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Sample records for 3-year clinical evaluation

  1. Development and implementation of the Clinical Tooth Shade Differentiation Course – an evaluation over 3 years

    PubMed Central

    Olms, Constanze; Haak, Rainer; Jakstat, Holger A.

    2016-01-01

    Objective: Tooth shade differentiation concerns the identification and classification of tooth shades. The objective of this project was to implement the Clinical Tooth Shade Differentiation Course in the preclinical stage of studies and to evaluate the students' perspective over a period of 3 years. Methodology: The course is planned for a duration of 10 weeks with two 45-minute sessions per semester week. The entire attendance time was 10:15 h. 2 lectures of 90 minutes each, 2 seminars of 60 min each and 2 teaching units with the phantom head and role playing took place. In addition to the various parameters of tooth shade, changes in tooth shade and the basics of dental esthetics, clinical procedures for manual and digital tooth shade determination were explained and practiced. 96% (69 of 72) of the students participated in the first evaluation in 2012/2013 (T1), and 68% of these were women. In the following year, 2013/2014 (T2), 92% (45 of 48 students) took part; 62% of these were women and 38% men. The 2014/2015 evaluation (T3) comprised 94% (45 of 48 students). Of these, 67% were women. Results: In the evaluation, the students gave the course a positive grade. The questions in "General/Organization" were given a mean (M) of 1.5 (SD=0.7) in T1 and T2 , and 1.2 (SD=0.3) in T3. The "Overall Assessment" yielded MT1=1.6 (SD=0.6), MT2=1.5 (SD=0.5) and MT3=1.1 (SD=0.3). In T1 and T2, the item "The instructor actively involved the students in the course" was given a mean of 2.1 (SD=0.9), and in T3 a mean of 1.2 (SD=0.5). Conclusions: The course presented here conceptually shows how practical dental skills can be taught in a theoretical and clinical context. Educational objectives from the role of a dental expert were taken from the national competence-based catalog of educational objectives for dentistry and can also be supplemented. The objectives can be transferred to other dental faculties. PMID:26958650

  2. A 3-year randomized clinical trial evaluating two different bonded posterior restorations: Amalgam versus resin composite

    PubMed Central

    Kemaloglu, Hande; Pamir, Tijen; Tezel, Huseyin

    2016-01-01

    Objective: To compare the performance and postoperative sensitivity of a posterior resin composite with that of bonded amalgam in 40 (n = 20) large sized cavities and to evaluate whether resin composite could be an alternative for bonded amalgam. Materials and Methods: This was a randomized clinical trial. Twenty patients in need of at least two posterior restorations were recruited. Authors randomly assigned one half of the restorations to receive bonded amalgam and the other half to composite restorations. Forty bonded amalgams (n = 20) and composites (n = 20) were evaluated for their performance on modified-US Public Health Service criteria and postoperative sensitivity using visual analogue scale (VAS) for 36-months. Results: Success rate of this study was 100%. First clinical alterations were rated as Bravo after 1 year in marginal discoloration, marginal adaptation, anatomical form, and surface roughness for both amalgam and composite. At the 3rd year, overall “Bravo” rated restorations were 12 for bonded amalgam and 13 for resin composites. There were no significant differences among the VAS scores of composites and bonded amalgams for all periods (P > 0.05) except for the comparisons at the 3rd year evaluation (P < 0.05). Conclusions: Within the limitation of this study, both resin composite and bonded amalgam were clinically acceptable. Postoperative sensitivity results tend to decrease more in composite restorations rather than amalgams. Therefore, it was concluded that posterior resin composite can be used even in large sized cavities. PMID:27011734

  3. Clinical evaluation of the marginal gingiva as a donor tissue to augment the width of keratinized gingiva: Series of 2 cases with 3-year follow-up

    PubMed Central

    Khanuja, Palka Kaur; Sharma, R. K.; Tewari, Shikha; Narula, S. C.

    2015-01-01

    The indications to increase the width of keratinized gingiva have not been proven beyond doubt; however it becomes indispensable in certain clinical situations. Inspite of frequently encountered complications, palate is considered most preferred area to harvest the free gingival graft (FGG). This procedure aimed at investigating the potential of buccal marginal gingiva as a donor to augment keratinized gingiva. To the best of our knowledge, no such cases have been documented in the literature. FGG harvested from maxillary buccal marginal gingiva was used to augment gingiva in the mandibular anterior region for two patients. This not only improved plaque control but also resulted in acceptable esthetic results over 3 years. Furthermore, gingiva at donor sites gained its normal form and was in harmony with the neighboring teeth. It may be concluded that buccal marginal gingiva may provide a predictable substitute to other donor tissues to augment gingiva. PMID:25821366

  4. Clinical evaluation of 860 anterior and posterior lithium disilicate restorations: retrospective study with a mean follow-up of 3 years and a maximum observational period of 6 years.

    PubMed

    Fabbri, Giacomo; Zarone, Fernando; Dellificorelli, Gianluca; Cannistraro, Giorgio; De Lorenzi, Marco; Mosca, Alberto; Sorrentino, Roberto

    2014-01-01

    This study aimed to assess the clinical performance of lithium disilicate restorations supported by natural teeth or implants. Eight hundred sixty lithium disilicate adhesive restorations, including crowns on natural teeth and implant abutments, veneers, and onlays, were made in 312 patients. Parafunctional patients were included, but subjects with uncontrolled periodontitis and gingival inflammation were excluded. Veneers up to 0.5 mm thick were luted with flowable composite resin or light curing cements, while dual-curing composite systems were used with veneers up to 0.8 mm thick. Onlays up to 2 mm in thickness were luted with flowable composite resins or dual-curing composite cements. Crowns up to 1 mm in thickness were cemented with self-adhesive or dual-curing resin cements. The observational period ranged from 12 to 72 months, with a mean follow-up of 3 years. The mechanical and esthetic outcomes of the restorations were evaluated according to the modified California Dental Association (CDA) criteria. Data were analyzed with descriptive statistics. Twenty-six mechanical complications were observed: 17 porcelain chippings, 5 fractures, and 4 losses of retention. Structural drawbacks occurred mainly in posterior segments, and monolithic restorations showed the lowest number of mechanical complications. The clinical ratings of the successful restorations, both monolithic and layered, were satisfactory according to the modified CDA criteria for color match, porcelain surface, and marginal integrity. The cumulative survival rates of lithium disilicate restorations ranged from 95.46% to 100%, while cumulative success rates ranged from 95.39% to 100%. All restorations recorded very high survival and success rates. The use of lithium disilicate restorations in fixed prosthodontics proved to be effective and reliable in the short- and medium-term.

  5. Caries preventive effects of toothpastes containing monofluorophosphate and trimetaphosphate: a 3-year clinical trial.

