as moderately complex or complex to extract. The distribution differed significantly between the health care systems studied. Conclusions: Although highly desirable, a learning health care system does not automatically emerge from the implementation of electronic health records (EHRs). Innovative methods to improve the structured capture of clinical data are needed to facilitate the use of routinely collected clinical data for patient phenotyping. PMID:25848594

  19. Availability of structured and unstructured clinical data for comparative effectiveness research and quality improvement: a multisite assessment.

    Science.gov (United States)

    Capurro, Daniel; Yetisgen, Meliha; van Eaton, Erik; Black, Robert; Tarczy-Hornoch, Peter

    2014-01-01

    A key attribute of a learning health care system is the ability to collect and analyze routinely collected clinical data in order to quickly generate new clinical evidence, and to monitor the quality of the care provided. To achieve this vision, clinical data must be easy to extract and stored in computer readable formats. We conducted this study across multiple organizations to assess the availability of such data specifically for comparative effectiveness research (CER) and quality improvement (QI) on surgical procedures. This study was conducted in the context of the data needed for the already established Surgical Care and Outcomes Assessment Program (SCOAP), a clinician-led, performance benchmarking, and QI registry for surgical and interventional procedures in Washington State. We selected six hospitals, managed by two Health Information Technology (HIT) groups, and assessed the ease of automated extraction of the data required to complete the SCOAP data collection forms. Each data element was classified as easy, moderate, or complex to extract. Overall, a significant proportion of the data required to automatically complete the SCOAP forms was not stored in structured computer-readable formats, with more than 75 percent of all data elements being classified as moderately complex or complex to extract. The distribution differed significantly between the health care systems studied. Although highly desirable, a learning health care system does not automatically emerge from the implementation of electronic health records (EHRs). Innovative methods to improve the structured capture of clinical data are needed to facilitate the use of routinely collected clinical data for patient phenotyping.

  20. The structure of brain glycogen phosphorylase-from allosteric regulation mechanisms to clinical perspectives.

    Science.gov (United States)

    Mathieu, Cécile; Dupret, Jean-Marie; Rodrigues Lima, Fernando

    2017-02-01

    Glycogen phosphorylase (GP) is the key enzyme that regulates glycogen mobilization in cells. GP is a complex allosteric enzyme that comprises a family of three isozymes: muscle GP (mGP), liver GP (lGP), and brain GP (bGP). Although the three isozymes display high similarity and catalyze the same reaction, they differ in their sensitivity to the allosteric activator adenosine monophosphate (AMP). Moreover, inactivating mutations in mGP and lGP have been known to be associated with glycogen storage diseases (McArdle and Hers disease, respectively). The determination, decades ago, of the structure of mGP and lGP have allowed to better understand the allosteric regulation of these two isoforms and the development of specific inhibitors. Despite its important role in brain glycogen metabolism, the structure of the brain GP had remained elusive. Here, we provide an overview of the human brain GP structure and its relationship with the two other members of this key family of the metabolic enzymes. We also summarize how this structure provides valuable information to understand the regulation of bGP and to design specific ligands of potential pharmacological interest. © 2016 Federation of European Biochemical Societies.

  1. The structure of peritraumatic dissociation: A cross validation in clinical and nonclinical samples

    NARCIS (Netherlands)

    Sijbrandij, Marit; Engelhard, Iris M.; Opmeer, Brent C.; van de Schoot, Rens; Carlier, Ingrid V. E.; Gersons, Berthold P. R.; Olff, Miranda

    2012-01-01

    Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma-exposed samples: (a) trauma-exposed police

  2. Rhizomes of Eremostachys laciniata: Isolation and Structure Elucidation of Chemical Constituents and a Clinical Trial on Inflammatory Diseases

    Directory of Open Access Journals (Sweden)

    Abbas Delazar

    2013-08-01

    Full Text Available Purpose: The purpose of this study was the isolation and structure elucidation of chemical compounds from the rhizomes of Eremostachys laciniata (L Bunge (EL, an Iranian traditional medicinal herb with a thick root and pale purple or white flowers as well as the clinical studies on the therapeutic efficacy and safety of topical application of the EL extract in the management of some inflammatory conditions, e.g., arthritis, rheumatoid arthritis and septic arthritis (Riter’s syndrome. Methods: The structures of the isolated compounds were elucidated unequivocally on the basis of one and two dimensional NMR, UV and HR-FABMS spectroscopic data analyses. A single-blinded randomized clinical trial was carried out with the extract of the rhizomes of E. laciniata (EL to determine the efficacy and safety of the traditional uses of EL compared to that of piroxicam in treatment of inflammatory diseases, e.g., osteoarthritis, rheumatoid arthritis and Reiter’s syndrome. Results: Eleven iridoid glycosides, two phenylethanoids and two phytosterols were isolated and identified for the first time from the rhizomes of EL. After 14 days of treatment with the EL and piroxicam ointments, all groups showed significant improvements compared to the control groups. EL (5% ointment induced better initial therapeutic response than piroxicam (5% onitment. Conclusion: This clinical trial established that EL was suitable for topical applications as a safe and effective complementary therapy for inflammatory diseases.

  3. Use of conditional rule structure to automate clinical decision support: a comparison of artificial intelligence and deterministic programming techniques.

    Science.gov (United States)

    Friedman, R H; Frank, A D

    1983-08-01

    A rule-based computer system was developed to perform clinical decision-making support within a medical information system, oncology practice, and clinical research. This rule-based system, which has been programmed using deterministic rules, possesses features of generalizability, modularity of structure, convenience in rule acquisition, explanability, and utility for patient care and teaching, features which have been identified as advantages of artificial intelligence (AI) rule-based systems. Formal rules are primarily represented as conditional statements; common conditions and actions are stored in system dictionaries so that they can be recalled at any time to form new decision rules. Important similarities and differences exist in the structure of this system and clinical computer systems utilizing artificial intelligence (AI) production rule techniques. The non-AI rule-based system possesses advantages in cost and ease of implementation. The degree to which significant medical decision problems can be solved by this technique remains uncertain as does whether the more complex AI methodologies will be required.

  4. Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure.

    Science.gov (United States)

    Glisson, Charles; Schoenwald, Sonja K; Kelleher, Kelly; Landsverk, John; Hoagwood, Kimberly Eaton; Mayberg, Stephen; Green, Philip

    2008-03-01

    The present study incorporates organizational theory and organizational characteristics in examining issues related to the successful implementation of mental health services. Following the theoretical foundations of socio-technical and cultural models of organizational effectiveness, organizational climate, culture, legal and service structures, and workforce characteristics are examined as correlates of therapist turnover and new program sustainability in a nationwide sample of mental health clinics. Results of General Linear Modeling (GLM) with the organization as the unit of analysis revealed that organizations with the best climates as measured by the Organizational Social Context (OSC) profiling system, had annual turnover rates (10%) that were less than half the rates found in organizations with the worst climates (22%). In addition, organizations with the best culture profiles sustained new treatment or service programs over twice as long (50 vs. 24 months) as organizations with the worst cultures. Finally, clinics with separate children's services units had higher turnover rates than clinics that served adults and children within the same unit. The findings suggest that strategies to support the implementation of new mental health treatments and services should attend to organizational culture and climate, and to the compatibility of organizational service structures with the demand characteristics of treatments.

  5. Facilitating peer based learning through summative assessment - An adaptation of the Objective Structured Clinical Assessment tool for the blended learning environment.

    Science.gov (United States)

    Wikander, Lolita; Bouchoucha, Stéphane L

    2018-01-01

    Adapting a course from face to face to blended delivery necessitates that assessments are modified accordingly. In Australia the Objective Structured Clinical Assessment tool, as a derivative from the Objective Structured Clinical Examination, has been used in the face-to-face delivery mode as a formative or summative assessment tool in medicine and nursing since 1990. The Objective Structured Clinical Assessment has been used at Charles Darwin University to assess nursing students' simulated clinical skills prior to the commencement of their clinical placements since 2008. Although the majority of the course is delivered online, students attend a one-week intensive clinical simulation block yearly, prior to attending clinical placements. Initially, the Objective Structured Clinical Assessment was introduced as a lecturer assessed summative assessment, over time it was adapted to better suit the blended learning environment. The modification of the tool from an academic to peer assessed assessment tool, was based on the empirical literature, student feedback and a cross-sectional, qualitative study exploring academics' perceptions of the Objective Structured Clinical Assessment (Bouchoucha et al., 2013a, b). This paper presents an overview of the process leading to the successful adaptation of the Objective Structured Clinical Assessment to suit the requirements of a preregistration nursing course delivered through blended learning. This is significant as many universities are moving their curriculum to fully online or blended delivery, yet little attention has been paid to adapting the assessment of simulated clinical skills. The aim is to identify the benefits and drawbacks of using the peer assessed Objective Structured Clinical Assessment and share recommendations for successful implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Structural basis for effectiveness of siderophore-conjugated monocarbams against clinically relevant strains of Pseudomonas aeruginosa

    Energy Technology Data Exchange (ETDEWEB)

    Han, Seungil; Zaniewski, Richard P.; Marr, Eric S.; Lacey, Brian M.; Tomaras, Andrew P.; Evdokimov, Artem; Miller, J. Richard; Shanmugasundaram, Veerabahu (Pfizer)

    2012-02-08

    Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen that causes nosocomial infections for which there are limited treatment options. Penicillin-binding protein PBP3, a key therapeutic target, is an essential enzyme responsible for the final steps of peptidoglycan synthesis and is covalently inactivated by {beta}-lactam antibiotics. Here we disclose the first high resolution cocrystal structures of the P. aeruginosa PBP3 with both novel and marketed {beta}-lactams. These structures reveal a conformational rearrangement of Tyr532 and Phe533 and a ligand-induced conformational change of Tyr409 and Arg489. The well-known affinity of the monobactam aztreonam for P. aeruginosa PBP3 is due to a distinct hydrophobic aromatic wall composed of Tyr503, Tyr532, and Phe533 interacting with the gem-dimethyl group. The structure of MC-1, a new siderophore-conjugated monocarbam complexed with PBP3 provides molecular insights for lead optimization. Importantly, we have identified a novel conformation that is distinct to the high-molecular-weight class B PBP subfamily, which is identifiable by common features such as a hydrophobic aromatic wall formed by Tyr503, Tyr532, and Phe533 and the structural flexibility of Tyr409 flanked by two glycine residues. This is also the first example of a siderophore-conjugated triazolone-linked monocarbam complexed with any PBP. Energetic analysis of tightly and loosely held computed hydration sites indicates protein desolvation effects contribute significantly to PBP3 binding, and analysis of hydration site energies allows rank ordering of the second-order acylation rate constants. Taken together, these structural, biochemical, and computational studies provide a molecular basis for recognition of P. aeruginosa PBP3 and open avenues for future design of inhibitors of this class of PBPs.

  7. Factor structure and clinical utility of the Beck depression inventory in patients with binge eating disorder and obesity.

    Science.gov (United States)

    Udo, Tomoko; McKee, Sherry A; Grilo, Carlos M

    2015-01-01

    The Beck Depression Inventory (BDI) is often used to assess depression symptoms, but its factor structure and its clinical utility have not been evaluated in patients with binge eating disorder (BED) and obesity. A total of 882 treatment-seeking obese patients with BED were administered structured interviews (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders) and completed self-report questionnaires. Exploratory and confirmatory factor analyses supported a brief 16-item BDI version with a three-factor structure (affective, attitudinal and somatic). Both 21- and 16-item versions showed excellent internal consistency (both α=0.89) and had significant correlation patterns with different aspects of eating disorder psychopathology; three factors showed significant but variable associations with eating disorder psychopathology. Area under the curves (AUC) for both BDI versions were significant in predicting major depressive disorder (MDD; AUC=0.773 [16-item], 73.5% sensitivity/70.2% specificity, AUC=0.769 [21-item], 79.5% sensitivity/64.1% specificity) and mood disorders (AUC=0.763 [16-item], 67.1% sensitivity/71.5% specificity, AUC=0.769 [21-item], 84.2% sensitivity/55.7% specificity). The 21-item BDI (cutoff score ≥16) showed higher negative predictive values (94.0% vs. 93.0% [MDD]; 92.4% vs. 88.3% [mood disorders]) than the brief 16-item BDI (cutoff score ≥13). Both BDI versions demonstrated moderate performance as a screening instrument for MDD/mood disorders in obese patients with BED. Advantages and disadvantages for both versions are discussed. A three-factor structure has potential to inform the conceptualization of depression features. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. OBSERVATION ON ARRANGEMENT OF HILAR STRUCTURES IN CADAVERIC KIDNEYS AND THEIR CLINICAL SIGNIFICANCE

    Directory of Open Access Journals (Sweden)

    Sanjay Kumar Sinha

    2014-12-01

    Full Text Available Hilum of an organ is a depression, pit or slit like opening through which vital structures enter or leave the organ. In addition to the kidney, hilum is also observed in the cerebellum, lung, ovary, spleen and suprarenal gland. Laparoscopic nephron-sparing surgery for solid renal masses can be achieved successfully both transperitoneally and retroperitoneally if a comprehensive knowledge of both normal and variant hilar anatomy of the kidneys is in the mind of the operating surgeon. Documented text is available on various aspects of the kidneys but an observation on variations in hilar arrangement is infrequently cited. In standard text from anterior to posterior the structures at the renal hilum are renal vein, renal artery and the renal pelvis.

  9. HIGHER ORDER FACTOR STRUCTURE OF THE WISC-IV IN A CLINICAL NEUROPSYCHOLOGICAL SAMPLE

    Science.gov (United States)

    Bodin, Doug; Pardini, Dustin A.; Burns, Thomas G.; Stevens, Abigail B.

    2010-01-01

    A confirmatory factor analysis was conducted examining the higher order factor structure of the WISC-IV scores for 344 children who participated in neuropsychological evaluations at a large children’s hospital. The WISC-IV factor structure mirrored that of the standardization sample. The second order general intelligence factor (g) accounted for the largest proportion of variance in the first-order latent factors and in the individual subtests, especially for the working memory index. The first-order processing speed factor exhibited the most unique variance beyond the influence of g. The results suggest that clinicians should not ignore the contribution of g when interpreting the first-order factors. PMID:19132580

  10. How well do second-year students learn physical diagnosis? Observational study of an objective structured clinical examination (OSCE

    Directory of Open Access Journals (Sweden)

    Simon Steven R

    2002-01-01

    Full Text Available Abstract Background Little is known about using the Objective Structured Clinical Examination (OSCE in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course. Methods Cross-sectional study at Harvard Medical School, 1997–1999, for 489 second-year students. Results Average total OSCE score was 57% (range 39–75%. Among clinical skills, students scored highest on patient interaction (72%, followed by examination technique (65%, abnormality identification (62%, history-taking (60%, patient presentation (60%, physical examination knowledge (47%, and differential diagnosis (40% (p Conclusions Students scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching.

  11. Factor structure and clinical correlates of the Food Thought Suppression Inventory within treatment seeking obese women with binge eating disorder

    Science.gov (United States)

    Barnes, Rachel D.; Sawaoka, Takuya; White, Marney A.; Masheb, Robin M.; Grilo, Carlos M.

    2013-01-01

    Prior research on the relations among eating behaviors and thought suppression is limited to a measure of general thought suppression, the White Bear Suppression Inventory. To address this limitation, researchers recently validated the Food Thought Suppression Inventory (FTSI). Analyses using this measure suggest that food thought suppression is distinct from and is more predictive of eating disorder psychopathology than is general thought suppression. The FTSI, however, has not yet been validated in clinical samples. The purpose of the current study is to examine the factor structure and clinical correlates of the FTSI within treatment seeking obese women with binge eating disorder (BED; N = 128). Analyses revealed a valid and reliable one-factor measure of food thought suppression that was related to higher levels of eating and general psychopathology. The findings provide evidence for the use of the FTSI with obese women with BED. Future research should examine the psychometric properties of the FTSI within larger and more diverse samples. PMID:23265399

  12. Fully automated structural MRI of the brain in clinical dementia workup.

    Science.gov (United States)

    Persson, Karin; Selbæk, Geir; Brækhus, Anne; Beyer, Mona; Barca, Maria; Engedal, Knut

    2017-06-01

    Background The dementia syndrome has been regarded a clinical diagnosis but the focus on supplemental biomarkers is increasing. An automatic magnetic resonance imaging (MRI) volumetry method, NeuroQuant® (NQ), has been developed for use in clinical settings. Purpose To evaluate the clinical usefulness of NQ in distinguishing Alzheimer's disease dementia (AD) from non-dementia and non-AD dementia. Material and Methods NQ was performed in 275 patients diagnosed according to the criteria of ICD-10 for AD, vascular dementia and Parkinson's disease dementia (PDD); the Winblad criteria for mild cognitive impairment; the Lund-Manchester criteria for frontotemporal dementia; and the revised consensus criteria for Lewy body dementia (LBD). Receiver operating curve (ROC) analyses with calculation of area under the curve (AUC) and regression analyses were carried out. Results Forebrain parenchyma (AUC 0.82), hippocampus (AUC 0.80), and inferior lateral ventricles (AUC 0.78) yielded the highest AUCs for AD/non-dementia discrimination. Only hippocampus (AUC 0.62) and cerebellum (AUC 0.67) separated AD from non-AD dementia. Cerebellum separated AD from PDD-LBD (AUC 0.83). Separate multiple regression analyses adjusted for age and gender, showed that memory (CERAD 10-word delayed recall) (beta 0.502, P dementia (beta -0.392, P dementia fairly well but generally poorer from non-AD dementia. Degree of memory impairment, age, and gender, but not diagnostic distinction, were associated to the hippocampus volume in adjusted analyses. Surprisingly, cerebellum was found relevant in separating AD from PDD-LBD.

  13. ANATOMICAL AND CLINICAL ORBSERVATIONS ON STRUCTURAL CHANGES OF THE HIP JOINT.

    Science.gov (United States)

    Macovei, Luana-Andreea; Rezus, Elena

    2016-01-01

    The hip, the second largest joint of the human body, with its primary contribution to locomotion, is exposed to numerous traumatic or non-traumatic risks. Regardless of the initial pathology, there is always almost the same result: diminution of range of motion, onset of pain and functional impotence, as well as change of biomechanics of walking. Through its high frequency, morpho-functional imbalance (clinically expressed both imagistic and biologically, in one or several joints), osteoarthritis is a disease with a multifactorial etiology and a complex pathogeny. The study included 244 patients aged between 18-85 years, clinically and paraclinically investigated, especially for the osteoarthritis of the hip, admitted to Rheumatology Clinic I, Rehabilitation Hospital in Iasi, from January 2012 to December 2014. The high prevalence of degenerative diseases of the joints in old age is analyzed in accordance with the results of the estimations, which showed that, in fact, most of the patients remain undetected, undiagnosed and untreated. Main symptoms are pain in the coxofemoral joint, radiating or not on the lateral or anterior face of the thigh down to the knee, morning stiffness after a long rest, limping or walking with small steps, and muscle atrophy of the group of muscles that are responsible for the stability of the joint. A strict discipline is needed from the patient's side, in order to keep and apply the doctor's indications in a chronic disease that requires a long therapy, on one hand; on the other hand, a close cooperation between various experts is needed, in order to customize and apply the most effective program, at the right time.

  14. Reconciling disparate information in continuity of care documents: Piloting a system to consolidate structured clinical documents.

    Science.gov (United States)

    Hosseini, Masoud; Jones, Josette; Faiola, Anthony; Vreeman, Daniel J; Wu, Huanmei; Dixon, Brian E

    2017-10-01

    Due to the nature of information generation in health care, clinical documents contain duplicate and sometimes conflicting information. Recent implementation of Health Information Exchange (HIE) mechanisms in which clinical summary documents are exchanged among disparate health care organizations can proliferate duplicate and conflicting information. To reduce information overload, a system to automatically consolidate information across multiple clinical summary documents was developed for an HIE network. The system receives any number of Continuity of Care Documents (CCDs) and outputs a single, consolidated record. To test the system, a randomly sampled corpus of 522 CCDs representing 50 unique patients was extracted from a large HIE network. The automated methods were compared to manual consolidation of information for three key sections of the CCD: problems, allergies, and medications. Manual consolidation of 11,631 entries was completed in approximately 150h. The same data were automatically consolidated in 3.3min. The system successfully consolidated 99.1% of problems, 87.0% of allergies, and 91.7% of medications. Almost all of the inaccuracies were caused by issues involving the use of standardized terminologies within the documents to represent individual information entries. This study represents a novel, tested tool for de-duplication and consolidation of CDA documents, which is a major step toward improving information access and the interoperability among information systems. While more work is necessary, automated systems like the one evaluated in this study will be necessary to meet the informatics needs of providers and health systems in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Nursing Clinical Documentation System Structured on NANDA-I, NOC, and NIC Classification Systems.

    Science.gov (United States)

    Peres, Heloisa Helena C; de Almeida Lopes M da Cruz, Diná; Tellez, Michelle; de Cassia Gengo e Silva, Rita; dos S Diogo, Regina Celia; Ortiz, Diley Cardoso F; Ortiz, Dóris R

    2015-01-01

    Information is a key feature that health professionals need to exercise their profession with efficiency and quality. This study aims to present the experience of the usage of an electronic system for clinical documentation in nursing in a university hospital. It is a methodological research of technology production. The system was developed in four phases: Conception, Elaboration, Construction, and Transition, and was named Electronic Documentation System of the University of São Paulo Nursing Process (PROCEnf-USP™). The knowledge base of PROCEnf-USP™ was organized in hierarchy of domains and classes, according to NNN linkages.

  16. Clinical and Genetic Aspects of Chronic Pyelonephritis in Children: the Structure of Addiction and Primary Prognosis

    Directory of Open Access Journals (Sweden)

    T.O. Kryuchko

    2013-04-01

    Full Text Available Currently studying the mechanisms of recognition of foreign agents, which is implemented by Toll-like receptor of innate immune system, has become one of the main tasks of clinical immunology. The aim of our study was an analysis of the association between Toll-like receptor 4 gene polymorphism (Asp299Gly and main pathogens of urinary system infections. These results confirm the important role of Toll-like receptors in the realization of an innate immune response and enables to consider Toll-like receptor 4 gene polymorphism as an additional prognostic indicator in genetic researches.

  17. An evaluation of structural changes in diabetic neuropathy. Clinical study with magnetic resonance imaging (MRI)

    Energy Technology Data Exchange (ETDEWEB)

    Yasuda, Kikuko; Suzuki, Eiji; Shibata, Toshiroh [Gifu Univ. (Japan). School of Medicine] [and others

    1996-01-01

    To investigate changes in tissue hydration and structural changes in diabetic patients using an MRI scanner (SIGNA 1.5-Tesla) with an extremity coil, spin-lattice relaxation time (T{sub 1} value), cross-sectional area, and coefficient of variation (CV value) of signal intensities of the sural nerve, respectively, were determined as indexes of nerve edema, nerve swelling or shrinkage and structural change, and were calculated in normal subjects (normal group, n=7) and diabetic patients (diabetic group, n=33). T{sub 1} value of the sural nerve, but not muscle or adipose tissue, was significantly prolonged in diabetic group (1000{+-}273 vs 702{+-}324 msec, P<0.01), indicating the presence of nerve edema in the diabetic group. There were no differences in cross-sectional area. CV values were significantly higher in the diabetic group (P<0.05). T{sub 1} values were positively correlated with glycemic control (fasting plasma glucose: r=40, HbA{sub 1}c: r=0.35) (P<0.05) and negatively correlated with motor nerve conduction velocity (r=-0.42, P<0.01). These findings indicate that MRI is of value in the objective evaluation of structural changes in diabetic neuropathy. (author).

  18. Child abuse: a model for the use of structured clinical forms.

    Science.gov (United States)

    Bar-on, M E; Zanga, J R

    1996-09-01

    To assess the effectiveness of structured forms in the collection and documentation of information essential to the evaluation of abused children. Retrospective chart review. Five hundred sixty-seven children were evaluated for physical or sexual abuse during a 24-month period. Specific items crucial to the evaluation of abuse were selected for both physical and sexual abuse. By using these items as markers, we compared the data obtained and documented during abuse evaluations after the introduction of the forms with those obtained before their introduction. The information that occurred more frequently when using the structured forms included: a history of the assault from both the child and an adult (and in cases of physical abuse, a developmental history); specific sexual acts; mechanism of injury; a detailed description of the genital examination; drawings of findings (both sexual and physical); documentation of laboratory studies, photographs, and radiographic studies; and reporting to Child Protective Services. Structured forms significantly increased the information collected and documented in medical records during evaluations of abused children. These forms were found to be more effective than the previously used unstructured, institutional form.

  19. An electrocardiography algorithm combined with clinical features could localize the origins of focal atrial tachycardias in adjacent structures.

    Science.gov (United States)

    Uhm, Jae-Sun; Shim, Jaemin; Wi, Jin; Mun, Hee-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung; Joung, Boyoung

    2014-07-01

    It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.

  20. Hypothyroidism Side Effect in Patients Treated with Sunitinib or Sorafenib: Clinical and Structural Analyses

    Science.gov (United States)

    Shu, Mao; Zai, Xiaoli; Zhang, Beina; Wang, Rui; Lin, Zhihua

    2016-01-01

    Tyrosine kinase inhibitors (TKIs) provide more effective targeted treatments for cancer, but are subject to a variety of adverse effects, such as hypothyroidism. TKI-induced hypothyroidism is a highly complicated issue, because of not only the unrealized toxicological mechanisms, but also different incidences of individual TKI drugs. While sunitinib is suspected for causing thyroid dysfunction more often than other TKIs, sorafenib is believed to be less risky. Here we integrated clinical data and in silico drug-protein interactions to examine the pharmacological distinction between sunitinib and sorafenib. Statistical analysis on the FDA Adverse Event Reporting System (FAERS) confirmed that sunitinib is more concurrent with hypothyroidism than sorafenib, which was observed in both female and male patients. Then, we used docking method and identified 3 proteins specifically binding to sunitinib but not sorafenib, i.e., retinoid X receptor alpha, retinoic acid receptors beta and gamma. As potential off-targets of sunitinib, these proteins are well known to assemble with thyroid hormone receptors, which can explain the profound impact of sunitinib on thyroid function. Taken together, we established a strategy of integrated analysis on clinical records and drug off-targets, which can be applied to explore the molecular basis of various adverse drug reactions. PMID:26784451

  1. Structure and clinical correlates of obsessive-compulsive symptoms in a large sample of children and adolescents

    DEFF Research Database (Denmark)

    Højgaard, D. R. M. A.; Mortensen, E. L.; Ivarsson, T.

    2017-01-01

    subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination....../cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores...

  2. Structural diversity of marine cyclic peptides and their molecular mechanisms for anticancer, antibacterial, antifungal, and other clinical applications.

    Science.gov (United States)

    Lee, Yeji; Phat, Chanvorleak; Hong, Soon-Cheol

    2017-09-01

    Many cyclic peptides and analogues derived from marine sources are known to possess biological properties, including anticancer, antitumor, antibacterial, antifungal, antiparasitic, anti-inflammation, anti-proliferative, anti-hypertensive, cytotoxic, and antibiotic properties. These compounds demonstrate different activities and modes of action according to their structure such as cyclic oligopeptide, cyclic lipopeptide, cyclic glycopeptide and cyclic depsipeptide. The recent advances in application of the above-mentioned cyclic peptides were reported in dolastatins, soblidotin, didemnin B, aplidine, salinosporamide A, kahalalide F and bryostatin 1 and they are currently in clinical trials. These cyclic peptides are possible novel drugs discovered and developed from marine origin. Literature data concerning the potential properties of marine cyclic peptides were reviewed here, and the structural diversity and biological activities of marine cyclic peptides are discussed in relation to the molecular mechanisms of these marine cyclic peptides. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Second-order factor structure of the Vancouver Obsessive Compulsive Inventory (VOCI) in a non-clinical sample.

    Science.gov (United States)

    Chiorri, Carlo; Melli, Gabriele; Smurra, Rosa

    2011-10-01

    The Vancouver Obsessive Compulsive Inventory (VOCI) is a self-report measure of the severity of obsessive-compulsive problems such as contamination, checking, obsessions, hoarding, needing things to be just right, and indecisiveness. In the seminal paper a six-correlated-factor structure was found in a sample of OC patients, but the issue of the factor structure of the VOCI in non-clinical populations was not addressed. This study assesses the psychometric properties and the factor structure of the Italian version of the VOCI in a non-clinical sample. The VOCI was administered to a large community sample (n = 445). Some participants also completed a battery including measures of OC behaviour, worry, anxiety and depression (n = 89) and were administered the VOCI twice at an 8-week interval (n = 46). Confirmatory factor analyses replicated the six-correlated-factor structure originally found in a patient sample, but a more parsimonious, second-order-factor model showed a statistically higher fit, suggesting that VOCI subscales can be considered as facets of a higher-order OCD factor. The whole item pool and each of the subscales showed good internal consistency, unidimensionality, test-retest reliability and convergent construct validity. As in the original version, limited support for discriminant validity was found. Scores were weakly associated with age, gender and education. Although some key issues still need to be investigated (e.g. sensitivity to change), the VOCI seems to be a psychometrically sound instrument for the assessment of OCD-related behaviours and thoughts and can be used in cultural contexts different from the original.

  4. Resilience moderates the relationship between emotional intelligence and clinical communication ability among Chinese practice nursing students: A structural equation model analysis.

    Science.gov (United States)

    Kong, Linghua; Liu, Yun; Li, Guopeng; Fang, Yueyan; Kang, Xiaofei; Li, Ping

    2016-11-01

    To examine the positive association between emotional intelligence and clinical communication ability among practice nursing students, and to determine whether resilience plays a moderating role in the relationship between emotional intelligence and clinical communication ability among Chinese practice nursing students. Three hundred and seventy-seven practice nursing students from three hospitals participated in this study. They completed questionnaires including the Emotional Intelligence Inventory (EII), Connor-Davidson Resilience Scale (CD-RISC-10), and Clinical Communication Ability Scale (CCAS). Structural equation modeling was used to analyze the relationships among emotional intelligence, resilience, and clinical communication ability. Emotional intelligence was positively associated with clinical communication ability (Pintelligence and clinical communication ability (Pintelligence is positively related to clinical communication ability among Chinese practice nursing students, and resilience moderates the relationship between emotional intelligence and clinical communication ability, which may provide scientific evidence to aid in developing intervention strategies to improve clinical communication ability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Hispanic ethnicity and Caucasian race: Relations with posttraumatic stress disorder's factor structure in clinic-referred youth.

    Science.gov (United States)

    Contractor, Ateka A; Claycomb, Meredith A; Byllesby, Brianna M; Layne, Christopher M; Kaplow, Julie B; Steinberg, Alan M; Elhai, Jon D

    2015-09-01

    The severity of posttraumatic stress disorder (PTSD) symptoms is linked to race and ethnicity, albeit with contradictory findings (reviewed in Alcántara, Casement, & Lewis-Fernández, 2013; Pole, Gone, & Kulkarni, 2008). We systematically examined Caucasian (n = 3,767) versus non-Caucasian race (n = 2,824) and Hispanic (n = 2,395) versus non-Hispanic ethnicity (n = 3,853) as candidate moderators of PTSD's 5-factor model structural parameters (Elhai et al., 2013). The sample was drawn from the National Child Traumatic Stress Network's Core Data Set, currently the largest national data set of clinic-referred children and adolescents exposed to potentially traumatic events. Using confirmatory factor analysis, we tested the invariance of PTSD symptom structural parameters by race and ethnicity. Chi-square difference tests and goodness-of-fit values showed statistical equivalence across racial and ethnic groups in the factor structure of PTSD and in mean item-level indicators of PTSD symptom severity. Results support the structural invariance of PTSD's 5-factor model across the compared racial and ethnic groups. Furthermore, results indicated equivalent item-level severity across racial and ethnic groups; this supports the use of item-level comparisons across these groups. (c) 2015 APA, all rights reserved).

  6. Structure and measurement of depression in youths: applying item response theory to clinical data.

    Science.gov (United States)

    Cole, David A; Cai, Li; Martin, Nina C; Findling, Robert L; Youngstrom, Eric A; Garber, Judy; Curry, John F; Hyde, Janet S; Essex, Marilyn J; Compas, Bruce E; Goodyer, Ian M; Rohde, Paul; Stark, Kevin D; Slattery, Marcia J; Forehand, Rex

    2011-12-01

    Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.

  7. Factor structure of the SOCRATES in a clinical sample of adolescents.

    Science.gov (United States)

    Maisto, Stephen A; Chung, Tammy A; Cornelius, Jack R; Martin, Christopher S

    2003-06-01

    This study investigated the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES; W. R. Miller & J. S. Tonigan, 1996) in adolescents presenting for treatment of alcohol use disorder (AUD). The participants were 80 males and 43 females (mean age = 16.8 years) who presented for AUD treatment (95.1% outpatient, 4.9% inpatient). Participants completed assessments at baseline and 1 year and provided information on alcohol use and related variables monthly between these 2 assessments. Principal-components and confirmatory factor analyses of the baseline SOCRATES identified 2 factors, Taking Steps and Recognition, which showed good internal consistency and concurrent and predictive evidence of validity. The results were interpreted as supporting the use of the SOCRATES with clinical samples of adolescents.

  8. [Acute hepatitis of unspecified etiology: etiological structure and clinical-laboratory characteristics].

    Science.gov (United States)

    Iushchuk, N D; Tsyganova, E V; Znoĭko, O O; Karetkina, G N; Solonin, S A; Mikhaĭlov, M I; Isaguliants, M G; Petrova, T V; Kashirin, V I; Cheshik, D S

    2009-01-01

    The straight line nucleic acids detection method of viruses and wide spectrum of virus antigens immunodiagnostics in acute hepatitis of unknown etiology patients has allowed verifying the diagnosis at 19% cases (a viral hepatitis A, C or E). Results of research do not allow to consider hepatotropic viruses HGV, TTV, PV B19, EBV, CMV, HHV 1, 2, 6 and 8 type, NV-F as etiological agents at the majority of patients of investigated group, and the data of the anamnesis and a clinical and laboratory picture of a current of disease does not allow to exclude at 29.4% of patients a drug-induced hepatitis. Despite detailed molecular-biological and immunological inspection of patients, at 37.9% of acute hepatitis of unknown etiology patients it was not possible to establish a connection with hepatitis and defined etiological factor (the infectious agent).

  9. Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey.

    Science.gov (United States)

    Baker, Kenneth F; Jandial, Sharmila; Thompson, Ben; Walker, David; Taylor, Ken; Foster, Helen E

    2016-10-21

    Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice. Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training. Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools. We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.

  10. Clinical experience using polyetheretherketone (PEEK) intervertebral structural cage for anterior cervical corpectomy and fusion.

    Science.gov (United States)

    Kasliwal, Manish K; O'Toole, John E

    2014-02-01

    Anterior cervical corpectomy and fusion (ACCF) is commonly performed for various pathologies involving the cervical spine. Although polyetheretherketone (PEEK) cages have been widely used following anterior cervical discectomy and fusion (ACDF), clinical literature demonstrating its efficacy following ACCF is sparse. A retrospective review of patients enrolled in a prospective database who underwent single/multi-level ACCF was performed. Fifty-nine patients were identified who underwent corpectomy reconstruction with PEEK cages for symptomatic degenerative, neoplastic, infectious, or traumatic pathologies of the cervical spine. Thirty-five patients having at least 6 months follow-up (FU) were included in the final analysis. The mean age of patients was 51 years (range, 18-81 years) with FU ranging from 6 to 33 months (mean, 6.6 months). None of the patients had dysphagia at last FU. There was no implant failure with fusion occurring in all patients. While 57% of patients (20/35) remained stable with no progression of myelopathy, 43% (15/35) improved one (11 patients) or two (four patients) Nurick grades after surgery. The use of PEEK cages packed with autograft or allograft is safe and effective following anterior cervical corpectomy, demonstrating high fusion rates and good clinical results. This synthetic material obviates the morbidity associated with autograft harvest and possible infectious risks of allograft. The wide array of cage dimensions facilitates ease of use in patients of all sizes and appears safe for use in the typical pathologic conditions encountered in the cervical spine. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Analysis of foot structural damage in rheumatoid arthritis: clinical evaluation by validated measures and serological correlations

    Directory of Open Access Journals (Sweden)

    E. Bartoloni Bocci

    2011-06-01

    Full Text Available Objective: To examine foot involvement in rheumatoid arthritis (RA and to characterize structural alterations in patients with anti-cyclic citrullinated peptide (CCP antibody-positive and -negative disease. Methods: Seventy-eight patients with RA with foot pain were consecutively enrolled. The Manchester Hallux Valgus (MHV rating scale was used to evaluate the hallux valgus deformity degree. The Foot Posture Index (FPI6, a novel, foot-specific outcome measure, was adopted in order to quantify variation in the position of the foot. The findings were correlated with disease duration and presence or absence of anti-CCP antibodies. Results: About 84.6% patients had different degrees of hallux valgus and 65.4% subjects had a pronated foot. These two foot alterations were prevalently found in patients with long-standing disease and circulating anti-CCP antibodies. On the contrary, RA patients without anti-CCP and early disease essentially displayed a supinated foot without relevant hallux valgus deformity. Conclusion: Our findings allowed to identify different anatomic foot alterations in RA patients according to disease duration and negative prognostic factors such as anti-CCP antibodies. Our findings support the role of an accurate analysis of foot structural damage and may suggest the usefulness of a correct plantar orthosis prescription also in early phases of the disease.

  12. Reduction of the Number of Major Representative Allergens: From Clinical Testing to 3-Dimensional Structures

    Directory of Open Access Journals (Sweden)

    Ying He

    2014-01-01

    Full Text Available Vast amounts of allergen sequence data have been accumulated, thus complicating the identification of specific allergenic proteins when performing diagnostic allergy tests and immunotherapy. This study aims to rank the importance/potency of the allergens so as to logically reduce the number of allergens and/or allergenic sources. Meta-analysis of 62 allergenic sources used for intradermal testing on 3,335 allergic patients demonstrated that in southern China, mite, sesame, spiny amaranth, Pseudomonas aeruginosa, and house dust account for 88.0% to 100% of the observed positive reactions to the 62 types of allergenic sources tested. The Kolmogorov-Smironov Test results of the website-obtained allergen data and allergen family featured peptides suggested that allergen research in laboratories worldwide has been conducted in parallel on many of the same species. The major allergens were reduced to 21 representative allergens, which were further divided into seven structural classes, each of which contains similar structural components. This study therefore has condensed numerous allergenic sources and major allergens into fewer major representative ones, thus allowing for the use of a smaller number of allergens when conducting comprehensive allergen testing and immunotherapy treatments.

  13. Can the reporting of adverse skin reactions to cosmetics be improved? A prospective clinical study using a structured protocol.

    Science.gov (United States)

    Berne, Berit; Tammela, Monica; Färm, Gunilla; Inerot, Annica; Lindberg, Magnus

    2008-04-01

    The use of cosmetics is rising, and adverse reactions to these products are increasing. In Sweden, the Medical Products Agency (MPA) keeps a voluntary reporting system for such adverse reactions. However, the reporting is sparse, consisting almost only of cases with test-proven allergic contact dermatitis, thus under-reporting the more common irritant reactions. The aim of the study was to try to improve the reporting system. Dermatologists at 3 dermatology departments used a structured protocol during the clinical investigation of 151 consecutive patients reporting skin reactions to cosmetics. The protocol included symptoms, signs, affected body site, suspected products, and final diagnosis after patch testing. Based on clinical data and patch test results, a causality assessment for each product was made according to a protocol used at the MPA. Allergic contact dermatitis was found in 28% of the patients, and irritant reactions were equally common at 27%. Using this structured protocol, the cases of irritant dermatitis were also reported, and it is recommended that such a protocol is used as a standard to improve the reporting of adverse reactions to skin care products.

  14. The prevalence, clinical correlates and structure of phobic fears in Han Chinese women with recurrent major depression.