    PubMed

    Andlaw, R J; Palmer, J D; King, J; Kneebone, S B

    1983-06-01

    The caries-preventive effects of two toothpastes were tested in a 3-year clinical trial involving 1319 children aged 11-13 years. The test toothpastes were: 1) a low abrasion paste containing 0.8% sodium monofluorophosphate (MFP), and 2) a paste containing 3% sodium trimetaphosphate (TMP). The control toothpaste was a conventional, moderately abrasive paste containing 0.8% sodium monofluorophosphate. The children were examined clinically and radiologically each year. Toothpaste was supplied to the children's homes, and its use was unsupervised. Caries increments after 3 years, in terms of DMF teeth and DMF surfaces, showed no significant differences between the MFP test group (444 children) and the MFP control group (450 children). However, the TMP test group (425 children) had significantly higher caries increments than the MFP control group. All three groups of children showed some improvement in oral hygiene and in gingival health, but there were no significant differences between the groups. PMID:6342928

  6. Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

    PubMed Central

    Choi, Byoung Geol; Park, Taeshik; Choi, Se Yeon; Byun, Jae Kyeong; Shim, Min Suk; Xu, Shaopeng; Li, Hu; Park, Sang-Ho; Park, Ji Young; Choi, Woong Gil; Cho, Yun-Hyeong; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo

    2016-01-01

    Background and Objectives Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. Subjects and Methods A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. Results There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). Conclusion Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina. PMID:27721853

  7. The effect of sodium trimetaphosphate on caries: a 3-year clinical toothpaste trial.

    PubMed

    Städtler, P; Müller-Bruckschwaiger, K; Schäfer, F; Huntington, E

    1996-01-01

    The objective of this study was to assess the anticaries efficacy of a toothpaste containing 3% sodium trimetaphosphate (TMP; test) relative to a toothpaste containing no caries-preventive agent (control). The study was designed as a 3-year double-blind caries incidence study involving about 2,500 subjects aged 11 years at baseline. After a clinical examination, subjects were stratified by sex, presence of supragingival calculus and caries status and randomly assigned to either the control or the test group. Clinical examinations then took place at annual intervals. At baseline and at the final examination bite-wing radiographs were taken of subjects not radiographed within the previous 6 months. The change in caries between baseline and the 3-year examination was calculated as DMFS increments. The results showed a statistically significant difference of 8% between the test and control groups (p < 0.05). In subjects brushing twice daily the difference between the test and control group was 11% (p < 0.01). It is concluded that, when used regularly, a toothpaste containing 3% TMP will be effective against caries. PMID:8946103

  8. Community vs. Clinic-based modular treatment of children with early-onset ODD or CD: A clinical trial with 3-year follow-up

    PubMed Central

    Kolko, David J.; Bukstein, Oscar G.; Padini, Dustin; Holden, Elizabeth A.; Hart, Jonathan; Dorn, Lorah D.

    2016-01-01

    This study examines the treatment outcomes of 144, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders. PMID:19221871

  9. Maxillary Overdentures Supported by Four Splinted Direct Metal Laser Sintering Implants: A 3-Year Prospective Clinical Study

    PubMed Central

    Mangano, Francesco; Shibli, Jamil Awad; Anil, Sukumaran

    2014-01-01

    Purpose. Nowadays, the advancements in direct metal laser sintering (DMLS) technology allow the fabrication of titanium dental implants. The aim of this study was to evaluate implant survival, complications, and peri-implant marginal bone loss of DMLS implants used to support bar-retained maxillary overdentures. Materials and Methods. Over a 2-year period, 120 implants were placed in the maxilla of 30 patients (18 males, 12 females) to support bar-retained maxillary overdentures (ODs). Each OD was supported by 4 implants splinted by a rigid cobalt-chrome bar. At each annual follow-up session, clinical and radiographic parameters were assessed. The outcome measures were implant failure, biological and prosthetic complications, and peri-implant marginal bone loss (distance between the implant shoulder and the first visible bone-to-implant contact, DIB). Results. The 3-year implant survival rate was 97.4% (implant-based) and 92.9% (patient-based). Three implants failed. The incidence of biological complication was 3.5% (implant-based) and 7.1% (patient-based). The incidence of prosthetic complication was 17.8% (patient-based). No detrimental effects on marginal bone level were evidenced. Conclusions. The use of 4 DMLS titanium implants to support bar-retained maxillary ODs seems to represent a safe and successful procedure. Long-term clinical studies on a larger sample of patients are needed to confirm these results. PMID:25580124

  10. Reforming the Israeli health system: findings of a 3-year evaluation.

    PubMed

    Gross, R; Rosen, B; Shirom, A

    2001-04-01

    Israel, like many other European countries, has recently reformed its health care system. The regulated market created by the National Health Insurance (NHI) law embodies many of the principles of managed competition. The purpose of this paper is to present initial findings from an evaluation of the first 3 years of the reform (1995-1997) regarding the implementation of the reform and the extent to which it has achieved its main goals. The evaluation was conducted using multiple quantitative and qualitative research tools: interviews with key informants; analysis of documents and sick fund financial statements; analysis of trends in sick fund membership; and population surveys conducted in 1995 and 1997 to assess the impact of the reform on outcome measures related to level of services to the public. Data from the evaluation show that the NHI law achieved a considerable number of its goals: to provide insurance coverage for the entire population, to ensure freedom of movement among sick funds, and to standardize the way resources are allocated to sick funds. The incentives that are embodied in the law have encouraged the sick funds to improve the level of services provided to the average insuree, and to develop services in the periphery and for some of the weaker populations. From the financial perspective, concerns that NHI would lead to a rise in the national health expenditure were not realized as of 1997. In the wake of NHI, there has been a decline in the age adjusted per capita expenditure in three sick funds, with no reports by insurees, at least through 1997, on a decline in satisfaction or level of service. However, the Israeli experience shows that regulating competition does not necessarily lead to economic stability and equality. Regulating the competition also did not solve some of the major policy issues in the Israeli health system including level of resources allocated to health, organizational structure of the hospital system, manpower planning and

  11. Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience.

    PubMed

    Wright, Scott M; Kravet, Steven; Christmas, Colleen; Burkhart, Kathleen; Durso, Samuel C

    2010-12-01

    Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives. PMID:20978424

  12. Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience.

    PubMed

    Wright, Scott M; Kravet, Steven; Christmas, Colleen; Burkhart, Kathleen; Durso, Samuel C

    2010-12-01

    Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives.

  13. The 3-Year Clinical and Functional Course of Schizophrenia Among Individuals With and Without Diabetes at Study Entry

    PubMed Central

    Ascher-Svanum, Haya; Zhu, Baojin; Ernst, Frank R.; Faries, Douglas E.; Jacobson, Jennie G.; Doebbeling, Caroline C.

    2007-01-01

    Objective: This prospective observational study compared the 3-year clinical and functional course of schizophrenia among individuals with and without diabetes at study entry. Method: Data were drawn from a large, 3-year, multisite, prospective, naturalistic study of treatment for schizophrenia-related disorders. The study was conducted in the United States between July 1997 and September 2003 and represented treatment practices in diverse systems of care. Participants were diagnosed with schizophrenia or schizoaffective or schizophreniform disorders based on DSM-IV criteria. Clinical and functional outcomes were assessed at study enrollment and at 12-month intervals using standard psychiatric measures, medical records, and a validated patient-reported questionnaire. Diabetes status was determined by participant interview at enrollment. Statistical analyses used mixed models with repeated measures. Results: Of 594 participants queried about comorbid medical conditions at enrollment, 76 (12.8%) reported having diabetes. Other comor-bid conditions were reported by 79% of the diabetes group (N = 60) and 50% of the nondiabetes group (N = 259). Across the 3-year study, participants with diabetes differed significantly from participants without diabetes on 2 of 36 outcome measures: more contacts with nonpsychiatrist physicians (p < .001) and poorer physical health (p = .015). Groups did not differ significantly on mental health symptomatology, mental health resource utilization, legal and safety issues, substance use, productivity, activities and relationships, or quality of life. Conclusions: In this 3-year, prospective, naturalistic study, the course of schizophrenia did not differ significantly between participants with and without diabetes, although persons with diabetes did have poorer physical health and more contacts with nonpsychiatrist physicians. Findings highlight the need for better medical treatment for people with schizophrenia, both with and without

  14. Radiological evaluation of the Cresco system in combination with Osseospeed implants: a preliminary 3-year report

    PubMed Central

    BALDINI, N.; DE SANCTIS, M.; CAGIDIACO, M.C.; BALLERI, P.; VIGNOLETTI, F.; GORACCI, C.; FERRARI, M.

    2014-01-01

    SUMMARY Aim. In this preliminary study, the 3-year radiological outcomes of Osseospeed implant-supported fixed complete or partial prostheses made with two different laboratory protocols were compared. Methods. A convenience sample of 34 patients, who were either partially or completely edentulous in either jaw, were randomly assigned to two groups, of 17 patients each, using either a traditional laboratory protocol (control group) or the Cresco one (test group). The study’s objective was an assessment of marginal bone loss around implants, measured on intraoral radiographs at 3-year follow-up. Results. None of the implants inserted was lost during the study and radiological measurements of marginal bone level changes revealed that the mean marginal bone loss was respectively 0,73±0,33mm for test group and 0,88±1,13mm for control group. The differences between test and control groups were not statistically significant. Conclusion. This preliminary study did not demonstrate statistically significant differences in marginal bone loss around implant-prostheses prepared with the two different laboratory protocols, over the 3-year observational period. PMID:25694796

  15. Urinary interleukin-6 as a predictor of radiographic progression in rheumatoid arthritis: A 3-year evaluation

    PubMed Central

    Park, Yune-Jung; Yoo, Seung-Ah; Kim, Ga-Ram; Cho, Chul-Soo; Kim, Wan-Uk

    2016-01-01

    Previously, we demonstrated that the urine proteome signature of patients with rheumatoid arthritis (RA) reflects inflammation-related cellular processes. Here, we measured interleukin (IL)-6, IL-8, and chemokine ligand 2 (CCL2) concentrations in the urine of RA patients and prospectively investigated their role in predicting RA activity and prognosis. One hundred seventy-three RA patients and 62 non-RA controls were recruited. Urinary IL-6, CCL2, and IL-8 levels were elevated in RA patients and correlated well with disease activity. Urinary IL-6 level at presentation was an independent risk factor of radiographic progression at 1 and 3 years. High urinary IL-6 level increased the risk ratio of radiographic progression by 2.9-fold, which was comparable to high serum CRP. Moreover, combination of urinary IL-6 and serum CRP measures synergistically increased the predictability of radiographic progression. In a subgroup with normal ESR, patients with the highest tertile of urinary IL-6 were at 6.4-fold greater risk of radiographic progression. Conclusively, high urinary IL-6 level at presentation is an independent risk factor for radiographic progression of RA, reflecting disease activity. Urinary IL-6 in combination with serum CRP may be a useful parameter for estimating RA prognosis. PMID:27731382

  16. Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala

    PubMed Central

    Arnold, Benjamin; Arana, Byron; Mäusezahl, Daniel; Hubbard, Alan; Colford, John M

    2009-01-01

    Background The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities. Methods We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age. Results The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02–0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth. Conclusions To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials. PMID:19574492

  17. IQ Trajectory, Cognitive Reserve, and Clinical Outcome Following a First Episode of Psychosis: A 3-Year Longitudinal Study

    PubMed Central

    Leeson, Verity C.; Sharma, Pranev; Harrison, Masuma; Ron, Maria A.; Barnes, Thomas R. E.; Joyce, Eileen M.

    2011-01-01

    Comparison of current and estimated premorbid IQ in schizophrenia suggests that there are subgroups with low IQ, deteriorated IQ (DIQ), or preserved IQ and that this is established by psychosis onset. There are no controlled studies examining the trajectory of these IQ subgroups longitudinally or their relationship with clinical and social outcomes. Of 129 individuals with first-episode schizophrenia or schizoaffective disorder, 25% showed stable low IQ, 31% showed stable IQ in the average/high range, and 44% demonstrated intellectual deterioration by 10 points or more. Patients in the low and deteriorated groups were equally impaired on tests of memory and executive function compared with the preserved average/high-IQ group and controls and showed more negative and disorganization symptoms than the preserved average/high-IQ group. Sixty patients and 27 controls were assessed again 1 and 3 years later. There was no evidence that those with IQ deterioration at baseline continued on a declining cognitive trajectory or that those with preserved average/high IQ experienced subsequent IQ decline. The low IQ group showed no change in IQ, whereas both the DIQ and the preserved IQ groups improved. However, the rate of improvement of these 2 subgroups was no greater than that of the healthy controls, suggesting that this reflected practice effects. Both the low and the deteriorated groups had longer index admissions, more core negative symptoms, and worse occupational outcomes at 3 years. These data suggest that following psychosis onset, IQ is stable and that it is IQ at psychosis onset rather than premorbid IQ predicts a more severe illness. PMID:19934212

  18. IQ trajectory, cognitive reserve, and clinical outcome following a first episode of psychosis: a 3-year longitudinal study.

    PubMed

    Leeson, Verity C; Sharma, Pranev; Harrison, Masuma; Ron, Maria A; Barnes, Thomas R E; Joyce, Eileen M

    2011-07-01

    Comparison of current and estimated premorbid IQ in schizophrenia suggests that there are subgroups with low IQ, deteriorated IQ (DIQ), or preserved IQ and that this is established by psychosis onset. There are no controlled studies examining the trajectory of these IQ subgroups longitudinally or their relationship with clinical and social outcomes. Of 129 individuals with first-episode schizophrenia or schizoaffective disorder, 25% showed stable low IQ, 31% showed stable IQ in the average/high range, and 44% demonstrated intellectual deterioration by 10 points or more. Patients in the low and deteriorated groups were equally impaired on tests of memory and executive function compared with the preserved average/high-IQ group and controls and showed more negative and disorganization symptoms than the preserved average/high-IQ group. Sixty patients and 27 controls were assessed again 1 and 3 years later. There was no evidence that those with IQ deterioration at baseline continued on a declining cognitive trajectory or that those with preserved average/high IQ experienced subsequent IQ decline. The low IQ group showed no change in IQ, whereas both the DIQ and the preserved IQ groups improved. However, the rate of improvement of these 2 subgroups was no greater than that of the healthy controls, suggesting that this reflected practice effects. Both the low and the deteriorated groups had longer index admissions, more core negative symptoms, and worse occupational outcomes at 3 years. These data suggest that following psychosis onset, IQ is stable and that it is IQ at psychosis onset rather than premorbid IQ predicts a more severe illness. PMID:19934212

  19. Community action for preventing HIV in Cambodia: evaluation of a 3-year project.

    PubMed

    Sopheab, Heng; Fylkesnes, Knut; Lim, Yi; Godwin, Peter

    2008-07-01

    The 'Community Action for Preventing HIV/AIDS Project' was implemented in four provinces in Cambodia (2001-04) to support a comprehensive set of HIV prevention efforts. Implementation was strictly monitored in terms of inputs, outputs and outcomes. We examine changes in these variables during the project period to assess the extent to which they were related to the project. Inputs and outputs were monitored regularly by supervision and quarterly project reports. Baseline and follow-up surveys were conducted on 10 target groups to measure changes in outcome indicators related to sexual risk behaviours, uses of HIV voluntary counselling and testing (VCT), self-reported sexually transmitted infections (STIs) and other indicators. The analyses use data from surveys and from project monitoring. Spending on HIV-related work at provincial level increased markedly, including investments in VCT, STI facilities and staff training. Yearly expenditure increased about 7-fold compared with years immediately preceding the project. VCT centres increased from 3 to 12, numbers of counsellors from 10 to 27, and numbers of client visits more than doubled. STI laboratory facilities increased from 0 to 6 with coverage of STI check-ups among sex workers increasing from 70% to 93% and a decline in men attending STI clinics. The survey results indicate significant changes in a number of major outcome indicators such as consistent condom use related to sex work (>80%), HIV testing and counselling after HIV tests, especially among police (42 to 72%, P < 0.001) and brothel-based sex workers (48 to 89%, P < 0.001). Self-reported STIs declined in most groups. Finally, the programmatic systems for planning, managing and monitoring implementation of activities at both central and provincial level, as well as technical guidelines, developed under the project have become the standard for the national programme. In conclusion, the project appears to have been comprehensive and a number of favourable