    Science.gov (United States)

    Yang, Fuzhong; Qiu, Jianyin; Zhao, Hongsu; Wang, Zhoubing; Tao, Danhong; Xiao, Xue; Niu, Qihui; Wang, Qian; Li, Yajuan; Guo, Liyang; Li, Jianying; Li, Kan; Xia, Jing; Wang, Lina; Shang, Xiaofang; Sang, Wenhua; Gan, Zhaoyu; He, Kangmei; Zhao, Xiaochuan; Tian, Tian; Xu, Dan; Gu, Danhua; Weng, Xiaoqin; Li, Haimin; Tian, Jing; Yang, Lijun; Li, Qiang; Yang, Qingzhen; Wang, Hui; Dang, Yamei; Dai, Lei; Cui, Yanping; Ye, Dong; Cao, Juling; Guo, Li; Kang, Zhen; Liu, Jimeng; Chen, Bin; Liu, Jinhua; Zhang, Jinling; Yang, Donglin; Jiao, Bin; Yu, Fengyu; Geng, Feng; Li, Ling; Yang, Haiying; Dai, Hong; Wang, Hongli; Liu, Caixing; Liu, Haijun; Peng, Longyan; Wang, Xiaoping; Wei, Shaojun; Liu, Xiaojuan; Li, Chang; Liu, Zhengrong; Zhang, Qiwen; Di, Dongchuan; Shi, Shenxun; Flint, Jonathan; Kendler, Kenneth S

    2014-03-01

    Phobic fears are common in the general population and among individuals with major depression (MD). We know little about the prevalence, clinical correlates, and structure of phobic fears in Chinese women with MD. We assessed 22 phobic fears in 6017 Han Chinese women with MD. We used exploratory factor analysis to examine the structure of these phobic fears. We examined the relationship between individual phobic fears and the severity of MD, neuroticism, comorbid panic disorder, generalized anxiety disorder and dysthymia using logistic regression models. The frequency of phobic fears ranged from 3.0% (eating in public) to 36.0% (snakes). Phobic fears were significantly associated with more severe MD, high neuroticism, and co-morbid panic disorder, generalized anxiety disorder and dysthymia. Our factor analysis suggested four underlying subgroups of phobic fears which differed in their clinical correlates, severity and patterns of comorbidity. Data were collected retrospectively through interview and recall bias may have affected the results. Phobic fears are correlated with comorbid MD and more severe MD. These phobic fears clearly subdivide into four subgroups that differ meaningfully from each other. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Clinical efficacy of dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI

    Directory of Open Access Journals (Sweden)

    Leuthner KD

    2016-06-01

    Full Text Available Kimberly D Leuthner,1 Kristin A Buechler,1 David Kogan,1 Agafe Saguros,1 H Stephen Lee2 1Department of Pharmaceutical Services, University Medical Center of Southern Nevada, Las Vegas, NV, USA; 2Roseman University of Health Sciences College of Pharmacy, Henderson, NV, USA Abstract: Acute bacterial skin and skin structure infections (ABSSSI are a common disease causing patients to seek treatment through the health care system. With the continued increase of drug-resistant bacterial pathogens, these infections are becoming more difficult to successfully cure. Lipoglycopeptides have unique properties that allow the drug to remain active toward both common and challenging pathogens at the infected site for lengthy periods of time. Dalbavancin, a new lipoglycopeptide, provides two unique dosing regimens for the treatment of ABSSSI. The original regimen of 1,000 mg intravenous infusion followed by a 500 mg intravenous infusion after a week has been shown as safe and effective in multiple, randomized noninferiority trials. These studies also demonstrated that dalbavancin was similar to standard regimens in terms of both safety and tolerability. Recently a single 1,500 mg dose was demonstrated to be equivalent to the dalbavancin two-dose regimen for treating ABSSSI. With the introduction of dalbavancin, clinicians have the option to provide an intravenous antimicrobial agent shown to be as effective as traditional therapies, without requiring admission into the hospitals or prescribing a medication which may not be utilized optimally. Further understanding of dalbavancin and its unusual properties can provide unique treatment situations with potential benefits for both the patient and the overall health care system, which should be further explored. Keywords: dalbavancin, lipoglycopeptide, ABSSSI, skin and skin structure infection, dosing schedule, Gram-positive resistance

  16. Structured clinical follow-up for CKD stage 5 may safely postpone dialysis.

    Science.gov (United States)

    Dattolo, Pietro; Michelassi, Stefano; Amidone, Marco; Allinovi, Marco; Vignali, Lorenzo; Antognoli, Giulia; Roperto, Rosa; Pizzarelli, Francesco

    2015-08-01

    The optimal timing of dialysis initiation is still unclear. We aimed to ascertain whether a strict clinical follow-up can postpone need for dialysis in chronic kidney disease (CKD) stage 5 patients. We reviewed records of all consecutive adult patients attending our conservative CKD stage 5 outpatient clinic from 2001 to 2010. Chronicity was defined as two consecutive estimated glomerular filtration rate (eGFR) measurements below 15 ml/min/1.73 m(2). Characteristics of subjects, including comorbidities, were assessed at baseline; blood pressure and serum markers of uremia were assessed both at first and last visit. GFR was estimated by the 4-variable Modification of Diet in Renal Disease (MDRD) formula. In the 312 patients analyzed baseline eGFR was 9.7 ± 2.7 ml/min, which declined by 1.93 ± 4.56 ml/min after 15.6 ± 18.2 months. Age was inversely related to eGFR decline (r -0.27, p = 0.000). During conservative follow-up 55 subjects (18%) died. In comparison with those eventually entering dialysis, deceased subjects were older and had a longer follow-up with no CKD progression. Multivariate analysis identified age, proteinuria and lower baseline K values as the only independent determinants of death. One hundred ninety-four subjects (66%) started dialysis with an average eGFR of 6.1 ± 1.9 ml/min. During 35.8 ± 24.7 months of dialysis follow-up, 84 patients died. Multivariate analysis identified age as the main determinant of death (hazard ratio [HR] for every year 1.07, 95% confidence interval [CI] 1.04-1.11, p 0.000). Patients starting dialysis with eGFR below the median, e.g. dialysis entry as long as 1 year. Starting dialysis with eGFR lower than 6 ml/min does not confer any increased risk of death in selected early-referral patients.

  17. Endothelial nitric oxide synthase: From biochemistry and gene structure to clinical implications of NOS3 polymorphisms.

    Science.gov (United States)

    Oliveira-Paula, Gustavo H; Lacchini, Riccardo; Tanus-Santos, Jose E

    2016-01-10

    Nitric oxide (NO) is an important vasodilator with a well-established role in cardiovascular homeostasis. While mediator is synthesized from L-arginine by neuronal, endothelial, and inducible nitric oxide synthases (NOS1,NOS3 and NOS2 respectively), NOS3 is the most important isoform for NO formation in the cardiovascular system. NOS3 is a dimeric enzyme whose expression and activity are regulated at transcriptional, posttranscriptional,and posttranslational levels. The NOS3 gene, which encodes NOS3, exhibits a number of polymorphic sites including single nucleotide polymorphisms (SNPs), variable number of tandem repeats (VNTRs), microsatellites, and insertions/deletions. Some NOS3 polymorphisms show functional effects on NOS3 expression or activity, thereby affecting NO formation. Interestingly, many studies have evaluated the effects of functional NOS3 polymorphisms on disease susceptibility and drug responses. Moreover, some studies have investigated how NOS3 haplotypes may impact endogenous NO formation and disease susceptibility. In this article,we carried out a comprehensive review to provide a basic understanding of biochemical mechanisms involved in NOS3 regulation and how genetic variations in NOS3 may translate into relevant clinical and pharmacogenetic implications.

  18. Development of a formal structure for clinical management decisions: a mathematical analysis.

    Science.gov (United States)

    Card, W I

    1975-01-01

    Decision theory and the calculating power of the computer now enables us to contemplate the development of formal methods for making decisions about clinical management. In the simplest model, it is first necessary to define all treatment decisions as an exhaustive and mutually exclusive set and similarly to define the set of consequences or outcomes of treatment. The probability of each outcome conditional on treatment has to be estimated and this consequent state of health has to be quantified as a utility. Possible methods of estimating utilities of states of health are discussed and the construction of a unidimensional utility function based on a sequence of wagers. The states of health consequent on severe brain damage can only be described multidimensionally and the model has to be extended to include this case. While such a model would allow simple treatment decisions to be formalized, it could not decide whether the cost of treatment was worth while nor whether it would pay to carry out further investigative tests and thus buy more evidence. If these additional variables are to be included in the model, it is necessary to introduce the motion of an equivalence between monetary values and utilities. This implies attaching a monetary value to any given state of health.

  19. A randomized controlled clinical trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics.

    Science.gov (United States)

    Chien, Wai-Tong; Bressington, Daniel

    2015-09-30

    This study aimed to test the effectiveness of a nurse-led structured psychosocial intervention program in Chinese patients with first-onset mental illness. A single-blind, parallel group, randomized controlled trial design was used. The study involved 180 participants with mild to moderate-severe symptoms of psychotic or mood disorders who were newly referred to two psychiatric outpatient clinics in Hong Kong. Patients were randomly assigned to either an eight-session nurse-led psychosocial intervention program (plus usual care) or usual psychiatric outpatient care (both n=90). The primary outcome was psychiatric symptoms. Outcomes were measured at recruitment, one week and 12 months post-intervention. Patients in the psychosocial intervention group reported statistically significant improvements in symptoms compared to treatment as usual. There were also significant improvements in illness insight and perceived quality of life and reduction in length of re-hospitalizations over the 12-month follow-up. The findings provide evidence that the nurse-led psychosocial intervention program resulted in improved health outcomes in Chinese patients with first-onset mental illness. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Den danske udgave af Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD): Rationale, oversigt og oversættelse

    DEFF Research Database (Denmark)

    Kongerslev, Mickey T; Bach, Bo; Olsen, Cecilie Westergaard

    2017-01-01

    The chapter outlines the rationale for using structured clinical interviews to diagnose personality disorder, provides an overview of the changes from SCID-II to SCID-5-PD, and describes the translation procedures used for the Danish version......The chapter outlines the rationale for using structured clinical interviews to diagnose personality disorder, provides an overview of the changes from SCID-II to SCID-5-PD, and describes the translation procedures used for the Danish version...

  1. Toward a Two-Dimensional Model of Social Cognition in Clinical Neuropsychology: A Systematic Review of Factor Structure Studies.

    Science.gov (United States)

    Etchepare, Aurore; Prouteau, Antoinette

    2017-11-27

    Social cognition has received growing interest in many conditions in recent years. However, this construct still suffers from a considerable lack of consensus, especially regarding the dimensions to be studied and the resulting methodology of clinical assessment. Our review aims to clarify the distinctiveness of the dimensions of social cognition. Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, a systematic review was conducted to explore the factor structure of social cognition in the adult general and clinical populations. The initial search provided 441 articles published between January 1982 and March 2017. Eleven studies were included, all conducted in psychiatric populations and/or healthy participants. Most studies were in favor of a two-factor solution. Four studies drew a distinction between low-level (e.g., facial emotion/prosody recognition) and high-level (e.g., theory of mind) information processing. Four others reported a distinction between affective (e.g., facial emotion/prosody recognition) and cognitive (e.g., false beliefs) information processing. Interestingly, attributional style was frequently reported as an additional separate factor of social cognition. Results of factor analyses add further support for the relevance of models differentiating level of information processing (low- vs. high-level) from nature of processed information (affective vs. cognitive). These results add to a significant body of empirical evidence from developmental, clinical research and neuroimaging studies. We argue the relevance of integrating low- versus high-level processing with affective and cognitive processing in a two-dimensional model of social cognition that would be useful for future research and clinical practice. (JINS, 2017, 23, 1-14).

  2. Vascular Structures of the Right Colon: Incidence and Variations with Their Clinical Implications.

    Science.gov (United States)

    Alsabilah, J; Kim, W R; Kim, N K

    2017-06-01

    There is a demand for a better understanding of the vascular structures around the right colonic area. Although right hemicolectomy with the recent concept of meticulous lymph node dissection is a standardized procedure for malignant diseases among most surgeons, variations in the actual anatomical vascular are not well understood. The aim of the present review was to present a detailed overview of the vascular variation pertinent to the surgery for right colon cancer. Medical literature was searched for the articles highlighting the vascular variation relevant to the right colon cancer surgery. Recently, there have been many detailed studies on applied surgical vascular anatomy based on cadaveric dissections, as well as radiological and intraoperative examinations to overcome misconceptions concerning the arterial supply and venous drainage to the right colon. Ileocolic artery and middle colic artery are consistently present in all patients arising from the superior mesenteric artery. Even though the ileocolic artery passes posterior to the superior mesenteric vein in most of the cases, in some cases courses anterior to the superior mesenteric artery. The right colic artery is inconsistently present ranging from 63% to 10% across different studies. Ileocolic vein and middle colic vein is always present, while the right colic vein is absent in 50% of patients. The gastrocolic trunk of Henle is present in 46%-100% patients across many studies with variation in the tributaries ranging from bipodal to tetrapodal. Commonly, it is found that the right colonic veins, including the right colic vein, middle colic vein, and superior right colic vein, share the confluence forming the gastrocolic trunk of Henle in a highly variable frequency and different forms. Understanding the incidence and variations of the vascular anatomy of right side colon is of crucial importance. Failure to recognize the variation during surgery can result in troublesome bleeding especially during

  3. Clinical and microperimetric predictors of reading speed in low vision patients: a structural equation modeling approach.

    Science.gov (United States)

    Giacomelli, Giovanni; Virgili, Gianni; Giansanti, Fabrizio; Sato, Giovanni; Cappello, Ezio; Cruciani, Filippo; Varano, Monica; Menchini, Ugo

    2013-06-27

    To investigate the simultaneous association of several psychophysical measures with reading ability in patients with mild and moderate low vision attending rehabilitation services. Standard measurements of reading ability (Minnesota Reading [MNREAD] charts), visual acuity (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts), contrast sensitivity (Pelli-Robson charts), reading contrast threshold (Reading Explorer [REX] charts), retinal sensitivity, and fixation stability and localization (Micro Perimeter 1 [MP1] fundus perimetry) were obtained in 160 low vision patients with better eye visual acuity ranging from 0.3 to 1.0 logarithm of the minimum angle of resolution and affected by either age-related macular degeneration or diabetic retinopathy. All variables were moderately associated with reading performance measures (MNREAD reading speed and reading acuity and REX reading contrast threshold), as well as among each other. In a structural equation model, REX reading contrast threshold was highly associated with MNREAD reading speed (standardized coefficient, 0.63) and moderately associated with reading acuity (standardized coefficient, -0.30). REX test also mediated the effects of Pelli-Robson contrast sensitivity (standardized coefficient, 0.44), MP1 fixation eccentricity (standardized coefficient, -0.19), and the mean retinal sensitivity (standardized coefficient, 0.23) on reading performance. The MP1 fixation stability was associated with both MNREAD reading acuity (standardized coefficient, -0.24) and MNREAD reading speed (standardized coefficient, 0.23), while ETDRS visual acuity only affected reading acuity (standardized coefficient, 0.44). Fixation instability and contrast sensitivity loss are key factors limiting reading performance of patients with mild or moderate low vision. REX charts directly assess the impact of text contrast on letter recognition and text navigation and may be a useful aid in reading rehabilitation.

  4. Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment.

    Science.gov (United States)

    Andrés, Mariano; Bernal, José Antonio; Sivera, Francisca; Quilis, Neus; Carmona, Loreto; Vela, Paloma; Pascual, Eliseo

    2017-07-01

    Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk. Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools-the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves. 237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS. The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout. 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/.

  5. The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors

    Directory of Open Access Journals (Sweden)

    Jensen Tue

    2009-02-01

    attending the workshop described the characteristics of an acute, uncomplicated lumbar facet syndrome in much the same way as chronic pain from the facet joints has been described in the literature. Furthermore, the acute, uncomplicated facet syndrome was considered to have an uncomplicated clinical course, responding quickly to spinal manipulative therapy.

  6. Factor Structure and Clinical Utility of the Beck Depression Inventory in Patients with Binge Eating Disorder and Obesity

    Science.gov (United States)

    Udo, Tomoko; McKee, Sherry A.; Grilo, Carlos M.

    2015-01-01

    Objective The Beck Depression Inventory (BDI) is often used to assess depression symptoms, but its factor structure and clinical utility have not been evaluated in patients with binge eating disorder (BED) and obesity. Methods 882 treatment-seeking obese patients with BED were administered structured interviews (SCID-I/P) and completed self-report questionnaires. Results Exploratory and confirmatory factor analyses supported a brief 16-item BDI version with a three-factor structure (affective, attitudinal, and somatic). Both 21- and 16-item versions showed excellent internal consistency (both α=0.89) and had significant correlation patterns with different aspects of eating disorder psychopathology; three factors showed significant but variable associations with eating disorder psychopathology. Area under the curves (AUC) for both BDI versions were significant in predicting major depressive disorder (MDD; AUC=0.773 [16-item], 73.5% sensitivity/70.2% specificity, AUC=0.769 [21-item], 79.5% sensitivity/64.1% specificity) and mood disorders (AUC=0.763 [16-item], 67.1% sensitivity/71.5% specificity, AUC=0.769 [21-item], 84.2% sensitivity/55.7% specificity). 21-item BDI (cut-off score ≥16) showed higher negative predictive values (94.0% vs. 93.0% [MDD]; 92.4% vs. 88.3% [mood disorders]) than brief 16-item BDI (cut-off score ≥13). Conclusions Both BDI versions demonstrated moderate performance as a screening instrument for MDD/mood disorders in obese patients with BED. Advantages and disadvantages for both versions are discussed. A three-factor structure has potential to inform the conceptualization of depression features. PMID:25537344

  7. Internal Structure and Clinical Utility of the Anxiety Control Questionnaire-Revised (ACQ-R) Spanish Version.

    Science.gov (United States)

    Osma, Jorge; Barrada, Juan Ramón; García-Palacios, Azucena; Navarro-Haro, María; Aguilar, Alejandra

    2016-10-03

    Perceived control has shown predictive value for anxiety severity symptoms as well as cognitive-behavior therapy outcomes. The most commonly used measure of perceived control is the Anxiety Control Questionnaire (ACQ), and more recently the ACQ Revised (ACQ-R). However, both questionnaires have shown structural inconsistencies among several studies. Also, although the ACQ and ACQ-R seem to be multidimensional instruments, a single total score have been commonly used. This study examined the internal structure of the ACQ-R Spanish version using exploratory factor and exploratory bi-factor analysis in a sample of 382 college students and 52 people diagnosed of panic disorder (with or without agoraphobia). Also, in this study we assessed the preliminary diagnostic value of the ACQ-R scores. The results indicated that the ACQ-R Spanish version structure consisted of two factors: one related with perceived control of internal emotional reactions (Emotion Control) and another related with perceived control of external events (Threat and Stress Control). Both specific factors can be adequately summarized by a general factor (General Anxiety Perception of Control; CFI = .973, TLI = .954, RMSEA = .039; p = .002), which accounted for 70% of the common explained variance. The correlations between the ACQ-R scores and with variables like anxiety (r = -.66) or anxiety sensitivity (r = -.50) presented the expected pattern of results. Either the two dimensions structure or the total score have proved to be a good tool to distinguish between participants with panic disorder and non-clinical samples (area under the curve = 0.79).

  8. Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Gharedaghi

    2016-07-01

    cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia. Conclusion: Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery.

  9. Adult ADHD Symptoms and Five Factor Model Traits in a Clinical Sample: A Structural Equation Modeling Approach

    Science.gov (United States)

    Knouse, Laura E.; Traeger, Lara; O’Cleirigh, Conall; Safren, Steven A.

    2013-01-01

    Relationships among Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and adult personality traits have not been examined in larger clinically diagnosed samples. We collected multi-source ADHD symptom and self-report NEO Five-Factor Inventory (Costa & McCrae, 1992a) data from 117 adults with ADHD and tested symptom-trait associations using structural equation modeling. The final model fit the data. Inattention was positively associated with Neuroticism and negatively associated with Conscientiousness. Based on ADHD expression in adulthood, hyperactivity and impulsivity were estimated as separate constructs and showed differential relationships to Extraversion and Agreeableness. A significant positive relationship between Hyperactivity and Conscientiousness arose in the context of other pathways. ADHD symptoms are reliably associated with personality traits, suggesting a complex interplay across development that warrants prospective study into adulthood. PMID:24080671

  10. Effects of structured exercise and pharmacotherapy vs. pharmacotherapy for adults with depressive symptoms: A randomized clinical trial.

    Science.gov (United States)

    Carneiro, Lara S F; Fonseca, António Manuel; Vieira-Coelho, Maria Augusta; Mota, Maria Paula; Vasconcelos-Raposo, José

    2015-12-01

    Physical exercise has been consistently documented as a complementary therapy in the treatment of depressive disorders. However, despite a higher prevalence among women compared to men, the trials developed in women are scarce. In addition, the optimal dosage of exercise capable of producing benefits that reduce depressive symptoms remains unclear. This clinical trial is designed to measure the effect of a structured physical exercise program as a complement to antidepressant medication in the treatment of women with depression. From July 2013 to May 2014, we implemented a randomized controlled trial (HAPPY BRAIN study). A total of 26 women (aged 50.16 ± 12.08) diagnosed with clinical depression were randomized either to a supervised aerobic exercise group (45-50 min/week three times a week for four months) plus pharmacotherapy (intervention group), or only antidepressant medication (control group). The exercise group presented a decrease in BDI-II and DASS-21 total score scales. Relatively to DASS-21, it showed a significant decrease in anxiety and stress. The exercise group when compared to a control group showed improvement in relation to physical functioning parameters between baseline and post-intervention. Moreover, anthropometric parameters presented only significant differences between groups in fat mass percentage. Nonetheless, no differences were found between groups in weight, body mass index, waist circumference, and self-esteem. Our results showed that supervised structured aerobic exercise training could be an effective adjuvant therapy for treating women with depression, reducing depressive symptomatology and improving physical fitness. A key factor of this improvement included strict control of exercise workload parameters and adjustment to each subject's capacity. In our study, due to the sample size there is an increase in the probability of type II errors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Cost structure and clinical outcome of a stem cell transplantation program in a developing country: the experience in northeast Mexico.

    Science.gov (United States)

    Jaime-Pérez, José Carlos; Heredia-Salazar, Alberto Carlos; Cantú-Rodríguez, Olga G; Gutiérrez-Aguirre, Homero; Villarreal-Villarreal, César Daniel; Mancías-Guerra, Consuelo; Herrera-Garza, José Luís; Gómez-Almaguer, David

    2015-04-01

    Hematopoietic stem cell transplantation (HSCT) in developing countries is cost-limited. Our primary goal was to determine the cost structure for the HSCT program model developed over the last decade at our public university hospital and to assess its clinical outcomes. Adults and children receiving an allogeneic hematopoietic stem cell transplant from January 2010 to February 2011 at our hematology regional reference center were included. Laboratory tests, medical procedures, chemotherapy drugs, other drugs, and hospitalization costs were scrutinized to calculate the total cost for each patient and the median cost for the procedure. Data regarding clinical evolution were incorporated into the analysis. Physician fees are not charged at the institution and therefore were not included. Fifty patients were evaluated over a 1-year period. The total estimated cost for an allogeneic HSCT was $12,504. The two most expensive diseases to allograft were non-Hodgkin lymphoma ($11,760 ± $2,236) for the malignant group and thalassemia ($12,915 ± $5,170) for the nonmalignant group. Acute lymphoblastic leukemia ($11,053 ± 2,817) and acute myeloblastic leukemia ($10,251 ± $1,538) were the most frequent indications for HSCT, with 11 cases each. Median out-of-pocket expenses were $1,605, and 1-year follow-up costs amounted to $1,640, adding up to a total cost of $15,749 for the first year. The most expensive components were drugs and laboratory tests. Applying the cost structure described, HSCT is an affordable option for hematological patients living in a developing country. ©AlphaMed Press.

  12. The Structured Clinical Interview for DSM-5 Internet Gaming Disorder: Development and Validation for Diagnosing IGD in Adolescents.

    Science.gov (United States)

    Koo, Hoon Jung; Han, Doug Hyun; Park, Sung-Yong; Kwon, Jung-Hye

    2017-01-01

    This study aimed to develop and validate a Structured Clinical Interview for Internet Gaming Disorder (SCI-IGD) in adolescents. First, we generated preliminary items of the SCI-IGD based on the information from the DSM-5 literature reviews and expert consultations. Next, a total of 236 adolescents, from both community and clinical settings, were recruited to evaluate the psychometric properties of the SCI-IGD. First, the SCI-IGD was found to be consistent over the time period of about one month. Second, diagnostic concordances between the SCI-IGD and clinician's diagnostic impression were good to excellent. The Likelihood Ratio Positive and the Likelihood Ratio Negative estimates for the diagnosis of SCI-IGD were 10.93 and 0.35, respectively, indicating that SCI-IGD was 'very useful test' for identifying the presence of IGD and 'useful test' for identifying the absence of IGD. Third, SCI-IGD could identify disordered gamers from non-disordered gamers. The implications and limitations of the study are also discussed.

  13. Pronounced Structural and Functional Damage in Early Adult Pediatric-Onset Multiple Sclerosis with No or Minimal Clinical Disability

    Directory of Open Access Journals (Sweden)

    Antonio Giorgio

    2017-11-01

    Full Text Available Pediatric-onset multiple sclerosis (POMS may represent a model of vulnerability to damage occurring during a period of active maturation of the human brain. Whereas adaptive mechanisms seem to take place in the POMS brain in the short-medium term, natural history studies have shown that these patients reach irreversible disability, despite slower progression, at a significantly younger age than adult-onset MS (AOMS patients. We tested for the first time whether significant brain alterations already occurred in POMS patients in their early adulthood and with no or minimal disability (n = 15 in comparison with age- and disability-matched AOMS patients (n = 14 and to normal controls (NC, n = 20. We used a multimodal MRI approach by modeling, using FSL, voxelwise measures of microstructural integrity of white matter tracts and gray matter volumes with those of intra- and internetwork functional connectivity (FC (analysis of variance, p ≤ 0.01, corrected for multiple comparisons across space. POMS patients showed, when compared with both NC and AOMS patients, altered measures of diffusion tensor imaging (reduced fractional anisotropy and/or increased diffusivities and higher probability of lesion occurrence in a clinically eloquent region for physical disability such as the posterior corona radiata. In addition, POMS patients showed, compared with the other two groups, reduced long-range FC, assessed from resting functional MRI, between default mode network and secondary visual network, whose interaction subserves important cognitive functions such as spatial attention and visual learning. Overall, this pattern of structural damage and brain connectivity disruption in early adult POMS patients with no or minimal clinical disability might explain their unfavorable clinical outcome in the long term.

  14. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

    Science.gov (United States)

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B

    2012-01-01

    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  15. [The Establishment and Examination of the Reliability, Validity, Discrimination, and Difficulty of Nursing Objective Structured Clinical Examination (OSCE)].

    Science.gov (United States)

    Huang, Hsiang-Ping; Chao, Li-Fen; Wang, Yu-Hsin; Liu, Ying-Mei; Ni, Lee-Fen; Jane, Sui-Whi

    2017-12-01

    The objective structured clinical examination (OSCE) is one of the evaluation strategies used to examine the clinical competence of nursing students. More attention needs to be paid to establishing an examination that is based on the standardized protocol and on reliability and validity. The aims of this study were to develop an OSCE that is based on a standardized protocol and to analyze the content validity and predictive validity, inter-rater consistency, internal consistency, item-to-total correlation, and the degree of discrimination and difficulty of this OSCE. Based on the blueprint for OSCEs that use an 8-station format, this study used a descriptive, cross-sectional design and a sample population of 207 senior students who were preparing for their last-mile practicum at a nursing technology university in northern Taiwan. The study period lasted from September 2015 to October 2016. Furthermore, the validity, reliability, degree of discrimination, and difficulty of the OSCE were examined. An OSCE with an eight-station format was developed. The content validity index (CVI) was .85-1.0, inter-rater reliability was .80-1.0, Cronbach' alpha internal consistency was .53-.82, and item-to-total correlation was .36-.63. In addition, the level of difficulty of the OSCE was easy to moderate and the discrimination of the OSCE ranged from fair to excellent. Meanwhile, the OSCE scores of the participants appeared to be a valid predictor of scores on the last mile practicum. According to the standardized protocol of OSCE development, an 8- station nursing OSCE format is reliable and valid, providing fair levels of difficulty and discrimination. The developed OSCE may be applied to evaluate the clinical competence of nursing students prior to beginning their last mile practicum. The results from the present study may provide a reference for nursing educators who are responsible for developing OSCE evaluation strategies.

  16. Integrating population variation and protein structural analysis to improve clinical interpretation of missense variation: application to the WD40 domain.

    Science.gov (United States)

    Laskowski, Roman A; Tyagi, Nidhi; Johnson, Diana; Joss, Shelagh; Kinning, Esther; McWilliam, Catherine; Splitt, Miranda; Thornton, Janet M; Firth, Helen V; Wright, Caroline F

    2016-03-01

    We present a generic, multidisciplinary approach for improving our understanding of novel missense variants in recently discovered disease genes exhibiting genetic heterogeneity, by combining clinical and population genetics with protein structural analysis. Using six new de novo missense diagnoses in TBL1XR1 from the Deciphering Developmental Disorders study, together with population variation data, we show that the β-propeller structure of the ubiquitous WD40 domain provides a convincing way to discriminate between pathogenic and benign variation. Children with likely pathogenic mutations in this gene have severely delayed language development, often accompanied by intellectual disability, autism, dysmorphology and gastrointestinal problems. Amino acids affected by likely pathogenic missense mutations are either crucial for the stability of the fold, forming part of a highly conserved symmetrically repeating hydrogen-bonded tetrad, or located at the top face of the β-propeller, where 'hotspot' residues affect the binding of β-catenin to the TBLR1 protein. In contrast, those altered by population variation are significantly less likely to be spatially clustered towards the top face or to be at buried or highly conserved residues. This result is useful not only for interpreting benign and pathogenic missense variants in this gene, but also in other WD40 domains, many of which are associated with disease. © The Author 2016. Published by Oxford University Press.

  17. Nonclinical and clinical Enterococcus faecium strains, but not Enterococcus faecalis strains, have distinct structural and functional genomic features.

    Science.gov (United States)

    Kim, Eun Bae; Marco, Maria L

    2014-01-01

    Certain strains of Enterococcus faecium and Enterococcus faecalis contribute beneficially to animal health and food production, while others are associated with nosocomial infections. To determine whether there are structural and functional genomic features that are distinct between nonclinical (NC) and clinical (CL) strains of those species, we analyzed the genomes of 31 E. faecium and 38 E. faecalis strains. Hierarchical clustering of 7,017 orthologs found in the E. faecium pangenome revealed that NC strains clustered into two clades and are distinct from CL strains. NC E. faecium genomes are significantly smaller than CL genomes, and this difference was partly explained by significantly fewer mobile genetic elements (ME), virulence factors (VF), and antibiotic resistance (AR) genes. E. faecium ortholog comparisons identified 68 and 153 genes that are enriched for NC and CL strains, respectively. Proximity analysis showed that CL-enriched loci, and not NC-enriched loci, are more frequently colocalized on the genome with ME. In CL genomes, AR genes are also colocalized with ME, and VF are more frequently associated with CL-enriched loci. Genes in 23 functional groups are also differentially enriched between NC and CL E. faecium genomes. In contrast, differences were not observed between NC and CL E. faecalis genomes despite their having larger genomes than E. faecium. Our findings show that unlike E. faecalis, NC and CL E. faecium strains are equipped with distinct structural and functional genomic features indicative of adaptation to different environments.

  18. Nonclinical and Clinical Enterococcus faecium Strains, but Not Enterococcus faecalis Strains, Have Distinct Structural and Functional Genomic Features

    Science.gov (United States)

    Kim, Eun Bae

    2014-01-01

    Certain strains of Enterococcus faecium and Enterococcus faecalis contribute beneficially to animal health and food production, while others are associated with nosocomial infections. To determine whether there are structural and functional genomic features that are distinct between nonclinical (NC) and clinical (CL) strains of those species, we analyzed the genomes of 31 E. faecium and 38 E. faecalis strains. Hierarchical clustering of 7,017 orthologs found in the E. faecium pangenome revealed that NC strains clustered into two clades and are distinct from CL strains. NC E. faecium genomes are significantly smaller than CL genomes, and this difference was partly explained by significantly fewer mobile genetic elements (ME), virulence factors (VF), and antibiotic resistance (AR) genes. E. faecium ortholog comparisons identified 68 and 153 genes that are enriched for NC and CL strains, respectively. Proximity analysis showed that CL-enriched loci, and not NC-enriched loci, are more frequently colocalized on the genome with ME. In CL genomes, AR genes are also colocalized with ME, and VF are more frequently associated with CL-enriched loci. Genes in 23 functional groups are also differentially enriched between NC and CL E. faecium genomes. In contrast, differences were not observed between NC and CL E. faecalis genomes despite their having larger genomes than E. faecium. Our findings show that unlike E. faecalis, NC and CL E. faecium strains are equipped with distinct structural and functional genomic features indicative of adaptation to different environments. PMID:24141120

  19. Clinical significance of cartilage biomarkers for monitoring structural joint damage in rheumatoid arthritis patients treated with anti-TNF therapy.

    Science.gov (United States)

    Niki, Yasuo; Takeuchi, Tsutomu; Nakayama, Masanori; Nagasawa, Hayato; Kurasawa, Takahiko; Yamada, Harumoto; Toyama, Yoshiaki; Miyamoto, Takeshi

    2012-01-01

    With the current use of biologics in rheumatoid arthritis (RA), there is a need to monitor ongoing structural joint damage due to the dissociation of articular cartilage damage from disease activity of RA. This study longitudinally analyzed levels of serum cartilage biomarkers during 54 weeks of infliximab therapy, to evaluate the feasibility of biomarkers for monitoring structural joint damage. Subjects comprised 33 patients with early RA and 33 patients with established RA. All patients received 3 mg/kg of infliximab and methotrexate for 54 weeks. Levels of the following serum cartilage markers were measured at baseline and at weeks 14, 22, and 54: hyaluronan (HA); cartilage oligometric matrix protein (COMP); type II collagen (CII)-related neoepitope (C2C); type II procollagen carboxy-propeptide (CPII); and keratin sulfate (KS). Time courses for each biomarker were assessed, and relationships between these biomarkers and clinical or radiographic parameters generally used for RA were investigated. Levels of CRP, MMP-3, DAS28-CRP, and annual progression of TSS were improved to similar degrees in both groups at week 54. HA and C2C/CPII were significantly decreased compared to baseline in the early RA group (pstructural joint damage with the least association with CRP, and that irreversible cartilage damage in established RA limits restoration of the C2C/CPII level, even with tight control of joint inflammation. The temporal course of C2C/CPII level during anti-TNF therapy indicates that CII turnover shifts toward CII synthesis in early RA, but not in established RA, potentially due to irreversible cartilage damage. ΔC2C/CPII appears to offer a useful marker reflecting ongoing structural joint damage, dissociated from inflammatory indices such as CRP and MMP-3.

  20. Glycan analysis of Fonsecaea monophora from clinical and environmental origins reveals different structural profile and human antigenic response

    Directory of Open Access Journals (Sweden)

    Juliana Reis Burjack

    2014-10-01

    Full Text Available Dematiaceous fungi constitute a large and heterogeneous group, characterized by having a dark pigment, the dihydroxynaftalen melanin - DHN, inside their cell walls. In nature they are found mainly as soil microbiota or decomposing organic matter, and are spread in tropical and subtropical regions. The fungus Fonsecaea monophora causes chromoblastomycosis in humans, and possesses essential mechanisms that may enhance pathogenicity, proliferation and dissemination inside the host. Glycoconjugates confer important properties to these pathogenic microorganisms. In this work, structural characterization of glycan structures present in two different strains of F. monophora MMHC82 and FE5p4, from clinical and environmental origins, respectively, was performed. Each one were grown on Minimal Medium (MM and Czapeck-Dox (CD medium, and the water soluble cell wall glycoconjugates and exopolysaccharides (EPS were evaluated by NMR, methylation and principal component analysis (PCA. By combining the methylation and 2D NMR analyses, it was possible to visualize the glycosidic profiles of the complex carbohydrate mixtures. Significant differences were observed in β-D-Galf-(1→5 and (1→6 linkages, α- and β-D-Glcp-(1→3, (1→4 and (1→6 units, as well as in α-D-Manp. PCA from 1H-NMR data showed that MMHC82 from CD medium showed a higher variation in the cell wall carbohydrates, mainly related to O-2 substituted β-D-Galf (δ 106.0/5.23 and δ 105.3/5.23 units. In order to investigate the antigenic response of the glycoconjugates, these were screened against serum from chromoblastomycosis patients. The antigen which contained the cell wall of MMHC82 grown in MM had β-D-Manp units that promoted higher antigenic response. The distribution of these fungal species in nature and the knowledge of how cell wall polysaccharides and glycoconjugates structure vary, may contribute to the better understanding and the elucidation of the pathology caused by this

  1. A Structured Protocol Model of Depression Care versus Clinical Acumen: A Cluster Randomized Trial of the Effects on Depression Screening, Diagnostic Evaluation, and Treatment Uptake in Ugandan HIV Clinics.

    Science.gov (United States)

    Wagner, Glenn J; Ngo, Victoria; Goutam, Prodyumna; Glick, Peter; Musisi, Seggane; Akena, Dickens

    2016-01-01

    Depression is common among people living with HIV, and it has consequences for both HIV prevention and treatment response, yet depression treatment is rarely integrated into HIV care in sub-Saharan Africa, partly due to the paucity of mental health professionals. We conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by medical providers: one that utilized a structured protocol, and one that relied on clinical acumen, in 10 HIV clinics in Uganda. Both models started with routine depression screening of all clients at triage using the 2-item Patient Health Questionnaire (PHQ-2), from which we enrolled 1252 clients (640 at structured protocol clinics, 612 at clinical acumen clinics) who had screened positive over 12 months. We compared the two models on (1) proportion of all client participants, and those clinically depressed (based on survey-administered 9-item PHQ-9>9), who received post-screening evaluation for depression using the PHQ-9; and (2) proportion of clinically depressed who were prescribed antidepressant therapy. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering; patient characteristics, clinic size and time fixed effects were included as covariates. Among all client participants, those in the structured protocol arm were far more likely to have received further evaluation by a medical provider using the PHQ-9 (84% vs. 49%; beta = .33; p = .01). Among the clinically depressed clients (n = 369), the advantage of the structured protocol model over clinical acumen was not statistically significant with regard to PHQ-9 depression evaluation (93% vs. 68%; beta = .21; p = .14) or prescription of antidepressants (69% vs. 58%; beta = .10; p = .50), in part because only 30% of clients who screened positive were clinically depressed. These findings reveal that in both models depression care practices were widely adopted by providers, and

  2. A Structured Protocol Model of Depression Care versus Clinical Acumen: A Cluster Randomized Trial of the Effects on Depression Screening, Diagnostic Evaluation, and Treatment Uptake in Ugandan HIV Clinics.

    Directory of Open Access Journals (Sweden)

    Glenn J Wagner

    Full Text Available Depression is common among people living with HIV, and it has consequences for both HIV prevention and treatment response, yet depression treatment is rarely integrated into HIV care in sub-Saharan Africa, partly due to the paucity of mental health professionals. We conducted a cluster randomized controlled trial of two task-shifting models to facilitating depression care delivered by medical providers: one that utilized a structured protocol, and one that relied on clinical acumen, in 10 HIV clinics in Uganda. Both models started with routine depression screening of all clients at triage using the 2-item Patient Health Questionnaire (PHQ-2, from which we enrolled 1252 clients (640 at structured protocol clinics, 612 at clinical acumen clinics who had screened positive over 12 months. We compared the two models on (1 proportion of all client participants, and those clinically depressed (based on survey-administered 9-item PHQ-9>9, who received post-screening evaluation for depression using the PHQ-9; and (2 proportion of clinically depressed who were prescribed antidepressant therapy. Linear probability regression analyses were conducted using a wild cluster bootstrap to control for clustering; patient characteristics, clinic size and time fixed effects were included as covariates. Among all client participants, those in the structured protocol arm were far more likely to have received further evaluation by a medical provider using the PHQ-9 (84% vs. 49%; beta = .33; p = .01. Among the clinically depressed clients (n = 369, the advantage of the structured protocol model over clinical acumen was not statistically significant with regard to PHQ-9 depression evaluation (93% vs. 68%; beta = .21; p = .14 or prescription of antidepressants (69% vs. 58%; beta = .10; p = .50, in part because only 30% of clients who screened positive were clinically depressed. These findings reveal that in both models depression care practices were widely adopted by

  3. Objective Structured Clinical Examination (OSCE)-based Assessment of the Advanced Trauma Life Support (ATLS) Course in Iran.