  20. Evaluation of the poly-L-lactic acid implant for treatment of the nasolabial fold: 3-year follow-up evaluation.

    PubMed

    Salles, A G; Lotierzo, P H; Gimenez, R; Camargo, C P; Ferreira, M C

    2008-09-01

    The search for an ideal filler for soft tissue augmentation still continues. Because aging changes are continuous, temporary fillers should be preferred against permanent ones. Since 1999, the poly-L-lactic acid filler (PLA) has been marketed in Europe as Newfill. As a synthetic biocompatible polymer, PLA originally was used in suture materials and screws. In 2004, the U.S. Food and Drug Administration approved PLA under the name of Sculptra for the treatment of human immunodeficiency virus-related facial lipoatrophy. This study aimed to evaluate a 3-year follow-up investigation into the effect of PLA implant injection for the treatment of sunken nasolabial folds. Between October 2003 and February 2004, 10 women with a median age of 54 years (range, 43-60 years) were injected with polylactic acid hydrogel (Newfill) in the nasolabial fold area for aesthetic reasons. All the patients underwent three injections: one injection per month for 3 months. Evaluation of the results based on clinical examination and photography was performed at each session, at 6 months, and then 36 months after the third session. Injectable PLA was able to correct nasolabial folds successfully with a more lasting result than absorbable fillers commonly used in clinical practice, such as hyaluronic acid and collagen. Careful and standardized photographic documentation is indispensable.

  1. Evaluation of Clinical Competence.

    ERIC Educational Resources Information Center

    Newble, David I.

    In Australia the usual evaluation of whether a student will perform adequately as a doctor is a subjective evaluation of his clinical performance, usually at the completion of five or six years at medical school. The evaluation is performed on an inadequate and uncontrolled patient sample and appears to be subject to many errors. Recent work…

  2. Occurrence and molecular characterization of Klebsiella pneumoniae ST37 clinical isolates producing plasmid-mediated AmpC recovered over a 3-year period.

    PubMed

    Illiaquer, Marina; Caroff, Nathalie; Bémer, Pascale; Aubin, Guillaume G; Juvin, Marie-Emmanuelle; Lepelletier, Didier; Reynaud, Alain; Corvec, Stéphane

    2012-09-01

    We investigated the clinical and microbiological epidemiology of AmpC plasmidic cephalosporinases (pAmpC) in Klebsiella pneumoniae strains resistant to ceftazidime, during a 3-year period (2007-2009). Among 1505 K. pneumoniae, 7 were pAmpC producers. Molecular characterization revealed the spread of a ST37 strain producing DHA-1 within intensive care units and the diffusion of the same plasmid among unrelated strains.

  3. Occurrence and molecular characterization of Klebsiella pneumoniae ST37 clinical isolates producing plasmid-mediated AmpC recovered over a 3-year period.

    PubMed

    Illiaquer, Marina; Caroff, Nathalie; Bémer, Pascale; Aubin, Guillaume G; Juvin, Marie-Emmanuelle; Lepelletier, Didier; Reynaud, Alain; Corvec, Stéphane

    2012-09-01

    We investigated the clinical and microbiological epidemiology of AmpC plasmidic cephalosporinases (pAmpC) in Klebsiella pneumoniae strains resistant to ceftazidime, during a 3-year period (2007-2009). Among 1505 K. pneumoniae, 7 were pAmpC producers. Molecular characterization revealed the spread of a ST37 strain producing DHA-1 within intensive care units and the diffusion of the same plasmid among unrelated strains. PMID:22749243

  4. Long-term performance of the second-generation cobalt-chromium sirolimus-eluting stents in real-world clinical practice: 3-year clinical outcomes from the prospective multicenter FOCUS registry

    PubMed Central

    Zhang, Feng; Yang, Ji’e; Qian, Juying; Ge, Lei; Zhou, Jun

    2016-01-01

    Background The short- and mid-term outcomes of the second-generation cobalt-chromium sirolimus-eluting stent (CoCr-SES) in real-world patients had been reported previously, but the long-term performance remained unclear. The objective of this analysis was to evaluate the long-term safety and efficacy of the second-generation CoCr-SES from the FOCUS registry. Methods The FOCUS registry (ClinicalTrials.gov Identifier: NCT00868829) enrolled all-comers eligible to receive Firebird-2 CoCr-SES. Follow-up was continued to 3 years to evaluate long-term safety and effectiveness of the second-generation CoCr-SES in real-world practice. Results of the extended-use group and standard-use group are compared to explore performance of CoCr-SES in more severe patients with more complex lesions. Results The rate of 3-year MACE was 7.37%, consisting of 84 cases (1.78%) of cardiac death, 166 cases (3.52%) of MI and 98 cases (2.08%) of TVR. ARC definite/probable stent thrombosis happened in 34 (0.72%) patients, only 3 new cases (<0.1%) of very late stent thrombosis was reported in the third year. Meanwhile, the difference of MACE (7.77% vs. 6.06%; P=0.058), TLF (4.71% vs. 3.49%; P=0.085) and ARC definite/probable stent thrombosis (0.83% vs. 0.37%; P=0.116) between extended-use group and standard-use group showed no significance. Conclusions The second-generation CoCr-SES was associated with continued low rates of 3-year MACE, TLF and stent thrombosis in a broad spectrum of patients. PMID:27499948

  5. Evaluating Student Clinical Performance.

    ERIC Educational Resources Information Center

    Foster, Danny T.

    When the University of Iowa's athletic training education department developed evaluation criteria and methods to be used with students, attention was paid to validity, consistency, observation, and behaviors. The observations of student behaviors reflect three types of learning outcomes important to clinical education: cognitive, psychomotor, and…

  6. Can Severely Language Delayed 3-Year-Olds Be Identified at 18 Months? Evaluation of a Screening Version of the MacArthur-Bates Communicative Development Inventories

    ERIC Educational Resources Information Center

    Westerlund, Monica; Berglund, Eva; Eriksson, Marten

    2006-01-01

    Purpose: To evaluate the effectiveness of a screening instrument (the Swedish Communication Screening at 18 months of age; SCS18), derived from the Swedish MacArthur-Bates Communicative Development Inventory, in identification of 18-month-old children who will be severely language disabled by 3 years of age, the authors (a) analyzed which SCS18's…

  7. Flapless CAD/CAM-guided surgery for staged transition from failing dentition to complete arch implant rehabilitation: a 3-year clinical report.

    PubMed

    Papaspyridakos, Panos; White, George Shelby; Lal, Kunal

    2012-03-01

    The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient be rendered edentulous and has to wear a complete removable dental prosthesis for varying periods of time. This is objectionable to many patients. A staged treatment approach allows a fixed interim restoration, patient comfort, and prosthodontic control throughout the rehabilitation process. CAD/CAM-guided flapless implant surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae. A patient with a failing dentition was treated with this combined protocol and was followed up for 3 years after loading. Implant and prosthesis survival rates were 100%, with no technical complications encountered up to the last recall. The purpose of this clinical report is to describe a combination of CAD/CAM-guided flapless surgery and a staged treatment approach, thereby giving the patient a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process. The various surgical, laboratory, and prosthetic stages are illustrated for the complete arch prosthetic rehabilitation, and the 3-year follow-up outcome is reported.

  8. A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation

    PubMed Central

    Arujuna, Aruna; Karim, Rashed; Zarinabad, Niloufar; Gill, Jaspal; Rhode, Kawal; Schaeffter, Tobias; Wright, Matthew; Rinaldi, C. Aldo; Cooklin, Michael; Razavi, Reza; O'Neill, Mark D.; Gill, Jaswinder S.

    2015-01-01

    Aims To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. Methods and results Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei® X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. Conclusion Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures. PMID:25687748

  9. Developmental milestones record - 3 years

    MedlinePlus

    Normal childhood growth milestones - 3 years; Growth milestones for children - 3 years; Childhood growth milestones - 3 years ... milestones are typical for children in their third year of life. Always keep in mind that some ...

  10. The Predictive Value of Cognitive Impairments Measured at the Start of Clinical Rehabilitation for Health Status 1 Year and 3 Years Poststroke

    ERIC Educational Resources Information Center

    Verhoeven, Clara L.; Schepers, Vera P.; Post, Marcel W.; van Heugten, Caroline M.

    2011-01-01

    The objective of this study was to investigate the value of screening for cognitive functions at the start of an inpatient rehabilitation programme to predict the health status 1 and 3 years poststroke. In this longitudinal cohort study of stroke patients in inpatient rehabilitation data of 134 participants were analysed. Cognitive and clinical…

  11. TRMM 3-Year Anniversary

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Ever wonder about the rain? Beyond the practicality of needing an umbrella, climate researchers have wondered about the science of rainfall for a long time. But it's only in the past few years that they've begun to roll back some of its secrets. One of their tools for doing so is a powerful satellite called the Tropical Rainfall Measuring Mission, or TRMM. Now, after three years of continual operation, project scientists have released dramatic new maps of rainfall patterns gathered across a wide band of the Earth. And with measurements from one of the satellite's advanced sensors, meteorologists are now able to calibrate ground-based rain monitoring systems with greater precision than ever before. A complete accounting of the world's total rainfall has long been a major goal of climate researchers. Rain acts as the atmosphere's fundamental engine for heat exchange; every time a raindrop falls, the atmosphere gets churned up and latent heat flows back into the total climate system. Considering that rainfall is the primary driving force of heat in the atmosphere, and that two thirds of all rain falls in the tropics, these measurements are significant for our understanding of overall climate. The above image shows a one month average of rainfall measurements taken by the TRMM's unique precipitation radar during January of 1998. Areas of low rainfall are colored light blue, while regions with heavy rainfal are colored orange and red. TRMM began collecting data in December of 1997, and continues today. For more information about TRMM's 3-year anniversary, read Maps of Falling Water To learn more about the TRMM mission or order TRMM data, see the TRMM Home Page. Image courtesy TRMM Science team and the NASA GSFC Scientific Visualization Studio.

  12. Evaluation of a Program to Teach Phonemic Awareness to Young Children: A 2- and 3-Year Follow-Up and a New Preschool Trial.

    ERIC Educational Resources Information Center

    Byrne, Brian; Fielding-Barnsley, Ruth

    1995-01-01

    A follow-up study of 62 children in grades 1 and 2 instructed in phonemic awareness in preschool showed that, compared with 53 controls, trained children were superior in nonword reading 2 and 3 years later and in reading comprehension at 3 years. A supplemental study supported these results. (SLD)

  13. Clinical Approach to Teacher Evaluation.

    ERIC Educational Resources Information Center

    Tipton, William

    This manual, prepared for the state of Washington, provides tools and strategies aimed at assisting building administrators in clinical approaches to teacher evaluation. The first section provides preliminary thoughts on the evaluation process and discusses the two major problems: acceptance and time. The second section discusses the sources and…

  14. Clinical Outcome 3 Years After Autologous Chondrocyte Implantation Does Not Correlate With the Expression of a Predefined Gene Marker Set in Chondrocytes Prior to Implantation but Is Associated With Critical Signaling Pathways

    PubMed Central

    Stenberg, Johan; de Windt, Tommy S.; Synnergren, Jane; Hynsjö, Lars; van der Lee, Josefine; Saris, Daniel B.F.; Brittberg, Mats; Peterson, Lars; Lindahl, Anders

    2014-01-01

    Background: There is a need for tools to predict the chondrogenic potency of autologous cells for cartilage repair. Purpose: To evaluate previously proposed chondrogenic biomarkers and to identify new biomarkers in the chondrocyte transcriptome capable of predicting clinical success or failure after autologous chondrocyte implantation. Study Design: Controlled laboratory study and case-control study; Level of evidence, 3. Methods: Five patients with clinical improvement after autologous chondrocyte implantation and 5 patients with graft failures 3 years after implantation were included. Surplus chondrocytes from the transplantation were frozen for each patient. Each chondrocyte sample was subsequently thawed at the same time point and cultured for 1 cell doubling, prior to RNA purification and global microarray analysis. The expression profiles of a set of predefined marker genes (ie, collagen type II α1 [COL2A1], bone morphogenic protein 2 [BMP2], fibroblast growth factor receptor 3 [FGFR3], aggrecan [ACAN], CD44, and activin receptor–like kinase receptor 1 [ACVRL1]) were also evaluated. Results: No significant difference in expression of the predefined marker set was observed between the success and failure groups. Thirty-nine genes were found to be induced, and 38 genes were found to be repressed between the 2 groups prior to autologous chondrocyte implantation, which have implications for cell-regulating pathways (eg, apoptosis, interleukin signaling, and β-catenin regulation). Conclusion: No expressional differences that predict clinical outcome could be found in the present study, which may have implications for quality control assessments of autologous chondrocyte implantation. The subtle difference in gene expression regulation found between the 2 groups may strengthen the basis for further research, aiming at reliable biomarkers and quality control for tissue engineering in cartilage repair. Clinical Relevance: The present study shows the possible

  15. [Clinical, biochemical and histopathological development of post-transfusional non-A, non-B hepatitis from the acute picture to chronicity during 13.3 years].

    PubMed

    de Andrade Júnior, D R; Câmara Lopes, L H; de Souza, F C; de Andrade, D R

    1989-01-01

    This case was of a 45 year old female patient with a post-transfusion non-A non-B hepatitis which was accompanied since an acute phase to hepatic cirrhosis during a period of 159.7 months or 13.3 years. Four hepatic biopsies were carried out and they divided the follow-up into 5 evolutive periods. The biopsies revealed a progressive histologic from chronic persistent hepatitis to an active chronic hepatitis and cirrhosis. The aminotransferases followed a floating course in the whole period, with ALT greater than AST starting from the 3rd period. The 3rd period (from 5th to 8th year) was of least activity of the aminotransferases, and the 4th and 5th periods (from 8th to 13th year) showed the highest activity of ALT. The 2nd period (from 3rd to 5th year) showed the least portion of gamma globulin and the highest of albumin in comparison with the others. There was no connection between the levels of aminotransferases and the values of gamma globulin and albumin in the follow up process. The treatment employed in the 5th evolutive period (prednisone and colchicine) did not present any biochemical improvement.