    Science.gov (United States)

    Abbasi, Hamid Reza; Amini, Mitra; Bolandparvaz, Shahram; Paydar, Shahram; Ali, Jameel; Sefidbakht, Sepideh

    2016-04-01

    To evaluate the effect of advance trauma life support (ATLS®) training on general surgery residents clinical reasoning skills using the national boards-style objective structured clinical examination (OSCE). This cross-sectional single-center study was conducted in Shiraz University of Medical Sciences including 51 surgery residents that participated in a mandatory national board style OSCE between May 2014 and May 2015. OSCE scores of two groups of general surgery residents including 23 ATLS® trained and 28 non-ATLS® trained were compared using Mann-Whitney U test. The exam was graded out of 20 points and the passing score was ≥14 including 40% trauma cases. There were 8(15.7%) women and 43(84.3%) men among the participants with mean age of 31.12 ± 2.69 and 33.67 ± 4.39 years in women and men respectively. Overall 7 (87.5%) women and 34 (79.07%) men passed the OSCE. The trauma section OSCE score was significantly higher in the ATLS® trained participants when compared to non-ATLS®(7.79 ± 0.81vs.6.90 ± 1.00; p=0.001). In addition, the total score was also significantly higher in ATLS® trained residents (16.07 ± 1.41 vs. 14.60 ± 1.40; p=0.001). There was no association between gender and ATLS® score (p=0.245) or passing the OSCE (p=0.503). ATLS® training is associated with improved overall OSCE scores of general surgery residents completing the board examinations suggesting a positive transfer of ATLS learned skills to management of simulated surgical patients including trauma cases.

  4. Structural Allograft versus Autograft for Instrumented Atlantoaxial Fusions in Pediatric Patients: Radiologic and Clinical Outcomes in Series of 32 Patients.

    Science.gov (United States)

    Zhang, Yue-Hui; Shen, Lei; Shao, Jiang; Chou, Dean; Song, Jia; Zhang, Jing

    2017-09-01

    Allograft with wire techniques showed a low fusion rate in pediatric atlantoaxial fusions (AAFs) in early studies. Using allograft in pediatric AAFs with screw/rod constructs has not been reported. Thus we compared the fusion rate and clinical outcomes in pediatric patients who underwent AAFs with screw/rod constructs using either a structural autograft or allograft. Pediatric patients (aged ≤12 years) who underwent AAFs between 2007 and 2015 were retrospectively evaluated. Patients were divided into 2 groups (allograft or autograft). Clinical and radiographic results were collected from hospital records and compared. A total of 32 patients were included (18 allograft, 14 autograft). There were no significant group differences in age, sex, weight, diagnosis, or duration of follow-up. A similar fusion rate was achieved (allograft: 94%, 17/18; autograft: 100%, 14/14); however, the average fusion time was 3 months longer in the allograft group. Blood loss was significantly lower in the allograft group (68 ± 8.5 mL) than the autograft group (116 ± 12.5 mL). Operating time and length of hospitalization were slightly (nonsignificantly) shorter for the allograft group. A significantly higher overall incidence of surgery-related complications was seen in the autograft group, including a 16.7% (2/14) rate of donor-site-related complications. The use of allograft for AAF was safe and efficacious when combined with rigid screw/rod constructs in pediatric patients, with a similar fusion rate to autografts and an acceptable complication rate. Furthermore, blood loss was less when using allograft and donor-site morbidity was eliminated; however, the fusion time was increased. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Fast nonclinical ventricular tachycardia inducible after ablation in patients with structural heart disease: Definition and clinical implications.

    Science.gov (United States)

    Watanabe, Masaya; de Riva, Marta; Piers, Sebastiaan R D; Dekkers, Olaf M; Ebert, Micaela; Venlet, Jeroen; Trines, Serge A; Schalij, Martin J; Pijnappels, Daniël A; Zeppenfeld, Katja

    2018-01-08

    Noninducibility of ventricular tachycardia (VT) with an equal or longer cycle length (CL) than the clinical VT is considered the minimum ablation endpoint in patients with structural heart disease (SHD). Since their clinical relevance remains unclear, fast nonclinical VTs are often not targeted. However, an accepted definition for fast VT is lacking. The shortest possible CL of a monomorphic reentrant VT is determined by the ventricular refractory period (VRP). We propose a patient-specific definition for fast VT based on the individual VRP (fVTVRP) and assess the prognostic significance of persistent inducibility after ablation of fVTVRP for VT recurrence. Out of 191 patients with prior myocardial infarction or with nonischemic cardiomyopathy undergoing VT ablation, 70 (63±13 years, 64% ischemic) remained inducible for a nonclinical VT and comprised the study population. A fVTVRP was defined as any VT with CL ≤VRP400 +30ms. Patients were followed for VT recurrence. After ablation, 30 patients (43%) remained inducible exclusively for fVTVRP and 40 (57%) for any slower VT. Patients with only fVTVRP had a 3-year VT free-survival of 64% (CI95%:46-82%) compared to 27% (CI95%:14-48%) for patients with any slower remaining VT (P=0.013). Inducibility of only fVTVRP was independently associated with lower VT recurrence (HR:0.38, CI95%:0.19-0.86; P=0.019). Within 36 patients inducible for any fVTVRP, only one recurred with a fVTVRP. In patients with SHD, inducibility of exclusively fVTVRP after ablation is associated with low VT recurrence. Copyright © 2018. Published by Elsevier Inc.

  6. Assessment of Clinical Competence of Medical Students Using the Objective Structured Clinical Examination: First 2 Years' Experience in Taipei Veterans General Hospital

    Directory of Open Access Journals (Sweden)

    Chin-Chou Huang

    2010-11-01

    Conclusion: The OSCE is an effective method for assessing the clinical competence of medical students. The OSCE could be improved further by modifying the examination questions and promoting effective training for standardized patients and examiners.

  7. [The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires].

    Science.gov (United States)

    Hamui, Magalí; Ferreira, Juan Pablo; Paganini, Agustina; Torres, Fernando; Ossorio, María Fabiana; Yulitta, Horacio; Eiguchi, Kumiko; Ferrero, Fernando

    2016-01-01

    The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Structural Integration as an Adjunct to Outpatient Rehabilitation for Chronic Nonspecific Low Back Pain: A Randomized Pilot Clinical Trial

    Directory of Open Access Journals (Sweden)

    Eric E. Jacobson

    2015-01-01

    Full Text Available Structural Integration (SI is an alternative method of manipulation and movement education. To obtain preliminary data on feasibility, effectiveness, and adverse events (AE, 46 outpatients from Boston area with chronic nonspecific low back pain (CNSLBP were randomized to parallel treatment groups of SI plus outpatient rehabilitation (OR versus OR alone. Feasibility data were acceptable except for low compliance with OR and lengthy recruitment time. Intent-to-treat data on effectiveness were analyzed by Wilcoxon rank sum, n=23 per group. Median reductions in VAS Pain, the primary outcome, of -26 mm in SI + OR versus 0 in OR alone were not significantly different (P=0.075. Median reductions in RMDQ, the secondary outcome, of -2 points in SI + OR versus 0 in OR alone were significantly different (P=0.007. Neither the proportions of participants with nor the seriousness of AE were significantly different. SI as an adjunct to OR for CNSLBP is not likely to provide additional reductions in pain but is likely to augment short term improvements in disability with a low additional burden of AE. A more definitive trial is feasible, but OR compliance and recruitment might be challenging. This trial is registered with ClinicalTrials.gov (NCT01322399.

  9. Objective Structured Clinical Examination (OSCE) in Psychiatry Education: A Review of Its Role in Competency-Based Assessment.

    Science.gov (United States)

    Plakiotis, Christos

    2017-01-01

    Over the last two decades, Objective Structured Clinical Examination (OSCE) has become an increasingly important part of psychiatry education and assessment in the Australian context. A reappraisal of the evidence base regarding the use of OSCE in psychiatry is therefore timely. This paper reviews the literature regarding the use of OSCE as an assessment tool in both undergraduate and postgraduate psychiatry training settings. Suitable articles were identified using the search terms 'psychiatry AND OSCE' in the ERIC (educational) and PubMed (healthcare) databases and grouped according to their predominant focus: (1) the validity of OSCEs in psychiatry; (2) candidate preparation and other factors impacting on performance; and (3) special topics. The literature suggests that the OSCE has been widely adopted in psychiatry education, as a valid and reliable method of assessing psychiatric competencies that is acceptable to both learners and teachers alike. The limited evidence base regarding its validity for postgraduate psychiatry examinations suggests that more research is needed in this domain. Despite any shortcomings, OSCEs are currently ubiquitous in all areas of undergraduate and postgraduate medicine and proposing a better alternative for competency-based assessment is difficult. A critical question is whether OSCE is sufficient on its own to assess high-level consultancy skills, and aspects of professionalism and ethical practice, that are essential for effective specialist practice, or whether it needs to be supplemented by additional testing modalities.

  10. Use of Drop-In Clinic Versus Appointment-Based Care for LGBT Youth: Influences on the Likelihood to Access Different Health-Care Structures.

    Science.gov (United States)

    Newman, Bernie S; Passidomo, Kim; Gormley, Kate; Manley, Alecia

    2014-06-01

    The structure of health-care service delivery can address barriers that make it difficult for lesbian, gay, bisexual, and transgender (LGBT) adolescents to use health services. This study explores the differences among youth who access care in one of two service delivery structures in an LGBT health-care center: the drop-in clinic or the traditional appointment-based model. Analysis of 578 records of LGBT and straight youth (aged 14-24) who accessed health care either through a drop-in clinic or appointment-based care within the first year of offering the drop-in clinic reveals patterns of use when both models are available. We studied demographic variables previously shown to be associated with general health-care access to determine how each correlated with a tendency to use the drop-in structure versus routine appointments. Once the covariates were identified, we conducted a logistic regression analysis to identify its association with likelihood of using the drop-in clinic. Insurance status, housing stability, education, race, and gender identity were most strongly associated with the type of clinic used. Youth who relied on Medicaid, those in unstable housing, and African Americans were most likely to use the drop-in clinic. Transgender youth and those with higher education were more likely to use the appointment-based clinic. Although sexual orientation and HIV status were not related to type of clinic used, youth who were HIV positive used the appointment-based clinic more frequently. Both routes to health care served distinct populations who often experience barriers to accessible, affordable, and knowledgeable care. Further study of the factors related to accessing health care may clarify the extent to which drop-in hours in a youth-friendly context may increase the use of health care by the most socially marginalized youth.

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

    LENUS (Irish Health Repository)

    Meagher, Frances M

    2009-11-01

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

  12. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity.

    Science.gov (United States)

    Heuberer, Philipp R; Smolen, Daniel; Pauzenberger, Leo; Plachel, Fabian; Salem, Sylvia; Laky, Brenda; Kriegleder, Bernhard; Anderl, Werner

    2017-05-01

    The number of arthroscopic rotator cuff surgeries is consistently increasing. Although generally considered successful, the reported number of retears after rotator cuff repair is substantial. Short-term clinical outcomes are reported to be rarely impaired by tendon retears, whereas to our knowledge, there is no study documenting long-term clinical outcomes and tendon integrity after arthroscopic rotator cuff repair. To investigate longitudinal long-term repair integrity and clinical outcomes after arthroscopic rotator cuff reconstruction. Case series; Level of evidence, 4. Thirty patients who underwent arthroscopic rotator cuff repair with suture anchors for a full-tendon full-thickness tear of the supraspinatus or a partial-tendon full-thickness tear of the infraspinatus were included. Two and 10 years after initial arthroscopic surgery, tendon integrity was analyzed using magnetic resonance imaging (MRI). The University of California, Los Angeles (UCLA) score and Constant score as well as subjective questions regarding satisfaction with the procedure and return to normal activity were used to evaluate short- and long-term outcomes. At the early MRI follow-up, 42% of patients showed a full-thickness rerupture, while 25% had a partial rerupture, and 33% of tendons remained intact. The 10-year MRI follow-up (129 ± 11 months) showed 50% with a total rerupture, while the other half of the tendons were partially reruptured (25%) or intact (25%). The UCLA and Constant scores significantly improved from preoperatively (UCLA total: 50.6% ± 20.2%; Constant total: 44.7 ± 10.5 points) to 2 years (UCLA total: 91.4% ± 16.0% [ P Arthroscopic rotator cuff repair showed good clinical long-term results despite a high rate of retears. Nonetheless, intact tendons provided significantly superior clinical long-term outcomes, making the improvement of tendon healing and repair integrity important goals of future research efforts.

  13. Short-interval test-retest interrater reliability of the Dutch version of the structured clinical interview for DSM-IV personality disorders (SCID-II)

    NARCIS (Netherlands)

    Weertman, A; ArntZ, A; Dreessen, L; van Velzen, C; Vertommen, S

    2003-01-01

    This study examined the short-interval test-retest reliability of the Structured Clinical Interview (SCID-II: First, Spitzer, Gibbon, & Williams, 1995) for DSM-IV personality disorders (PDs). The SCID-II was administered to 69 in- and outpatients on two occasions separated by 1 to 6 weeks. The

  14. THE SUBSTANTIATION OF SEMESTER COMPLEX EXAM TEST AND OBJECTIVE STRUCTURED CLINICAL EXAMINATION OBJECTIVITY FOR KNOWLEDGE AND SKILLS ASSESSMENT OF THE INTERNAL MEDICINE PROPEDEUTICS

    Directory of Open Access Journals (Sweden)

    V. P. Martsenyuk

    2012-12-01

    Full Text Available The article deals with an experience of implementing innovative teaching and assessment methods, as well as learning practical skills, while conducting Internal Medicine Propedeutics in I. Ya. Horbachevsky Ternopil State Medical University. According to the subject evaluation results, the objectivity of semester exam test and objective structured clinical examination has been substantiated.

  15. Does Changing Examiner Stations During UK Postgraduate Surgery Objective Structured Clinical Examinations Influence Examination Reliability and Candidates' Scores?

    Science.gov (United States)

    Brennan, Peter A; Croke, David T; Reed, Malcolm; Smith, Lee; Munro, Euan; Foulkes, John; Arnett, Richard

    2016-01-01

    Objective structured clinical examinations (OSCE) are widely used for summative assessment in surgery. Despite standardizing these as much as possible, variation, including examiner scoring, can occur which may affect reliability. In study of a high-stakes UK postgraduate surgical OSCE, we investigated whether examiners changing stations once during a long examining day affected marking, reliability, and overall candidates' scores compared with examiners who examined the same scenario all day. An observational study of 18,262 examiner-candidate interactions from the UK Membership of the Royal College of Surgeons examination was carried at 3 Surgical Colleges across the United Kingdom. Scores between examiners were compared using analysis of variance. Examination reliability was assessed with Cronbach's alpha, and the comparative distribution of total candidates' scores for each day was evaluated using t-tests of unit-weighted z scores. A significant difference was found in absolute scores differences awarded in the morning and afternoon sessions between examiners who changed stations at lunchtime and those who did not (p < 0.001). No significant differences were found for the main effects of either broad content area (p = 0.290) or station content area (p = 0.450). The reliability of each day was not affected by examiner switching (p = 0.280). Overall, no difference was found in z-score distribution of total candidate scores and categories of examiner switching. This large study has found that although the range of marks awarded varied when examiners change OSCE stations, examination reliability and the likely candidate outcome were not affected. These results may have implications for examination design and examiner experience in surgical OSCEs and beyond. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Incorporation of the da Vinci Surgical Skills Simulator at urology Objective Structured Clinical Examinations (OSCEs): a pilot study.

    Science.gov (United States)

    Noureldin, Yasser A; Stoica, Ana; Kassouf, Wassim; Tanguay, Simon; Bladou, Franck; Andonian, Sero

    2016-02-01

    To incorporate the da Vinci Surgical Skills Simulator (dVSSS) into Objective Structured Clinical Examinations (OSCEs) and to assess basic robotic skills of urology Post-Graduate Trainees (PGTs). PGTs in post-graduate years (PGY-3 to PGY-5) from two Quebec urology training programs were recruited. During a 20 minute OSCE station, PGTs were asked to fill in a questionnaire and perform two tasks: pick and place, and energy dissection level 1. For each exercise, the norm-referenced method was used to establish a passing score to determine competency. The participant was considered competent in these two basic dVSSS exercises if he/she gained the passing score on both tasks. All nine PGTs who attended the OSCE voluntarily participated in the study. They had performed a median of 10 (IQR: 2.5-16) laparoscopic procedures, 2 (0-8) robotic procedures, and assisted 10 (IQR: 0-15) robotic procedures at the bedside prior to this OSCE. Based on a passing score of 90 for task 1 and 72 for task 2, there were 3 (33%) competent PGTs, all of whom were from PGY-5 level. Therefore, there was significant difference among PGY levels in terms of competency for the basic robotic skills tested (p = 0.01). When compared with PGTs, experts had performed significantly higher numbers of robotic procedures (5.2 +/- 2.4 versus 25 +/- 8.7; p = 0.02). However, there was no significant difference in the performance parameters between PGTs and experts in both tasks. This study confirms the feasibility of incorporating dVSSS into OSCEs to assess basic robotic skills of urology PGTs. Future studies need to include more complex exercises and larger sample size to expand on these results.

  17. How to set the bar in competency-based medical education: standard setting after an Objective Structured Clinical Examination (OSCE).

    Science.gov (United States)

    Dwyer, Tim; Wright, Sarah; Kulasegaram, Kulamakan Mahan; Theodoropoulos, John; Chahal, Jaskarndip; Wasserstein, David; Ringsted, Charlotte; Hodges, Brian; Ogilvie-Harris, Darrell

    2016-01-04

    The goal of the Objective Structured Clinical Examination (OSCE) in Competency-based Medical Education (CBME) is to establish a minimal level of competence. The purpose of this study was to 1) to determine the credibility and acceptability of the modified Angoff method of standard setting in the setting of CBME, using the Borderline Group (BG) method and the Borderline Regression (BLR) method as a reference standard; 2) to determine if it is feasible to set different standards for junior and senior residents, and 3) to determine the desired characteristics of the judges applying the modified Angoff method. The results of a previous OSCE study (21 junior residents, 18 senior residents, and six fellows) were used. Three groups of judges performed the modified Angoff method for both junior and senior residents: 1) sports medicine surgeons, 2) non-sports medicine orthopedic surgeons, and 3) sports fellows. Judges defined a borderline resident as a resident performing at a level between competent and a novice at each station. For each checklist item, the judges answered yes or no for "will the borderline/advanced beginner examinee respond correctly to this item?" The pass mark was calculated by averaging the scores. This pass mark was compared to that created using both the BG and the BLR methods. A paired t-test showed that all examiner groups expected senior residents to get significantly higher percentage of checklist items correct compared to junior residents (all stations p setting different pass marks for senior and junior residents. The use of this method enables both senior and junior residents to sit the same OSCE, preferable in the regular assessment environment of CBME.

  18. Communication Skills in Candidates for Accreditation in Rheumatology Are Correlated With Candidate's Performance in the Objective Structured Clinical Examination.

    Science.gov (United States)

    Pascual-Ramos, Virginia; Flores-Alvarado, Diana Elsa; Portela-Hernández, Margarita; Maldonado-Velázquez, María Del Rocío; Amezcua-Guerra, Luis Manuel; López-Zepeda, Judith; Álvarez, Everardo; Rubio, Nadina; Lastra, Olga Vera; Saavedra, Miguel Ángel; Arce-Salinas, César Alejandro

    2017-07-26

    The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. From 2015 to 2017, 8areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found. CS assessed during a national accreditation process correlated with the candidate's performance at the station level and with the overall OSCE. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  19. Development, validation and initial outcomes of a questionnaire to examine human factors in postgraduate surgical objective structured clinical examinations.

    Science.gov (United States)

    Brennan, P A; Konieczny, K; Groves, J; Parker, M; Sherman, K P; Foulkes, J; Hills, S; Featherstone, C

    2015-03-01

    Human factors including stress, repetition, burnout and fatigue are associated with possible sources of error. Objective structured clinical examinations (OSCEs), where examiners concentrate for long periods, would benefit from a human factors approach to see whether these factors affect consistency of examiner behaviour, attitude and marking. Little has been published for OSCEs, in part due to the lack of a validated tool for collecting data in this setting. A 46-item questionnaire was developed based on the Human Factors Analysis and Classification System (HFACS) domains and completed by examiners in the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination. To refine the questionnaire, an initial analysis focused on response patterns of each item. Cronbach's α was used to assess internal consistency, and a factor analysis was performed to uncover different domains emerging from the data. A total of 108 examiners completed the questionnaire (90·0 per cent response rate). The questionnaire, refined to 38 items based on an initial analysis of response patterns, showed good reliability for internal consistency (Cronbach's α = 0·76) and test-retest reliability (r = 0·85, n = 48, P factors had a close themed resemblance to the original HFACS domains, but were associated with different items, suggesting that the four human-factor domains might be linked to different behaviours and attitudes in an examination setting. Analyses according to sex, professional background and experience highlighted additional stress levels in examiners from one of the surgical Royal Colleges (P human factors in OSCEs is needed to improve examiner experience and behaviour in order to influence delivery, candidate experience and quality assurance of these examinations. © 2015 BJS Society Ltd. Published by John Wiley & Sons, Ltd.

  20. A simple framework for assessing technical skills in a resident observed structured clinical examination (OSCE): vaginal laceration repair.

    Science.gov (United States)

    Winkel, Abigail Ford; Lerner, Veronica; Zabar, Sondra R; Szyld, Demian

    2013-01-01

    Educators of trainees in procedure-based specialties need focused assessment tools that are valid, objective, and assess technical skills in a realistic context. A framework for hybrid assessment using standardized patient scenarios and bench skills testing might facilitate evaluation of competency. Seven PGY-1 obstetrics and gynecology residents participated in a hybrid assessment that used observed structured clinical examination (OSCE) by a standardized patient who had sustained a vaginal laceration during vaginal delivery. The residents elicited a history and counseled the patient, and then completed a laceration repair on a pelvic model. The residents were rated on their performance in the scenario, which included issues of cultural competency, rapport-building, patient counseling. The technical skills were videotaped and rated using a modified global assessment form by 2 faculty members on a 3-point scale from "not done" to "partly done" to "well-done." Residents also completed a subjective assessment of the station. Mean technical performance of the residents on the technical skills was 55% "well-done," with a range of 20%-90%. The assessment identified 3 residents as below the mean, and 1 resident with areas of deficiency. Subjective assessment by the residents was that juggling the technical, cognitive, and affective components of the examination was challenging. Technical skills can be included in a case-based assessment using scenarios that address a range of cognitive and affective skills required of physicians. Results may help training programs assess individuals' abilities as well as identify program needs for curricular improvement. This framework might be useful in setting standards for competency and identifying poor performers. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Exploring personality dimensions that influence practice and performance of a simulated laparoscopic task in the objective structured clinical examination.

    Science.gov (United States)

    Malhotra, Neha; Poolton, Jamie M; Wilson, Mark R; Leung, Gilberto; Zhu, Frank; Fan, Joe K M; Masters, Rich S W

    2015-01-01

    Surgical educators have encouraged the investigation of individual differences in aptitude and personality in surgical performance. An individual personality difference that has been shown to influence laparoscopic performance under time pressure is movement specific reinvestment. Movement specific reinvestment has 2 dimensions, movement self-consciousness (MS-C) (i.e., the propensity to consciously monitor movements) and conscious motor processing (CMP) (i.e., the propensity to consciously control movements), which have been shown to differentially influence laparoscopic performance in practice but have yet to be investigated in the context of psychological stress (e.g., the objective structured clinical examination [OSCE]). This study investigated the role of individual differences in propensity for MS-C and CMP in practice of a fundamental laparoscopic skill and in laparoscopic performance during the OSCE. Furthermore, this study examined whether individual differences during practice of a fundamental laparoscopic skill were predictive of laparoscopic performance during the OSCE. Overall, 77 final-year undergraduate medical students completed the movement specific reinvestment scale, an assessment tool that quantifies the propensity for MS-C and CMP. Participants were trained to proficiency on a fundamental laparoscopic skill. The number of trials to reach proficiency was measured, and completion times were recorded during early practice, later practice, and the OSCE. There was a trend for CMP to be negatively associated with the number of trials to reach proficiency (p = 0.064). A higher propensity for CMP was associated with fewer trials to reach proficiency (β = -0.70, p = 0.023). CMP and MS-C did not significantly predict completion times in the OSCE (p > 0.05). Completion times in early practice (β = 0.05, p = 0.016) and later practice (β = 0.47, p personality differences and individual differences in ability during practice could help inform the

  2. Axis I psychopathology in bariatric surgery candidates with and without binge eating disorder: results of structured clinical interviews.

    Science.gov (United States)

    Jones-Corneille, LaShanda R; Wadden, Thomas A; Sarwer, David B; Faulconbridge, Lucy F; Fabricatore, Anthony N; Stack, Rebecca M; Cottrell, Faith A; Pulcini, Melissa E; Webb, Victoria L; Williams, Noel N

    2012-03-01

    Prior studies have reached contradictory conclusions concerning whether binge eating disorder (BED) is associated with greater psychopathology in extremely obese patients who seek bariatric surgery. This study used the Structured Clinical Interview for DSM-IV Diagnoses (SCID) to compare rates of axis I psychopathology in surgery candidates who were determined to have BED or to be currently free of eating disorders. The relationship of BED to other psychosocial functioning and weight loss goals also was examined. One hundred ninety five bariatric surgery patients completed the Weight and Lifestyle Inventory and the Beck Depression Inventory-II (BDI-II) and were later administered the Eating Disorder Examination. Of these 195, 44 who were diagnosed with BED, and 61 who were currently free of eating pathology, completed a telephone-administered SCID. Significantly more BED than non-BED participants had a current mood disorder (27.3% vs. 4.9%, p = 0.002) as well as a lifetime history of this condition (52.3% vs. 23.0%, p = 0.003). More BED than non-BED participants also had a current anxiety disorder (27.3% vs. 8.2%, p = 0.014) and lifetime anxiety disorder (36.4% vs. 16.4%, p = 0.019). BED also was associated with greater symptoms of depression, as measured by the BDI-II, as well as with lower self-esteem. BED and non-BED groups, however, did not differ in their desired weight loss goals following surgery. The present findings indicate that the presence of BED, in patients who seek bariatric surgery, is associated with an increased prevalence of axis I psychopathology, beyond the already elevated rate observed with severe (i.e., class III) obesity.

  3. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE)--A Systematic Review of Rating Scales.

    Science.gov (United States)

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students' communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed in order to yield psychometrically

  4. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE) - A Systematic Review of Rating Scales

    Science.gov (United States)

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Background Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. Methods We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Results Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Discussion Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed

  5. Designing Objective Structured Clinical Examination in Basic Community Pharmacy Clerkship Course and Assessment of Its Relationship with Conventional Exam

    Directory of Open Access Journals (Sweden)

    Leila Kouti

    2015-10-01

    Full Text Available Background: Over 90% of pharmacy students’ work in pharmacies after graduation which needs both knowledge and skill, thus one of the most essential courses of their education is pharmacy clerkship. An important part of an educational program is the evaluation of the trainees. Different studies show that conventional written exams are not successful in evaluating the skills of the students and can mostly evaluate their knowledge. Thus Objective Structured Clinical Examination (OSCE is used to evaluate the students in different aspects.Methods: An OSCE and a conventional test were given to a group of students at the end of basic community pharmacy clerkship course. The OSCE test consisted of six different stations (reading prescriptions, identifying drugs, pharmacist’s recommendation, patient education, drug information resources, and drug usage instructions. Two questions were asked at each station by different examiners. The scores and results of these tests were compared and analyzed.Results: There was no significant correlation between OSCE final scores and written test scores (P: = 0.217. No significant correlation between each station’s score and the written test score was found.Conclusion: The absence of significant correlation between OSCE and conventional exams shows that the skills evaluated by OSCE cannot be evaluated by the best possible written tests. This type of examination is not commonly used in Iran’s pharmacy schools but due to the findings of this study, it seems that this multiform method, despite being more difficult to arrange, can be a more suitable and relevant way to evaluate basic community pharmacy clerkship compared to conventional written tests.

  6. A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care

    Directory of Open Access Journals (Sweden)

    Dipak Kalra

    2013-05-01

    Full Text Available Background The case has historically been presented that structured and/or coded electronic health records (EHRs benefit direct patient care, but the evidence base for this is not well documented.Methods We searched for evidence of direct patient care value from the use of structured and/or coded information within EHRs. We interrogated nine international databases from 1990 to 2011. Value was defined using the Institute of Medicine’s six areas for improvement for healthcare systems: effectiveness, safety, patient-centredness, timeliness, efficiency and equitability. We included studies satisfying the Cochrane Effective Practice and Organisation of Care (EPOC group criteria.Results Of 5016 potentially eligible papers, 13 studies satisfied our criteria: 10 focused on effectiveness, with eight demonstrating potential for improved proxy and actual clinical outcomes if a structured and/or coded EHR was combined with alerting or advisory systems in a focused clinical domain. Three studies demonstrated improvement in safety outcomes. No studies were found reporting value in relation to patient-centredness, timeliness, efficiency or equitability.Conclusions We conclude that, to date, there has been patchy effort to investigate empirically the value from structuring and coding EHRs for direct patient care. Future investments in structuring and coding of EHRs should be informed by robust evidence as to the clinical scenarios in which patient care benefits may be realised.

  7. Subregional Structural Alterations in Hippocampus and Nucleus Accumbens Correlate with the Clinical Impairment in Patients with Alzheimer’s Disease Clinical Spectrum: Parallel Combining Volume and Vertex-Based Approach

    Directory of Open Access Journals (Sweden)

    Xiuling Nie

    2017-08-01

    Full Text Available Deep gray matter structures are associated with memory and other important functions that are impaired in Alzheimer’s disease (AD and mild cognitive impairment (MCI. However, systematic characterization of the subregional atrophy and deformations in these structures in AD and MCI still need more investigations. In this article, we combined complex volumetry- and vertex-based analysis to investigate the pattern of subregional structural alterations in deep gray matter structures and its association with global clinical scores in AD (n = 30 and MCI patients (n = 30, compared to normal controls (NCs, n = 30. Among all seven pairs of structures, the bilateral hippocampi and nucleus accumbens showed significant atrophy in AD compared with NCs (p < 0.05. But only the subregional atrophy in the dorsal–medial part of the left hippocampus, the ventral part of right hippocampus, and the left nucleus accumbens, the posterior part of the right nucleus accumbens correlated with the worse clinical scores of MMSE and MOCA (p < 0.05. Furthermore, the medial–ventral part of right thalamus significantly shrank and correlated with clinical scores without decreasing in its whole volume (p > 0.05. In conclusion, the atrophy of these four subregions in bilateral hippocampi and nucleus accumbens was associated with cognitive impairment of patients, which might be potential target regions of treatment in AD. The surface analysis could provide additional information to volume comparison in finding the early pathological progress in deep gray matter structures.

  8. Communication skills training in surgical residency: a needs assessment and metacognition analysis of a difficult conversation objective structured clinical examination.

    Science.gov (United States)

    Falcone, John L; Claxton, René N; Marshall, Gary T

    2014-01-01

    The objective structured clinical examination (OSCE) can be used to evaluate the Accreditation Council for Graduate Medical Education Core Competencies of Professionalism and Interpersonal and Communication Skills. The aim of this study was to describe general surgery resident performance on a "difficult conversation" OSCE. In this prospective study, junior and senior residents participated in a 2-station OSCE. Junior stations involved discussing operative risks and benefits and breaking bad news. Senior stations involved discussing goals of care and discussing transition to comfort measures only status. Residents completed post-OSCE checklist and Likert-based self-evaluations of experience, comfort, and confidence. Trained standardized patients (SPs) evaluated residents using communication skill-based checklists and Likert-based assessments. Pearson correlation coefficients were determined between self-assessment and SP assessment. Mann-Whitney U tests were conducted between junior and senior resident variables, using α = 0.05. There were 27 junior residents (age 28.1 ± 1.9 years [29.6% female]) and 27 senior residents (age 32.1 ± 2.5 years [26.9% female]). The correlation of self-assessment and SP assessment of overall communication skills by junior residents was -0.32 on the risks and benefits case and 0.07 on the breaking bad news case. The correlation of self-assessment and SP assessment of overall communication skills by senior residents was 0.30 on the goals of care case and 0.26 on the comfort measures only case. SP assessments showed that junior residents had higher overall communication skills than senior residents (p = 0.03). Senior residents perceived that having difficult conversations was more level appropriate (p skills are correlated, and that skills-based training is needed across all residency levels. This well-received method may be used to observe, document, and provide resident feedback for these important skills. © 2014 Published by

  9. Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam.

    Science.gov (United States)

    Stansfield, R Brent; Diponio, Lisa; Craig, Cliff; Zeller, John; Chadd, Edmund; Miller, Joshua; Monrad, Seetha

    2016-10-14

    Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning. A multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students' ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson's correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression. Inter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a

  10. A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Structured Applied Behavior Analysis (ABA) Intervention for Children with Autism

    OpenAIRE

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaee,Mohammad; Rafiee, Seyed Majid

    2014-01-01

    Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two ABA intervention procedures, a naturalistic approach, Pivotal Response Treatment (PRT) with a structured ABA approach in a school setting. A Randomized Clinical Trial design using two groups of children, matched ac...

  11. A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination

    Directory of Open Access Journals (Sweden)

    Renata Mahfuz Daud-Gallotti

    2011-01-01

    Full Text Available INTRODUCTION: Patient safety is seldom assessed using objective evaluations during undergraduate medical education. OBJECTIVE: To evaluate the performance of fifth-year medical students using an objective structured clinical examination focused on patient safety after implementation of an interactive program based on adverse events recognition and disclosure. METHODS: In 2007, a patient safety program was implemented in the internal medicine clerkship of our hospital. The program focused on human error theory, epidemiology of incidents, adverse events, and disclosure. Upon completion of the program, students completed an objective structured clinical examination with five stations and standardized patients. One station focused on patient safety issues, including medical error recognition/disclosure, the patient-physician relationship and humanism issues. A standardized checklist was completed by each standardized patient to assess the performance of each student. The student's global performance at each station and performance in the domains of medical error, the patient-physician relationship and humanism were determined. The correlations between the student performances in these three domains were calculated. RESULTS: A total of 95 students participated in the objective structured clinical examination. The mean global score at the patient safety station was 87.59 ± 1.24 points. Students' performance in the medical error domain was significantly lower than their performance on patient-physician relationship and humanistic issues. Less than 60% of students (n = 54 offered the simulated patient an apology after a medical error occurred. A significant correlation was found between scores obtained in the medical error domains and scores related to both the patient-physician relationship and humanistic domains. CONCLUSIONS: An objective structured clinical examination is a useful tool to evaluate patient safety competencies during the medical

  12. A new method for the assessment of patient safety competencies during a medical school clerkship using an objective structured clinical examination.

    Science.gov (United States)

    Daud-Gallotti, Renata Mahfuz; Morinaga, Christian Valle; Arlindo-Rodrigues, Marcelo; Velasco, Irineu Tadeu; Martins, Milton Arruda; Tiberio, Iolanda Calvo

    2011-01-01

    Patient safety is seldom assessed using objective evaluations during undergraduate medical education. To evaluate the performance of fifth-year medical students using an objective structured clinical examination focused on patient safety after implementation of an interactive program based on adverse events recognition and disclosure. In 2007, a patient safety program was implemented in the internal medicine clerkship of our hospital. The program focused on human error theory, epidemiology of incidents, adverse events, and disclosure. Upon completion of the program, students completed an objective structured clinical examination with five stations and standardized patients. One station focused on patient safety issues, including medical error recognition/disclosure, the patient-physician relationship and humanism issues. A standardized checklist was completed by each standardized patient to assess the performance of each student. The student's global performance at each station and performance in the domains of medical error, the patient-physician relationship and humanism were determined. The correlations between the student performances in these three domains were calculated. A total of 95 students participated in the objective structured clinical examination. The mean global score at the patient safety station was 87.59 ± 1.24 points. Students' performance in the medical error domain was significantly lower than their performance on patient-physician relationship and humanistic issues. Less than 60% of students (n = 54) offered the simulated patient an apology after a medical error occurred. A significant correlation was found between scores obtained in the medical error domains and scores related to both the patient-physician relationship and humanistic domains. An objective structured clinical examination is a useful tool to evaluate patient safety competencies during the medical student clerkship.

  13. Complete Genome Sequence of Rothia mucilaginosa DY-18: A Clinical Isolate with Dense Meshwork-Like Structures from a Persistent Apical Periodontitis Lesion

    Science.gov (United States)

    2010-09-25

    allowed to progress, apical periodontitis can cause the destruction of supporting connective tissues and bones, ultimately resulting in tooth loss. The...of Rothiamucilaginosa DY-18: A Clinical Isolate with DenseMeshwork-Like Structures from a Persistent Apical Periodontitis Lesion Kazuyoshi Yamane,1...University, 8-1 Kuzuhahanazono-cho, Hirakata-shi, Osaka 573-1121, Japan 2Microbiology Branch, U.S. Army Dental and Trauma Research Detachment, Walter

  14. Factor structure of a Korean-language version of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in a clinical sample of clients with alcohol dependence.

    Science.gov (United States)

    Chun, Young-Min; Cho, Sung-Min; Shin, Sung-Man

    2010-12-01

    The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is an instrument used to measure the level of motivation in regards to changing drinking and other addictive behaviors. While some initial factor analysis studies on the SOCRATES described a three-factor orthogonal structure of the scale, some other studies found a two-factor correlated structure. Therefore, the primary objective of the present study was to test the validity of the Korean language version of the instrument using a Korean population. The study examined the factor structure of the Korean version of the SOCRATES with clinical samples consisting of 219 inpatients and 271 outpatients with alcohol dependency. An exploratory factor analysis with an alpha factoring method revealed a three-factor correlated structure (i.e., Taking Steps, Recognition, and Ambivalence). The factorial structure of the SOCRATES Korean version corresponded almost exactly to that of its original French version as well as the German version. Moreover, confirmatory factor analyses showed that a three-factor correlated structure provided the best fit for the data. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  15. Mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination to assess their competence in medicine administration.

    Science.gov (United States)

    Hemingway, Steve; Stephenson, John; Roberts, Bronwyn; McCann, Terence

    2014-08-01

    The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.

  16. Group observed structured encounter (GOSCE) for third-year medical students improves self-assessment of clinical communication.

    Science.gov (United States)

    Ludwig, Allison B; Raff, Amanda C; Lin, Juan; Schoenbaum, Ellie

    2017-09-01

    This study assesses the effectiveness of a GOSCE in teaching medical students clinical communication, as well as group collaboration and peer feedback. The GOSCE was administered during the Internal Medicine clerkship. Groups consisted of 4-6 students and one faculty member. Students completed pre- and post-GOSCE surveys to assess confidence in clinical communication and a GOSCE evaluation to rate the overall experience. Pre- and post-GOSCE program survey scores were compared, and the mean score and standard deviation of the GOSCE evaluation was calculated. Students perceived improvement in their general (Mean 4.49-4.57, p < .0001), case-specific (3.61-3.84, p < .0001) and group clinical communication (3.75-4.09, p < .0001) skills. Students agreed or strongly agreed that the GOSCE taught them something new (91.20%), made them more comfortable in giving (64.31%) and receiving (66.57%) feedback and working with a group (64.22%). Students found the GOSCE to be as effective as an OSCE (70.97%). A GOSCE is a valuable resource for use in formative assessment of clinical communication, and it offers the benefit of group collaboration and peer feedback. These findings support the broader use of GOSCEs in undergraduate medical education.

  17. Structural profiles of TP53 gene mutations predict clinical outcome in diffuse large B-cell lymphoma

    DEFF Research Database (Denmark)

    Young, Ken H; Leroy, Karen; Møller, Michael Boe

    2008-01-01

    The purpose of this study is to correlate the presence of TP53 gene mutations with the clinical outcome of a cohort of patients with diffuse large B-cell lymphoma (DLBCL) assembled from 12 medical centers. TP53 mutations were identified in 102 of 477 patients and the overall survival (OS) of pati...

  18. Tools to reduce first year nursing students' anxiety levels prior to undergoing objective structured clinical assessment (OSCA) and how this impacts on the student's experience of their first clinical placement.