  16. Clinical evaluation of functional dysphonia.

    PubMed

    Monday, L A

    1983-10-01

    Functional dysphonia is a voice impairment without any organic lesion of the phonating system. It may be classified into two categories: functional dysphonia itself where no lesions are found and functional laryngopathies where vocal cord lesions may be attributed to vocal abuse or misuse. The clinical evaluation of a dysphonic patient is performed in three steps: history taking, vocal evaluation, and examination. History taking helps the diagnosis and may be considered also as a therapeutic procedure. Vocal evaluation is oriented toward the voice itself and how it is produced. Then an ENT examination is performed with special attention to the larynx. In functional dysphonia, usually, everything looks normal but there may be signs of inflammation, hyperkinetism, hypokinetism, excessive laryngeal movements, etc. Functional laryngopathies include vocal nodules, laryngitis, polyps, and contact ulcer.

  17. Gynecomastia: Clinical evaluation and management

    PubMed Central

    Cuhaci, Neslihan; Polat, Sefika Burcak; Evranos, Berna; Ersoy, Reyhan; Cakir, Bekir

    2014-01-01

    Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery. The main aim of any intervention is to relieve the symptoms and exclude other etiological factors. PMID:24741509

  18. [Clinical evaluation of a hyperferritinemia].

    PubMed

    Sogni, Philippe; Buffet, Catherine

    2013-04-01

    A hyperferritinemia has to be interpreted in relation with age and sex. The clinical evaluation begins with the interpretation of transferrine saturation which has to be controlled with a second fasting blood test. In case of high transferrine saturation associated with hyperferritinemia, HFE testing has first to be realized since the first diagnosis suspected is a HFE hemochromatosis. In case of normal transferrine saturation associated with a hyperferritinemia, the more frequent diagnosis is a metabolic syndrome, an inflammatory syndrome, a syndrome of cellular lysis or an excessive alcohol consumption. In case of HFE hemochromatosis, phlebotomy prevents complications. The goal is to obtain and to maintain a normal-low ferritin level. In case of metabolic syndrome, phlebotomy could be useful in case of high hepatic iron concentration measured with MRI or in case of on-alcoholic steato-hepatitis.

  19. A Novel Approach to Evaluating the Iron and Folate Status of Women of Reproductive Age in Uzbekistan after 3 Years of Flour Fortification with Micronutrients

    PubMed Central

    Hund, Lauren; Northrop-Clewes, Christine A.; Nazario, Ronald; Suleymanova, Dilora; Mirzoyan, Lusine; Irisova, Munira; Pagano, Marcello; Valadez, Joseph J.

    2013-01-01

    Background The Uzbekistan 1996 Demographic Health Survey reported 60.4% of women of reproductive age (WRA) had low hemoglobin concentrations (<120 g/L), and anemia was an important public health problem. Fortification of wheat flour was identified as an appropriate intervention to address anemia due to the ubiquitous consumption of wheat flour. A National Flour Fortification Program (NFFP) was implemented in 2005. Methodology/Principal Findings After 3-years of the NFFP, a national survey using large country-lot quality assurance sampling was carried out to assess iron, folate, hemoglobin and inflammation status of WRA; the coverage and knowledge of the fortified first grade UzDonMakhsulot (UDM) flour/grey loaf program; and consumption habits of women to investigate the dietary factors associated with anemia. Estimated anemia prevalence was 34.4% (95% CI: 32.0, 36.7), iron depletion 47.5% (95% CI: 45.1, 49.9) and folate deficiency 28.8% (95% CI: 26.8, 30.8); the effect of inflammation was minimal (4% with CRP >5 mg/L). Severe anemia was more prevalent among folate deficient than iron depleted WRA. Presence of UDM first grade flour or the grey loaf was reported in 71.3% of households. Among WRA, 32.1% were aware of UDM fortification; only 3.7% mentioned the benefits of fortification and 12.5% understood causes of anemia. Consumption of heme iron-containing food (91%) and iron absorption enhancers (97%) was high, as was the consumption of iron absorption inhibitors (95%). Conclusions/Significance The NFFP coincided with a substantial decline in the prevalence of anemia. Folate deficiency was a stronger predictor of severe anemia than iron depletion. However, the prevalence of iron depletion was high, suggesting that women are not eating enough iron or iron absorption is inhibited. Fortified products were prevalent throughout Uzbekistan, though UDM flour must be adequately fortified and monitored in the future. Knowledge of fortification and anemia was low, suggesting

  20. Early management of type 2 diabetes based on a SMBG strategy: the way to diabetes regression--the St Carlos study : a 3-year, prospective, randomized, clinic-based, interventional study with parallel groups.

    PubMed

    García de la Torre, Nuria; Durán, Alejandra; Del Valle, Laura; Fuentes, Manuel; Barca, Idoya; Martín, Patricia; Montañez, Carmen; Perez-Ferre, Natalia; Abad, Rosario; Sanz, Fuencisla; Galindo, Mercedes; Rubio, Miguel A; Calle-Pascual, Alfonso L

    2013-08-01

    The aims are to define the regression rate in newly diagnosed type 2 diabetes after lifestyle intervention and pharmacological therapy based on a SMBG (self-monitoring of blood glucose) strategy in routine practice as compared to standard HbA1c-based treatment and to assess whether a supervised exercise program has additional effects. St Carlos study is a 3-year, prospective, randomized, clinic-based, interventional study with three parallel groups. Hundred and ninety-five patients were randomized to the SMBG intervention group [I group; n = 130; Ia: SMBG (n = 65) and Ib: SMBG + supervised exercise (n = 65)] and to the HbA1c control group (C group) (n = 65). The primary outcome was to estimate the regression rate of type 2 diabetes (HbA1c <6 % on metformin treatment). After 3 years of follow-up, diabetes regression was achieved by 56 patients, 6 (9.2 %) from the C group, 21 (32.3 %) from the Ia group and 29 (44.6 %) from the Ib group. RR (95 % CI) for diabetes regression in the intervention group (Ia + Ib) was 4.5 (2.1-9); p < 0.001 and remained after stratification by gender, age and BMI. This difference was associated with healthier changes in lifestyle and greater weight loss. RR for a weight loss >4 kg was 3.6 (1.8-7); p < 0.001. This study shows that the use of SMBG in an educational program effectively increases the regression rate in newly diagnosed type 2 diabetic patients after 3 years of follow-up. These data suggest that SMBG-based programs should be extended to primary care settings where diabetic patients are usually attended.

  1. Food allergy in infants and children: clinical evaluation and management.

    PubMed

    Levy, Y; Kornbroth, B; Ofer, I; Garty, B Z; Danon, Y L

    1994-12-01

    A total of 122 infants and children up to age 17 (69 males and 53 females) who were referred for food allergy to the Pediatric Allergy and Clinical Immunology Unit were evaluated by complete history, emphasizing the implicated foods, clinical presentation and involvement of various organ systems, physical examination, and prick skin tests to food allergens. Fourteen infants with a history of egg white allergy and positive skin tests to egg white also underwent skin tests (prick and intradermal in 1:100 dilution) to measles-mumps-rubella (MMR) vaccine; 35 children under 3 years old had 41 oral challenges with the suspected foods; and 9 children over 3 years old had 12 oral challenges with the suspected foods. We found that cow milk/humanized milk formula, egg white, soybean, and peanut are the main allergenic foods in the pediatric population. Thirteen children had 13 positive oral challenges: 12 to cow milk/humanized milk formula and one to egg white. Symptoms reproduced by oral challenges included urticarial and erythematous rash, conjunctival itching, angioedema, abdominal pain, vomiting, diarrhea, and rhinorrhea. No anaphylactic shock was reported. Negative skin test has an excellent predictive accuracy for negative oral challenge with the suspected food in children > 3 years old. The negative predictive accuracy of cow milk skin test in children < 3 years was 73%. Positive skin test is not a good predictor of a clinical reaction to food. Oral food challenge performed cautiously in a medical setting is the "gold standard" for diagnosis. MMR vaccine can be safely administered to infants with egg white allergy after skin tests with the vaccine are performed.