    Science.gov (United States)

    Stunden, Annette; Halcomb, Elizabeth; Jefferies, Diana

    2015-09-01

    One form of assessment that tests students' theoretical skills and confidence in their clinical practice is known as the Objective Structured Clinical Assessment (OSCA). Traditionally it was first launched from medical education, and is now being incorporated by other disciplines, such as nursing. This review seeks to present the best available evidence into strategies that help reduce first year nursing students' anxiety levels prior to undergoing OSCA and clinical placement. A systematic literature search was performed using Medline and CINAHL. This review considered any English language original research published between 2005 and 2013. A literature search located 117 articles. Eight articles were identified as meeting the inclusion in criteria. Majority of studies reported simulation session prior to the OSCA increased students confidence and reduced their anxiety levels. This resulted in students' reporting that they valued the OSCA as a worthwhile assessment. However there were four major themes: that students were anxious about attending the OSCA; that adequate preparation was seen as a coping strategy; that simulation was a further cause for anxiety; and that the simulation experience could also be used as an OSCA tool. Students who have been exposed to simulation scenarios before the OSCA are able to cope much better during the OSCA. Therefore, it is highly recommended to incorporate simulation scenarios into the nursing curricula for first year nursing students' clinical units to help reduce their anxiety levels prior to OCSA. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Application of machine learning classification for structural brain MRI in mood disorders: Critical review from a clinical perspective.

    Science.gov (United States)

    Kim, Yong-Ku; Na, Kyoung-Sae

    2018-01-03

    Mood disorders are a highly prevalent group of mental disorders causing substantial socioeconomic burden. There are various methodological approaches for identifying the underlying mechanisms of the etiology, symptomatology, and therapeutics of mood disorders; however, neuroimaging studies have provided the most direct evidence for mood disorder neural substrates by visualizing the brains of living individuals. The prefrontal cortex, hippocampus, amygdala, thalamus, ventral striatum, and corpus callosum are associated with depression and bipolar disorder. Identifying the distinct and common contributions of these anatomical regions to depression and bipolar disorder have broadened and deepened our understanding of mood disorders. However, the extent to which neuroimaging research findings contribute to clinical practice in the real-world setting is unclear. As traditional or non-machine learning MRI studies have analyzed group-level differences, it is not possible to directly translate findings from research to clinical practice; the knowledge gained pertains to the disorder, but not to individuals. On the other hand, a machine learning approach makes it possible to provide individual-level classifications. For the past two decades, many studies have reported on the classification accuracy of machine learning-based neuroimaging studies from the perspective of diagnosis and treatment response. However, for the application of a machine learning-based brain MRI approach in real world clinical settings, several major issues should be considered. Secondary changes due to illness duration and medication, clinical subtypes and heterogeneity, comorbidities, and cost-effectiveness restrict the generalization of the current machine learning findings. Sophisticated classification of clinical and diagnostic subtypes is needed. Additionally, as the approach is inevitably limited by sample size, multi-site participation and data-sharing are needed in the future. Copyright

  20. Structure-Based Prediction of Subtype Selectivity of Histamine H3 Receptor Selective Antagonists in Clinical Trials

    DEFF Research Database (Denmark)

    Kim, Soo-Kyung; Fristrup, Peter; Abrol, Ravinder

    2011-01-01

    applications, including treatment of Alzheimer’s disease, attention deficit hyperactivity disorder (ADHD), epilepsy, and obesity.(1) However, many of these drug candidates cause undesired side effects through the cross-reactivity with other histamine receptor subtypes. In order to develop improved selectivity......Histamine receptors (HRs) are excellent drug targets for the treatment of diseases, such as schizophrenia, psychosis, depression, migraine, allergies, asthma, ulcers, and hypertension. Among them, the human H3 histamine receptor (hH3HR) antagonists have been proposed for specific therapeutic...... and activity for such treatments, it would be useful to have the three-dimensional structures for all four HRs. We report here the predicted structures of four HR subtypes (H1, H2, H3, and H4) using the GEnSeMBLE (GPCR ensemble of structures in membrane bilayer environment) Monte Carlo protocol,(2) sampling...

  1. Structured Dietary Management Dramatically Improves Marked Transaminitis, Metabolic and Clinical Profiles in Glycogen Storage Disease Type IXa

    Directory of Open Access Journals (Sweden)

    Indrajit S. Karande DCH, FRACP

    2016-12-01

    Full Text Available Glycogen storage disease type IXa (GSD IXa presents in childhood with hepatomegaly, poor growth, and ketotic hypoglycemia. Clinical course is usually mild, often not requiring treatment with attenuation of symptoms with increasing age. The phenotypic spectrum has recently expanded to include more severe involvement with hepatic fibrosis or cirrhosis warranting dietary therapy. We report a 2-year-old boy with a severe phenotype of GSD IXa presenting with a massive hepatomegaly, significant transaminitis, recurrent ketotic hypoglycemia, and short stature. Aggressive dietary management with regular feeds, frequent uncooked cornstarch doses, and protein supplementation resulted in clinical improvements including enhanced growth velocity, energy levels, overall well-being, and reduction in hepatomegaly with restitutions in biochemical parameters. We concur with a recent report which proposed that GSD IXa is not always a mild condition but instead part of an expanding phenotypic spectrum warranting intensive dietary management to optimize metabolic control and quality of life.

  2. Influence of clinical use on physical-structural surface properties and electrochemical potential of NiTi endodontic instruments.

    Science.gov (United States)

    Pereira, E S J; Amaral, C C F; Gomes, J A C P; Peters, O A; Buono, V T L; Bahia, M G A

    2017-03-22

    To investigate the surface morphology and electrochemical potential of superelastic (SE), M-Wire (MW) and shape memory technology (SMT) NiTi instruments before and after single clinical use in vivo. A total of 60 ProTaper Universal F2 (PTU-SE), ProTaper Next X2 (PTN-MW), Typhoon (TYP), Hyflex (HF) and Vortex Blue (VB), the last three SMT, and size 25, .06 taper (n = 6 of each type) files were examined. Scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDS) and electrochemical potential analysis were employed before and after clinical use. Statistical analysis was performed with one-way analysis of variance and Bonferroni's post hoc test. Significance was determined at the 95% confidence level for both tests. SEM observations of new instruments indicated the presence of marks left by the machining process during manufacturing and EDS revealed the existence of an oxide coating on shape memory instruments. After clinical use, the five types were associated with propagation of transverse cracks 3 mm from the tip. The surface oxide layer of TYP, HF and VB instruments had microcracks in multiple directions, whilst TYP and HF had fragmentation in chip form of the oxide layer. EDS analysis demonstrated a significant reduction of the oxide layer in shape memory instruments, except for VB. Electrochemical potentials were higher for shape memory instruments than for M-Wire and superelastic NiTi instruments, respectively (P < 0.05). It appears that shape memory technology NiTi instruments have a dysfunctional oxide layer after clinical use. Additionally, they featured higher electrochemical potential relative to NiTi instruments manufactured from M-Wire, and conventional superelastic NiTi alloy. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  3. Changes in Self-Schema Structure in Cognitive Therapy for Major Depressive Disorder: A Randomized Clinical Trial

    Science.gov (United States)

    Dozois, David J. A.; Bieling, Peter J.; Patelis-Siotis, Irene; Hoar, Lori; Chudzik, Susan; McCabe, Katie; Westra, Henny A.

    2009-01-01

    Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for…

  4. Structure and clinical correlates of obsessive-compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations.

    Science.gov (United States)

    Højgaard, D R M A; Mortensen, E L; Ivarsson, T; Hybel, K; Skarphedinsson, G; Nissen, J B; Valderhaug, R; Dahl, K; Weidle, B; Torp, N C; Grados, M; Lewin, A B; Melin, K H; Storch, E A; Wolters, L H; Murphy, T K; Sonuga-Barke, E J S; Thomsen, P H

    2017-03-01

    The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors.

  5. Clinical, biometric and structural evaluation of the long-term effects of a topical treatment with ascorbic acid and madecassoside in photoaged human skin.

    Science.gov (United States)

    Haftek, Marek; Mac-Mary, Sophie; Le Bitoux, Marie-Aude; Creidi, Pierre; Seité, Sophie; Rougier, André; Humbert, Philippe

    2008-11-01

    Skin ageing is a complex process determined by the genetic endowment of individual and environmental factors, such as sun exposure. The effects of skin ageing are mostly encountered in the superficial dermis and in the epidermis. We have previously demonstrated in vivo the beneficial effect of a topically applied formula of 5% vitamin C in the treatment of skin ageing. Another active compound, madecassoside extracted from Centella asiatica, known to induce collagen expression and/or to modulate inflammatory mediators, might thus prevent and correct some signs of ageing. A randomized double-blind study was carried out on photoaged skin of 20 female volunteers to investigate the effects of topically applied 5% vitamin C and 0.1% madecassoside on the clinical, biophysical and structural skin properties. After 6 months of treatment, we observed a significant improvement of the clinical score for deep and superficial wrinkles, suppleness, firmness, roughness and skin hydration. These results were corroborated by measurements of skin elasticity and semi-quantitative histological assessment of the elastic fibre network in the papillary dermis. Two-thirds of the subjects showed an improvement. The re-appearance of a normally structured elastic fibre network was observed. Our results revealed a functional and structural remodelling of chronically sun-damaged skin.

  6. MiSynPat: An integrated knowledge base linking clinical, genetic, and structural data for disease-causing mutations in human mitochondrial aminoacyl-tRNA synthetases.

    Science.gov (United States)

    Moulinier, Luc; Ripp, Raymond; Castillo, Gaston; Poch, Olivier; Sissler, Marie

    2017-10-01

    Numerous mutations in each of the mitochondrial aminoacyl-tRNA synthetases (aaRSs) have been implicated in human diseases. The mutations are autosomal and recessive and lead mainly to neurological disorders, although with pleiotropic effects. The processes and interactions that drive the etiology of the disorders associated with mitochondrial aaRSs (mt-aaRSs) are far from understood. The complexity of the clinical, genetic, and structural data requires concerted, interdisciplinary efforts to understand the molecular biology of these disorders. Toward this goal, we designed MiSynPat, a comprehensive knowledge base together with an ergonomic Web server designed to organize and access all pertinent information (sequences, multiple sequence alignments, structures, disease descriptions, mutation characteristics, original literature) on the disease-linked human mt-aaRSs. With MiSynPat, a user can also evaluate the impact of a possible mutation on sequence-conservation-structure in order to foster the links between basic and clinical researchers and to facilitate future diagnosis. The proposed integrated view, coupled with research on disease-related mt-aaRSs, will help to reveal new functions for these enzymes and to open new vistas in the molecular biology of the cell. The purpose of MiSynPat, freely available at http://misynpat.org, is to constitute a reference and a converging resource for scientists and clinicians. © 2017 The Authors. Human Mutation published by Wiley Periodicals, Inc.

  7. The role of structural disorder in cell cycle regulation, related clinical proteomics, disease development and drug targeting.

    Science.gov (United States)

    Tantos, Agnes; Kalmar, Lajos; Tompa, Peter

    2015-06-01

    Understanding the molecular mechanisms of the regulation of cell cycle is a central issue in molecular cell biology, due to its fundamental role in the existence of cells. The regulatory circuits that make decisions on when a cell should divide are very complex and particularly subtly balanced in eukaryotes, in which the harmony of many different cells in an organism is essential for life. Several hundred proteins are involved in these processes, and a great deal of studies attests that most of them have functionally relevant intrinsic structural disorder. Structural disorder imparts many functional advantages on these proteins, and we discuss it in detail that it is involved in all key steps from signaling through the cell membrane to regulating transcription of proteins that execute timely responses to an ever-changing environment.

  8. How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school.

    Science.gov (United States)

    Świerszcz, Jolanta; Stalmach-Przygoda, Agata; Kuźma, Marcin; Jabłoński, Konrad; Cegielny, Tomasz; Skrzypek, Agnieszka; Wieczorek-Surdacka, Ewa; Kruszelnicka, Olga; Chmura, Kaja; Chyrchel, Bernadeta; Surdacki, Andrzej; Nowakowski, Michał

    2017-09-01

    As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. Analysis of routinely collected data. One Polish medical school. Complete OSCE records for 462 second-year students and 445 third-year students. OSCE scores by matriculation year. In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG - tasks which had not been included in the second-year preclinical training. Our results suggest the importance of preclinical training in a CS laboratory to improve students' competence in physical examination at the completion of introductory clinical clerkships during

  9. Separating generalized anxiety disorder from major depression using clinical, hormonal, and structural MRI data: A multimodal machine learning study.

    Science.gov (United States)

    Hilbert, Kevin; Lueken, Ulrike; Muehlhan, Markus; Beesdo-Baum, Katja

    2017-03-01

    Generalized anxiety disorder (GAD) is difficult to recognize and hard to separate from major depression (MD) in clinical settings. Biomarkers might support diagnostic decisions. This study used machine learning on multimodal biobehavioral data from a sample of GAD, MD and healthy subjects to differentiate subjects with a disorder from healthy subjects (case-classification) and to differentiate GAD from MD (disorder-classification). Subjects with GAD (n = 19), MD without GAD (n = 14), and healthy comparison subjects (n = 24) were included. The sample was matched regarding age, sex, handedness and education and free of psychopharmacological medication. Binary support vector machines were used within a nested leave-one-out cross-validation framework. Clinical questionnaires, cortisol release, gray matter (GM), and white matter (WM) volumes were used as input data separately and in combination. Questionnaire data were well-suited for case-classification but not disorder-classification (accuracies: 96.40%, p  .22). The opposite pattern was found for imaging data (case-classification GM/WM: 58.71%, p = .09/43.18%, p > .66; disorder-classification GM/WM: 68.05%, p = .034/58.27%, p > .15) and for cortisol data (38.02%, p = .84; 74.60%, p = .009). All data combined achieved 90.10% accuracy (p disorder-classification. In line with previous evidence, classification of GAD was difficult using clinical questionnaire data alone. Particularly cortisol and GM volume data were able to provide incremental value for the classification of GAD. Findings suggest that neurobiological biomarkers are a useful target for further research to delineate their potential contribution to diagnostic processes.

  10. The structure of contraceptive education and instruction within nurse led family planning clinics: a grounded theory study.

    Science.gov (United States)

    Hayter, Mark

    2009-09-01

    This study aimed to explore and analyse how nurses instruct women in contraceptive use during consultations in family planning clinics to produce a grounded theory of contraceptive education. Nurses play a key role in instructing women how to use contraception in family planning clinic consultations. These one-to-one situations are encounters where women are taught how to use contraceptive methods effectively. However, very little is known about the nature of these consultations. A qualitative study using a grounded theory approach was used. Three linked 'core categories' emerged from the data analysis. Firstly, women are educated about their body and how it responds to contraception: 'reproductive education'. This core category is closely linked to 'surveillance' where women are taught to monitor their reproductive health and to 'contraceptive regimen' where women are instructed in techniques to successfully use a contraceptive method. Together these three core categories present a grounded theory of 'contraceptive education'. Nursing practice in this important area of women's health care is complex and requires skilled practitioners. This study presents unique empirical data into how nurses conduct one-to-one consultations with women - providing a novel insight into how contraception is explained in clinical situations. Key issues for practice from the data were the lack of a balance when discussing side effects, the rigidity of some instructions and the lack of recognition of risk from sexually transmitted infection. Nurses working in sexual health need to ensure that women understand the often complex instructions they provide and that rigid instruction be occasionally amended to enable some flexibility. The manner in which side-effects are discussed should also be balanced. Nurses need to address the risk of sexually transmitted infections more substantially in contraceptive discussions.

  11. Clinical characteristics of pain originating from intra-articular structures of the knee joint in patients with medial knee osteoarthritis

    OpenAIRE

    Ikeuchi, Masahiko; Izumi, Masashi; Aso, Koji; Sugimura, Natsuki; Tani, Toshikazu

    2013-01-01

    Purpose Although disease progression of osteoarthritis has been well documented, pain pathophysiology is largely unknown. This study was designed with two purposes: 1) to characterize patients with knee pain predominantly originating from intra-articular structures and 2) to describe the location and pattern of their pain. Materials and methods 103 patients with medial knee osteoarthritis underwent an intra-articular injection of local anesthetics (joint block). At least 70% pain relief was d...

  12. Structural insights from binding poses of CCR2 and CCR5 with clinically important antagonists: a combined in silico study.

    Directory of Open Access Journals (Sweden)

    Gugan Kothandan

    Full Text Available Chemokine receptors are G protein-coupled receptors that contain seven transmembrane domains. In particular, CCR2 and CCR5 and their ligands have been implicated in the pathophysiology of a number of diseases, including rheumatoid arthritis and multiple sclerosis. Based on their roles in disease, they have been attractive targets for the pharmaceutical industry, and furthermore, targeting both CCR2 and CCR5 can be a useful strategy. Owing to the importance of these receptors, information regarding the binding site is of prime importance. Structural studies have been hampered due to the lack of X-ray crystal structures, and templates with close homologs for comparative modeling. Most of the previous models were based on the bovine rhodopsin and β2-adrenergic receptor. In this study, based on a closer homolog with higher resolution (CXCR4, PDB code: 3ODU 2.5 Å, we constructed three-dimensional models. The main aim of this study was to provide relevant information on binding sites of these receptors. Molecular dynamics simulation was done to refine the homology models and PROCHECK results indicated that the models were reasonable. Here, binding poses were checked with some established inhibitors of high pharmaceutical importance against the modeled receptors. Analysis of interaction modes gave an integrated interpretation with detailed structural information. The binding poses confirmed that the acidic residues Glu291 (CCR2 and Glu283 (CCR5 are important, and we also found some additional residues. Comparisons of binding sites of CCR2/CCR5 were done sequentially and also by docking a potent dual antagonist. Our results can be a starting point for further structure-based drug design.

  13. Inhibition of Human Aldehyde Oxidase Activity by Diet-Derived Constituents: Structural Influence, Enzyme-Ligand Interactions, and Clinical Relevance

    OpenAIRE

    Barr, John T.; Jones, Jeffrey P.; Oberlies, Nicholas H.; Paine, Mary F.

    2015-01-01

    The mechanistic understanding of interactions between diet-derived substances and conventional medications in humans is nascent. Most investigations have examined cytochrome P450–mediated interactions. Interactions mediated by other phase I enzymes are understudied. Aldehyde oxidase (AO) is a phase I hydroxylase that is gaining recognition in drug design and development programs. Taken together, a panel of structurally diverse phytoconstituents (n = 24) was screened for inhibitors of the AO-m...

  14. [Structures and practice of psychology departments in orthopaedic and cardiac rehabilitation: a comparison of outpatient and inpatient clinics in Germany].

    Science.gov (United States)

    Mittag, O; Reese, C; Gülich, M; Jäckel, W H

    2012-12-01

    We aimed at comparing the present structural quality and practice of psychological services in ambulatory (outpatient) and inpatient rehabilitation in Germany.A nationwide survey of psychological services in orthopaedic and cardiac outpatient rehab centres was carried out. Results were compared to those of an identical study of inpatient services that was conducted simultaneously.Data were obtained from 81 ambulatory centres (return rate: 44%). Structures and practice (e. g., diagnostic procedures, psychological interventions) in ambulatory and inpatient rehabilitation only differed marginally. Differences concern the staff/patient ratio which is slightly better in ambulatory centres and some aspects of working conditions (e. g., less assisting staff or supervision).From its beginning, ambulatory rehabilitation in Germany has followed the standards of the inpatient model as far as structural quality and processes are concerned. Psychological practice in the ambulatory setting reflects that too. It is discussed whether the uniformity of ambulatory and inpatient rehabilitation services really is appropriate, or whether a more flexible model (e. g., regarding treatment duration) is needed in the German rehabilitation system. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Comparison and use of 3D scanners to improve the quantification of medical images (surface structures and volumes) during follow up of clinical (surgical) procedures

    Science.gov (United States)

    Tokkari, Niki; Verdaasdonk, Rudolf M.; Liberton, Niels; Wolff, Jan; den Heijer, Martin; van der Veen, Albert; Klaessens, John H.

    2017-02-01

    It is difficult to obtain quantitative measurements as to surface areas and volumes from standard photos of the body parts of patients which is highly desirable for objective follow up of treatments in e.g. dermatology. plastic, aesthetic and reconstructive surgery. Recently, 3-D scanners have become available to provide quantification. Phantoms (3-D printed hand, nose and ear, colored bread sculpture) were developed to compare a range from low-cost (Sense), medium (HP Sprout) to high end (Artec Spider, Vectra M3) scanners using different 3D imaging technologies, as to resolution, working range, surface color representation, user friendliness. The 3D scans files (STL, OBJ) were processed with Artec studio and GOM software as to deviation compared to the high resolution Artec Spider scanner taken as `golden' standard. The HP Spout, which uses a fringe projection, proved to be nearly as good as the Artec, however, needs to be converted for clinical use. Photogrammetry as used by the Vectra M3 scanner is limited to provide sufficient data points for accurate surface mapping however provides good color/structure representation. The low performance of the Sense is not recommended for clinical use. The Artec scanner was successfully used to measure the structure/volume changes in the face after hormone treatment in transgender patients. 3D scanners can greatly improve quantitative measurements of surfaces and volumes as objective follow up in clinical studies performed by various clinical specialisms (dermatology, aesthetic and reconstructive surgery). New scanning technologies, like fringe projection, are promising for development of low-cost, high precision scanners.

  16. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making

    Directory of Open Access Journals (Sweden)

    Manns PJ

    2012-11-01

    Full Text Available Patricia J Manns, Johanna DarrahDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaBackground and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study.Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1 identify prevalent condition and brainstorm interventions; (2 literature search; (3 develop scenario framework; and (4 write scenario.Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation.Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.Keywords: physical therapists, clinical decision making, evaluation, curriculum

  17. Design, synthesis and structure-activity relationships of (indo-3-yl) heterocyclic derivatives as agonists of the CB1 receptor. Discovery of a clinical candidate.

    Science.gov (United States)

    Ratcliffe, Paul; Adam, Julia M; Baker, James; Bursi, Roberta; Campbell, Robert; Clark, John K; Cottney, Jean E; Deehan, Maureen; Easson, Anna-Marie; Ecker, Daniel; Edwards, Darren; Epemolu, Ola; Evans, Louise; Fields, Ruth; Francis, Stuart; Harradine, Paul; Jeremiah, Fiona; Kiyoi, Takao; McArthur, Duncan; Morrison, Angus; Passier, Paul; Pick, Jack; Schnabel, Peter G; Schulz, Jurgen; Steinbrede, Heinz; Walker, Glenn; Westwood, Paul; Wishart, Grant; Udo de Haes, Joanna

    2011-04-15

    We report an expansion of the structure-activity relationship (SAR) of a novel series of indole-3-heterocyclic CB1 receptor agonists. Starting from the potent but poorly soluble lead, 1, a rational approach was taken in order to balance solubility, hERG activity and potency while retaining the desired long duration of action within the mouse tail flick test. This led to the discovery of compound 38 which successfully progressed into clinical development. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Adaptation of Campylobacter jejuni to biocides used in the food industry affects biofilm structure, adhesion strength, and cross-resistance to clinical antimicrobial compounds.

    Science.gov (United States)

    Techaruvichit, Punnida; Takahashi, Hajime; Kuda, Takashi; Miya, Satoko; Keeratipibul, Suwimon; Kimura, Bon

    2016-08-01

    The emergence of biocide-adapted Campylobacter jejuni strains that developed into biofilms and their potential to develop clinical resistance to antimicrobial compounds was studied. C. jejuni was grown in sub-lethal concentrations of five biocides used in the food industry. C. jejuni exhibited adaptation to these biocides with increased minimum inhibitory concentrations. The 3-D structures of the biofilms produced by the biocide-adapted cells were investigated by atomic force microscopy (AFM). The results revealed marked variability in biofilm architecture, including ice-crystal-like structures. Adaptation to the biocides enhanced biofilm formation, with significant increases in biovolume, surface coverage, roughness, and the surface adhesion force of the biofilms. Adaptation to commercial biocides induced resistance to kanamycin and streptomycin. This study suggests that the inappropriate use of biocides may lead to cells being exposed to them at sub-lethal concentrations, which can result in adaptation of the pathogens to the biocides and a subsequent risk to public health.

  19. Neutron structure of human carbonic anhydrase II in complex with methazolamide: mapping the solvent and hydrogen-bonding patterns of an effective clinical drug

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    Mayank Aggarwal

    2016-09-01

    Full Text Available Carbonic anhydrases (CAs; EC 4.2.1.1 catalyze the interconversion of CO2 and HCO3−, and their inhibitors have long been used as diuretics and as a therapeutic treatment for many disorders such as glaucoma and epilepsy. Acetazolamide (AZM and methazolamide (MZM, a methyl derivative of AZM are two of the classical CA inhibitory drugs that have been used clinically for decades. The jointly refined X-ray/neutron structure of MZM in complex with human CA isoform II (hCA II has been determined to a resolution of 2.2 Å with an Rcryst of ∼16.0%. Presented in this article, along with only the second neutron structure of a clinical drug-bound hCA, is an in-depth structural comparison and analyses of differences in hydrogen-bonding network, water-molecule orientation and solvent displacement that take place upon the binding of AZM and MZM in the active site of hCA II. Even though MZM is slightly more hydrophobic and displaces more waters than AZM, the overall binding affinity (Ki for both of the drugs against hCA II is similar (∼10 nM. The plausible reasons behind this finding have also been discussed using molecular dynamics and X-ray crystal structures of hCA II–MZM determined at cryotemperature and room temperature. This study not only allows a direct comparison of the hydrogen bonding, protonation states and solvent orientation/displacement of AZM and MZM, but also shows the significant effect that the methyl derivative has on the solvent organization in the hCA II active site.

  20. Factor structure of the General Health Questionnaire-28 (GHQ-28 from infertile women attending the Yazd Research and Clinical Center for Infertility

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    Zahra Shayan

    2015-12-01

    Full Text Available Background: Nowadays, infertility problems have become a social concern, and are associated with multiple psychological and social problems. Also, it affects the interpersonal communication between the individual, familial, and social characteristics. Since women are exposed to stressors of physical, mental, social factors, and treatment of infertility, providing a psychometric screening tool is necessary for disorders of this group. Objective: The aim of this study was to determine the factor structure of the general health questionnaire-28 to discover mental disorders in infertile women. Materials and Methods: In this study, 220 infertile women undergoing treatment of infertility were selected from the Yazd Research and Clinical Center for Infertility with convenience sampling in 2011. After completing the general health questionnaire by the project manager, validity and, reliability of the questionnaire were calculated by confirmatory factor structure and Cronbach's alpha, respectively. Results: Four factors, including anxiety and insomnia, social dysfunction, depression, and physical symptoms were extracted from the factor structure. 50.12% of the total variance was explained by four factors. The reliability coefficient of the questionnaire was obtained 0.90. Conclusion: Analysis of the factor structure and reliability of General Health Questionnaire-28 showed that it is suitable as a screening instrument for assessing general health of infertile women.

  1. A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE

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    Sobowale Oluwaseun

    2011-03-01

    Full Text Available Abstract Background The General Medical Council states that teaching doctors and students is important for the care of patients. Our aim was to deliver a structured teaching program to final year medical students, evaluate the efficacy of teaching given by junior doctors and review the pertinent literature. Methods We developed a revision package for final year medical students sitting the Objective Structured Clinical Examination (OSCE. The package was created and delivered exclusively by recent medical graduates and consisted of lectures and small group seminars covering the core areas of medicine and surgery, with a focus on specific OSCE station examples. Students were asked to complete a feedback questionnaire during and immediately after the program. Results One hundred and eighteen completed feedback questionnaires were analysed. All participants stated that the content covered was relevant to their revision. 73.2% stated that junior doctors delivered teaching that is comparable to that of consultant - led teaching. 97.9% stated the revision course had a positive influence on their learning. Conclusions Our study showed that recent medical graduates are able to create and deliver a structured, formal revision program and provide a unique perspective to exam preparation that was very well received by our student cohort. The role of junior doctors teaching medical students in a formal structured environment is very valuable and should be encouraged.

  2. Integration einer OSCE in das zahnmedizinische Physikum [Integration of an Objective Structured Clinical Examination (OSCE into the Dental Preliminary Exams

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    Ratzmann, Anja

    2012-02-01

    Full Text Available [english] Introduction: In the pre-clinical phase of the study of dentistry at the University of Greifswald, the course “Early Patient Contact (EPC” is conducted within the framework of Community Medicine/Dentistry. The course is based on three pillars: the patient visiting program, special problem-oriented seminars, and communication training for doctors. The essential goal consists of providing students with real patient contact right at the beginning of their study of dentistry, thus making the study of dentistry patient-based very early on. Students are trained in taking comprehensive anamneses and recording clinical findings.Methods: Within the framework of the dental preliminary exams, the course is evaluated using an OSCE on a standardized patient. Furthermore, the added value of an additional training unit (conducting anamnesis and clinical examination in preparation for the OSCE was evaluated. The exam results of a group without training (control group were compared with those of a group with training (intervention group.Results: The intervention group performed significantly better than the control on the following items: the total number of points achieved on the OSCE early patient contact, and in the most important points of the anamnesis and clinical examination. In addition, the intervention group tended to score higher in terms of the item “oral health status”.Conclusion: The present study showed a positive effect of an additional training unit on students’ performance in the OSCE. Taking the limitations of the study and the results of a literature review into account, we recommend conducting such training as preparation for the OSCE.[german] Einleitung: An der Universität Greifswald wird im vorklinischen Abschnitt des Studienganges der Zahnmedizin im Rahmen der Community Medicine/Dentistry der Kurs „Der Frühe Patientenkontakt (FPK“ durchgeführt. Der Kurs basiert auf drei Prinzipien: dem Patientenbesuchsprogramm

  3. Detecting Lung and Colorectal Cancer Recurrence Using Structured Clinical/Administrative Data to Enable Outcomes Research and Population Health Management.

    Science.gov (United States)

    Hassett, Michael J; Uno, Hajime; Cronin, Angel M; Carroll, Nikki M; Hornbrook, Mark C; Ritzwoller, Debra

    2017-12-01

    Recurrent cancer is common, costly, and lethal, yet we know little about it in community-based populations. Electronic health records and tumor registries contain vast amounts of data regarding community-based patients, but usually lack recurrence status. Existing algorithms that use structured data to detect recurrence have limitations. We developed algorithms to detect the presence and timing of recurrence after definitive therapy for stages I-III lung and colorectal cancer using 2 data sources that contain a widely available type of structured data (claims or electronic health record encounters) linked to gold-standard recurrence status: Medicare claims linked to the Cancer Care Outcomes Research and Surveillance study, and the Cancer Research Network Virtual Data Warehouse linked to registry data. Twelve potential indicators of recurrence were used to develop separate models for each cancer in each data source. Detection models maximized area under the ROC curve (AUC); timing models minimized average absolute error. Algorithms were compared by cancer type/data source, and contrasted with an existing binary detection rule. Detection model AUCs (>0.92) exceeded existing prediction rules. Timing models yielded absolute prediction errors that were small relative to follow-up time (data is feasible. These tools will enable extensive, novel research on quality, effectiveness, and outcomes for lung and colorectal cancer patients and those who develop recurrence.

  4. Building the rationale and structure for a complex physical therapy intervention within the context of a clinical trial: a multimodal individualized treatment for patients with hip osteoarthritis.

    Science.gov (United States)

    Bennell, Kim L; Egerton, Thorlene; Pua, Yong-Hao; Abbott, J Haxby; Sims, Kevin; Buchbinder, Rachelle

    2011-10-01

    Evaluating the efficacy of complex interventions such as multimodal, impairment-based physical therapy treatments in randomized controlled trials is essential to inform practice and compare relative benefits of available treatment options. Studies of physical therapy interventions using highly standardized intervention protocols, although methodologically rigorous, do not necessarily reflect "real-world" clinical practice, and in many cases results have been disappointing. Development of a complex intervention that includes multiple treatment modalities and individualized treatment technique selection requires a systematic approach to designing all aspects of the intervention based on theory, evidence, and practical constraints. This perspective article outlines the development of the rationale and structure of a multimodal physical therapy program for painful hip osteoarthritis to be assessed in a clinical trial. The resulting intervention protocol comprises a semi-structured program of exercises and manual therapy, advice, physical activity, and optional prescription of a gait aid that is standardized, yet can be individualized according to physical assessment and radiographic findings. The program is evidence based and reflects contemporary physical therapist practice, while also being reproducible and reportable. This perspective article aims to encourage physical therapy researchers involved in evaluation of complex interventions to better document their own intervention development, as well as the outcomes, thus generating a body of knowledge about the development processes and protocols that is generalizable to the real-world complexity of providing physical therapy to individual patients.

  5. Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale.

    Science.gov (United States)

    Kessler, Ronald C; Green, Jennifer Greif; Adler, Lenard A; Barkley, Russell A; Chatterji, Somnath; Faraone, Stephen V; Finkelman, Matthew; Greenhill, Laurence L; Gruber, Michael J; Jewell, Mark; Russo, Leo J; Sampson, Nancy A; Van Brunt, David L

    2010-11-01

    Controversy exists about the appropriate criteria for a diagnosis of adult attention-deficit/hyperactivity disorder (ADHD). To examine the structure and symptoms most predictive of DSM-IV adult ADHD. The data are from clinical interviews in enriched subsamples of the National Comorbidity Survey Replication (n = 131) and a survey of a large managed health care plan (n = 214). The physician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current adult ADHD. Analyses examined the stability of symptoms from childhood to adulthood, the structure of adult ADHD, and the adult symptoms most predictive of current clinical diagnoses. The ACDS was administered telephonically by clinical research interviewers with extensive experience in the diagnosis and treatment of adult ADHD. An enriched sample of community respondents. Diagnoses of DSM-IV /ACDS adult ADHD. Almost half of the respondents (45.7%) who had childhood ADHD continued to meet the full DSM-IV criteria for current adult ADHD, with 94.9% of these patients having current attention-deficit disorder and 34.6% having current hyperactivity disorder. Adult persistence was much greater for inattention than for hyperactivity/impulsivity. Additional respondents met the full criteria for current adult ADHD despite not having met the full childhood criteria. A 3-factor structure of adult symptoms included executive functioning (EF), inattention/hyperactivity, and impulsivity. Stepwise logistic regression found EF problems to be the most consistent and discriminating predictors of adult DSM-IV /ACDS ADHD. These findings document the greater persistence of inattentive than of hyperactive/impulsive childhood symptoms of ADHD in adulthood but also show that inattention is not specific to ADHD because it is strongly associated with other adult mental disorders. In comparison, EF problems are more specific and consistently important predictors of DSM-IV adult ADHD

  6. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making.

    Science.gov (United States)

    Manns, Patricia J; Darrah, Johanna

    2012-01-01

    Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors' curriculum research study. Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1) identify prevalent condition and brainstorm interventions; (2) literature search; (3) develop scenario framework; and (4) write scenario. Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios - ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation. The use of scenarios has been very helpful to capture therapists' reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.

  7. An automatic quantification system for MS lesions with integrated DICOM structured reporting (DICOM-SR) for implementation within a clinical environment

    Science.gov (United States)

    Jacobs, Colin; Ma, Kevin; Moin, Paymann; Liu, Brent

    2010-03-01

    Multiple Sclerosis (MS) is a common neurological disease affecting the central nervous system characterized by pathologic changes including demyelination and axonal injury. MR imaging has become the most important tool to evaluate the disease progression of MS which is characterized by the occurrence of white matter lesions. Currently, radiologists evaluate and assess the multiple sclerosis lesions manually by estimating the lesion volume and amount of lesions. This process is extremely time-consuming and sensitive to intra- and inter-observer variability. Therefore, there is a need for automatic segmentation of the MS lesions followed by lesion quantification. We have developed a fully automatic segmentation algorithm to identify the MS lesions. The segmentation algorithm is accelerated by parallel computing using Graphics Processing Units (GPU) for practical implementation into a clinical environment. Subsequently, characterized quantification of the lesions is performed. The quantification results, which include lesion volume and amount of lesions, are stored in a structured report together with the lesion location in the brain to establish a standardized representation of the disease progression of the patient. The development of this structured report in collaboration with radiologists aims to facilitate outcome analysis and treatment assessment of the disease and will be standardized based on DICOM-SR. The results can be distributed to other DICOM-compliant clinical systems that support DICOM-SR such as PACS. In addition, the implementation of a fully automatic segmentation and quantification system together with a method for storing, distributing, and visualizing key imaging and informatics data in DICOM-SR for MS lesions improves the clinical workflow of radiologists and visualizations of the lesion segmentations and will provide 3-D insight into the distribution of lesions in the brain.

  8. Soluble monomers, dimers and HLA-G-expressing extracellular vesicles: the three dimensions of structural complexity to use HLA-G as a clinical biomarker.

    Science.gov (United States)

    Nardi, F da Silva; König, L; Wagner, B; Giebel, B; Santos Manvailer, L F; Rebmann, V

    2016-09-01

    The HLA-G molecule belongs to the family of nonclassical human leukocyte antigen (HLA) class I. At variance to classical HLA class I, HLA-G displays (i) a low number of nucleotide variations within the coding region, (ii) a high structural diversity, (iii) a restricted peptide repertoire, (iv) a limited tissue distribution and (v) strong immune-suppressive properties. The physiological HLA-G surface expression is restricted to the maternal-fetal interface and to immune-privileged adult tissues. Soluble forms of HLA-G (sHLA-G) are detectable in various body fluids. Cellular activation and pathological processes are associated with an aberrant or a neo-expression of HLA-G/sHLA-G. Functionally, HLA-G and its secreted forms are considered to be key players in the induction of short- and long-term tolerance. Thus, its unique expression profile and tolerance-inducing functions render HLA-G/sHLA-G an attractive biomarker to monitor the systemic health/disease status and disease activity/progression for clinical approaches in disease management and treatments. Here, we place emphasis on (i) the current status of the tolerance-inducing functions by HLA-G/sHLA-G, (ii) the current complexity to implement this molecule as a meaningful clinical biomarker regarding the three dimensions of structural diversity (monomers, dimers and HLA-G-expressing extracellular vesicles) with its functional implications, and (iii) novel and future approaches to detect and quantify sHLA-G structures and functions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Clinical relevance of retinal structure in children with laser-treated retinopathy of prematurity versus controls - using optical coherence tomography.

    Science.gov (United States)

    Stoica, Florina; Chirita-Emandi, Adela; Andreescu, Nicoleta; Stanciu, Alina; Zimbru, Cristian G; Puiu, Maria

    2017-09-19

    We aimed to assess the macular anatomy using spectral domain optical coherence tomography (SD-OCT), in children born preterm who had laser-treated retinopathy of prematurity (ROP), and to investigate the relationship between structural changes in macula and visual function. Thirty-seven 3-8 years old children were included in the study in two groups: 20 children born preterm [(characteristic curve (ROC) analysis, with BCVA as static variable (category 0 = BCVA ≤0.3 logMAR), the CFT cut-off was 257 μm (sensitivity: 0.917; specificity: 0.661; area under the curve: 0.810, p = 0.001). Years after the laser intervention, central fovea was significantly thicker in ROP laser-treated children born preterm when compared to controls. Central fovea thickness (CFT) correlated strongly and inversely with BW and gestational age (GA) at birth, while a CFT value above 257 μm was suggestive for suboptimal visual acuity. The proposed cut-off value needs to be validated in future larger studies. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  10. Electron microscopy of human peripheral nerves of clinical relevance to the practice of nerve blocks. A structural and ultrastructural review based on original experimental and laboratory data.

    Science.gov (United States)

    Reina, M A; Arriazu, R; Collier, C B; Sala-Blanch, X; Izquierdo, L; de Andrés, J

    2013-12-01

    The goal is to describe the ultrastructure of normal human peripheral nerves, and to highlight key aspects that are relevant to the practice of peripheral nerve block anaesthesia. Using samples of sciatic nerve obtained from patients, and dural sac, nerve root cuff and brachial plexus dissected from fresh human cadavers, an analysis of the structure of peripheral nerve axons and distribution of fascicles and topographic composition of the layers that cover the nerve is presented. Myelinated and unmyelinated axons, fascicles, epineurium, perineurium and endoneurium obtained from patients and fresh cadavers were studied by light microscopy using immunohistochemical techniques, and transmission and scanning electron microscopy. Structure of perineurium and intrafascicular capillaries, and its implications in blood-nerve barrier were revised. Each of the anatomical elements is analyzed individually with regard to its relevance to clinical practice to regional anaesthesia. Routine practice of regional anaesthetic techniques and ultrasound identification of nerve structures has led to conceptions, which repercussions may be relevant in future applications of these techniques. In this regard, the ultrastructural and histological perspective accomplished through findings of this study aims at enlightening arising questions within the field of regional anaesthesia. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  11. Magnetic resonance imaging quality and volumes of brain structures from live and postmortem imaging of California sea lions with clinical signs of domoic acid toxicosis.

    Science.gov (United States)

    Montie, Eric W; Wheeler, Elizabeth; Pussini, Nicola; Battey, Thomas W K; Barakos, Jerome; Dennison, Sophie; Colegrove, Kathleen; Gulland, Frances

    2010-09-17

    Our goal in this study was to compare magnetic resonance images and volumes of brain structures obtained alive versus postmortem of California sea lions Zalophus californianus exhibiting clinical signs of domoic acid (DA) toxicosis and those exhibiting normal behavior. Proton density-(PD) and T2-weighted images of postmortem-intact brains, up to 48 h after death, provided similar quality to images acquired from live sea lions. Volumes of gray matter (GM) and white matter (WM) of the cerebral hemispheres were similar to volumes calculated from images acquired when the sea lions were alive. However, cerebrospinal fluid (CSF) volumes decreased due to leakage. Hippocampal volumes from postmortem-intact images were useful for diagnosing unilateral and bilateral atrophy, consequences of DA toxicosis. These volumes were similar to the volumes in the live sea lion studies, up to 48 h postmortem. Imaging formalin-fixed brains provided some information on brain structure; however, images of the hippocampus and surrounding structures were of poorer quality compared to the images acquired alive and postmortem-intact. Despite these issues, volumes of cerebral GM and WM, as well as the hippocampus, were similar to volumes calculated from images of live sea lions and sufficient to diagnose hippocampal atrophy. Thus, postmortem MRI scanning (either intact or formalin-fixed) with volumetric analysis can be used to investigate the acute, chronic and possible developmental effects of DA on the brain of California sea lions.

  12. Structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction, comorbided with arterial hypertension

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    V. D. Syvolap

    2013-12-01

    Full Text Available Recently, much attention was paid to left ventricular diastolic dysfunction and its role in the occurrence of chronic heart failure. In patients after myocardial infarction, diastolic dysfunction often precedes systolic dysfunction and predicts prognosis. In patients after myocardial infarction, diastolic dysfunction is caused by a violation of early diastolic relaxation in the area of increasing stiffness. Diastolic dysfunction is formed by hypertrophy, fibrosis, myocardial ischemia and arterial hypertension. Given the important role of diastolic dysfunction in the formation of heart failure in postinfarction patients with concomitant arterial hypertension, the mechanisms of its impact on clinical features and structural-functional changes of the heart is an actual problem. Objective: To determine the structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction with concomitant arterial hypertension. Materials and methods: In 91 patients with post-infarction cardiosclerosis and preserved left ventricular ejection fraction (EF > 45 % with arterial hypertension were investigated structural and functional changes in the heart and clinical features of heart failure by assessing clinical status and ultrasound of the heart. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 3 groups. The first group included 50 patients with diastolic dysfunction and symptoms of heart failure (mean age 64,1 ± 1,2 years. In the second group were 31 patients with diastolic dysfunction without heart failure symptoms (mean age 59,5 ± 1,6 years. The third group consisted of 10 patients without diastolic dysfunction and manifestations of heart failure (mean age 57 ± 2,8 years. Results and discussion: 10% patients with postinfarction cardiosclerosis and concomitant hypertension with diastolic heart failure had NYHA

  13. The Implementation and Development of an Objective Structured Clinical Examination in the Community Pharmacy Course of a Select Gulf-Region Academic Institution (Ras Al Khaimah College of Pharmaceutical Sciences): A Pilot Study

    Science.gov (United States)

    Al-Azzawi, Amad Mohammed Jamil; Nagavi, B.G.; Hachim, Mahmood Y.; Mossa, Omar H.

    2016-01-01

    Background: Objective Structured Clinical Examinations (OSCEs) were used to assess translational pharmacotherapeutic skills of a Gulf-region representative academic institution. Aim: The aim of the current study was to assess the clinical skills of students enrolled within the third year Bachelor of Pharmacy (BPharm) programme within Ras Al…

  14. Hubungan Tingkat Kecemasan dalam Menghadapi Objective Structured Clinical Examination (OSCE dengan Kelulusan OSCE pada Mahasiswa Fakultas Kedokteran Universitas Andalas

    Directory of Open Access Journals (Sweden)

    Dinda Putri Amir

    2016-01-01

    Full Text Available AbstrakKecemasan adalah normal terjadi dalam kehidupan, namun kecemasan dapat menjadi abnormal jika respons terhadap stimulus berlebihan. Pada mahasiswa, kecemasan berpengaruh terhadap proses pendidikan. OSCE merupakan salah satu bagian dari ujian komprehensif yang menguji keterampilan medis mahasiswa yang akan memasuki kepaniteraan klinik. Ujian ini hampir sama dengan ujian skills lab, tapi materi ujian lebih banyak dan setting ujian juga berbeda sehingga situasi tersebut menimbulkan kecemasan pada mahasiswa menjelang OSCE. Tujuan penelitian ini adalah menentukan hubungan tingkat kecemasan dalam menghadapi OSCE dengan kelulusan OSCE pada mahasiwa FK Unand. Jenis penelitian ini adalah deskriptif analitik dengan sampel sebanyak 34 orang. Data diperoleh melalui wawancara kepada peserta OSCE menggunakan kuesioner Hamilton Rating Scale for Anxiety (HRS-A dan Bagian Akademik FK Unand yang selanjutnya dianalisis melalui uji korelasi Gamma dan Somers’d. Hasil penelitian ini didapatkan nilai koefisien korelasi (r sebesar -0,106 dan nilai signifikansi p>0,05. Berdasarkan hasil penelitian dapat disimpulkan bahwa tidak terdapat hubungan yang bermakna antara tingkat kecemasan dalam menghadapi OSCE dengan kelulusan OSCE pada mahasiwa FK Unand.Kata kunci: kecemasan, ujian, OSCE, HRS-A AbstractAnxiety normally occurs in life, but anxiety can become abnormal if the response to the stimulus is excessive. In student, anxiety affects the educational process. OSCE is a part of comprehensive exam that examine medical skills of the students who will enter their clinical stage. Although this exam is similiar like skills lab exam but the matters of exam is more complex and the setting of exam is different too, so these situations cause anxiety in students toward OSCE. The objective of this study was to determine the correlation between anxiety level in facing OSCE to students’ graduation of OSCE in Faculty of Medicine Andalas University. This study was a

  15. Correlation of the Structural Changes in the Thyroid Gland with Clinical and Laboratory Parameters in Patients with Diabetes Mellitus Type 2

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    T.Yu. Uzvenko

    2016-04-01

    Full Text Available The article presents the results of the study on the influence of clinical and laboratory parameters on the presence of structural changes in the thyroid gland (TG of patients with diabetes mellitus (DM type 2. Objective — to evaluate the frequency and nature of the structural changes in the TG in DM type 2. Materials and methods. We have examined 122 patients, including 92 — with type 2 DM, and 30 — with obesity without DM type 2 (47 men and 75 women. Control group consisted of individuals without DM symptoms and obesity (n = 35. Examined groups did not differ by the age and sex. Results. In patients with type 2 DM, thyroid pathology was detected in 93.5 % of cases, in obesity without diabetes — in 86.7 %. These figures are significantly higher than population level (65.7 %. Structural changes in the form of nodules are detected significantly more often in DM type 2 (55.4 %. In general, nodules occurred 3.2 times more frequently in type 2 DM type than in obesity, and 4.9 times more often than in the control group. When comparing the nature of changes in the TG with clinical and laboratory parameters of DM type 2, it was found that with increasing duration of DM type 2, the number of nodules significantly increases. During insulin therapy in patients with DM, the percentage of thyroid nodules was significantly lower. Thyroid nodules are diagnosed significantly more frequently in the presence of microvascular complications and arterial hypertension. Nodules in type 2 DM were detected significantly more often in patients with obesity I degree than in patients with normal body mass (64.2 and 21.8 %, respectively (p < 0.01. Nodules of the TG are found significantly more often in patients with DM, in whom hepatic steatosis criteria were detected by echography of the liver (p < 0.05. Conclusions. Dynamic ultrasound examination of the TG in the duration of DM type 2 over five years, the presence of microangiopathy, obesity

  16. Structure of a short-chain dehydrogenase/reductase (SDR) within a genomic island from a clinical strain of Acinetobacter baumannii.

    Science.gov (United States)

    Shah, Bhumika S; Tetu, Sasha G; Harrop, Stephen J; Paulsen, Ian T; Mabbutt, Bridget C

    2014-10-01

    Over 15% of the genome of an Australian clinical isolate of Acinetobacter baumannii occurs within genomic islands. An uncharacterized protein encoded within one island feature common to this and other International Clone II strains has been studied by X-ray crystallography. The 2.4 Å resolution structure of SDR-WM99c reveals it to be a new member of the classical short-chain dehydrogenase/reductase (SDR) superfamily. The enzyme contains a nucleotide-binding domain and, like many other SDRs, is tetrameric in form. The active site contains a catalytic tetrad (Asn117, Ser146, Tyr159 and Lys163) and water molecules occupying the presumed NADP cofactor-binding pocket. An adjacent cleft is capped by a relatively mobile helical subdomain, which is well positioned to control substrate access.

  17. Adult attention deficit hyperactivity disorder symptoms and five-factor model traits in a clinical sample: a structural equation modeling approach.

    Science.gov (United States)

    Knouse, Laura E; Traeger, Lara; O'Cleirigh, Conall; Safren, Steven A

    2013-10-01

    Relationships among attention deficit hyperactivity disorder (ADHD) symptoms and adult personality traits have not been examined in larger clinically diagnosed samples. We collected multisource ADHD symptom and self-report NEO Five-Factor Inventory (Costa and McCrae [Odessa, FL: Psychological Assessment Resources, Inc, 1992) data from 117 adults with ADHD and tested symptom-trait associations using structural equation modeling. The final model fit the data. Inattention was positively associated with neuroticism and negatively associated with conscientiousness. On the basis of ADHD expression in adulthood, hyperactivity and impulsivity were estimated as separate constructs and showed differential relationships to extraversion and agreeableness. A significant positive relationship between hyperactivity and conscientiousness arose in the context of other pathways. ADHD symptoms are reliably associated with personality traits, suggesting a complex interplay across development that warrants prospective study into adulthood.

  18. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research

    Directory of Open Access Journals (Sweden)

    Andriy Fedorov

    2016-05-01

    Full Text Available Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT quantitative imaging (QI biomarker development applied to head and neck cancer (HNC treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM® international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK was improved to simplify the task of DICOM encoding by introducing new API

  19. DICOM for quantitative imaging biomarker development: a standards based approach to sharing clinical data and structured PET/CT analysis results in head and neck cancer research.

    Science.gov (United States)

    Fedorov, Andriy; Clunie, David; Ulrich, Ethan; Bauer, Christian; Wahle, Andreas; Brown, Bartley; Onken, Michael; Riesmeier, Jörg; Pieper, Steve; Kikinis, Ron; Buatti, John; Beichel, Reinhard R

    2016-01-01

    Background. Imaging biomarkers hold tremendous promise for precision medicine clinical applications. Development of such biomarkers relies heavily on image post-processing tools for automated image quantitation. Their deployment in the context of clinical research necessitates interoperability with the clinical systems. Comparison with the established outcomes and evaluation tasks motivate integration of the clinical and imaging data, and the use of standardized approaches to support annotation and sharing of the analysis results and semantics. We developed the methodology and tools to support these tasks in Positron Emission Tomography and Computed Tomography (PET/CT) quantitative imaging (QI) biomarker development applied to head and neck cancer (HNC) treatment response assessment, using the Digital Imaging and Communications in Medicine (DICOM(®)) international standard and free open-source software. Methods. Quantitative analysis of PET/CT imaging data collected on patients undergoing treatment for HNC was conducted. Processing steps included Standardized Uptake Value (SUV) normalization of the images, segmentation of the tumor using manual and semi-automatic approaches, automatic segmentation of the reference regions, and extraction of the volumetric segmentation-based measurements. Suitable components of the DICOM standard were identified to model the various types of data produced by the analysis. A developer toolkit of conversion routines and an Application Programming Interface (API) were contributed and applied to create a standards-based representation of the data. Results. DICOM Real World Value Mapping, Segmentation and Structured Reporting objects were utilized for standards-compliant representation of the PET/CT QI analysis results and relevant clinical data. A number of correction proposals to the standard were developed. The open-source DICOM toolkit (DCMTK) was improved to simplify the task of DICOM encoding by introducing new API abstractions

  20. Clinical Validation of Atlas-Based Auto-Segmentation of Multiple Target Volumes and Normal Tissue (Swallowing/Mastication) Structures in the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Teguh, David N. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Levendag, Peter C., E-mail: p.levendag@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Voet, Peter W.J.; Al-Mamgani, Abrahim [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Han Xiao; Wolf, Theresa K.; Hibbard, Lyndon S. [Elekta-CMS Software, Maryland Heights, MO 63043 (United States); Nowak, Peter; Akhiat, Hafid; Dirkx, Maarten L.P.; Heijmen, Ben J.M.; Hoogeman, Mischa S. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2011-11-15

    Purpose: To validate and clinically evaluate autocontouring using atlas-based autosegmentation (ABAS) of computed tomography images. Methods and Materials: The data from 10 head-and-neck patients were selected as input for ABAS, and neck levels I-V and 20 organs at risk were manually contoured according to published guidelines. The total contouring times were recorded. Two different ABAS strategies, multiple and single subject, were evaluated, and the similarity of the autocontours with the atlas contours was assessed using Dice coefficients and the mean distances, using the leave-one-out method. For 12 clinically treated patients, 5 experienced observers edited the autosegmented contours. The editing times were recorded. The Dice coefficients and mean distances were calculated among the clinically used contours, autocontours, and edited autocontours. Finally, an expert panel scored all autocontours and the edited autocontours regarding their adequacy relative to the published atlas. Results: The time to autosegment all the structures using ABAS was 7 min/patient. No significant differences were observed in the autosegmentation accuracy for stage N0 and N+ patients. The multisubject atlas performed best, with a Dice coefficient and mean distance of 0.74 and 2 mm, 0.67 and 3 mm, 0.71 and 2 mm, 0.50 and 2 mm, and 0.78 and 2 mm for the salivary glands, neck levels, chewing muscles, swallowing muscles, and spinal cord-brainstem, respectively. The mean Dice coefficient and mean distance of the autocontours vs. the clinical contours was 0.8 and 2.4 mm for the neck levels and salivary glands, respectively. For the autocontours vs. the edited autocontours, the mean Dice coefficient and mean distance was 0.9 and 1.6 mm, respectively. The expert panel scored 100% of the autocontours as a 'minor deviation, editable' or better. The expert panel scored 88% of the edited contours as good compared with 83% of the clinical contours. The total editing time was 66 min

  1. Effects of Bullying Experience on Psychological Well-Being Mediated by Conflict Management Styles and Psychological Empowerment among Nursing Students in Clinical Placement: A Structural Equation Modeling Approach.

    Science.gov (United States)

    Ren, Liping; Kim, Hyunli

    2017-10-01

    This study aimed to test a proposed structural equation model in which bullying experience, conflict management styles and psychological empowerment predict psychological well-being among Chinese nursing students in clinical placement. Three hundred and sixty-six nursing students recruited from five hospitals in J city and Y city were assessed with self-report questionnaires on bullying experience, conflict management styles, psychological empowerment and psychological well-being including depression, self-esteem, and academic major satisfaction. Data were analyzed using SPSS version 20.0 and AMOS version 22.0. The evaluation parameters included the comparative fit index at .90, the goodness of fit index at .93, the root mean square error of approximation at .07, and χ²/df ratio at 2.66, indicating that the proposed structural equation model provided a good fit to the data. Experience of being bullied during clinical placement, conflict management styles and psychological empowerment explained 93.0% of the variance and had significant effects on psychological well-being, with conflict management styles and psychological empowerment mediating the association between bullying and psychological well-being. The findings indicated that mediation by conflict management styles and psychological empowerment alleviated the negative influence of bullying on psychological well-being. To limit bullying and its negative effects, development of effective guidelines to deal with bullying will be a critical tool for both Chinese nursing students and their instructors. Further research should incorporate conflict management styles and psychological empowerment into the specific intervention strategies for handling bullying behaviors among nursing students and staff nurses and promoting nursing students' psychological well-being.

  2. [Application of objective structured clinical examination system in pediatric dental education for 8-year-program and 5-year-program students].

    Science.gov (United States)

    Wang, Lu-Lu; Jiang, Yang; Zhou, Zhi-Fei; Yuan, Shuai; Wang, Xiao-Jing

    2017-02-01

    To explore a more comprehensive and objective method for dental students examination, and improve the quality of pediatric dental education. Fifteen 8-year-program students and 30 5-year-program dental students from School of Stomatology, the Fourth Military Medical University were enrolled in this study. Objective structured clinical examination (OSCE), traditional diadactic test and questionnaires were carried out in all students. The scores of the two testing methods between students in 2 groups were compared using SPSS 11.5 software package. The average score of OSCE for 8-year-program students was significantly higher than that of 5-year-program students. In contrast, the traditional test score of 8-year-program students was significantly lower than that of 5-year-program students. Most students accepted OSCE and approved the evaluation system combining OSCE with traditional test. As a comprehensive, objective and effective evaluation system, OSCE is helpful for students to master knowledge and improve clinical ability.

  3. Reliability and validity of the Turkish version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D): a preliminary study.

    Science.gov (United States)

    Kundakçi, Turgut; Sar, Vedat; Kiziltan, Emre; Yargiç, Ilhan L; Tutkun, Hamdi

    2014-01-01

    A total of 34 consecutive patients with dissociative identity disorder or dissociative disorder not otherwise specified were evaluated using the Turkish version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). They were compared with a matched control group composed of 34 patients who had a nondissociative psychiatric disorder. Interrater reliability was evaluated by 3 clinicians who assessed videotaped interviews conducted with 5 dissociative and 5 nondissociative patients. All subjects who were previously diagnosed by clinicians as having a dissociative disorder were identified as positive, and all subjects who were previously diagnosed as not having a dissociative disorder were identified as negative. The scores of the main symptom clusters and the total score of the SCID-D differentiated dissociative patients from the nondissociative group. There were strong correlations between the SCID-D and the Dissociative Experiences Scale total and subscale scores. These results are promising for the validity and reliability of the Turkish version of the SCID-D. However, as the present study was conducted on a predominantly female sample with very severe dissociation, these findings should not be generalized to male patients, to dissociative disorders other than dissociative identity disorder, or to broader clinical or nonclinical populations.

  4. Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

    Science.gov (United States)

    O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

    2008-09-01

    Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

  5. Comparing biosimilar SB2 with reference infliximab after 54 weeks of a double-blind trial: clinical, structural and safety results.

    Science.gov (United States)

    Smolen, Josef S; Choe, Jung-Yoon; Prodanovic, Nenad; Niebrzydowski, Jaroslaw; Staykov, Ivan; Dokoupilova, Eva; Baranauskaite, Asta; Yatsyshyn, Roman; Mekic, Mevludin; Porawska, Wieskawa; Ciferska, Hana; Jedrychowicz-Rosiak, Krystyna; Zielinska, Agnieszka; Choi, Jasmine; Rho, Young Hee

    2017-10-01

    SB2 is a biosimilar to the reference infliximab (INF). Similar efficacy, safety and immunogenicity between SB2 and INF up to 30 weeks were previously reported. This report investigates such clinical similarity up to 54 weeks, including structural joint damage. In this phase III, double-blind, parallel-group, multicentre study, patients with moderate to severe RA despite MTX were randomized (1:1) to receive 3 mg/kg of either SB2 or INF at 0, 2, 6 and every 8 weeks thereafter. Dose escalation by 1.5 mg/kg up to a maximum dose of 7.5 mg/kg was allowed after week 30. Efficacy, safety and immunogenicity were measured at each visit up to week 54. Radiographic damage evaluated by modified total Sharp score was measured at baseline and week 54. A total of 584 patients were randomized to receive SB2 (n = 291) or INF (n = 293). The rate of radiographic progression was comparable between SB2 and INF (mean modified total Sharp score difference: SB2, 0.38; INF, 0.37) at 1 year. ACR responses, 28-joint DAS, Clinical Disease Activity Index and Simplified Disease Activity Index were comparable between SB2 and INF up to week 54. The incidence of treatment-emergent adverse events and anti-drug antibodies were comparable between treatment groups. Such comparable trends of efficacy, safety and immunogenicity were consistent from baseline up to 54 weeks. The pattern of dose increment was also comparable between SB2 and INF. SB2 maintained similar efficacy, safety and immunogenicity with INF up to 54 weeks in patients with moderate to severe RA. Radiographic progression was comparable at 1 year. ClinicalTrials.gov (http://clinicaltrials.gov; NCT01936181) and EudraCT (https://www.clinicaltrialsregister.eu; 2012-005733-37).

  6. Structure of a short-chain dehydrogenase/reductase (SDR) within a genomic island from a clinical strain of Acinetobacter baumannii

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Bhumika S., E-mail: bhumika.shah@mq.edu.au; Tetu, Sasha G. [Macquarie University, Research Park Drive, Sydney, NSW 2109 (Australia); Harrop, Stephen J. [University of New South Wales, Sydney, NSW 2052 (Australia); Paulsen, Ian T.; Mabbutt, Bridget C. [Macquarie University, Research Park Drive, Sydney, NSW 2109 (Australia)

    2014-09-25

    The structure of a short-chain dehydrogenase encoded within genomic islands of A. baumannii strains has been solved to 2.4 Å resolution. This classical SDR incorporates a flexible helical subdomain. The NADP-binding site and catalytic side chains are identified. Over 15% of the genome of an Australian clinical isolate of Acinetobacter baumannii occurs within genomic islands. An uncharacterized protein encoded within one island feature common to this and other International Clone II strains has been studied by X-ray crystallography. The 2.4 Å resolution structure of SDR-WM99c reveals it to be a new member of the classical short-chain dehydrogenase/reductase (SDR) superfamily. The enzyme contains a nucleotide-binding domain and, like many other SDRs, is tetrameric in form. The active site contains a catalytic tetrad (Asn117, Ser146, Tyr159 and Lys163) and water molecules occupying the presumed NADP cofactor-binding pocket. An adjacent cleft is capped by a relatively mobile helical subdomain, which is well positioned to control substrate access.

  7. Implant-supported overdenture manufactured using CAD/CAM techniques to achieve horizontal path insertion between the primary and secondary structure: A clinical case report

    Science.gov (United States)

    Agustín-Panadero, Rubén; Peñarrocha-Oltra, David; Gomar-Vercher, Sonia; Ferreiroa, Alberto

    2015-01-01

    This report describes the case of an edentulous patient with an atrophic maxilla and severe class III malocclusion. Prosthetic rehabilitation was performed using CAD/CAM techniques for manufacturing an implant-supported overdenture with horizontal insertion. A vestibulo-lingual insertion overdenture is a precision prosthesis with a fixation system affording a good fit between the primary and secondary structure. Both structures exhibit passive horizontal adjustment. This treatment option requires the same number of implants as implant-supported fixed dentures. The horizontal assembly system prevents the prosthesis from loosening or moving in response to axial and non-axial forces. The technique was used to rehabilitate a patient presenting an atrophic upper maxilla, with the insertion of 8 implants. No complications were reported at follow-up 3, 6 and 12 months after fitting of the prosthesis. This system offers solutions to the clinical and laboratory complications associated with hybrid prostheses, concealing emergence of the chimneys and improving implant-prosthesis hygiene. PMID:26140179

  8. Classification of a Proteus penneri clinical isolate with a unique O-antigen structure to a new Proteus serogroup, O80.

    Science.gov (United States)

    Siwińska, Małgorzata; Levina, Evgeniya A; Ovchinnikova, Olga G; Drzewiecka, Dominika; Shashkov, Alexander S; Różalski, Antoni; Knirel, Yuriy A

    2015-04-30

    Proteus penneri is an opportunistic pathogen, which may cause severe diseases, most frequently urinary tract infections in immunocompromised patients. P. penneri Br 114 exhibiting a good swarming growth ability as an S-form strain was isolated from a wound of a patient in Łódź, Poland. Serological studies using ELISA and Western blotting and chemical analyses along with (1)H and (13)C NMR spectroscopy showed that the O-antigen (O-polysaccharide) of this strain is unique among the known Proteus serotypes O1-O79. It possesses a linear pentasaccharide repeating unit containing a partially O-acetylated amide of D-glucuronic acid (GlcA) with L-serine having the following structure: [structure: see text]. These data are a basis for creating a new Proteus serogroup, O80, so far represented by the single Br 114 isolate. The O80 is the 21st O-serogroup containing P. penneri strains and the fourth serogroup based on Proteus spp. clinical isolates from Łódź, Poland. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Structure of a Kdo-containing O polysaccharide representing Proteus O79, a newly described serogroup for some clinical Proteus genomospecies isolates from Poland.

    Science.gov (United States)

    Arbatsky, Nikolay P; Drzewiecka, Dominika; Palusiak, Agata; Shashkov, Alexander S; Zabłotni, Agnieszka; Siwińska, Małgorzata; Knirel, Yuriy A

    2013-09-20

    From 41 Proteus genomospecies strains isolated in Poland, seven displayed similar serospecificity in ELISA with intact and adsorbed O antisera as well as in Western blot. The cross-reacting strains were found to belong to Proteus genomospecies 5/6 and classified into a new Proteus serogroup, O79, which seems to be widespread among Proteus genomospecies clinical isolates in Lodz, Poland. The O polysaccharide of the lipopolysaccharide of a representative O79 strain, 11 B-r, was studied by chemical analyses and (1)H and (13)C NMR spectroscopy, and the following structure of the repeating unit was established: →4)-α-D-GlcpNAlaAc-(1→5)-α-Kdop-(2→2)-α-D-Glcp-(1→3)-β-D-GlcpNAc-(1→ where AlaAc indicates N-acetyl-L-alanyl and Kdo indicates 3-deoxy-D-manno-oct-2-ulosonic acid. The O polysaccharide was unstable under mild acidic conditions and cleaved by acid-labile linkages of Kdo residues to yield a tetrasaccharide with Kdo at the reducing end. The structure established is unique among Proteus O polysaccharides, which is in agreement with the lack of any significant cross-reactivity for the lipopolysaccharide of strain 11 B-r and O antisera against strains of all known Proteus O serogroups and vice versa. Copyright © 2013. Published by Elsevier Ltd.

  10. Implant-supported overdenture manufactured using CAD/CAM techniques to achieve horizontal path insertion between the primary and secondary structure: A clinical case report.

    Science.gov (United States)

    Agustín-Panadero, Rubén; Peñarrocha-Oltra, David; Gomar-Vercher, Sonia; Ferreiroa, Alberto; Peñarrocha-Diago, Miguel

    2015-06-01

    This report describes the case of an edentulous patient with an atrophic maxilla and severe class III malocclusion. Prosthetic rehabilitation was performed using CAD/CAM techniques for manufacturing an implant-supported overdenture with horizontal insertion. A vestibulo-lingual insertion overdenture is a precision prosthesis with a fixation system affording a good fit between the primary and secondary structure. Both structures exhibit passive horizontal adjustment. This treatment option requires the same number of implants as implant-supported fixed dentures. The horizontal assembly system prevents the prosthesis from loosening or moving in response to axial and non-axial forces. The technique was used to rehabilitate a patient presenting an atrophic upper maxilla, with the insertion of 8 implants. No complications were reported at follow-up 3, 6 and 12 months after fitting of the prosthesis. This system offers solutions to the clinical and laboratory complications associated with hybrid prostheses, concealing emergence of the chimneys and improving implant-prosthesis hygiene.

  11. A Comparison of Clinical and Non-Clinical Samples Using the Concepts of: Individual Personality, Family Structure, Family of Origin Perception, Sexuality, and Adjustment/Adaptability To Determine Family Risk for Father Daughter Incest.

    Science.gov (United States)

    Utesch, William E.

    Father-daughter incest is more traumatic than any other type of child-sexual molestation. This study examines some of the factors which may lead to father-daughter incest. The author divided 40 Caucasian couples into three groups: (1) clinical incest group; (2) clinical non-incest group (to control for clinical status); and (3) non-clinical group.…

  12. Improved self- and external assessment of the clinical abilities of medical students through structured improvement measures in an internal medicine bedside course.

    Science.gov (United States)

    Fünger, S M; Lesevic, H; Rosner, S; Ott, I; Berberat, P; Nikendei, C; Sonne, C

    2016-01-01

    Bedside courses are of outstanding importance when training medical students. The fact that less and less teaching is taking place nowadays at the patient's bedside makes it all the more important that the available time be put to effective use. The aim of this study was to check whether structured improvement measures in the course (scripts, lecturer briefing, e-learning cases) would improve the abilities of the students on the basis of a subjective self-assessment as well as an external assessment by the lecturers with respect to clinical abilities. Bedside teaching takes place in the fourth study year in the Medical Clinics of the TU Munich. Both students and lecturers had the chance to hand in an anonymous, quantitative self- and external assessment of the clinical abilities of the students (German grading system) after every course date. This assessment took place online in the three categories "Medical history & examination", "Diagnosis" and "Therapy". An overall period of four semesters, each with 6 course dates, was investigated. After two of the total of four semesters in the study, the course was changed by introducing scripts, lecturer briefing as well as interactive e-learning cases. The self- and external assessment was compared both within the semester (date 1-3: A; date 4-6: B), during the course as well as before and after introducing the improvement measures ("before" (T0): SS 2012, SS 2013, "after" (T1): WS 2013/2014, SS 2014). There was a significant improvement in one's own abilities on the basis of the self-assessment within each semester when comparing the first (A) and the last (B) course dates. Moreover, there was a significant improvement in the performances in all three categories when T0 was compared with T1, from both the point of view of the students ("Medical history & examination": T0 =2.5±0.9, T1=2.2±0.7, ppexternal evaluation by lecturers confirmed the improvement with respect to the diagnostic and therapeutic abilities. They only

  13. [Amygdalin - structure and clinical significance].

    Science.gov (United States)

    Zdrojewicz, Zygmunt; Otlewska, Anna; Hackemer, Paweł; Otlewska, Agnieszka

    2015-05-01

    In this publication we described amygdalin. It was isolated for the first time in the 19th century. Amygdalin is called interchangeably vitamin B17 or laetrile. Since more than a hundred years, there has been reports about its unique anticancer properties. We tried to introduce the present knowledge about therapeutic efficacy of laetrile. Most of these studies has been made in the in vitro environment. The lack of appropriate studies forced scientists to examine the positive influence of amygdalin on many diseases like: bladder cancer, prostate cancer, cervical cancer, colon cancer, promyelocytic leukemia, chronic kidney disease, psoriasis and other. © 2015 MEDPRESS.

  14. Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

    Science.gov (United States)

    Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

    2016-01-01

    The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  15. Course of serum amyloid A (SAA) plasma concentrations in horses undergoing surgery for injuries penetrating synovial structures, an observational clinical study.

    Science.gov (United States)

    Haltmayer, Eva; Schwendenwein, Ilse; Licka, Theresia F

    2017-05-22

    measurements of plasma SAA could potentially be used as an additional inexpensive, quick and easy tool for monitoring the treatment response in otherwise healthy horses presented with injuries penetrating synovial structures. However further studies will be necessary to ascertain its clinical utility.

  16. Improved self- and external assessment of the clinical abilities of medical students through structured improvement measures in an internal medicine bedside course

    Directory of Open Access Journals (Sweden)

    Fünger, S. M.

    2016-08-01

    Full Text Available Background: Bedside courses are of outstanding importance when training medical students. The fact that less and less teaching is taking place nowadays at the patient's bedside makes it all the more important that the available time be put to effective use. The aim of this study was to check whether structured improvement measures in the course (scripts, lecturer briefing, e-learning cases would improve the abilities of the students on the basis of a subjective self-assessment as well as an external assessment by the lecturers with respect to clinical abilities. Methods: Bedside teaching takes place in the fourth study year in the Medical Clinics of the TU Munich. Both students and lecturers had the chance to hand in an anonymous, quantitative self- and external assessment of the clinical abilities of the students (German grading system after every course date. This assessment took place online in the three categories "Medical history & examination", "Diagnosis" and "Therapy". An overall period of four semesters, each with 6 course dates, was investigated. After two of the total of four semesters in the study, the course was changed by introducing scripts, lecturer briefing as well as interactive e-learning cases. The self- and external assessment was compared both within the semester (date 1-3: A; date 4-6: B, during the course as well as before and after introducing the improvement measures ("before" (T0: SS 2012, SS 2013, "after" (T1: WS 2013/2014, SS 2014.Results: There was a significant improvement in one's own abilities on the basis of the self-assessment within each semester when comparing the first (A and the last (B course dates. Moreover, there was a significant improvement in the performances in all three categories when T0 was compared with T1, from both the point of view of the students ("Medical history & examination": T0 =2.5±0.9, T1=2.2±0.7, pp<0.001; "Diagnosis" T0=3.1±1.0, T1=2.8 ±0.9, pp<0.001; "Therapy": T0=3.8±1.3, T1

  17. Attitude of Dental Prostheses Residents of Faculty of Dentistry of Tabriz University of Medical Sciences to Objective Structured Clinical Examination(OSCE

    Directory of Open Access Journals (Sweden)

    Ali Hafezeqoran

    2015-12-01

    Full Text Available Introduction: Objective Structured Clinical Examination (OSCE is one of the most authentic ways to evaluate clinical skills. The present study aimed at evaluating the attitude of dental prostheses residents of the faculty of dentistry of Tabriz University of Medical Sciences toward this kind of examination. Methods: In this cross sectional-descriptive study, two questionnaires were designed. One questionnaire dealt with nature of OSCE and the other dealt with the attitude of residents about OSCE. After holding the OSCE in July 2012, 2013, and 2014, the questionnaires were delivered to all dental prostheses residents of the Tabriz dental faculty. In total, 40 questionnaires were filled out within three years. Questions included five-choice items based on a Likert scale. Furthermore, the students’ scores in each exam were recorded to evaluate any possible relationship between the acquired grade and the student’s attitude toward the exam. The collected data were analyzed using SPSS17 software (α=5%. Results: Most residents (62.5% referred to the large number of questions as a positive factor. In addition, a majority of residents (90% suffered from high levels of stress during OSCE. There was a close relation between the grade acquired by the residents in the examination and their attitude to OSCE as well as their evaluation about the examination. The students with better grades had more positive attitudes toward OSCE. Conclusion: Considering the satisfaction level of the students in this study, OSCE was held efficiently and may be considered as part of the training program of the residents.

  18. Cross-cultural adaptation of the VISA-A questionnaire, an index of clinical severity for patients with Achilles tendinopathy, with reliability, validity and structure evaluations

    Directory of Open Access Journals (Sweden)

    Thomeé Roland

    2005-03-01

    Full Text Available Abstract Background Achilles tendinopathy is considered to be one of the most common overuse injuries in elite and recreational athletes and the recommended treatment varies. One factor that has been stressed in the literature is the lack of standardized outcome measures that can be used in all countries. One such standardized outcome measure is the Victorian Institute of Sports Assessment – Achilles (VISA-A questionnaire, which is designed to evaluate the clinical severity for patients with Achilles tendinopathy. The purpose of this study was to cross-culturally adapt the VISA-A questionnaire to Swedish, and to perform reliability, validity and structure evaluations. Methods Cross-cultural adaptation was performed in several steps including translations, synthesis of translations, back translations, expert committee review and pre-testing. The final Swedish version, the VISA-A Swedish version (VISA-A-S was tested for reliability on healthy individuals (n = 15, and patients (n = 22. Tests for internal consistency, validity and structure were performed on 51 patients. Results The VISA-A-S had good reliability for patients (r = 0.89, ICC = 0.89 and healthy individuals (r = 0.89–0.99, ICC = 0.88–0.99. The internal consistency was 0.77 (Cronbach's alpha. The mean [95% confidence interval] VISA-A-S score in the 51 patients (50 [44–56] was significantly lower than in the healthy individuals (96 [94–99]. The VISA-A-S score correlated significantly (Spearman's r = -0.68 with another tendon grading system. Criterion validity was considered good when comparing the scores of the Swedish version with the English version in both healthy individuals and patients. The factor analysis gave the factors pain/symptoms and physical activity Conclusion The VISA-A-S questionnaire is a reliable and valid instrument and comparable to the original version. It measures two factors: pain/symptoms and physical activity, and can be used in both research and the

  19. The efficacy and safety of ceftobiprole in the treatment of complicated skin and skin structure infections: evidence from 2 clinical trials.

    Science.gov (United States)

    Deresinski, Stanley C

    2008-05-01

    Complicated skin and skin structure infections (cSSSIs) are common and are associated with significant health and economic costs. These infections are predominantly characterized by infection with Staphylococcus aureus, and SENTRY Surveillance data indicate that the occurrence of this pathogen in cSSSIs has increased and that almost half of the isolated pathogens are methicillin-resistant S. aureus (MRSA). Surveillance data also indicate that Gram-negative isolates are not uncommon in cSSSIs. In the past, empiric antimicrobial coverage of both Gram-positive and Gram-negative infections has generally necessitated the use of at least 2 antimicrobial agents. Ceftobiprole, a novel advanced-generation pyrrolidinone cephalosporin, is currently under review by the Food and Drug Administration as therapy for cSSSIs. This article presents a summary of the results of 2 recently published multicenter noninferiority trials involving approximately 1600 patients with a variety of cSSSIs. In the 1st trial, which included patients with Gram-positive cSSSI, the clinical cure rate at the test-of-cure (TOC) visit (the primary end point) among patients receiving ceftobiprole was 93.3%. The 2nd trial included a broad range of cSSSIs of varying pathogenicity. In this trial, the clinical cure rate among patients receiving ceftobiprole for S. aureus and MRSA infection was 94.6% and 91.8%, respectively. Ceftobiprole's capacity as a broad-spectrum agent was demonstrated in the 2nd trial, in which the clinical cure rate at TOC was 90.5% against a variety of infections and pathogens (including Gram negatives). In addition, the cure rate among patients with moderate to severe diabetic foot infection who received ceftobiprole was 86.2%, and these patients experienced a shorter length of stay in the hospital than those who received a comparator. This article also addresses the results of these trials in the context of the current medical need for safe broad-spectrum antimicrobial agents with

  20. Introducing transapical aortic valve implantation (part 1): effect of a structured training program on clinical outcome in a series of 500 procedures.

    Science.gov (United States)

    Pasic, Miralem; Unbehaun, Axel; Dreysse, Stephan; Buz, Semih; Drews, Thorsten; Kukucka, Marian; Mladenow, Alexander; D'Ancona, Giuseppe; Hetzer, Roland; Seifert, Burkhardt

    2013-04-01

    The purpose of the present study was to test whether the cumulative knowledge from the field of transapical transcatheter aortic valve implantation, when incorporated into a structured training and then gradually dispersed by internal proctoring, might eliminate the negative effect of the learning curve on the clinical outcomes. The present study was a retrospective, single-center, observational cohort study of prospectively collected data from all 500 consecutive high-risk patients undergoing transapical transcatheter aortic valve implantation at our institution from April 2008 to December 2011. Of the 500 patients, 28 were in cardiogenic shock. Differences during the study period in baseline characteristics, procedural and postprocedural variables, and survival were analyzed using different statistical methods, including cumulative sum charts. The overall 30-day mortality was 4.6% (95% confidence interval, 3.1%-6.8%) and was 4.0% (95% confidence interval, 2.6%-6.2%) for patients without cardiogenic shock. Throughout the study period, no significant change was seen in the 30-day mortality (Mann-Whitney U test, P = .23; logistic regression analysis, odds ratio, 0.83 per 100 patients; 95% confidence interval, 0.62-1.12; P = .23). Also, no difference was seen in survival when stratified by surgeon (30-day mortality, P = .92). An insignificant change was seen toward improved overall survival (hazard ratio, 0.90 per 100 patients; 95% confidence interval, 0.77-1.04; P = .15). The structured training program can be used to introduce transapical transcatheter aortic valve implantation and then gradually dispersed by internal proctoring to other members of the team with no concomitant detriment to patients. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Guidelines for the structure and function of an interdisciplinary team for persons with brain injury. Joint Committee on Interprofessional Relations between Division 40 (Clinical Neuropsychology) of the American Psychological Association and the American Speech-Language-Hearing Association.

    Science.gov (United States)

    1995-03-01

    This report provides guidelines for the structure and function of interdisciplinary teams assembled for the delivery of clinical services to individuals with brain injury. Specifically, the report addresses issues concerning team membership, skills required of the team coordinator, and the processes that facilitate the attainment of team goals. These general suggestions are designed to give rehabilitation professionals and health care administrators some guiding principles for interdisciplinary teams involved in the clinical management of individuals with brain injury.