  2. Identifying questions in the American Association of Swine Veterinarian's PRRS risk assessment survey that are important for retrospectively classifying swine herds according to whether they reported clinical PRRS outbreaks in the previous 3 years.

    PubMed

    Holtkamp, Derald J; Lin, Hui; Wang, Chong; O'Connor, Annette M

    2012-09-01

    The American Association of Swine Veterinarian's (AASV) Production Animal Disease Risk Assessment Program (PADRAP) is a web-based program that offers a set of risk assessment surveys being used by veterinarians who are members of the AASV. Members use PADRAP to help producers systematically assess risk factors that may be associated with clinical outcomes. As assessments are performed the completed surveys are added to the dataset maintained at the Iowa State University College of Veterinary Medicine. One of the surveys included in PADRAP is the porcine reproductive and respiratory syndrome (PRRS) Risk Assessment for the Breeding Herd. The aim of the study was to categorize questions in version 2 of the PRRS Risk Assessment for the Breeding Herd survey as important or unimportant for classifying herds according to whether they reported clinical PRRS outbreaks in the previous 3 years. The results elucidate the relative importance of risk factors and areas of risk factors for clinical outcomes and removing unimportant questions may reduce the time required to complete the survey without affecting the quality of information obtained. Surveys from 896 sow herd sites in the United States and Canada completed between March 2005 and March 2009 were included in the analysis. The survey contained a large number of questions with a complex correlation structure among the questions. Responses for several questions were dependent upon responses to others. To address these issues, an approach was developed using a series of statistical methods including random forest, principle component analysis, logistic regression and receiver operating characteristic (ROC) analysis to classify the herds using the questions in the survey as explanatory variables. Questions were ranked by importance and systematically excluded from least important to most important. The questions excluded, without significantly affecting the performance of the model for classifying herds were identified as

  3. Evaluating Clinical Teaching in Medicine.

    ERIC Educational Resources Information Center

    Irby, David; Rakestraw, Philip

    1981-01-01

    Medical students have been rating clinical teaching in an obstetrics and gynecology clerkship at the University of Washington using an assessment form designed to reflect six factors of clinical teaching effectiveness. High interrater reliability and the utility of the data for faculty development and advancement are discussed. (Author/JMD)

  4. The influence of immediate complete anterior guidance development technique on subjective symptoms in Myofascial pain patients: Verified using digital analysis of occlusion (Tek-scan) for analysing occlusion: A 3 years clinical observation

    PubMed Central

    Thumati, Prafulla

    2015-01-01

    Objectives: The purpose of this study is to evaluate the effect of occlusal equilibration using immediate complete anterior guidance development (ICAGD) technique by Kerstein and Farrell on the subjective symptoms of myofascial pain. This technique is the most advanced verifiable and measurable way of digitally analyzing the occlusion using T-scan technology. The primary objective is to reduce the anterior disclusion time to <0.4 s and the secondary objective is to reduce the signs and symptoms of myofascial pain. Materials and Methods: This study is to assess the reducing effects of subjective symptoms of 100 patients diagnosed as myofascial pain patients treated by ICAGD technique as described by Kerstein and Farrell. The common complaints of the patients were a pain in the masseter and temporal muscles, jaw tiredness in the mornings, night bruxing and difficulty in chewing. In this technique occlusal equilibration involves removal of posterior interferences and establish anterior guidance. The patients were treated over three visits 1-week apart and followed for 3 years with an interval of 3 months for the subsequent visits. A visual analog ordinal scale is used to rate the symptoms. The symptoms reduction occurred for all the patients after the first correction in about 5–10 days. In about a period of 3 years review, no recurrence was seen of the chronic myofascial symptoms. Results: In spite of the chronic nature of the patient's symptoms, symptom reduction occurred in a week's time. This was assessed by the results of the ordinal scale values. This agrees with the studies of Kerstein and Farrell. Conclusion: Equilibration of occlusion using digital analysis by T-scan in which force is quantified against time, should be done to establish free functional movements without any interference; otherwise the disturbances in the excursive movements may lead to muscle dysfunction at later years. PMID:26929516

  5. Method for evaluating performance of clinical pharmacists.

    PubMed

    Schumock, G T; Leister, K A; Edwards, D; Wareham, P S; Burkhart, V D

    1990-01-01

    A performance-evaluation process that satisfies Joint Commission on Accreditation of Healthcare Organizations criteria and state policies is described. A three-part, criteria-based, weighted performance-evaluation tool specific for clinical pharmacists was designed for use in two institutions affiliated with the University of Washington. The three parts are self-appraisal and goal setting, peer evaluation, and supervisory evaluation. Objective criteria within each section were weighted to reflect the relative importance of that characteristic to the job that the clinical pharmacist performs. The performance score for each criterion is multiplied by the weighted value to produce an outcome score. The peer evaluation and self-appraisal/goal-setting parts of the evaluation are completed before the formal performance-evaluation interview. The supervisory evaluation is completed during the interview. For this evaluation, supervisors use both the standard university employee performance evaluation form and a set of specific criteria applicable to the clinical pharmacists in these institutions. The first performance evaluations done under this new system were conducted in May 1989. Pharmacists believed that the new system was more objective and allowed more interchange between the manager and the pharmacist. The peer-evaluation part of the system was seen as extremely constructive. This three-part, criteria-based system for evaluation of the job performance of clinical pharmacists could easily be adopted by other pharmacy departments.

  6. Evaluation of toxicity: clinical issues.

    PubMed

    Vietti, T J

    1980-01-01

    Toxicity criteria used by three of the major cooperative groups are reviewed and discussed. The definition of acceptable toxicity will depend on the extent of disease and the availability of effective therapy. For some forms of toxicity there are adequate early warning signals; for other forms no satisfactory criteria yet exist. Until recently, no attempt had been made to systematically evaluate the quality of the patient's life during and after therapy. We are just now beginning to assess the long-term pathophysiologic changes that occur during and after multimodal therapy. The protocol must include information concerning agent toxicity, criteria for modification of therapy, and time intervals for documentation of toxicity. We must continue to develop therapeutic regimens which control the disease but interfere minimally with the quality of life.

  7. [Clinical evaluation of thymic function].