  2. Confirmation of the Factor Structure and Measurement Invariance of the Children's Scale of Hostility and Aggression: Reactive/Proactive in Clinic-Referred Children With and Without Autism Spectrum Disorder

    OpenAIRE

    Farmer, Cristan A.; Kaat, Aaron J.; Mazurek, Micah O.; Lainhart, Janet E.; DeWitt, Mary Beth; Cook, Edwin H.; Butter, Eric M.; Aman, Michael G.

    2016-01-01

    Objective: The measurement of aggression in its different forms (e.g., physical and verbal) and functions (e.g., impulsive and instrumental) is given little attention in subjects with developmental disabilities (DD). In this study, we confirm the factor structure of the Children's Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) and demonstrate measurement invariance (consistent performance across clinical groups) between clinic-referred groups with and without autism spectrum...

  3. The Structural Bases of Antibiotic Resistance in the Clinically Derived Mutant beta-Lactamases TEM-30, TEM-32, and TEM-34

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Xiaojun; Minasov, George; Shoichet, Brian K. (NWU)

    2010-03-08

    Widespread use of {beta}-lactam antibiotics has promoted the evolution of {beta}-lactamase mutant enzymes that can hydrolyze ever newer classes of these drugs. Among the most pernicious mutants are the inhibitor-resistant TEM {beta}-lactamases (IRTs), which elude mechanism-based inhibitors, such as clavulanate. Despite much research on these IRTs, little is known about the structural bases of their action. This has made it difficult to understand how many of the resistance substitutions act as they often occur far from Ser-130. Here, three IRT structures, TEM-30 (R244S), TEM-32 (M69I/M182T), and TEM-34 (M69V), are determined by x-ray crystallography at 2.00, 1.61, and 1.52 {angstrom}, respectively. In TEM-30, the Arg-244 {yields} Ser substitution (7.8 {angstrom} from Ser-130) displaces a conserved water molecule that usually interacts with the {beta}-lactam C3 carboxylate. In TEM-32, the substitution Met-69 {yields} Ile (10 {angstrom} from Ser-130) appears to distort Ser-70, which in turn causes Ser-130 to adopt a new conformation, moving its O{gamma} further away, 2.3 {angstrom} from where the inhibitor would bind. This substitution also destabilizes the enzyme by 1.3 kcal/mol. The Met-182 {yields} Thr substitution (20 {angstrom} from Ser-130) has no effect on enzyme activity but rather restabilizes the enzyme by 2.9 kcal/mol. In TEM-34, the Met-69 {yields} Val substitution similarly leads to a conformational change in Ser-130, this time causing it to hydrogen bond with Lys-73 and Lys-234. This masks the lone pair electrons of Ser-130 O{gamma}, reducing its nucleophilicity for cross-linking. In these three structures, distant substitutions result in accommodations that converge on the same point of action, the local environment of Ser-130. TEM-1 {beta}-lactamase is the predominant source of resistance to {beta}-lactams, such as the penicillins. TEM-1 and related class A {beta}-lactamases confer resistance by hydrolyzing the {beta}-lactam ring of these antibiotics

  4. Structure-guided lead optimization of triazolopyrimidine-ring substituents identifies potent Plasmodium falciparum dihydroorotate dehydrogenase inhibitors with clinical candidate potential.

    Science.gov (United States)

    Coteron, Jose M; Marco, María; Esquivias, Jorge; Deng, Xiaoyi; White, Karen L; White, John; Koltun, Maria; El Mazouni, Farah; Kokkonda, Sreekanth; Katneni, Kasiram; Bhamidipati, Ravi; Shackleford, David M; Angulo-Barturen, Iñigo; Ferrer, Santiago B; Jiménez-Díaz, María Belén; Gamo, Francisco-Javier; Goldsmith, Elizabeth J; Charman, William N; Bathurst, Ian; Floyd, David; Matthews, David; Burrows, Jeremy N; Rathod, Pradipsinh K; Charman, Susan A; Phillips, Margaret A

    2011-08-11

    Drug therapy is the mainstay of antimalarial therapy, yet current drugs are threatened by the development of resistance. In an effort to identify new potential antimalarials, we have undertaken a lead optimization program around our previously identified triazolopyrimidine-based series of Plasmodium falciparum dihydroorotate dehydrogenase (PfDHODH) inhibitors. The X-ray structure of PfDHODH was used to inform the medicinal chemistry program allowing the identification of a potent and selective inhibitor (DSM265) that acts through DHODH inhibition to kill both sensitive and drug resistant strains of the parasite. This compound has similar potency to chloroquine in the humanized SCID mouse P. falciparum model, can be synthesized by a simple route, and rodent pharmacokinetic studies demonstrated it has excellent oral bioavailability, a long half-life and low clearance. These studies have identified the first candidate in the triazolopyrimidine series to meet previously established progression criteria for efficacy and ADME properties, justifying further development of this compound toward clinical candidate status.

  5. Structure-Guided Lead Optimization of Triazolopyrimidine-Ring Substituents Identifies Potent Plasmodium falciparum Dihydroorotate Dehydrogenase Inhibitors with Clinical Candidate Potential

    Energy Technology Data Exchange (ETDEWEB)

    Coteron, Jose M.; Marco, Maria; Esquivias, Jorge; Deng, Xiaoyi; White, Karen L.; White, John; Koltun, Maria; El Mazouni, Farah; Kokkonda, Sreekanth; Katneni, Kasiram; Bhamidipati, Ravi; Shackleford, David M.; Angulo-Barturen, Inigo; Ferrer, Santiago B.; Jimenez-Diaz, Maria Belen; Gamo, Francisco-Javier; Goldsmith, Elizabeth J.; Charman, William N.; Bathurst, Ian; Floyd, David; Matthews, David; Burrows, Jeremy N.; Rathod, Pradipsinh K.; Charman, Susan A.; Phillips, Margaret A. (UWASH); (MMV, Switzerland); (GSK); (Monash); (UW); (UTSMC)

    2012-02-27

    Drug therapy is the mainstay of antimalarial therapy, yet current drugs are threatened by the development of resistance. In an effort to identify new potential antimalarials, we have undertaken a lead optimization program around our previously identified triazolopyrimidine-based series of Plasmodium falciparum dihydroorotate dehydrogenase (PfDHODH) inhibitors. The X-ray structure of PfDHODH was used to inform the medicinal chemistry program allowing the identification of a potent and selective inhibitor (DSM265) that acts through DHODH inhibition to kill both sensitive and drug resistant strains of the parasite. This compound has similar potency to chloroquine in the humanized SCID mouse P. falciparum model, can be synthesized by a simple route, and rodent pharmacokinetic studies demonstrated it has excellent oral bioavailability, a long half-life and low clearance. These studies have identified the first candidate in the triazolopyrimidine series to meet previously established progression criteria for efficacy and ADME properties, justifying further development of this compound toward clinical candidate status.

  6. How to assess communication, professionalism, collaboration and the other intrinsic CanMEDS roles in orthopedic residents: use of an objective structured clinical examination (OSCE).

    Science.gov (United States)

    Dwyer, Tim; Glover Takahashi, Susan; Kennedy Hynes, Melissa; Herold, Jodi; Wasserstein, David; Nousiainen, Markku; Ferguson, Peter; Wadey, Veronica; Murnaghan, M Lucas; Leroux, Tim; Semple, John; Hodges, Brian; Ogilvie-Harris, Darrell

    2014-08-01

    Assessing residents' understanding and application of the 6 intrinsic CanMEDS roles (communicator, professional, manager, collaborator, health advocate, scholar) is challenging for postgraduate medical educators. We hypothesized that an objective structured clinical examination (OSCE) designed to assess multiple intrinsic CanMEDS roles would be sufficiently reliable and valid. The OSCE comprised 6 10-minute stations, each testing 2 intrinsic roles using case-based scenarios (with or without the use of standardized patients). Residents were evaluated using 5-point scales and an overall performance rating at each station. Concurrent validity was sought by correlation with in-training evaluation reports (ITERs) from the last 12 months and an ordinal ranking created by program directors (PDs). Twenty-five residents from postgraduate years (PGY) 0, 3 and 5 participated. The interstation reliability for total test scores (percent) was 0.87, while reliability for each of the communicator, collaborator, manager and professional roles was greater than 0.8. Total test scores, individual station scores and individual CanMEDS role scores all showed a significant effect by PGY level. Analysis of the PD rankings of intrinsic roles demonstrated a high correlation with the OSCE role scores. A correlation was seen between ITER and OSCE for the communicator role, while the ITER medical expert and total scores highly correlated with the communicator, manager and professional OSCE scores. An OSCE designed to assess the intrinsic CanMEDS roles was sufficiently valid and reliable for regular use in an orthopedic residency program.

  7. Money makes the (medical assessment) world go round: The cost of components of a summative final year Objective Structured Clinical Examination (OSCE).

    Science.gov (United States)

    Brown, Craig; Ross, Sarah; Cleland, Jennifer; Walsh, Kieran

    2015-04-29

    The widely used Objective Structured Clinical Examination (OSCE) is undoubtedly expensive. Cost-effectiveness is one of the components of the assessment utility index defining its usefulness. Our current financial climate demands increased transparency in the costs associated with medical education and it is now vital to ascertain how much is spent on assessments, such as the OSCE, and in particular costs associated with the different types of stations within the OSCE. A retrospective case-study approach was used to identify all costs associated with the development, production, administration and post-examination phases of the 2013 final year MBChB OSCE at the University of Aberdeen, Scotland. This 15 station OSCE was held over 2 days for 185 students. This OSCE cost £65,328 to run. Costs per station ranged from £3108 (prescribing) to £6577 (eye examination). The cost per student was £355. The costs of a "high stakes" OSCE are sobering. The bulk of costs identified are not modifiable in light of what is currently known about the metrics of OSCE utility, particularly reliability and validity. Providers, and funders, of medical education must be prepared to assign significant resource to OSCE assessment and centres should be encouraged to calculate precise costs associated with assessment to inform resource allocation decisions.

  8. Comparative structural study of the configuration of coping strategies among female patients with eating disorders and a non-clinical control group.

    Science.gov (United States)

    Brytek-Matera, Anna; Schiltz, Lony

    2013-12-01

    The aim of this research was to assess the relationship between coping mechanisms and eating disorders as well as to determine coping strategies as predictors of eating disorders pathology. Participants included 52 females meeting the DSM-IV criteria for anorexia nervosa and bulimia nervosa and 55 university students. Assessment tools were the Brief Coping Orientation to Problems Experienced Scale and the Stress Coping Questionnaire. Eating disorders were positively related to substance use, substitute gratification, avoidance, aggression, and drug use. Additionally, significant negative correlations were found between eating disorders and relaxation, planning, using instrumental support, acceptance as well as venting. The regression analysis revealed that eating disorders were positively associated with coping strategies focused on substance use and religion, and negatively associated with using emotional support, positive self-instructions and positive reframing. The non linear principal components analysis allowed for exploring similarities and differences in the latent structure of the configuration of coping strategies between the clinical group and the control group. Since women with anorexia and bulimia nervosa apply emotion-focused coping strategies to manage their stress, psychotherapeutic intervention with these patients should focus on changing inappropriate coping mechanisms.

  9. Clinical Response of Tedizolid versus Linezolid in Acute Bacterial Skin and Skin Structure Infections by Severity Measure Using a Pooled Analysis from Two Phase 3 Double-Blind Trials.

    Science.gov (United States)

    Sandison, Taylor; De Anda, Carisa; Fang, Edward; Das, Anita F; Prokocimer, Philippe

    2017-05-01

    Tedizolid phosphate is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSI). In a pooled analysis of 1,333 ABSSSI patients from the ESTABLISH clinical trials, treatment with tedizolid or linezolid demonstrated similar early and posttherapy clinical responses in nonsevere and severe disease, irrespective of the parameters used to measure ABSSSI severity. Shorter 6-day treatment of ABSSSI, including those that were severe, with tedizolid phosphate demonstrated efficacy comparable to that of 10-day treatment with linezolid. (The ESTABLISH studies discussed in this paper have been registered at ClinicalTrials.gov under identifiers NCT01170221 and NCT01421511.). Copyright © 2017 American Society for Microbiology.

  10. Mums 4 Mums: structured telephone peer-support for women experiencing postnatal depression. Pilot and exploratory RCT of its clinical and cost effectiveness

    Directory of Open Access Journals (Sweden)

    McKenzie-McHarg Kirstie

    2011-03-01

    Full Text Available Abstract Background Postnatal depression (PND can be experienced by 13% of women who give birth, and such women often exhibit disabling symptoms, which can have a negative effect on the mother and infant relationship, with significant consequences in terms of the child's later capacity for affect regulation. Research has shown that providing support to mothers experiencing PND can help reduce their depressive symptoms and improve their coping strategies. The Mums4Mums study aims to evaluate the impact of telephone peer-support for women experiencing PND. Methods/Design The study design adopts the MRC framework for the development and evaluation of complex interventions. Health visitors in Warwickshire and Coventry Primary Care Trusts are screening potential participants at the 8-week postnatal check using either the Edinburgh Postnatal Depression Scale (EPDS > = 10 or the three Whooley questions recommended by NICE (http://guidance.nice.org.uk/CG45. The Mums4Mums telephone support intervention is being delivered by trained peer-supporters over a period of four months. The primary outcome is depressive symptomatology as measured by the Edinburgh Postnatal Depression Scale. Secondary outcomes include mother-child interaction, dyadic adjustment, parenting sense of competence scale, and self-efficacy. Maternal perceptions of the telephone peer-support are being assessed using semi-structured interviews following the completion of the intervention. Discussion The proposed study will develop current innovative work in peer-led support interventions and telecare by applying existing expertise to a new domain (i.e. PND, testing the feasibility of a peer-led telephone intervention for mothers living with PND, and developing the relationship between the lay and clinical communities. The intervention will potentially benefit a significant number of patients and support a future application for a larger study to undertake a full evaluation of the clinical

  11. The method used to set the pass mark in an objective structured clinical examination defines the performance of candidates for certification as rheumatologists.

    Science.gov (United States)

    Pascual-Ramos, Virginia; Guilaisne Bernard-Medina, Ana; Flores-Alvarado, Diana Elsa; Portela-Hernández, Margarita; Maldonado-Velázquez, María Del Rocío; Jara-Quezada, Luis Javier; Amezcua-Guerra, Luis Manuel; Rubio-Judith López-Zepeda, Nadina E; Álvarez-Hernandez, Everardo; Saavedra, Miguel Ángel; Arce-Salinas, César Alejandro

    2017-02-01

    The Mexican Accreditation Council for Rheumatology certifies trainees (TR) on an annual basis using both a multiple-choice question (MCQ) test and an objective structured clinical examination (OSCE). For 2013 and 2014, the OSCE pass mark (PM) was set by criterion referencing as ≥6 (CPM), whereas overall rating of borderline performance method (BPM) was added for 2015 and 2016 accreditations. We compared OSCE TR performance according to CPM and BPM, and examined whether correlations between MCQ and OSCE were affected by PM. Forty-three (2015) and 37 (2016) candidates underwent both tests. Altogether, OSCE were integrated by 15 validated stations; one evaluator per station scored TR performance according to a station-tailored check-list and a Likert scale (fail, borderline, above range) of overall performance. A composite OSCE score was derived for each candidate. Appropriate statistics were used. Mean (±standard derivation [SD]) MCQ test scores were 6.6±0.6 (2015) and 6.4±0.6 (2016) with 5 candidates receiving a failing score each year. Mean (±SD) OSCE scores were 7.4±0.6 (2015) and 7.3±0.6 (2016); no candidate received a failing CPM score in either 2015 or 2016 OSCE, although 21 (49%) and 19 (51%) TR, respectively, received a failing BPM score (calculated as 7.3 and 7.4, respectively). Stations for BPM ranged from 4.5 to 9.5; overall, candidates showed better performance in CPM. In all, MCQ correlated with composite OSCE, r=0.67 (2015) and r=0.53 (2016); P≤.001. Trainees with a passing BPM score in OSCE had higher MCQ scores than those with a failing score. Overall, OSCE-PM selection impacted candidates' performance but had a limited affect on correlation between clinical and practical examinations. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  12. Diagnostic Efficiency among Psychiatric Outpatients of a Self-Report Version of a Subset of Screen Items of the Structured Clinical Interview for DSM-IV-TR Personality Disorders (SCID-II)

    Science.gov (United States)

    Germans, Sara; Van Heck, Guus L.; Masthoff, Erik D.; Trompenaars, Fons J. W. M.; Hodiamont, Paul P. G.

    2010-01-01

    This article describes the identification of a 10-item set of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) items, which proved to be effective as a self-report assessment instrument in screening personality disorders. The item selection was based on the retrospective analyses of 495 SCID-II interviews. The…

  13. Diagnostic efficiency among psychiatric outpatients of a self-report version of a subset of screen items of the Structured Clinical Interview for DSM-IV-TR Personality Disorders (SCID-II).

    NARCIS (Netherlands)

    Germans, S.; Heck, G.L. van; Masthoff, E.D.M.; Trompenaars, F.J.; Hodiamont, P.P.G.

    2010-01-01

    This article describes the identification of a 10-item set of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) items, which proved to be effective as a self-report assessment instrument in screening personality disorders. The item selection was based on the retrospective

  14. Unraveling the structural basis of grazoprevir potency against clinically relevant substitutions in hepatitis C virus NS3/4A protease from genotype 1a.

    Science.gov (United States)

    Guo, Zhuyan; Black, Stuart; Hu, Yuan; McMonagle, Patricia; Ingravallo, Paul; Chase, Robert; Curry, Stephanie; Asante-Appiah, Ernest

    2017-04-14

    Grazoprevir is a potent pan-genotype and macrocyclic inhibitor of hepatitis C virus (HCV) NS3/4A protease and was developed for treating chronic HCV infection. In HCV genotype (GT) 1a, grazoprevir maintains potent activity against a majority of NS3 resistance-associated amino acid substitutions, including the highly prevalent and naturally occurring Q80K polymorphism that impacts simeprevir, another NS3/4A protease inhibitor. The basis for an unexpected difference in the clinical impact of some NS3 substitutions was investigated. Phenotypic analysis of resistance-associated substitutions identified in NS3 from GT1a-infected patients who failed therapy with grazoprevir (in combination with elbasvir, an inhibitor of HCV NS5A protein) showed that positions 56, 156, and 168 in NS3 were most impactful because they diminished protein-inhibitor interactions. Although an amino acid substitution from aspartic acid to alanine at position 168 (D168A) reduced the potency of grazoprevir, its combination with R155K unexpectedly nullified this effect. Molecular dynamics and free-energy surface studies indicated that Asp-168 is important in anchoring Arg-155 for ligand binding but is not critical for Lys-155 because of the inherent flexibility of its side chain. Moreover, modeling studies supported a strong direct cation-heterocycle interaction between the Lys-155 side chain of the double substitution, R155K/D168A, and the lone pair on the quinoxaline in grazoprevir. This unique interaction provides a structural basis for grazoprevir's higher potency than simeprevir, an inhibitor to which the double substitution confers a significant reduction in potency. Our findings are consistent with the detection of R155K/D168A in NS3 from virologic failures treated with simeprevir but not grazoprevir. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  15. Does an Advanced Pelvic Simulation Curriculum Improve Resident Performance on a Pediatric and Adolescent Gynecology Focused Objective Structured Clinical Examination? A Cohort Study.

    Science.gov (United States)

    Dumont, Tania; Hakim, Julie; Black, Amanda; Fleming, Nathalie

    2016-06-01

    To determine the effect of an advanced pelvic simulation curriculum on resident performance on a pediatric and adolescent gynecology (PAG) focused objective structured clinical examination (OSCE). Obstetrics and gynecology residents in a single academic Canadian center participated in a PAG simulation curriculum. An OSCE on prepubertal vaginal bleeding was administered at the biannual OSCE examination 2 months before the simulation curriculum and again 3 months after the simulation curriculum. Academic half-day at the University of Ottawa Skills and Simulation Centre. Obstetrics and gynecology residents from the University of Ottawa. Participants completed 4 stations teaching PAG-appropriate history-taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child and/or adolescent. Advanced pelvic models were used for procedure-specific stations. The primary outcome measure was change in mean score on a prepubertal vaginal bleeding OSCE station. Secondary outcome measures were changes in individual component scores. Fourteen residents completed the simulation curriculum and the PAG OSCE at the 2 separate time points (before and after simulation curriculum). The mean OSCE score before the simulation curriculum was 54.6% (20.5 of 37) and mean score after the curriculum was 78.1% (28.9 of 37; P Gynecology Program Directors should consider incorporating PAG simulation training into their curriculum to ensure that residents meet their learning objectives and increase their knowledge and confidence, which will ultimately benefit patient care. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  16. Multi-institutional Quantitative Evaluation and Clinical Validation of Smart Probabilistic Image Contouring Engine (SPICE) Autosegmentation of Target Structures and Normal Tissues on Computer Tomography Images in the Head and Neck, Thorax, Liver, and Male Pelvis Areas

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Mingyao [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Bzdusek, Karl [Philips Healthcare, Fitchburg, Wisconsin (United States); Brink, Carsten [Institute of Clinical Research, University of Southern Denmark, Odense (Denmark); Laboratory of Radiation Physics, Odense University Hospital, Odense (Denmark); Eriksen, Jesper Grau [Department of Oncology, Odense University Hospital, Odense (Denmark); Hansen, Olfred [Institute of Clinical Research, University of Southern Denmark, Odense (Denmark); Department of Oncology, Odense University Hospital, Odense (Denmark); Jensen, Helle Anita [Department of Oncology, Odense University Hospital, Odense (Denmark); Gay, Hiram A.; Thorstad, Wade [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Widder, Joachim; Brouwer, Charlotte L.; Steenbakkers, Roel J.H.M.; Vanhauten, Hubertus A.M. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Cao, Jeffrey Q.; McBrayne, Gail [London Regional Cancer Centre, Ontario (Canada); Patel, Salil H. [Department of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island (United States); Cannon, Donald M. [Department of Human Oncology, University of Wisconsin—Madison (United States); Hardcastle, Nicholas [Department of Physical Science, Peter MacCallum Cancer Centre, Melbourne (Australia); Tomé, Wolfgang A. [Montefiore Medical Center and Institute of Onco-Physics, Albert Einstein College of Medicine, Bronx, New York (United States); Guckenberg, Matthias [University of Würzburg, Department of Radiation Oncology, Würzburg (Germany); Parikh, Parag J., E-mail: pparikh@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-11-15

    Purpose: Clinical validation and quantitative evaluation of computed tomography (CT) image autosegmentation using Smart Probabilistic Image Contouring Engine (SPICE). Methods and Materials: CT images of 125 treated patients (32 head and neck [HN], 40 thorax, 23 liver, and 30 prostate) in 7 independent institutions were autosegmented using SPICE and computational times were recorded. The number of structures autocontoured were 25 for the HN, 7 for the thorax, 3 for the liver, and 6 for the male pelvis regions. Using the clinical contours as reference, autocontours of 22 selected structures were quantitatively evaluated using Dice Similarity Coefficient (DSC) and Mean Slice-wise Hausdorff Distance (MSHD). All 40 autocontours were evaluated by a radiation oncologist from the institution that treated the patients. Results: The mean computational times to autosegment all the structures using SPICE were 3.1 to 11.1 minutes per patient. For the HN region, the mean DSC was >0.70 for all evaluated structures, and the MSHD ranged from 3.2 to 10.0 mm. For the thorax region, the mean DSC was 0.95 for the lungs and 0.90 for the heart, and the MSHD ranged from 2.8 to 12.8 mm. For the liver region, the mean DSC was >0.92 for all structures, and the MSHD ranged from 5.2 to 15.9 mm. For the male pelvis region, the mean DSC was >0.76 for all structures, and the MSHD ranged from 4.8 to 10.5 mm. Out of the 40 autocontoured structures reviews by experts, 25 were scored useful as autocontoured or with minor edits for at least 90% of the patients and 33 were scored useful autocontoured or with minor edits for at least 80% of the patients. Conclusions: Compared with manual contouring, autosegmentation using SPICE for the HN, thorax, liver, and male pelvis regions is efficient and shows significant promise for clinical utility.

  17. Development of a Metacognitive Effort Construct of Empathy during Clinical Training: A Longitudinal Study of the Factor Structure of the Jefferson Scale of Empathy

    Science.gov (United States)

    Stansfield, R. Brent; Schwartz, Alan; O'Brien, Celia Laird; Dekhtyar, Michael; Dunham, Lisette; Quirk, Mark

    2016-01-01

    Empathy is crucial for effective clinical care but appears to decline during undergraduate medical training. Understanding the nature of this decline is necessary for addressing it. The Jefferson Scale of Empathy (JSE) is used to measure medical students' clinical empathy attitudes. One recent study described a 3-factor model of the JSE. This…

  18. The Role of End-of-Life Issues in the Design and Reporting of Cancer Clinical Trials: A Structured Literature Review

    Science.gov (United States)

    Lange, Stefan; Hausner, Elke; Gerhardus, Ansgar; Simon, Steffen T.; Voltz, Raymond; Becker, Gerhild; Schmacke, Norbert

    2015-01-01

    Background Randomized controlled trials (RCTs) are important sources of information on the benefits and harms patients may expect from treatment options. The aim of this structured literature review by the German Institute for Quality and Efficiency in Health Care was to explore whether and how the end-of-life (EoL) situation of patients with advanced cancer is considered in RCTs investigating anti-cancer treatments. Methods Our journal pool comprised 19 medical journals, namely five preselected key general medical journals as well as 14 specialist journals (mainly cancer) identified via a scoping search. We systematically searched these journals in MEDLINE to identify RCTs investigating anti-cancer treatments for the following four cancer types: glioblastoma, lung cancer (stage IIIb-IV), malignant melanoma (stage IV), and pancreatic cancer (search via OVID; November 2012). We selected a representative sample of 100 publications, that is, the 25 most recent publications for each cancer type. EoL was defined as a life expectancy of ≤ two years. We assessed the information provided on (1) the descriptions of the terminal stage of the disease, (2) the therapeutic goal (i.e. the intended therapeutic benefit of the intervention studied), (3) the study endpoints assessed, (4) the authors’ concluding appraisal of the intervention’s effects, and (5) the terminology referring to the patients’ EoL situation. Results Median survival was ≤ one year for each of the four cancer types. Descriptions of the terminal stage of the disease were ambiguous or lacking in 29/100 publications. One or more therapeutic goals were mentioned in 51/100 publications; these goals were patient-relevant in 38 publications (survival alone: 30/38; health-related quality of life (HRQoL) or HRQoL and survival: 6/38; symptom control or symptom control and survival: 2/38). Primary endpoints included survival (50%), surrogates (44%), and safety (3%). Patient-reported outcomes (PROs) were

  19. How common is bipolar disorder in general primary care attendees? A systematic review and meta-analysis investigating prevalence determined according to structured clinical assessments.

    Science.gov (United States)

    Stubbs, Brendon; Vancampfort, Davy; Solmi, Marco; Veronese, Nicola; Fornaro, Michele

    2016-07-01

    There are mounting calls for bipolar disorder to be managed in primary care, yet the exact prevalence remains unclear. We conducted a meta-analysis to investigate the prevalence of bipolar disorder in general primary care attendees without other comorbid psychiatric diagnosis. We systematically searched major electronic databases from inception till 03/2015. Articles were included that reported the prevalence of bipolar disorder determined in line with structured clinical assessment in primary care settings. Two independent authors conducted searches, completed methodological appraisal and extracted data. A random effects meta-analysis and meta-regression were performed. Sixteen studies were included accounting for 425,691 participants (mean age = 41.1 years [standard deviation = 7.2 years] 33.3% males). Overall, the global prevalence of bipolar disorder was 1.9% (95% confidence interval = [0.6, 5.4]). The prevalence of bipolar disorder in studies recording a current diagnosis was 3.7% (95% confidence interval = [1.9, 6.0]) and 0.7% (95% confidence interval = [0.2, 1.5]) in studies considering a 12-month period. A diagnosis of bipolar disorder appeared higher in North America (3.7%, 95% confidence interval = [0.9, 8.1]) compared to Europe (0.8%, 95% confidence interval = [0.3, 1.5]). Meta-regression suggests that a more recent publication date (co-efficient = 0.089, 95% confidence interval = [0.0173, 0.1654], z = 2.19, p = 0.01, R(2) = 0.21) and younger age of participants (co-efficient -0.0851, 95% confidence interval = [-0.1696, 0.005], z = -1.97, p = 0.04, R(2) = 0.24) moderated a higher prevalence of bipolar disorder. The global prevalence of bipolar disorder in primary care is 1.9%, with potentially higher prevalence rates in North America compared to Europe. A more recent study publication date is a significant predictor of higher prevalence of bipolar disorder. Potential reasons/drivers of this are considered within the text.

  20. The Role of End-of-Life Issues in the Design and Reporting of Cancer Clinical Trials: A Structured Literature Review.

    Science.gov (United States)

    Gaertner, Jan; Weingärtner, Vera; Lange, Stefan; Hausner, Elke; Gerhardus, Ansgar; Simon, Steffen T; Voltz, Raymond; Becker, Gerhild; Schmacke, Norbert

    2015-01-01

    Randomized controlled trials (RCTs) are important sources of information on the benefits and harms patients may expect from treatment options. The aim of this structured literature review by the German Institute for Quality and Efficiency in Health Care was to explore whether and how the end-of-life (EoL) situation of patients with advanced cancer is considered in RCTs investigating anti-cancer treatments. Our journal pool comprised 19 medical journals, namely five preselected key general medical journals as well as 14 specialist journals (mainly cancer) identified via a scoping search. We systematically searched these journals in MEDLINE to identify RCTs investigating anti-cancer treatments for the following four cancer types: glioblastoma, lung cancer (stage IIIb-IV), malignant melanoma (stage IV), and pancreatic cancer (search via OVID; November 2012). We selected a representative sample of 100 publications, that is, the 25 most recent publications for each cancer type. EoL was defined as a life expectancy of ≤ two years. We assessed the information provided on (1) the descriptions of the terminal stage of the disease, (2) the therapeutic goal (i.e. the intended therapeutic benefit of the intervention studied), (3) the study endpoints assessed, (4) the authors' concluding appraisal of the intervention's effects, and (5) the terminology referring to the patients' EoL situation. Median survival was ≤ one year for each of the four cancer types. Descriptions of the terminal stage of the disease were ambiguous or lacking in 29/100 publications. One or more therapeutic goals were mentioned in 51/100 publications; these goals were patient-relevant in 38 publications (survival alone: 30/38; health-related quality of life (HRQoL) or HRQoL and survival: 6/38; symptom control or symptom control and survival: 2/38). Primary endpoints included survival (50%), surrogates (44%), and safety (3%). Patient-reported outcomes (PROs) were assessed in 36/100 RCTs. The

  1. Avaliação de desempenho do Self-Reporting Questionnaire como instrumento de rastreamento psiquiátrico: um estudo comparativo com o Structured Clinical Interview for DSM-IV-TR Performance of the Self-Reporting Questionnaire as a psychiatric screening questionnaire: a comparativestudy with Structured Clinical Interview for DSM-IV-TR

    Directory of Open Access Journals (Sweden)

    Daniel Maffasioli Gonçalves

    2008-02-01

    Full Text Available O SRQ (Self-Reporting Questionnaire é um instrumento de rastreamento psiquiátrico originalmente composto por 30 itens. A versão brasileira do SRQ-20 (versão com as 20 questões para rastreamento de transtornos mentais não-psicóticos foi validada no início da década de 1980. O objetivo deste estudo foi validar a versão brasileira do SRQ-20 e dos cinco itens de rastreamento de transtorno por uso de álcool oriundos do SRQ-30, comparando com entrevista psiquiátrica usando SCID-IV-TR (Structured Clinical Interview for DSM-IV-TR como padrão-ouro. O estudo foi conduzido em Santa Cruz do Sul, Rio Grande do Sul, Brasil, com 485 indivíduos (54,8% mulheres, idade média 40,04. Os 5 itens de rastreamento de transtornos por uso de álcool mostraram sensibilidade baixa (66%. O SRQ-20 apresentou como ponto de corte ideal 7/8, com sensibilidade de 86,33% e especificidade de 89,31%. O poder discriminante para diagnóstico psiquiátrico do SRQ-20 foi 0,91. O coeficiente Cronbach alfa foi 0,86.The SRQ (Self-Reporting Questionnaire is a psychiatric screening tool that originally included 30 questions. The Brazilian version of SRQ-20 (a version that includes the 20 items for non-psychotic mental disorders was validated in the early 1980s. The objective of the present study was to validate the Brazilian version of SRQ-20 and the 5 items for alcohol-related disorders as compared to the SCID-IV-TR (Structured Clinical Interview for DSM-IV-TR as the gold standard. The study was conducted in Santa Cruz do Sul, a small town in southern Brazil, with 485 subjects (54.8% females, mean age 40.04 years. The 5 items for alcohol-related disorders showed low sensitivity (66%. The optimum cutoff value for SRQ-20 was 7/8, with 86.33% sensitivity and 89.31% specificity. The discriminant power of SRQ-20 for psychiatric screening was 0.9, and Cronbach's alpha was 0.86.

  2. Understanding latent structures of clinical information logistics: A bottom-up approach for model building and validating the workflow composite score.

    Science.gov (United States)

    Esdar, Moritz; Hübner, Ursula; Liebe, Jan-David; Hüsers, Jens; Thye, Johannes

    2017-01-01

    Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score. Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice. We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were "flow of data and information", "mobility", "clinical decision support and patient safety", "electronic patient record" and "integration and distribution". The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach. Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness. Copyright © 2016 Elsevier Ireland

  3. Clinical Trials

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    Full Text Available ... harm. In later phases of clinical trials, researchers learn more about the new approach's risks and benefits. ... Clinical Studies Web page. Children and Clinical Studies Learn more about Children and Clinical Studies Importance of ...

  4. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study)

    Science.gov (United States)

    OBJECTIVE: To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations. DESIGN: Multicenter, single blinded randomized trial (Lifestyle Interventions and ...

  5. A Study to Determine the Best Organizational Structure, Both Administrative and Professional, between Reynolds Army Community Hospital, Fort Sill, Oklahoma, and its Troop Medical Clinics

    Science.gov (United States)

    1984-08-01

    direct supervision, the other with standardization.I The "Principles of Management," fathered by Henri Fayol , were concerned primarily with...relationship, both administrative and professional, between RACH and its TMCs. Footnotes Henry Mintzijerg, Structure in Fives Designing Effective Organiza...at different techniques t achieve the same goal. Footnotes Henry Mintzberg, Struct-ure in Fives Designing Effective Organi- zations (Engle,ood Cliffs

  6. A Novel Clinical-Simulated Suture Education for Basic Surgical Skill: Suture on the Biological Tissue Fixed on Standardized Patient Evaluated with Objective Structured Assessment of Technical Skill (OSATS) Tools.

    Science.gov (United States)

    Shen, Zhanlong; Yang, Fan; Gao, Pengji; Zeng, Li; Jiang, Guanchao; Wang, Shan; Ye, Yingjiang; Zhu, Fengxue

    2017-06-21

    Clinical-simulated training has shown benefit in the education of medical students. However, the role of clinical simulation for surgical basic skill training such as suturing techniques remains unclear. Forty-two medical students were asked to perform specific suturing tasks at three stations with the different settings within four minutes (Station 1: Synthetic suture pad fixed on the bench, Station 2: Synthetic suture pad fixed on the standardized patient, Station 3: Pig skin fixed on the standardized patient); the OSATS (Objective Structured Assessment of Technical Skill) tool was used to evaluate the performance of students. A questionnaire was distributed to the students following the examination. Mean performance score of Station 3 was significant lower than that of Station 1 and 2 in the general performance including tissue handling, time, and motion. The suturing techniques of students at Station 2 and 3 were not as accurate as that at Station 1. Inappropriate tension was applied to the knot at Station 2 compared with Station 1 and 3. On the questionnaire, 93% of students considered clinical-simulated training of basic surgical skills was necessary and may increase their confidence in future clinical work as surgeons; 98% of students thought the assessment was more objective when OSATS tool was used for evaluation. Clinical simulation examination assessed with OSATS might throw a novel light on the education of basic surgical skills and may be worthy of wider adoption in the surgical education of medical students.

  7. Feasibility of studying brain morphology in major depressive disorder with structural magnetic resonance imaging and clinical data from the electronic medical record: A pilot study

    Science.gov (United States)

    Hoogenboom, Wouter S.; Perlis, Roy H.; Smoller, Jordan W.; Zeng-Treitler, Qing; Gainer, Vivian S.; Murphy, Shawn N.; Churchill, Susanne E.; Kohane, Isaac S.; Shenton, Martha E.; Iosifescu, Dan V.

    2012-01-01

    For certain research questions related to long-term outcomes or to rare disorders, designing prospective studies is impractical or prohibitively expensive. Such studies could instead utilize clinical and magnetic resonance imaging data (MRI) collected as part of routine clinical care, stored in the electronic medical record (EMR). Using major depressive disorder (MDD) as a disease model, we examined the feasibility of studying brain morphology and associations with remission using clinical and MRI data exclusively drawn from the EMR. Advanced automated tools were used to select MDD patients and controls from the EMR who had brain MRI data, but no diagnosed brain pathology. MDD patients were further assessed for remission status by review of clinical charts. Twenty MDD patients (eight full-remitters, six partial-remitters, and six non-remitters), and fifteen healthy control subjects met all study criteria for advanced morphometric analyses. Compared to controls, MDD patients had significantly smaller right rostral-anterior cingulate volume, and level of non-remission was associated with smaller left hippocampus and left rostral-middle frontal gyrus volume. The use of EMR data for psychiatric research may provide a timely and cost-effective approach with the potential to generate large study samples reflective of the real population with the illness studied. PMID:23149041

  8. Alterations in left ventricular, left atrial, and right ventricular structure and function to cardiovascular risk factors in adolescents with type 2 diabetes participating in the TODAY clinical trial

    Science.gov (United States)

    Data on cardiovascular disease (CVD) risk in adolescents with type 2 diabetes (T2D) are limited. Echocardiography was performed in the last year of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial (median 4.5 yr from diagnosis of T2D, average age 18 yr), incl...

  9. Structured cues or modafinil for fatigue amelioration in clinicians? A double-blind, randomized controlled trial of critical clinical information recall in fatigued clinicians.

    Science.gov (United States)

    Flindall, Ian; Leff, Daniel Richard; Goodship, Jonathan; Sugden, Colin; Darzi, Ara

    2016-04-01

    To evaluate the impact of modafinil on "free" and "cued" recall of clinical information in fatigued but nonsleep-deprived clinicians. Despite attempts to minimize sleep deprivation through redesign of the roster of residents and staff surgeons, evidence suggests that fatigue remains prevalent. The wake-promoting agent modafinil improves cognition in the sleep-deprived fatigued state and may improve information recall in fatigued nonsleep-deprived clinicians. Twenty-four medical undergraduates participated in a double-blind, parallel, randomized controlled trial (modafinil-200 mg:placebo). Medication was allocated 2 hours before a 90-minute fatigue-inducing, continuous performance task (dual 2-back task). A case history memorization task was then performed. Clinical information recall was assessed as "free"(no cognitive aids) and "cued"(using aid memoirs). Open and closed cues represent information of increasing specificity to aid the recall of clinical information. Fatigue was measured objectively using the psychomotor vigilance task at induction, before and after the dual 2-back task. Modafinil decreased false starts and lapses (modafinil = 0.50, placebo = 9.83, P modafinil = 0.006, placebo = 0.098, P Modafinil improved free information recall (modafinil = 137.8, placebo = 106.0, P modafinil = 62.3, placebo = 52.8, P = .1) and closed cues (modafinil = 80.1, placebo = 75.9, P = .3). Modafinil attenuated fatigue and improved free recall of clinical information without improving cue-based recall under the design of our experimental conditions. Memory cues to aid retrieval of clinical information are convenient interventions that could decrease fatigue-related error without adverse effects of the neuropharmacology. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. The NEO Five-Factor Inventory: Latent Structure and Relationships with Dimensions of Anxiety and Depressive Disorders in a Large Clinical Sample

    Science.gov (United States)

    Rosellini, Anthony J.; Brown, Timothy A.

    2011-01-01

    The present study evaluated the latent structure of the NEO Five-Factor Inventory (NEO FFI) and relations between the five-factor model (FFM) of personality and dimensions of "DSM-IV" anxiety and depressive disorders (panic disorder, generalized anxiety disorder [GAD], obsessive-compulsive disorder, social phobia [SOC], major depressive disorder…

  11. Clinical Trials

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    Full Text Available ... participants. Children and Clinical Studies Learn about the importance of children in clinical studies and get answers to common questions. NIH Clinical Research Trials and You Get additional guidance on participating ...

  12. Clinical Trials

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    Full Text Available ... the same scientific safeguards as clinical trials for adults. For more information, go to "How Do Clinical ... based on what is known to work in adults. To improve clinical care of children, more studies ...

  13. Clinical Trials

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    Full Text Available ... you to explore NIH Clinical Center for patient recruitment and clinical trial information. For more information, please email the NIH Clinical Center Office of Patient Recruitment at cc-prpl@cc.nih.gov or call ...

  14. Clinical Trials

    Medline Plus

    Full Text Available ... and devices specific to children. Resources for a Wide Range of Audiences The Children and Clinical Studies ... medical centers, and hospitals. ClinicalTrials.gov View a database of clinical studies (past and present) funded or ...

  15. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

    Science.gov (United States)

    Munroe, Belinda; Curtis, Kate; Murphy, Margaret; Strachan, Luke; Considine, Julie; Hardy, Jennifer; Wilson, Mark; Ruperto, Kate; Fethney, Judith; Buckley, Thomas

    2016-08-01

    The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care. © 2016 John Wiley & Sons Ltd.

  16. The relationship, structure and profiles of schizophrenia measurements: a post-hoc analysis of the baseline measures from a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Chen Lei

    2011-12-01

    Full Text Available Background To fully assess the various dimensions affected by schizophrenia, clinical trials often include multiple scales measuring various symptom profiles, cognition, quality of life, subjective well-being, and functional impairment. In this exploratory study, we characterized the relationships among six clinical, functional, cognitive, and quality-of-life measures, identifying a parsimonious set of measurements. Methods We used baseline data from a randomized, multicenter study of patients diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder who were experiencing an acute symptom exacerbation (n = 628 to examine the relationship among several outcome measures. These measures included the Positive and Negative Syndrome Scale (PANSS, Montgomery-Asberg Depression Rating Scale (MADRS, Brief Assessment of Cognition in Schizophrenia Symbol Coding Test, Subjective Well-being Under Neuroleptics Scale Short Form (SWN-K, Schizophrenia Objective Functioning Instrument (SOFI, and Quality of Life Scale (QLS. Three analytic approaches were used: 1 path analysis; 2 factor analysis; and 3 categorical latent variable analysis. In the optimal path model, the SWN-K was selected as the final outcome, while the SOFI mediated the effect of the exogenous variables (PANSS, MADRS on the QLS. Results The overall model explained 47% of variance in QLS and 17% of the variance in SOFI, but only 15% in SWN-K. Factor analysis suggested four factors: "Functioning," "Daily Living," "Depression," and "Psychopathology." A strong positive correlation was observed between the SOFI and QLS (r = 0.669, and both the QLS and SOFI loaded on the "Functioning" factor, suggesting redundancy between these scales. The measurement profiles from the categorical latent variable analysis showed significant variation in functioning and quality of life despite similar levels of psychopathology. Conclusions Researchers should consider collecting PANSS, SOFI, and

  17. Brain cortical structural differences between non-central nervous system cancer patients treated with and without chemotherapy compared to non-cancer controls: a cross-sectional pilot MRI study using clinically indicated scans

    Science.gov (United States)

    Shiroishi, Mark S.; Gupta, Vikash; Bigjahan, Bavrina; Cen, Steven Y.; Rashid, Faisal; Hwang, Darryl H.; Lerner, Alexander; Boyko, Orest B.; Liu, Chia-Shang Jason; Law, Meng; Thompson, Paul M.; Jahanshad, Neda

    2017-11-01

    Background: Increases in cancer survival have made understanding the basis of cancer-related cognitive impairment (CRCI) more important. CRCI neuroimaging studies have traditionally used dedicated research brain MRIs in breast cancer survivors with small sample sizes; little is known about other non-CNS cancers. However, there is a wealth of unused data from clinically-indicated MRIs that could be used to study CRCI. Objective: Evaluate brain cortical structural differences in those with non-CNS cancers using clinically-indicated MRIs. Design: Cross-sectional Patients: Adult non-CNS cancer and non-cancer control (C) patients who underwent clinically-indicated MRIs. Methods: Brain cortical surface area and thickness were measured using 3D T1-weighted images. An age-adjusted linear regression model was used and the Benjamini and Hochberg false discovery rate (FDR) corrected for multiple comparisons. Group comparisons were: cancer cases with chemotherapy (Ch+), cancer cases without chemotherapy (Ch-) and subgroup of lung cancer cases with and without chemotherapy vs C. Results: Sixty-four subjects were analyzed: 22 Ch+, 23 Ch- and 19 C patients. Subgroup analysis of 16 LCa was also performed. Statistically significant decreases in either cortical surface area or thickness were found in multiple ROIs primarily within the frontal and temporal lobes for all comparisons. Limitations: Several limitations were apparent including a small sample size that precluded adjustment for other covariates. Conclusions: Our preliminary results suggest that various types of non-CNS cancers, both with and without chemotherapy, may result in brain structural abnormalities. Also, there is a wealth of untapped clinical MRIs that could be used for future CRCI studies.

  18. Long-Term Cultures of Human Cornea Limbal Explants Form 3D Structures Ex Vivo - Implications for Tissue Engineering and Clinical Applications.

    Directory of Open Access Journals (Sweden)

    Dóra Júlia Szabó

    Full Text Available Long-term cultures of cornea limbal epithelial stem cells (LESCs were developed and characterized for future tissue engineering and clinical applications. The limbal tissue explants were cultivated and expanded for more than 3 months in medium containing serum as the only growth supplement and without use of scaffolds. Viable 3D cell outgrowth from the explants was observed within 4 weeks of cultivation. The outgrowing cells were examined by immunofluorescent staining for putative markers of stemness (ABCG2, CK15, CK19 and Vimentin, proliferation (p63α, Ki-67, limbal basal epithelial cells (CK8/18 and differentiated cornea epithelial cells (CK3 and CK12. Morphological and immunostaining analyses revealed that long-term culturing can form stratified 3D tissue layers with a clear extracellular matrix deposition and organization (collagen I, IV and V. The LESCs showed robust expression of p63α, ABCG2, and their surface marker fingerprint (CD117/c-kit, CXCR4, CD146/MCAM, CD166/ALCAM changed over time compared to short-term LESC cultures. Overall, we provide a model for generating stem cell-rich, long-standing 3D cultures from LESCs which can be used for further research purposes and clinical transplantation.

  19. Perceived parental rearing style in childhood: internal structure and concurrent validity on the Egna Minnen Beträffande Uppfostran--Child Version in clinical settings.

    Science.gov (United States)

    Penelo, Eva; Viladrich, Carme; Domènech, Josep M

    2010-01-01

    We provide the first validation data of the Spanish version of the Egna Minnen Beträffande Uppfostran--Child Version (EMBU-C) in a clinical context. The EMBU-C is a 41-item self-report questionnaire that assesses perceived parental rearing style in children, comprising 4 subscales (rejection, emotional warmth, control attempts/overprotection, and favoring subjects). The test was administered to a clinical sample of 174 Spanish psychiatric outpatients aged 8 to 12. Confirmatory factor analyses were performed, analyzing the children's reports about their parents' rearing style. The results were almost equivalent for father's and mother's ratings. Confirmatory factor analysis yielded an acceptable fit to data of the 3-factor model when removing the items of the favoring subjects scale (root mean squared error of approximation .73), whereas control attempts scale showed lower values, as in previous studies. The influence of sex (of children and parents) on scale scores was inappreciable and children tended to perceive their parents as progressively less warm as they grew older. As predicted, the scores for rejection and emotional warmth were related to bad relationships with parents, absence of family support, harsh discipline, and lack of parental supervision. The Spanish version of EMBU-C can be used with psychometric guarantees to identify rearing style in psychiatric outpatients because evidences of quality in this setting match those obtained in community samples. Copyright 2010 Elsevier Inc. All rights reserved.

  20. On the road to replacing invasive testing with cell-based NIPT: Five clinical cases with aneuploidies, microduplication, unbalanced structural rearrangement, or mosaicism.

    Science.gov (United States)

    Vestergaard, Else Marie; Singh, Ripudaman; Schelde, Palle; Hatt, Lotte; Ravn, Katarina; Christensen, Rikke; Lildballe, Dorte Launholt; Petersen, Olav Bjørn; Uldbjerg, Niels; Vogel, Ida

    2017-09-07

    Trophoblastic fetal cells harvested from maternal blood have the capacity to be used for copy number analyses in a cell-based non-invasive prenatal test (cbNIPT). Potentially, this will result in increased resolution for detection of subchromosomal aberrations due to high quality DNA not intermixed with maternal DNA. We present 5 selected clinical cases from first trimester pregnancies where cbNIPT was used to demonstrate a wide range of clinically relevant aberrations. Blood samples were collected from high risk pregnancies in gestational week 12 + 1 to 12 + 5. Fetal trophoblast cells were enriched and stained using fetal cell specific antibodies. The enriched cell fraction was scanned, and fetal cells were picked using a capillary-based cell picking instrument. Subsequently, whole genome amplification (WGA) was performed on fetal cells, and the DNA was analyzed blindly by array comparative genomic hybridization (aCGH). We present 5 cases where non-invasive cell-based prenatal test results are compared with aCGH results on chorionic villus samples (CVS), demonstrating aneuploidies including mosaicism, unbalanced translocations, subchromosomal deletions, or duplications. Aneuploidy and subchromosomal aberrations can be detected using fetal cells harvested from maternal blood. The method has the future potential of being offered as a cell-based NIPT with large high genomic resolution. © 2017 John Wiley & Sons, Ltd.

  1. Testing of the preliminary OMERACT validation criteria for a biomarker to be regarded as reflecting structural damage endpoints in rheumatoid arthritis clinical trials: the example of C-reactive protein

    DEFF Research Database (Denmark)

    Keeling, Stephanie O; Landewe, Robert; van der Heijde, Desiree

    2007-01-01

    OBJECTIVE: A list of 14 criteria for guiding the validation of a soluble biomarker as reflecting structural damage endpoints in rheumatoid arthritis (RA) clinical trials was drafted by an international working group after a Delphi consensus exercise. C-reactive protein (CRP), a soluble biomarker...... of individual criteria in the draft set. METHODS: A systematic literature review was conducted to elicit evidence in support of each specific criterion composing the 14-criteria draft set. A summary of the key literature findings per criterion was presented to both the working group and to participants...

  2. Clinical Research and Clinical Trials

    Science.gov (United States)

    ... Contracts section of the NIH website. Find NICHD Clinical Trials NIH maintains the ClinicalTrials.gov website as the main database of publicly and privately funded clinical trials. Each trial has its own pre-defined research ...

  3. Assessing Clinical Laboratory Quality: A College of American Pathologists Q-Probes Study of Prothrombin Time INR Structures, Processes, and Outcomes in 98 Laboratories.

    Science.gov (United States)

    Howanitz, Peter J; Darcy, Theresa P; Meier, Frederick A; Bashleben, Christine P

    2015-09-01

    The anticoagulant warfarin has been identified as the second most frequent drug responsible for serious, disabling, and fatal adverse drug events in the United States, and its effect on blood coagulation is monitored by the laboratory test called international normalized ratio (INR). To determine the presence of INR policies and procedures, INR practices, and completeness and timeliness of reporting critical INR results in participants' clinical laboratories. Participants reviewed their INR policies and procedure requirements, identified their practices by using a questionnaire, and studied completeness of documentation and timeliness of reporting critical value INR results for outpatients and emergency department patients. In 98 participating institutions, the 5 required policies and procedures were in place in 93% to 99% of clinical laboratories. Fifteen options for the allowable variations among duplicate results from different analyzers, 12 different timeliness goals for reporting critical values, and 18 unique critical value limits were used by participants. All required documentation elements were present in 94.8% of 192 reviewed INR validation reports. Critical value INR results were reported within the time frame established by the laboratory for 93.4% of 2604 results, but 1.0% of results were not reported. Although the median laboratories successfully communicated all critical results within their established time frames and had all the required validation elements based in their 2 most recent INR calculations, those participants at the lowest 10th percentile were successful in 80.0% and 85.7% of these requirements, respectively. Significant opportunities exist for adherence to INR procedural requirements and for practice patterns and timeliness goals for INR critical results' reporting.

  4. Clinical assessment of bipolar depression: validity, factor structure and psychometric properties of the Korean version of the Bipolar Depression Rating Scale (BDRS).

    Science.gov (United States)

    Jung, Young-Eun; Kim, Moon-Doo; Bahk, Won-Myong; Woo, Young Sup; Lee, Jonghun; Jang, Sae-Heon; Won, Seunghee; Min, Kyung Joon; Chung, Sangkeun; Kwon, Young-Joon; Jon, Duk-In; Lee, Kwanghun; Yoon, Bo-Hyun

    2016-07-15

    The Bipolar Depression Rating Scale (BDRS) is a scale for assessment of the clinical characteristics of bipolar depression. The primary aims of this study were to describe the development of the Korean version of the BDRS (K-BDRS) and to establish more firmly its psychometric properties in terms of reliability and validity. The study included 141 patients (62 male and 79 female) who had been diagnosed with bipolar disorder, were currently experiencing symptoms of depression, and were interviewed using the K-BDRS. Other measures included the Montgomery and Asberg Depression Scale (MADRS), the 17-item Hamilton Depression Scale (HAMD), and the Young Mania Rating Scale (YMRS). Additionally, the internal consistency, concurrent validity, inter-rater reliability, and test-retest reliability of the K-BDRS were evaluated. The Cronbach's α-coefficient for the K-BDRS was 0.866, the K-BDRS exhibited strong correlations with the HAMD (r = 0.788) and MADRS (r = 0.877), and the mixed symptoms score of the K-BDRS was significantly correlated with the YMRS (r = 0.611). An exploratory factor analysis revealed three factors that corresponded to psychological depressive symptoms, somatic depressive symptoms, and mixed symptoms. The present findings suggest that the K-BDRS has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in patients with bipolar disorder.

  5. Clinical Trials

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    Full Text Available ... they work. The U.S. Food and Drug Administration (FDA) oversees these clinical trials. The NIH may partner ... the United States, the Food and Drug Administration (FDA) provides oversight for clinical trials that are testing ...

  6. Clinical Trials

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    Clinical trials are research studies that test how well new medical approaches work in people. Each study answers ... prevent, screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a ...

  7. Clinical Trials

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    Full Text Available ... comparison groups by chance, rather than choice. This method helps ensure that any differences observed during a ... a Clinical Trial If you're interested in learning more about, or taking part in, clinical trials, ...

  8. Clinical Trials

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    Full Text Available ... are research studies that explore whether a medical strategy, treatment, or device is safe and effective for ... a Clinical Trial If you're interested in learning more about, or taking part in, clinical trials, ...

  9. Clinical Trials

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    Full Text Available ... and Centers sponsor clinical trials. Many other groups, companies, and organizations also sponsor clinical trials. Examples include ... U.S. Departments of Defense and Veterans Affairs; private companies; universities; and nonprofit organizations. NIH Institutes and Centers ( ...

  10. Clinical Trials

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    Full Text Available ... treatment, or device is safe and effective for humans. What Are Clinical Trials? Clinical trials are research ... are required to have an IRB. Office for Human Research Protections The U.S. Department of Health and ...

  11. Clinical Trials

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    Full Text Available ... and groups sponsor clinical trials that test the safety of products, such as medicines, and how well they work. The U.S. Food and Drug Administration (FDA) oversees these clinical trials. ...

  12. Clinical Trials

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    Full Text Available ... Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and ... drugs, and devices specific to children. Resources for a Wide Range of Audiences The Children and Clinical ...

  13. Clinical Trials

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    Full Text Available ... Diseases Heart and Vascular Diseases Precision Medicine Activities Obesity, Nutrition, and Physical Activity Population and Epidemiology Studies ... the NHLBI's Children and Clinical Studies Web page. Children and Clinical Studies Learn more about Children and ...

  14. Clinical Trials

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    Full Text Available ... a Clinical Trial If you're interested in learning more about, or taking part in, clinical trials, ... lung, and blood disorders. By engaging the research community and a broad group of stakeholders and advisory ...

  15. Clinical Trials

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    Full Text Available ... you may get tests or treatments in a hospital, clinic, or doctor's office. In some ways, taking ... people will need to travel or stay in hospitals to take part in clinical trials. For example, ...

  16. Clinical Trials

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    Full Text Available ... and treatments that work best. How Clinical Trials Work If you take part in a clinical trial, ... care providers might be part of your treatment team. They will monitor your health closely. You may ...

  17. A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder.

    Science.gov (United States)

    Bateman, Anthony; O'Connell, Jennifer; Lorenzini, Nicolas; Gardner, Tessa; Fonagy, Peter

    2016-08-30

    Antisocial personality disorder (ASPD) is an under-researched mental disorder. Systematic reviews and policy documents identify ASPD as a priority area for further treatment research because of the scarcity of available evidence to guide clinicians and policymakers; no intervention has been established as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment which specifically targets the ability to recognise and understand the mental states of oneself and others, an ability shown to be compromised in people with ASPD. The aim of the study discussed in this paper is to investigate whether MBT can be an effective treatment for alleviating symptoms of ASPD. This paper reports on a sub-sample of patients from a randomised controlled trial of individuals recruited for treatment of suicidality, self-harm, and borderline personality disorder. The study investigates whether outpatients with comorbid borderline personality disorder and ASPD receiving MBT were more likely to show improvements in symptoms related to aggression than those offered a structured protocol of similar intensity but excluding MBT components. The study found benefits from MBT for ASPD-associated behaviours in patients with comorbid BPD and ASPD, including the reduction of anger, hostility, paranoia, and frequency of self-harm and suicide attempts, as well as the improvement of negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment. MBT appears to be a potential treatment of consideration for ASPD in terms of relatively high level of acceptability and promising treatment effects. ISRCTN ISRCTN27660668 , Retrospectively registered 21 October 2008.

  18. Structured Illumination Microscopy and a Quantitative Image Analysis for the Detection of Positive Margins in a Pre-Clinical Genetically Engineered Mouse Model of Sarcoma.

    Directory of Open Access Journals (Sweden)

    Henry L Fu

    Full Text Available Intraoperative assessment of surgical margins is critical to ensuring residual tumor does not remain in a patient. Previously, we developed a fluorescence structured illumination microscope (SIM system with a single-shot field of view (FOV of 2.1 × 1.6 mm (3.4 mm2 and sub-cellular resolution (4.4 μm. The goal of this study was to test the utility of this technology for the detection of residual disease in a genetically engineered mouse model of sarcoma. Primary soft tissue sarcomas were generated in the hindlimb and after the tumor was surgically removed, the relevant margin was stained with acridine orange (AO, a vital stain that brightly stains cell nuclei and fibrous tissues. The tissues were imaged with the SIM system with the primary goal of visualizing fluorescent features from tumor nuclei. Given the heterogeneity of the background tissue (presence of adipose tissue and muscle, an algorithm known as maximally stable extremal regions (MSER was optimized and applied to the images to specifically segment nuclear features. A logistic regression model was used to classify a tissue site as positive or negative by calculating area fraction and shape of the segmented features that were present and the resulting receiver operator curve (ROC was generated by varying the probability threshold. Based on the ROC curves, the model was able to classify tumor and normal tissue with 77% sensitivity and 81% specificity (Youden's index. For an unbiased measure of the model performance, it was applied to a separate validation dataset that resulted in 73% sensitivity and 80% specificity. When this approach was applied to representative whole margins, for a tumor probability threshold of 50%, only 1.2% of all regions from the negative margin exceeded this threshold, while over 14.8% of all regions from the positive margin exceeded this threshold.

  19. Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions.

    Science.gov (United States)

    Hunter, Sharyn; Arthur, Carol

    2016-05-01

    Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Clinical Pharmacopsychology

    DEFF Research Database (Denmark)

    Fava, Giovanni A.; Tomba, Elena; Bech, Per

    2017-01-01

    The aim of this critical review was to outline emerging trends and perspectives of clinical pharmacopsychology, an area of clinical psychology that is concerned with the psychological effects of medications. The historical development of clinical pharmacopsychology is outlined, with discussion......, the vulnerabilities induced by treatment (side effects, behavioral toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. Its aim is to provide a comprehensive assessment of the clinical important changes that are concerned with (a) wanted and expected treatment...... of its most representative expressions and reference to current challenges of clinical research, with particular reference to clinimetrics. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment...

  1. Confirmation of the Factor Structure and Measurement Invariance of the Children's Scale of Hostility and Aggression: Reactive/Proactive in Clinic-Referred Children With and Without Autism Spectrum Disorder.

    Science.gov (United States)

    Farmer, Cristan A; Kaat, Aaron J; Mazurek, Micah O; Lainhart, Janet E; DeWitt, Mary Beth; Cook, Edwin H; Butter, Eric M; Aman, Michael G

    2016-02-01

    The measurement of aggression in its different forms (e.g., physical and verbal) and functions (e.g., impulsive and instrumental) is given little attention in subjects with developmental disabilities (DD). In this study, we confirm the factor structure of the Children's Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) and demonstrate measurement invariance (consistent performance across clinical groups) between clinic-referred groups with and without autism spectrum disorder (ASD). We also provide evidence of the construct validity of the C-SHARP. Caregivers provided C-SHARP, Child Behavior Checklist (CBCL), and Proactive/Reactive Rating Scale (PRRS) ratings for 644 children, adolescents, and young adults 2-21 years of age. Five types of measurement invariance were evaluated within a confirmatory factor analytic framework. Associations among the C-SHARP, CBCL, and PRRS were explored. The factor structure of the C-SHARP had a good fit to the data from both groups, and strict measurement invariance between ASD and non-ASD groups was demonstrated (i.e., equivalent structure, factor loadings, item intercepts and residuals, and latent variance/covariance between groups). The C-SHARP Problem Scale was more strongly associated with CBCL Externalizing than with CBCL Internalizing, supporting its construct validity. Subjects classified with the PRRS as both Reactive and Proactive had significantly higher C-SHARP Proactive Scores than those classified as Reactive only, who were rated significantly higher than those classified by the PRRS as Neither Reactive nor Proactive. A similar pattern was observed for the C-SHARP Reactive Score. This study provided evidence of the validity of the C-SHARP through confirmation of its factor structure and its relationship with more established scales. The demonstration of measurement invariance demonstrates that differences in C-SHARP factor scores were the result of differences in the construct rather than to error or

  2. Clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder (PARADES): a pragmatic, multicentre, observer-blind, randomised controlled superiority trial.

    Science.gov (United States)

    Morriss, Richard; Lobban, Fiona; Riste, Lisa; Davies, Linda; Holland, Fiona; Long, Rita; Lykomitrou, Georgia; Peters, Sarah; Roberts, Christopher; Robinson, Heather; Jones, Steven

    2016-11-01

    Group psychoeducation is a low-cost National Institute for Health and Care Excellence-recommended treatment for bipolar disorder. However, the clinical effectiveness and acceptability of this intervention are unclear compared with unstructured peer support matched for delivery and aim of treatment, and for previous bipolar history. We aimed to assess the clinical effectiveness and acceptability of structured group psychoeducation versus optimised unstructured peer support for patients with remitted bipolar disorder. We did this pragmatic, multicentre, parallel-group, observer-blind, randomised controlled superiority trial at eight community sites in two regions in England. Participants aged 18 years or older with bipolar disorder and no episode in the preceding 4 weeks were recruited via self-referral or secondary care referral. Participants were individually randomly assigned (1:1), via a computer-generated stochastic allocation sequence, to attend 21 2-h weekly sessions of either structured group psychoeducation or optimised unstructured peer support. Randomisation was minimised by number of previous episodes (one to seven, eight to 19, or ≥20) and stratified by clinical site. Outcome assessors were masked to group allocation. The primary outcome was time from randomisation to next bipolar episode, with planned moderator analysis of number of previous bipolar episodes and qualitative interview of participant experience. We did analysis by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN62761948. Between Sept 28, 2009, and Jan 9, 2012, we randomly assigned 304 participants to receive psychoeducation (n=153) or peer support (n=151); all (100%) participants had complete primary outcome data. Attendance at psychoeducation groups was higher than at peer-support groups (median 14 sessions [IQR three to 18] vs nine sessions [two to 17]; p=0·026). At 96 weeks, 89 (58%) participants in the

  3. Signifikante Verbesserungen eines klinischen Untersuchungskurses nach einfachen strukturierten Veränderungen des Lehrinhalts und der Lehrmethoden [Significant improvement of a clinical training course in physical examination after basic structural changes in the teaching content and methods

    Directory of Open Access Journals (Sweden)

    Bott-Flügel, Lorenz

    2013-05-01

    Full Text Available [english] Background: Regular student evaluations at the Technical University Munich indicate the necessity for improvement of the clinical examination course. The aim of this study was to examine if targeted measures to restructure and improve a clinical examination course session lead to a higher level of student satisfaction as well as better self-assessment of the acquired techniques of clinical examination.Methods: At three medical departments of the Technical University Munich during the 2010 summer semester, the quantitative results of 49 student evaluations (ratings 1-6, German scholastic grading system of the clinical examination course were compared for a course before and a course after structured measures for improvement. These measures included structured teaching instructions, handouts and additional material from the Internet.Results: 47 evaluations were completed before and 34 evaluations after the measures for improvement. The measures named above led to a significant improvement of the evaluative ratings in the following areas: short introduction to the topic of each clinical examination course (from 2.4±1.2 to1.7±1.0; p=0.0020 and to basic measures of hygiene (from 3.8±1.9 to 2.5±1.8; p=0.004, structured demonstration of each clinical examination step (from 2.9±1.5 to 1.8±1.0; p=0.001, sufficient practice of each clinical examination step (from 3.1±1.8 to 2.2±1.4; p=0.030 structured feedback on each clinical examination step (from 3.0±1.4 to 2.3±1.0; p=0.0070, use of handouts (from 5.2±1.4 to 1.8±1.4; p[german] Hintergrund: Die regelmäßigen Evaluationen der Studierenden der Technischen Universität München deuten auf einen Verbesserungsbedarf des klinischen Untersuchungskurses hin. Ziel der vorliegenden Studie war es, zu prüfen, ob gezielte Maßnahmen zur Umstrukturierung und Verbesserung eines Untersuchungskurstages zu einer höheren Zufriedenheit der Studierenden und zu einer besseren Selbsteinschätzung der

  4. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena.

    Science.gov (United States)

    Mannix, Judy; Wilkes, Lesley; Jackson, Debra

    2013-01-01

    Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses' clinicians' views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses' understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An 'ideal nurse' may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community.

  5. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

    Science.gov (United States)

    2013-01-01

    Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community. PMID:23587282

  6. Appraising Medical Literature: The Effect of a Structured Journal Club Curriculum Using The Lancet Handbook of Essential Concepts in Clinical Research on Resident Self-Assessment and Knowledge in Milestone-Based Competencies.

    Science.gov (United States)

    Lentscher, Jessica A; Batig, Alison L

    2017-11-01

    Training in literature appraisal and statistical interpretation is one of the residency training requirements outlined by the Accreditation Council for Graduate Medical Education. Frequently, a journal club format is used to teach this competency although this teaching modality is not standardized or well studied in regard to its efficacy. This study sought to determine the effect of a structured journal club curriculum that incorporated The Lancet Handbook of Essential Concepts in Clinical Research on objective and self-assessed knowledge pertaining to study design and interpretation. The study was a retrospective observational study evaluating the effect of a structured journal club curriculum using the Lancet text with pre- and postimplementation assessment using a resident self-assessment survey. The study examined a monthly journal club curriculum that covered 1 topic/chapter from the assigned text, paired with a contemporary article to highlight the chapter topic. Resident self-assessed and objective knowledge was evaluated and compared using a survey taken before and after the curriculum change. The study was completed during 1 academic year at Madigan Army Medical Center in Tacoma, Washington, an academic military medical training and tertiary care center. Study surveys were distributed to all 17 obstetrics and gynecology residents throughout the 4 residency training years. Of the 17 potential participants, 13 (76%) participated in the precurriculum assessment and 14 (82%) participated after its completion. There was no significant improvement in resident self-assessed knowledge following curriculum implementation. There was a trend toward improved objective knowledge pertaining to study design and interpretation after curriculum completion, but this was not statistically significant. There is a lack of standardized and well-studied methods to teach residents how to evaluate and appraise medical literature and research. The Lancet Handbook of Essential

  7. Clinical Practice

    DEFF Research Database (Denmark)

    Contarino, Maria Fiorella; Van Den Dool, Joost; Balash, Yacov

    2017-01-01

    issues still remain open in the clinical practice. We performed a systematic review of the literature on botulinum toxin treatment for CD based on a question-oriented approach, with the aim to provide practical recommendations for the treating clinicians. Key questions from the clinical practice were...... of anticoagulants, neurological comorbidities) should also be further explored....

  8. Objective Structured Clinical Examination (OSCE) Seven Years ...

    African Journals Online (AJOL)

    It was first held in may 2000 (batch I- 21 students) and the numbers gradually increasing, till it ... Lessons learned and conclusions: A well-organized OSCE requires significant investment in terms of planning, resources and enthusiasm, but can have potentially beneficial impacts on the assessments tools especially in big ...

  9. Fructosamine: Structure, Analysis, and Clinical Usefulness

    Science.gov (United States)

    1987-09-09

    tests mea- % from postprandial blood glucose concentrations, random sure different molecules with different half-lives and there- sampling is...David A. Armbruster E Glucose molecules are joined to protein molecules to form long-term control of blood sugar., Another new test. the stable ketoamines...to the abnormally high concentration of sugar in blood . The glucose in blood during the preceding several weeks. As vet, concentration of fructosamine

  10. Clinical Research

    DEFF Research Database (Denmark)

    Christensen, Irene

    2016-01-01

    This paper is about the logic of problem solving and the production of scientific knowledge through the utilisation of clinical research perspective. Ramp-up effectiveness, productivity, efficiency and organizational excellence are topics that continue to engage research and will continue doing so...... for years to come. This paper seeks to provide insights into ramp-up management studies through providing an agenda for conducting collaborative clinical research and extend this area by proposing how clinical research could be designed and executed in the Ramp- up management setting....

  11. Clinical Trials

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    Full Text Available ... review data from a clinical trial for safety problems or differences in results among different groups. The DSMB also reviews research results from other relevant studies. These results may ...

  12. Clinical Trials

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    Full Text Available ... help produce reliable study results. Clinical trials are one of the final stages of a long and ... trials that test principles or strategies. For example, one NHLBI study explored whether the benefits of lowering ...

  13. Clinical Trials

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    Full Text Available ... preexisting differences between the patients. Usually, a computer program makes the group assignments. Masking The term "masking" ... Range of Audiences The Children and Clinical Studies Program has been successfully developed and evaluated to fill ...

  14. Clinical Trials

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    Full Text Available ... or treatment is having harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight for clinical trials that ...

  15. Clinical Trials

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    Full Text Available ... treatment is having harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight for clinical trials that are ...

  16. Clinical Trials

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    Full Text Available ... always, parents must give legal consent for their child to take part in a clinical trial. When ... minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older ...

  17. Clinical Trials

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    Full Text Available ... A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders ... to fill an important gap in information and education for parents, clinicians, researchers, children, and the general ...

  18. Clinical Trials

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    Full Text Available ... to Expect During a clinical trial, doctors, nurses, social workers, and other health care providers might be ... the new approach. You also will have the support of a team of health care providers, who ...

  19. Clinical Trials

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    Full Text Available ... States, the Food and Drug Administration (FDA) provides oversight for clinical trials that are testing new medicines or medical devices. The FDA reviews applications for new medicines ...

  20. Clinical Trials

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    Full Text Available ... the strategy or treatment is having harmful effects. Food and Drug Administration In the United States, the Food and Drug Administration (FDA) provides oversight for clinical ...

  1. Clinical Trials

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    Full Text Available ... care providers might be part of your treatment team. They will monitor your health closely. You may ... taking part in a clinical trial. Your treatment team also may ask you to do other tasks. ...

  2. Clinical Trials

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    Full Text Available ... and devices specific to children. Resources for a Wide Range of Audiences The Children and Clinical Studies ... have not only shaped medical practice around the world, but have improved the health of millions of ...

  3. Clinical Trials

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    Full Text Available Skip to main content U.S. Department of Health & Human Services Health Topics Health Topics A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders ...

  4. Clinical Trials

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    Full Text Available ... Diseases Heart and Vascular Diseases Precision Medicine Activities Obesity, Nutrition, and Physical Activity Population and Epidemiology Studies ... always, parents must give legal consent for their child to take part in a clinical trial. When ...

  5. Clinical Trials

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    Full Text Available ... clinical trials are required to have an IRB. Office for Human Research Protections The U.S. Department of Health and Human Services’ (HHS’) Office for Human Research Protections (OHRP) oversees all research ...

  6. Clinical Trials

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    Full Text Available ... works well in the lab or animals doesn't always work well in people. Thus, research in ... Clinical research is done only if doctors don't know whether a new approach works well in ...

  7. Clinical Trials

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    Full Text Available ... include factors such as a patient's age and gender, the type and stage of disease, and whether ... in a clinical trial, find out ahead of time about costs and coverage. You should learn about ...

  8. Clinical cytology

    OpenAIRE

    Seili-Bekafigo, Irena; Štemberger, Christophe; Rajković Molek, Koraljka

    2016-01-01

    Clinical cytology is a diagnostic medical branch that by means of light microscopic analysis of cell and tissue specimens recognizes various physiological variations, benign and malignant diseases. Cytology is involved in diagnostics of virtually every organ and tissue. Cytology has been a separate specialization in Croatia for almost 40 years, at first as Medical cytology, later as Clinical cytology. In 2015 a new specialization was introduced, synthesizing cytology and pathology, and is cal...

  9. How to maintain equity and objectivity in assessing the communication skills in a large group of student nurses during a long examination session, using the Objective Structured Clinical Examination (OSCE).

    Science.gov (United States)

    Bagnasco, Annamaria; Tolotti, Angela; Pagnucci, Nicola; Torre, Giancarlo; Timmins, Fiona; Aleo, Giuseppe; Sasso, Loredana

    2016-03-01

    While development, testing, and innovation of the Objective Structured Clinical Examination (OSCE) are common in the international literature, studies from the United States of America (USA), Australia, and the United Kingdom (UK) predominate. There is little known about OSCE use in European countries, such as Italy, where other than cost analysis, there is little reporting of OSCE use or validation. This paper reports on one Italian initiative, which evaluated the equity and objectivity of the OSCE method of assessing communication skills. An OSCE method was used to assess the communication skills of first-year students of the Degree Course in Nursing. A method of simulation was implemented through role-playing with standardized patients. An observational method was used to collect data. Four hundred and twenty-one first-year undergraduate nursing students at one university site in Italy took part. Ten examination sessions were carried out. The students' performances were assessed by two examiners who used a structured observation grid and conducted their assessment separately. A situation simulated by four nurses with experience as actors was used as the topic for the students' examination. Calculation of the daily rate of students who passed the examination revealed a random distribution over time. The nonparametric correlation indexes referring to the assessments and to the scores assigned by the two examiners proved statistically significant (P≤0.001). The study confirmed the validity of the OSCE method in ensuring equity and objectivity of communication skills assessment in a large population of nursing students for the purpose of certification throughout the duration of the examination. This has important implications for nurse education and practice as the extent to which OSCE approaches, while deemed objective, are culturally sensitive or valid and reliable across cultures is not clear. This is something that requires further research and examination in

  10. A longitudinal study of empathy in pre-clinical and clinical medical students and clinical supervisors

    OpenAIRE

    Mahoney, Sarah; Sladek, Ruth M; Neild, Tim

    2016-01-01

    Background Although appropriate empathy in health professionals is essential, a loss of empathy can occur during medical education. The structure of clinical learning may be one factor that is implicated in a loss of empathy. This study examines student and doctor empathy, and possible associations between empathy and the structure of clinical learning. Methods There were three groups of participants: medical students (n?=?281), who completed a longitudinal survey consisting of the Jefferson ...

  11. The value of episodic, intensive blood glucose monitoring in non-insulin treated persons with type 2 diabetes: Design of the Structured Testing Program (STeP Study, a cluster-randomised, clinical trial [NCT00674986

    Directory of Open Access Journals (Sweden)

    Jelsovsky Zhihong

    2010-05-01

    Full Text Available Abstract Background The value and utility of self-monitoring of blood glucose (SMBG in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues. Methods/design The Structured Testing Program (STeP study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c ≥ 7.5%, non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG. A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010. Discussion The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of

  12. The value of episodic, intensive blood glucose monitoring in non-insulin treated persons with Type 2 Diabetes: design of the Structured Testing Program (STeP) study, a cluster-randomised, clinical trial [NCT00674986].

    Science.gov (United States)

    Polonsky, William; Fisher, Lawrence; Schikman, Charles; Hinnen, Deborah; Parkin, Christopher; Jelsovsky, Zhihong; Amstutz, Linda; Schweitzer, Matthias; Wagner, Robin

    2010-05-18

    The value and utility of self-monitoring of blood glucose (SMBG) in non-insulin treated T2DM has yet to be clearly determined. Findings from studies in this population have been inconsistent, due mainly to design differences and limitations, including the prescribed frequency and timing of SMBG, role of the patient and physician in responding to SMBG results, inclusion criteria that may contribute to untoward floor effects, subject compliance, and cross-arm contamination. We have designed an SMBG intervention study that attempts to address these issues. The Structured Testing Program (STeP) study is a 12-month, cluster-randomised, multi-centre clinical trial to evaluate whether poorly controlled (HbA1c >or= 7.5%), non-insulin treated T2DM patients will benefit from a comprehensive, integrated physician/patient intervention using structured SMBG in US primary care practices. Thirty-four practices will be recruited and randomly assigned to an active control group (ACG) that receives enhanced usual care or to an enhanced usual care group plus structured SMBG (STG). A total of 504 patients will be enrolled; eligible patients at each site will be randomly selected using a defined protocol. Anticipated attrition of 20% will yield a sample size of at least 204 per arm, which will provide a 90% power to detect a difference of at least 0.5% in change from baseline in HbA1c values, assuming a common standard deviation of 1.5%. Differences in timing and degree of treatment intensification, cost effectiveness, and changes in patient self-management behaviours, mood, and quality of life (QOL) over time will also be assessed. Analysis of change in HbA1c and other dependent variables over time will be performed using both intent-to-treat and per protocol analyses. Trial results will be available in 2010. The intervention and trial design builds upon previous research by emphasizing appropriate and collaborative use of SMBG by both patients and physicians. Utilization of per

  13. Clinical Studies

    DEFF Research Database (Denmark)

    Pallesen, Ulla

    universities and practicing dentists restore millions of teeth throughout the World with composite resin materials. Do we know enough about the clinical performance of these restorations over time? Numerous in vitro studies are being published on resin materials and adhesion, some of them attempting to imitate...... and results from own up to 30-year prospective clinical university studies and practice based studies from Public Dental Health Service on the clinical performance of posterior composite resin restorations.......Within the last 25 years composite resin materials have in many countries successively replaced amalgam as a restorative for posterior teeth. Resin materials and bonding systems are continuously being improved by the manufactures, adhesive procedures are now included in the curriculum of most...

  14. Structural cladding /clad structures

    DEFF Research Database (Denmark)

    Beim, Anne

    2012-01-01

    Structural Cladding /Clad Structures: Studies in Tectonic Building Practice A. Beim CINARK – Centre for Industrialized Architecture, Institute of Architectural Technology, The Royal Danish Academy of Fine Arts School of Architecture, Copenhagen, Denmark ABSTRACT: With point of departure...... of materials, the structural features and the construction details of building systems in selected architectural works. With a particular focus at heavy constructions made of solid wood and masonry, and light weight constructions made of wooden frame structures and steel profiles, it is the intention...... tightness in constructions. At the same time a need for longevity and effortless maintenance have lead to contemporary architectural structures, where the exterior walls and the building envelope most often are made of several layers of advanced materials and separate building elements. In most contemporary...

  15. Clinical Trials

    Medline Plus

    Full Text Available ... This shows how the approach affects a living body and whether it's harmful. However, an approach that works well in the lab or animals doesn't always work well in people. Thus, research in humans is needed. For safety purposes, clinical trials start ...

  16. Clinical Trials

    Medline Plus

    Full Text Available ... educational programs and materials, and offer advice on research-related issues. Data Safety Monitoring Board Every National Institutes of Health ( ... III clinical trial is required to have a Data and Safety Monitoring Board ... of a group of research and study topic experts. The NIH also requires ...

  17. Clinical pharmacology

    African Journals Online (AJOL)

    Clinical pharmacology. Acute pain management in children. Early and appropriate pain management, and the reduction of pain during diagnostic and therapeutic procedures, are essential in all trauma patients, but paediatric patients present particular challenges. Appropriate analgesia, as well as appropriate routes.

  18. Clinical Trials

    Medline Plus

    Full Text Available ... examples of clinical trials that test principles or strategies include studies that explore whether surgery or other medical treatments ... board consists of a group of research and study topic experts. The NIH also ... alternative strategies for diagnosis or treatment. In addition, the NIH ...

  19. Clinical Trials

    Medline Plus

    Full Text Available ... The results from other clinical trials show what doesn't work or may cause harm. For example, the NHLBI Women's Health Initiative tested whether hormone therapy (HT) reduced the risk of heart disease in postmenopausal women. (When the trial began, HT was already in common ...

  20. Clinical Trials

    Science.gov (United States)

    ... and her initial results. Nueva Esperanza Para Las Enfermedades Del Corazón 09/23/2014 Milena tuvo un ... Story 09/23/2014 Nueva Esperanza Para Las Enfermedades Del Corazón 09/23/2014 Children and Clinical ...

  1. Clinical biochemistry

    Science.gov (United States)

    Alexander, W. C.; Leach, C. S.; Fischer, C. L.

    1975-01-01

    The objectives of the biochemical studies conducted for the Apollo program were (1) to provide routine laboratory data for assessment of preflight crew physical status and for postflight comparisons; (2) to detect clinical or pathological abnormalities which might have required remedial action preflight; (3) to discover as early as possible any infectious disease process during the postflight quarantine periods following certain missions; and (4) to obtain fundamental medical knowledge relative to man's adjustment to and return from the space flight environment. The accumulated data presented suggest that these requirements were met by the program described. All changes ascribed to the space flight environment were subtle, whereas clinically significant changes were consistent with infrequent illnesses unrelated to the space flight exposure.

  2. Clinical Investigation.

    Science.gov (United States)

    1979-09-30

    normal postprandial blood glucose and glucoreguiatory hormone concentrations following a test meal whicii provides more physiologic stimulus than pure...hypo- glycemia do in fact have low postprandial blood glucose on altered levels of glucoregulatory hormones associated with clinical findings...Fertility and Sterility 30:560-564, 1978. 00~3 Ma Endocrinology Service - continued Hofeldt, F.D.: Transitional Low Blood Glucose States. Rocky

  3. Structural cladding /clad structures:

    DEFF Research Database (Denmark)

    Beim, Anne

    2013-01-01

    tendencies, which can be traced in the use of materials, the structural features and the construction details of building systems in selected architectural works. With a particular focus at heavy constructions made of solid wood and masonry, and light weight constructions made of wooden frame structures......With point of departure in the present challenges found in the construction industry, which concern a reduced use of energy in buildings and consumption of material resources – this paper forms a tectonic inquiry into contemporary building practice. The aim is to look at specific performative...

  4. Clinical arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Arndt, R.; Horns, J.W.; Gold, R.H.; Blaschke, D.D.

    1985-01-01

    This book deals with the method and interpretation of arthrography of the shoulder, knee, ankle, elbow, hip, wrist, and metacarpophalangeal, interphalangeal, and temporomandibular joints. The emphasis is on orthopaedic disorders, usually of traumatic origin, which is in keeping with the application of arthrography in clinical practice. Other conditions, such as inflammatory and degenerative diseases, congenital disorders and, in the case of the hip, arthrography of reconstructive joint surgery, are included. Each chapter is devoted to one joint and provides a comprehensive discussion on the method of arthrography, including single and double contrast techniques where applicable, normal radiographic anatomy, and finally, the interpretation of the normal and the abnormal arthrogram.

  5. Measurement of the levels anxiety, self-perception of preparation and expectations for success using an objective structured clinical examination, a written examination, and a preclinical preparation test in Kerman dental students.

    Science.gov (United States)

    Kalantari, Mahsa; Zadeh, Nazila Lashkari; Agahi, Raha Habib; Navabi, Nader; Hashemipour, Maryam Alsadat; Nassab, Amir Hossein Gandjalikhan

    2017-01-01

    Examinations have an important role in evaluating students' learning outcomes and their mastery of a subject. Passing or failing an examination can have far-reaching consequences for the students. Therefore, it is not surprising that international studies consistently show that dental students report examinations and grades among the highest ranking stressors in dental schools. The aim of this research was to measure the levels of anxiety, self-perception of preparation and expectations for success using an objective structured clinical examination (OSCE), a written examination and a preclinical preparation test, and to examine the effects of the three predictive variables on the outcomes of assessments. The present research is a cross-sectional study. The population under consideration was students of Kerman Dental School in 2013. Examination anxiety was measured with Spielberger's state anxiety inventory. Preparation for the assessment (I am fully prepared = 4, I am prepared = 3, I'm not prepared = 2, I'm not fully prepared = 1) and expectation to succeed (I am quite successful = 4, I am successful = 3, I'm not successful = 2, I'm not quite successful = 1) were quantified with Likert scale. The questionnaire was completed during an OSCE, a written examination, a preclinical crown and bridge preparation test and a nonexamination situation. The study population consisted of 138 4(th), 5(th), and 6(th) year Kerman dental students (65 males and 73 females). The results showed that all the assessment methods induced a significant increase in state anxiety compared to baseline levels with the highest anxiety levels reported during an OSCE (62.4 ± 8.1, P = 0.04) and a written examination (48.8 ± 9.2, P = 0.04). The preparation levels in females were significantly higher than those in males in OSCE (P = 0.03) and written (P = 0.04). State anxiety was high in all the three assessment methods. OSCE induced more anxiety than other assessment formats. However, anxiety was

  6. Plasma growth hormones, P300 event-related potential and test of variables of attention (TOVA) are important neuroendocrinological predictors of early cognitive decline in a clinical setting: evidence supported by structural equation modeling (SEM) parameter estimates.

    Science.gov (United States)

    Braverman, Eric R; Chen, Thomas J H; Prihoda, Thomas J; Sonntag, William; Meshkin, Brian; Downs, B William; Mengucci, Julie F; Blum, Seth H; Notaro, Alison; Arcuri, Vanessa; Varshavskiy, Michael; Blum, Kenneth

    2007-09-01

    A review of the literature in both animals and humans reveals that changes in sex hormone have often been associated with changes in behavioral and mental abilities. Previously published research from our laboratory, and others, provides strong evidence that P300 (latency) event-related potential (ERP), a marker of neuronal processing speed, is an accurate predictor of early memory impairment in both males and females across a wide age range. It is our hypothesis, given the vast literature on the subject, that coupling growth hormones (insulin-like growth factor-I, (IGF-I) and insulin-like growth factor binding protein 3 (IGF-BP3)), P300 event-related potential and test of variables of attention (TOVA) are important neuroendocrinological predictors of early cognitive decline in a clinical setting. To support this hypothesis, we utilized structural equation modeling (SEM) parameter estimates to determine the relationship between aging and memory, as mediated by growth hormone (GH) levels (indirectly measured through the insulin-like growth factor system), P300 latency and TOVA, putative neurocognitive predictors tested in this study. An SEM was developed hypothesizing a causal directive path, leading from age to memory, mediated by IGF-1 and IGF-BP3, P300 latency (speed), and TOVA decrements. An increase in age was accompanied by a decrease in IGF-1 and IGF-BP3, an increase in P300 latency, a prolongation in TOVA response time, and a decrease in memory functioning. Moreover, independent of age, decreases in IGF-1 and IGF-BP3, were accompanied by increases in P300 latency, and were accompanied by increases in TOVA response time. Finally, increases in P300 latency were accompanied by decreased memory function, both directly and indirectly through mediation of TOVA response time. In summary, this is the first report utilizing SEM to reveal the finding that aging affects memory function negatively through mediation of decreased IGF-1 and IGF-BP3, and increased P300

  7. Clinically isolated laryngeal sarcoidosis

    DEFF Research Database (Denmark)

    Plaschke, Christina Caroline; Owen, Hanne Hoejris; Rasmussen, Niels

    2011-01-01

    to a combination of CO(2)-laser excision of supraglottic tissue and closure of the incision with sutures. All serological tests were negative or normal, including angiotensin 1 converting enzyme. The clinical expression was uniform with pale, smooth swellings of the supraglottic structures. Surgery proved...... successful to maintain normal breathing. None of the many parameters examined--some previously having been found to be abnormal in sarcoidosis--were abnormal in the present cohort. We are therefore unable to elucidate the pathogenesis. The combined surgical approach re-established normal airway function...

  8. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    McAlindon, T. E.; Driban, J. B.; Henrotin, Y.

    2015-01-01

    the members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population......The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct...

  9. Learn about Clinical Studies

    Science.gov (United States)

    ... Glossary of Common Site Terms Learn About Clinical Studies Contents What Is a Clinical Study? Clinical Trials ... Participation Questions to Ask What Is a Clinical Study? A clinical study involves research using human volunteers ( ...

  10. [Obesity clinic].

    Science.gov (United States)

    Suter, P M; Vetter, W

    2000-08-01

    The cornerstone of the evaluation of an obese patient is the medical examination in combination with a few selected obesity specific measurements. Key elements in the obesity specific history are the patient's weight history, the diet history, evaluation of the present and past physical activity pattern and the evaluation of the patient's target weight. Central elements in the examination are the computation of the body mass index (BMI) as well the measurement of the waist circumference. The waist circumference shows a higher degree of correlation with different morbidities than the BMI. A waist circumference of > 80 cm in women and > 94 cm in men is associated with an increased overall morbidity risk. In general a minimal biochemical work-up--including fasting glucose, total cholesterol, HDL and triacylglycerol, urate, electrolytes and TSH--is enough. Special tests (screening examination for e.g. M. Cushing) are only indicated in the case of clinical suspicion; the determination of leptin is presently of no diagnostic nor therapeutic relevance. The indication for weight reduction should be formulated individually. In the long term weight stability has to be regarded as a success for most patients. Presently the prevention of weight gain and obesity is still the safest and most efficient "therapeutic" approach.

  11. Validity and reliability of the Structured Clinical Interview for Mood Spectrum: Brazilian version (SCIMOODS-VB Validade e confiabilidade da versão brasileira da Entrevista Clínica Estruturada para o Espectro do Humor (SCIMOODS-VB

    Directory of Open Access Journals (Sweden)

    Roberto Ratzke

    2011-03-01

    Full Text Available OBJECTIVE: The aim of this study was to translate the Structured Clinical Interview for Mood Spectrum into Brazilian Portuguese, measuring its reliability, validity, and defining scores for bipolar disorders. METHOD: Questionnaire was translated (into Brazilian Portuguese and back-translated into English. Sample consisted of 47 subjects with bipolar disorder, 47 with major depressive disorder, 18 with schizophrenia and 22 controls. Inter-rater reliability was tested in 20 subjects with bipolar disorder and MDD. Internal consistency was measured using the Kuder Richardson formula. Forward stepwise discriminant analysis was performed. Scores were compared between groups; manic (M, depressive (D and total (T threshold scores were calculated through receiver operating characteristic (ROC curves. RESULTS: Kuder Richardson coefficients were between 0.86 and 0.94. Intraclass correlation coefficient was 0.96 (CI 95 % 0.93-0.97. Subjects with bipolar disorder had higher M and T, and similar D scores, when compared to major depressive disorder (ANOVA, p OBJETIVO: Traduzir e validar para o português a Entrevista Clínica Estruturada para Distúrbios do Humor, mensurando sua validade, confiabilidade, bem como definindo os escores para transtornos bipolares. MÉTODO: A entrevista foi traduzida (para o português e novamente traduzida para o inglês. A amostra incluiu 47 indivíduos com transtornos bipolares, 47 com transtorno depressivo maior, 18 com esquizofrenia e 22 controles. A confiabilidade entre avaliadores foi testada em 20 indivíduos com transtornos bipolares e transtorno depressivo maior. A consistência interna foi mensurada por meio da fórmula de Kuder Richardson. Análise discriminante foi realizada. Escores dos diversos grupos foram comparados; limiares para mania (M, depressão (D e valores totais foram calculados usando curvas de "receiver operating characteristic" (ROC. RESULTADOS: Coeficientes de Kuder Richardson ficaram entre 0,86 e 0

  12. Distribution Structures

    NARCIS (Netherlands)

    Friedrich, H.; Tavasszy, L.A.; Davydenko, I.

    2013-01-01

    Distribution structures are important elements of the freight transportation system. Goods are routed via warehouses on their way from production to consumption. This chapter discusses drivers behind these structures, logistics decisions connected to distribution structures on the micro level, and

  13. How GPs implement clinical guidelines in everyday clinical practice

    DEFF Research Database (Denmark)

    Videbæk Le, Jette; Hansen, Helle P; Riisgaard, Helle

    2015-01-01

    . Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. RESULTS: Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective......BACKGROUND: Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood....... OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form...

  14. Meet Clinical Trial Participants

    Science.gov (United States)

    ... page please turn JavaScript on. Feature: Clinical Trials Meet Clinical Trial Participants Past Issues / Fall 2016 Table ... Articles Clinical Trials, A Healthier Future for All / Meet Clinical Trial Participants / North Carolinians Volunteer for Knee ...

  15. Textbook of clinical trials

    National Research Council Canada - National Science Library

    Day, Simon; Machin, David; Green, Sylvan B

    2006-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 The Development of Clinical Trials Simon...

  16. Anomaly detection in clinical processes.

    Science.gov (United States)

    Huang, Zhengxing; Lu, Xudong; Duan, Huilong

    2012-01-01

    Meaningful anomalies in clinical processes may be related to caring performance or even the patient survival. It is imperative that the anomalies be timely detected such that useful and actionable knowledge of interest could be extracted to clinicians. Many previous approaches assume prior knowledge about the structure of clinical processes, using which anomalies are detected in a supervised manner. For a majority of clinical settings, however, clinical processes are complex, ad hoc, and even unknown a prior. In this paper, we investigate how to facilitate detection of anomalies in an unsupervised manner. An anomaly detection model is presented by applying a density-based clustering method on patient careflow logs. Using the learned model, it is possible to detect whether a particular patient careflow trace is anomalous with respect to normal traces in the logs. The approach has been validated over real data sets collected from a Chinese hospital.

  17. Testing of the preliminary OMERACT validation criteria for a biomarker to be regarded as reflecting structural damage endpoints in rheumatoid arthritis clinical trials: the example of C-reactive protein

    DEFF Research Database (Denmark)

    Keeling, Stephanie O; Landewe, Robert; van der Heijde, Desiree

    2007-01-01

    extensively studied in RA, was then used to test these criteria. Our objectives were: (1) To assess the strength of evidence in support of CRP as a soluble biomarker reflecting structural damage in RA according to the draft validation criteria. (2) To assess the strength of recommendation for inclusion...

  18. Graduate Program Organization in Clinical Veterinary Medicine.

    Science.gov (United States)

    Horne, R. D.

    1979-01-01

    Graduate training in clinical veterinary medicine is discussed. The options available to the student and problems that must be dealt with are presented, along with the requirements to accomplish a finely structured program that satisfies the needs of both the trainee and clinical veterinary medicine. (Author/MLW)

  19. Characteristics and Roles of Literacy Clinic Directors

    Science.gov (United States)

    Ortlieb, Evan; Pearce, Daniel L.

    2013-01-01

    A literacy clinic is an ideal setting where research and exploration often lead to breakthroughs in reading remediation; that information can then be transferred to classroom instruction (Morris, 2003). Although it is clear that literacy clinics should be structured around what works for their student populations, there remains ambiguity…

  20. Website Structure

    Science.gov (United States)

    Jackson, Larry S.

    2009-01-01

    This dissertation reports the results of an exploratory data analysis investigation of the relationship between the structures used for information organization and access and the associated storage structures within state government websites. Extending an earlier claim that hierarchical directory structures are both the preeminent information…

  1. Writing clinical scenarios for clinical science questions.

    Science.gov (United States)

    Smith, Phil Em; Mucklow, John C

    2016-04-01

    Written knowledge assessments for physicians in training typically involve multiple-choice questions that use a clinical scenario in a single-best-answer format. The Royal College of Physicians Part 1 MRCP(UK) examination includes basic sciences themes that are challenging to assess through a clinical scenario. A realistic clinical setting based on everyday clinical practice and integral to the question is the clearest demonstration that the knowledge being assessed is clinically relevant. However, without special attention to detail, the scenario in a clinical science question can appear redundant or artificial. Reading unnecessary material frustrates candidates and threatens the reputation of the assessment. In this paper we discuss why a clinical scenario is important for basic science questions and offer advice on setting realistic and plausible clinical scenarios for such questions. © 2016 Royal College of Physicians.

  2. Vcsel structure

    DEFF Research Database (Denmark)

    2015-01-01

    The invention relates to a VCSEL structure based on a novel grating reflector. The grating reflector comprises a grating layer with a contiguous core grating region having a grating structure, wherein an index of refraction of high-index sections of the grating structure is at least 2.5, and wher......The invention relates to a VCSEL structure based on a novel grating reflector. The grating reflector comprises a grating layer with a contiguous core grating region having a grating structure, wherein an index of refraction of high-index sections of the grating structure is at least 2...... the projection of the core grating region, the grating layer is also abutted by a second low-index layer and/or by air, an index of refraction of the second low-index layer or air being less than 2. The VCSEL structure furthermore comprises a first reflector and an active region for providing a cavity...

  3. Hypothyroidism in clinical practice

    Directory of Open Access Journals (Sweden)

    Faiza Qari

    2014-01-01

    Full Text Available Background: Hypothyroidism is the most common endocrine disease that was seen in the clinical practice especially for family physicians. Methods: This review article covered the important practical clinical issues for managing overt hypothyroidism, subclinical hypothyroidism and hypothyroidism during pregnancy. Conclusions: The clinical issues were addressed by clinical scenario followed by questions and stressed on the important clinical points.

  4. [Clinical question for psychosis.].

    Science.gov (United States)

    Apollon, W

    1984-01-01

    The analysis treatment of a psychotic individual presupposes a global problem focus on the causes of psychosis, its structure, its outbreak, and the stages in its development. Here, psychosis is viewed in its specifically psychic dimension, where Lacanian theory, to which the author adheres, places the cause of the sickness: (the "forclusion" of the names of the father). This formula indicates the absence of the paternal function. This lack originates in the fact that a dysfunction of the symbolic order in the family structure presides over the birth of a subject. The locating of the elements (the signifiers) of such symbolic dysfunction is essential because the delusion attempts to repair this defect in the representational order. Against this defect the subject first constructed imaginary assemblings which allow him a provisional articulation, satisfying for him, to others and to social reality. The outbreak of the psychosis results in the collapse of such imaginary scaffoldings. Then after a period of bewilderment and psychic retreat, all the effort of the psychotic is directed at the reconstitution of a new representational order. The work of the analysis consistants of attempting, on the basis of the signifiers put forward by the delusion, to assist the psychotic in his reconstitution of symbolic order. The delusion is the access road to this work in psychosis just as the dream is the royal road to the unconscious in the neurosis. The effort of this article is directed at situating these stages in the treatment of psychosis in their theorical and clinical foundations.

  5. Clinical engagement: improving healthcare together.

    Science.gov (United States)

    Riches, E; Robson, B

    2014-02-01

    Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

  6. Clinical Databases for Chest Physicians.

    Science.gov (United States)

    Courtwright, Andrew M; Gabriel, Peter E

    2018-01-10

    A clinical database is a repository of patient medical and sociodemographic information focused on one or more specific health condition or exposure. Although clinical databases may be used for research purposes, their primary goal is to collect and track patient data for quality improvement, quality assurance, and/or actual clinical management. This article aims to provide an introduction and practical advice on the development of small-scale clinical databases for chest physicians and practice groups. Through example projects, we discuss the pros and cons of available technical platforms, including Microsoft Excel and Access, relational database management systems such as Oracle and PostgreSQL, and Research Electronic Data Capture. We consider approaches to deciding the base unit of data collection, creating consensus around variable definitions, and structuring routine clinical care to complement database aims. We conclude with an overview of regulatory and security considerations for clinical databases. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  7. Determining the Most Robust Dimensional Structure of Categories from the International Classification of Functioning, Disability and Health Across Subgroups of Persons With Spinal Cord Injury to Build the Basis for Future Clinical Measures

    DEFF Research Database (Denmark)

    Ballert, Carolina S; Stucki, Gerold; Biering-Sørensen, Fin

    2014-01-01

    OBJECTIVE: To determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of lesion level, health care context, sex, age, and resources of the country. DESIGN......-sectional, multicentric study for the Development of ICF Core Sets for Spinal Cord Injury. PARTICIPANTS: Persons with SCI (N=1048) from the early postacute and long-term living context from 14 middle/low- and high-resource countries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Ratings of categories of the ICF...

  8. Fertility Clinic Success Rates

    Science.gov (United States)

    ... Defects ART and Autism 2013 Assisted Reproductive Technology Fertility Clinic Success Rates Report Recommend on Facebook Tweet ... Additional Information About ART in the United States. Fertility Clinic Tables Introduction to Fertility Clinic Tables [PDF - ...

  9. XML, Ontologies, and Their Clinical Applications.

    Science.gov (United States)

    Yu, Chunjiang; Shen, Bairong

    2016-01-01

    The development of information technology has resulted in its penetration into every area of clinical research. Various clinical systems have been developed, which produce increasing volumes of clinical data. However, saving, exchanging, querying, and exploiting these data are challenging issues. The development of Extensible Markup Language (XML) has allowed the generation of flexible information formats to facilitate the electronic sharing of structured data via networks, and it has been used widely for clinical data processing. In particular, XML is very useful in the fields of data standardization, data exchange, and data integration. Moreover, ontologies have been attracting increased attention in various clinical fields in recent years. An ontology is the basic level of a knowledge representation scheme, and various ontology repositories have been developed, such as Gene Ontology and BioPortal. The creation of these standardized repositories greatly facilitates clinical research in related fields. In this chapter, we discuss the basic concepts of XML and ontologies, as well as their clinical applications.

  10. Exploring Clinical Overview

    DEFF Research Database (Denmark)

    Fleron, Benedicte

    Clinical overview is explored at four emergency departments (EDs) during the introduction of a new IT system to support hereof. Important aspects of clinical overview are described for the clinical practice and for the further development of the IT system.......Clinical overview is explored at four emergency departments (EDs) during the introduction of a new IT system to support hereof. Important aspects of clinical overview are described for the clinical practice and for the further development of the IT system....

  11. The three-factor structure of the Levenson self-report psychopathy scale: fool's gold or true gold? A study in a sample of Italian adult non-clinical participants.

    Science.gov (United States)

    Somma, Antonella; Fossati, Andrea; Patrick, Christopher; Maffei, Cesare; Borroni, Serena

    2014-10-01

    The major aim of this study was to evaluate the factor structure of the Italian translation of the Levenson Self-Report Psychopathy Scale (LSRP) in a sample of 740 community dwelling adult participants. Hull method, minimum average partial analysis and quasi-inferential parallel analysis techniques were used to identify a three-factor solution that appeared broadly consistent with previous work. The three factors exhibited reliability coefficients >0.70, and the three-factor structure was adequately reproduced across gender, educational level and civil status strata (median congruence coefficients = 0.94, 0.93 and 0.95 respectively) and remained largely unchanged when the effect of participants' age was controlled for (median factor score correlation = 0.99). Although Factor 3 in our study was demarcated mainly by reverse-keyed items, the LSRP factors yielded meaningful relations with retrospective measures of antisocial behaviour in adolescence and HEXACO personality traits and were conceptually consistent with the triarchic model of psychopathy of Patrick, Fowles and Krueger (2009). Copyright © 2014 John Wiley & Sons, Ltd.

  12. [Implementation of clinical ethics consultation in German hospitals].

    Science.gov (United States)

    Schochow, M; May, A T; Schnell, D; Steger, F

    2014-10-01

    There have been different initiatives for the implementation of clinical ethics consultation during the past years. The present study surveys current data. A structured questionnaire was used. Of the 1,858 contacted hospitals throughout Germany 550 answered to that questionnaire (return rate 29,6 %). The survey took place between September 2013 and January 2014. The clinical ethics committee is the mostly implemented structure of clinical ethics consultation. Recommendations to implement those structures (ZEKO 2006, AEM 2010) show less influence than the legally binding standard (HKHG 2011). Structures of clinical ethics consultation are respected as instrument to solving ethical conflicts in clinical routines. Establishing ethics consultation should be promoted. Preferably appropriate legal rules for the implementation of clinical ethics consultation should be developed further as well as their structural framing. © Georg Thieme Verlag KG Stuttgart · New York.

  13. [Clinical aspects of witchcraft delusions].

    Science.gov (United States)

    Pashkovskiĭ, V E

    2005-01-01

    To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.

  14. Patient records and clinical overview

    DEFF Research Database (Denmark)

    Jensen, Lotte Groth

    will be to investigate the creation of overview in daily clinical practice among physicians and analyse the processes involved in this creation. The primary focus will be on practice and the work that is accomplished in daily clinical practice among physicians at hospitals. By this focus, the dissertation will render....... The theoretical framework for the dissertation is primarily constituted by Actor-network Theory, Narrative Theory and the theory about Distributed Cognition. Among other things, Actor-Network Theory introduces a focus on materiality and contingency, Narrative Theory provides an understanding of the structures...... in the overview interface. This mistrust is very much correlated with an underlying discussion of standardisation of documentation practice and the importance of understanding how different parts of the EPR system are connected. If the goal is to support the creation of clinical overview among physicians...

  15. Differentiating 'clinical' and 'non-clinical' depression.

    Science.gov (United States)

    Parker, G; Paterson, A

    2015-06-01

    There has been increasing concern about extensions to the definition of 'clinical' depression, but little evident investigation as to how clinical and non-clinical depressive states might best be differentiated. This review considers the potential of many candidate symptom and non-symptom parameters. We overview representative concerns and theories about the nature of psychiatric disorders before reviewing the potential utility of candidate parameters for differentiating clinical and non-clinical depressive states. While we detail limitations to all candidate parameters designed to distinguish between clinical and non-clinical depression, their actual utility may only be able to be judged by empirical testing across appropriate comparison groups. We argue for initial comparisons being made between prototypically defined categorical (i.e. psychotic, melancholic and bipolar) depressive disease states and residual non-melancholic clinical depressive states, before considering how each of those two clinical subsets might differ from non-clinical depressive mood states. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Future requirements. Clinical investigations

    DEFF Research Database (Denmark)

    Qvist, V.

    2002-01-01

    Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics......Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics...

  17. [Clinical Management: Basics and organization].

    Science.gov (United States)

    Torres, Juan; Mingo, Carlos

    2015-01-01

    Many strategies have been proposed over the last years to ensure the Health Care System sustainability, mainly after the recent global economic crisis. One of the most attractive approaches is clinical management, which is a way of organizing health care units based on active participation of professionals who receive the transference of responsibilities dispoto achieve the objectives with the mission of ensuring a proper patient centered care, taking into consideration the rational use of resources (Efficiency) For the start up of Health Care structures based on clinical management, it is necessary a previous management culture within the departments involved and the center's executive board. Furthermore, to achieve the objectives proposed various tools must be used, such as evidence based medicine, clinical practice variability analysis, process management, in addition of quality and safety strategies. The units involved have to propose a management plan that will result in a management contract with the center's executive board. This agreement will establish some activity, expense and quality objectives that will be quantifiable through various indicators. Risk transference to the unit must include certain budget allocation and incentive decision capacity. Clinical management must not be employed as a savings tool from the part of macro and meso management. There is not a health care structure based on clinical management that have a general character for all health care organizations, existing a great variability in the adoption of various organizational formulas, so that every center must perform its own analysis and decide the most adequate model. In our country there are many clinical management experiences, although there is a long way to go.

  18. How essential are unstructured clinical narratives and information fusion to clinical trial recruitment?

    Science.gov (United States)

    Raghavan, Preethi; Chen, James L; Fosler-Lussier, Eric; Lai, Albert M

    2014-01-01

    Electronic health records capture patient information using structured controlled vocabularies and unstructured narrative text. While structured data typically encodes lab values, encounters and medication lists, unstructured data captures the physician's interpretation of the patient's condition, prognosis, and response to therapeutic intervention. In this paper, we demonstrate that information extraction from unstructured clinical narratives is essential to most clinical applications. We perform an empirical study to validate the argument and show that structured data alone is insufficient in resolving eligibility criteria for recruiting patients onto clinical trials for chronic lymphocytic leukemia (CLL) and prostate cancer. Unstructured data is essential to solving 59% of the CLL trial criteria and 77% of the prostate cancer trial criteria. More specifically, for resolving eligibility criteria with temporal constraints, we show the need for temporal reasoning and information integration with medical events within and across unstructured clinical narratives and structured data.

  19. Protein Structure

    Science.gov (United States)

    Asmus, Elaine Garbarino

    2007-01-01

    Individual students model specific amino acids and then, through dehydration synthesis, a class of students models a protein. The students clearly learn amino acid structure, primary, secondary, tertiary, and quaternary structure in proteins and the nature of the bonds maintaining a protein's shape. This activity is fun, concrete, inexpensive and…

  20. STRUCTURAL MODELLING

    Directory of Open Access Journals (Sweden)

    Tea Ya. Danelyan

    2014-01-01

    Full Text Available The article states the general principles of structural modeling in aspect of the theory of systems and gives the interrelation with other types of modeling to adjust them to the main directions of modeling. Mathematical methods of structural modeling, in particular method of expert evaluations are considered.

  1. Anatomo-clinical overlapping maps (AnaCOM): a new method to create anatomo-functional maps from neuropsychological tests and structural MRI scan of subjects with brain lesions

    Science.gov (United States)

    Kinkingnehun, Serge R. J.; du Boisgueheneuc, Foucaud; Golmard, Jean-Louis; Zhang, Sandy X.; Levy, Richard; Dubois, Bruno

    2004-04-01

    We have developed a new technique to analyze correlations between brain anatomy and its neurological functions. The technique is based on the anatomic MRI of patients with brain lesions who are administered neuropsychological tests. Brain lesions of the MRI scans are first manually segmented. The MRI volumes are then normalized to a reference map, using the segmented area as a mask. After normalization, the brain lesions of the MRI are segmented again in order to redefine the border of the lesions in the context of the normalized brain. Once the MRI is segmented, the patient's score on the neuropsychological test is assigned to each voxel in the lesioned area, while the rest of the voxels of the image are set to 0. Subsequently, the individual patient's MRI images are superimposed, and each voxel is reassigned the average score of the patients who have a lesion at that voxel. A threshold is applied to remove regions having less than three overlaps. This process leads to an anatomo-functional map that links brain areas to functional loss. Other maps can be created to aid in analyzing the functional maps, such as one that indicates the 95% confidence interval of the averaged scores for each area. This anatomo-clinical overlapping map (AnaCOM) method was used to obtain functional maps from patients with lesions in the superior frontal gyrus. By finding particular subregions more responsible for a particular deficit, this method can generate new hypotheses to be tested by conventional group methods.

  2. Building structures

    CERN Document Server

    Ambrose, James

    2011-01-01

    James Ambrose is Editor of the Parker/Ambrose Series of Simplified Design Guides. He practiced as an architect in California and Illinois and as a structural engineer in Illinois. He was a professor of architecture at the University of Southern California. Patrick Tripeny is an Associate Professor, former director of the School of Architecture, and the current Director of the Center for Teaching and Learning Excellence at the University of Utah. He is a licensed architect in California. He has been the recipient of a number of teaching awards at the local and national level for his work in teaching structures and design. With James Ambrose, he is the coauthor of Simplified Engineering for Architects and Builders, Eleventh Edition; Simplified Design of Steel Structures, Eighth Edition; Simplified Design of Concrete Structures, Eighth Edition; and Simplified Design of Wood Structures, Sixth Edition, all published by Wiley.

  3. Structural Behaviour of Reciprocal Structures

    DEFF Research Database (Denmark)

    Parigi, Dario; Kirkegaard, Poul Henning

    2013-01-01

    The present paper focuses on the comparison of several two-dimensional and three-dimensional reciprocal configurations. The goal of such comparison is to analyse the structural behaviour when changing the geometric parameters used to describe the geometry of reciprocal structures.......The present paper focuses on the comparison of several two-dimensional and three-dimensional reciprocal configurations. The goal of such comparison is to analyse the structural behaviour when changing the geometric parameters used to describe the geometry of reciprocal structures....

  4. Clinical learning spaces: Crucibles for practice development in physiotherapy clinical education.

    Science.gov (United States)

    Patton, Narelle; Higgs, Joy; Smith, Megan

    2018-01-10

    This paper, through a deep examination of clinical workplaces as learning spaces, uses a holistic interpretation of clinical education and offers a practice development crucible metaphor as a useful way to deepen how clinical education can be conceptualized. An in-depth conceptualization of clinical education is needed if educators are able to develop wise educational practice and optimize the time students spend in clinical learning settings. The research reported here was undertaken in the qualitative paradigm guided by philosophical hermeneutics. Data collection strategies included observation, semi-structured interviews, focus groups and photo-elicitation. Twenty-four undergraduate physiotherapy students and twelve physiotherapy clinical supervisors participated in this research. Consistent with hermeneutic principles of dialogue of question and answer and hermeneutic circle, data analysis was achieved through an iterative process of reading, interpreting and re-reading the transcripts resulting in the emergence of a deeper understanding of clinical education that is represented for the reader. Clinical education has been revealed as a multidimensional learning space where workplace influences, engagement in professional practices, clinical supervisors' intentions and actions in combination with students' dispositions interact to shape and challenge students' clinical learning. A practice development crucible metaphor has been introduced as a way to represent this complexity and conceptualize clinical education, not as a set of techniques or supervision ratios but as a relational, fluid, complex space where learning is catalyzed. Importantly, the crucible metaphor assists academics, clinical supervisors and students to harness the power of clinical education to facilitate learning during clinical placements.

  5. Clinical supervisors and cultural competence.

    Science.gov (United States)

    Berger, Gabriella; Conroy, Sheree; Peerson, Anita; Brazil, Victoria

    2014-08-01

    To investigate how clinical supervisors of junior doctors provide feedback and assessment on cultural competence, one of several professionalism skills outlined in the Australian Curriculum Framework for Junior Doctors. Twenty clinical supervisors were recruited to a qualitative study in a regional hospital in Queensland, Australia. Data from semi-structured interviews (June-August 2011) were thematically analysed. Interviews revealed that cultural competence was interpreted by the supervising clinicians as a vague concept, and that junior doctors were not assessed in this area. Additional themes related to the cultural competence of junior doctors, as reported by their supervisors, included: limited direct supervision of, and feedback to, junior doctors; variations in approaches to assessment; clinicians' communication focuses on clinical aspects of disease process; perceived lack of cultural diversity among staff and patients; acceptance of laypersons as English interpreters; language barriers with international medical graduates; and patients' low levels of health literacy. Supervisors were unable to define cultural competence in ways that enable them to apply the concept to clinical training for junior doctors. Specific training in cultural competence, and guidelines for its assessment, is therefore recommended for clinical supervisors and junior doctors to improve their approaches to patient care and health outcomes. © 2014 John Wiley & Sons Ltd.

  6. Clinical excellence in cardiology.

    Science.gov (United States)

    Ziegelstein, Roy C

    2011-08-15

    A recent study identified 7 domains of clinical excellence on the basis of interviews with "clinically excellent" physicians at academic institutions in the United States: (1) communication and interpersonal skills, (2) professionalism and humanism, (3) diagnostic acumen, (4) skillful negotiation of the health care system, (5) knowledge, (6) taking a scholarly approach to clinical practice, and (7) having passion for clinical medicine. What constitutes clinical excellence in cardiology has not previously been defined. The author discusses clinical excellence in cardiology using the framework of these 7 domains and also considers the additional domain of clinical experience. Specific aspects of the domains of clinical excellence that are of greatest relevance to cardiology are highlighted. In conclusion, this discussion characterizes what constitutes clinical excellence in cardiology and should stimulate additional discussion of the topic and an examination of how the domains of clinical excellence in cardiology are related to specific patient outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical Studies NHLBI Trials Clinical Trial Websites ...

  8. Discovery of a Clinical Stage Multi Kinase Inhibitor Sodium (E)-2-{2-Methoxy-5-[(2′, 4′, 6′-trimethoxystyrylsulfonyl)methyl]phenylamino}acetate (ON 01910.Na): Synthesis, Structure Activity Relationship and Biological Activity

    Science.gov (United States)

    Reddy, M.V. Ramana; Venkatapuram, Padmavathi; Mallireddigari, Muralidhar R; Pallela, Venkat R; Cosenza, Stephen C; Robell, Kimberly A; Akula, Balaiah; Hoffman, Benjamin S; Reddy, E. Premkumar

    2011-01-01

    Cyclin D proteins are elevated in many cancer cells and targeted deletion of Cyclin D1 gene in the mammary tissues protects mice from breast cancer. Accordingly, there is an increasing awareness of this novel non-enzymatic target for cancer therapeutics. We have developed novel, non-alkylating styryl benzyl sulfones that induce cell death in wide variety of cancer cells without affecting the proliferation and survival of normal cells. The development of derivatized Styryl Benzyl Sulfones followed logically from a tumor cell cytotoxicity screen performed in our laboratory that did not have an a priori target profile. Modifications of some of the precursor molecules led to lead optimization with regard to tumor cell cytotoxicity. In this report we describe the synthesis and structure-activity relationships of novel, non-alkylating (E) styryl benzyl sulfones, and the development of the novel anti-cancer agent sodium (E)-2-{2-methoxy-5-[(2′,4′,6′-trimethoxystyrylsulfonyl)methyl]phenylamino}-acetate (ON 01910.Na), which is in Phase III trials for myelodysplastic syndromes (MDS) associated with aberrant expression of cyclin D proteins. PMID:21812421

  9. Lasers in clinical ophthalmology

    Science.gov (United States)

    Ribeiro, Paulo A.

    1992-03-01

    The clinical application of lasers in ophthalmology is schematized, showing for each anatomic eye structure, pathologies that may be treated through this procedure. In the cornea, the unusual laser practice for suture removals and the promising possibility of the excimer laser in refractive surgery are discussed. In the iris, the camerular angle, and the ciliary body, the laser application is essentially used to treat the glaucoma and other situations that are not so frequent. The capsulotomy with YAG LASER is used in the treatment of structures related with crystalline and, at least, the treatment of the retina and choroid pathology is expanded. A. A. explained the primordial interest and important of laser in the diabetic retinopathy treatment and some results in patients with more than 5 years of evolution are: 55 of the patients with proliferative diabetic retinopathy (RDP) treated for more than 5 years noticed their vision improved or stabilized; 5 years after treating patients with PDR, 49.3 had their vision stabilized or even improved, provided the diabetics had declared itself more than 20 years ago, versus 61.7 provided the diabetics had declared itself less than 20 years before; finally, 53.8 of the patients under 40-years-old when the diabetics was diagnosed, had their vision improved or at least stabilized 5 years after the beginning of the treatment. On the other side, when patients were over 40 years old when the diabetics was diagnosed percentage increased to 55.9. This study was established in the follow-up of 149 cases over 10 years.

  10. Organizational structure

    NARCIS (Netherlands)

    Hendriks, P.H.J.

    2011-01-01

    For many decades, organization scientists have paid considerable attention to the link between knowledge and organization structure. An early contributor to these discussions was Max Weber (1922), who elaborated his concepts of professional bureaucracy. History shows a multitude of other

  11. Hydraulic Structures

    Data.gov (United States)

    Department of Homeland Security — This table is required whenever hydraulic structures are shown in the flood profile. It is also required if levees are shown on the FIRM, channels containing the...

  12. Hydraulic structures

    CERN Document Server

    Chen, Sheng-Hong

    2015-01-01

    This book discusses in detail the planning, design, construction and management of hydraulic structures, covering dams, spillways, tunnels, cut slopes, sluices, water intake and measuring works, ship locks and lifts, as well as fish ways. Particular attention is paid to considerations concerning the environment, hydrology, geology and materials etc. in the planning and design of hydraulic projects. It also considers the type selection, profile configuration, stress/stability calibration and engineering countermeasures, flood releasing arrangements and scouring protection, operation and maintenance etc. for a variety of specific hydraulic structures. The book is primarily intended for engineers, unde