    PubMed

    Castermans, E; Morrhaye, G; Marchand, S; Martens, H; Moutschen, M; Baron, F; Beguin, Y; Geenen, V

    2007-11-01

    The essential role of the thymus is to install an extremely diverse repertoire of T lymphocytes that are self-tolerant and competent against non-self, as well as to generate self-antigen specific regulatory T cells (Treg) able to inactivate in periphery self-reactive T cells having escaped the thymic censorship. Although indirect, techniques of medical imaging and phenotyping of peripheral T cells may help in the investigation of thymic function. Nowadays however, thymopoiesis is better evaluated through quantification by PCR of T-cell receptor excision circles (TREC) generated by intrathymic random recombination of the gene segments coding for the variable parts of the T-cell receptor for antigen (TCR). The TREC methodology is very valuable in the circumstances not associated with intense proliferation or apoptosis of peripheral T lymphocytes. PMID:18217644

  8. Hemodialysis safety: Evaluation of clinical practice.

    PubMed

    Fadili, Wafaa; Adnouni, Adil; Laouad, Inass

    2016-05-01

    Hemodialysis (HD) safety has become a clinical priority; therefore, the use of checklists for making the dialysis session safe is now widely adopted. The aim of our study was to assess different shortcomings in the clinical practice of nurses working in different Moroccan dialysis centers and to discuss the interest of using such checklists. This cross-sectional study was performed in 13 chronic HD centers. Clinical practice of nurses was evaluated through checklists used in European outpatient dialysis units. We noted several deficiencies mainly related to the clinical evaluation of dialysis patients and to aspects related to hygiene and protection measures against contamination. Optimal safety of dialysis sessions requires the use of simple and reproducible means that improve clinical skills of the health staff. PMID:27215249

  9. A Clinical Evaluation System for Anesthesiology Residents.

    ERIC Educational Resources Information Center

    Viets, J. L.; Foster, Scot D.

    1988-01-01

    Baylor College of Medicine's system for evaluating the clinical progress of anesthesiology residents, developed in response to problems of standards, staff cooperation, and student dissatisfaction with evaluation, assesses resident progress in terms of performance levels based on case complexity and degree of staff intervention. (Author/MSE)

  10. Benign prostatic hyperplasia: clinical manifestations and evaluation.

    PubMed

    Santos Dias, José

    2012-12-01

    Benign prostatic hyperplasia (BPH) is a very common condition, related to aging and causing symptoms, called lower urinary tract symptoms. On account of its huge prevalence, it is important for clinicians who are involved in the management of patients with BPH to be aware of the very strict recommendations for BPH evaluation. In this article, we describe the different steps and procedures doctors should follow to evaluate these patients; symptoms and signs of BPH are reviewed, as well as the clinical evaluation steps and examinations available. The basic evaluation of the patients with BPH should include, according to the recommendations of the most relevant international guidelines, lower urinary tract symptoms evaluation with appropriate symptom scores, digital rectal examination, voiding charts, prostate-specific antigen and creatinine measurement, urinalysis, and imaging of the urinary tract.

  11. Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective

    PubMed Central

    Hall, Toby; Briffa, Kathy; Hopper, Diana

    2008-01-01

    Headache is a common complaint that affects the majority of the population at some point in their lives. The underlying pathological bases for headache symptoms are many, diverse, and often difficult to distinguish. Classification of headache is principally based on the evaluation of headache symptoms as well as clinical testing. Although manual therapy has been advocated to treat a variety of different forms of headache, the current evidence only supports treatment for cervicogenic headache (CGH). This form of headache can be identified from migraine and other headache forms by a comprehensive musculoskeletal examination. Examination and subsequent diagnosis is essential not only to identify patients with headache where manual therapy is appropriate but also to form a basis for selection of the most appropriate treatment for the identified condition. The purpose of this paper is to outline, in clinical terms, the classification of headache, so that the clinician can readily identify those patients with headache suited to manual therapy. PMID:19119390

  12. Clinical outcomes of 3-year experience of targeted temperature management in patients with out-of-hospital cardiac arrest at Songklanagarind Hospital in Southern Thailand: an analysis of the MICU-TTM registry

    PubMed Central

    Vattanavanit, Veerapong; Bhurayanontachai, Rungsun

    2016-01-01

    Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of intensive care unit admission, which results in high hospital mortality. Targeted temperature management (TTM) was introduced several years ago and is considered to improve neurological and mortality outcomes. This management process was implemented in our hospital in 2012, which was expected to improve the standard of care in OHCA patients. Purpose We aimed to report the clinical and mortality outcomes after TTM was introduced to our hospital in 2012. Patients and methods An analysis of data from the Medical Intensive Care Unit-TTM registry between 2012 and 2015 was performed. After successful cardiopulmonary resuscitation, TTM was applied to all OHCA patients regardless of causes if there was no contraindication. The Cerebral Performance Category scale score and other clinical outcomes were recorded and analyzed. Results Out of 23 patients, 87% were male and the mean age was 54.5±18.1 years. The causes of OHCA from cardiac etiology comprised 52.2%. The most common initial cardiac rhythm was ventricular fibrillation (47.8%). The survival rate to hospital discharge was 47.8% (11/23), but neurological outcomes were in a persistent vegetative state (8/11, 72.7%). The group with poor neurological outcomes had a significantly higher Acute Physiologic Assessment and Chronic Health Evaluation II score than the group with good neurological outcomes (22.9±4.2 vs 16.0±3.6, P=0.01). In the multivariate analysis, initial shockable rhythm was associated with survival at hospital discharge (odds ratio 10.1, 95% confidence interval 1.1–94.3, P=0.04). Conclusion TTM in OHCA patients gave better mortality benefits compared to our previous records, despite poor neurological outcomes. Ventilator-associated pneumonia was the major complication of TTM. Therefore, TTM should be considered in OHCA patients, especially in shockable rhythms, after return of spontaneous circulation.

  13. A clinician's 3-year experience with perioscopy.

    PubMed

    Stambaugh, Roger V

    2002-11-01

    A medical endoscope has been modified for assisting the clinician in subgingival scaling and root planing. The dental endoscope provides real-time indirect visualization of the root surface for aiding the removal of root deposits and biofilm. When the majority of biofilm and visible calculus is removed from the root surface in a periodontal pocket, the pocket will most often close, resulting in a shallow sulcus. Many lesions on single-rooted teeth can be treated successfully with this technique, resulting in a significant reduction in probable pocket depth and a gain in the calibrated attachment level. Other sites, such as furcations and maxillary first bicuspids, may demonstrate significant improvement but not complete resolution of these parameters. Perioscopy is scaling and root planing aided by indirect vision with an endoscope. This technique can offer many patients an alternative to periodontal surgery in carefully selected sites. This article describes the clinical rationale for perioscopy, defines those sites that most predictably will respond to this mode of therapy, and offers some guidelines on integrating this technology into the dental practice. The observations and recommendations in this article are based on the author's 3-year experience with the dental endoscope in his periodontal practice, the experience of other periodontists and dental hygienists, and published reports. PMID:12789986

  14. A clinician's 3-year experience with perioscopy.

    PubMed

    Stambaugh, Roger V

    2002-11-01

    A medical endoscope has been modified for assisting the clinician in subgingival scaling and root planing. The dental endoscope provides real-time indirect visualization of the root surface for aiding the removal of root deposits and biofilm. When the majority of biofilm and visible calculus is removed from the root surface in a periodontal pocket, the pocket will most often close, resulting in a shallow sulcus. Many lesions on single-rooted teeth can be treated successfully with this technique, resulting in a significant reduction in probable pocket depth and a gain in the calibrated attachment level. Other sites, such as furcations and maxillary first bicuspids, may demonstrate significant improvement but not complete resolution of these parameters. Perioscopy is scaling and root planing aided by indirect vision with an endoscope. This technique can offer many patients an alternative to periodontal surgery in carefully selected sites. This article describes the clinical rationale for perioscopy, defines those sites that most predictably will respond to this mode of therapy, and offers some guidelines on integrating this technology into the dental practice. The observations and recommendations in this article are based on the author's 3-year experience with the dental endoscope in his periodontal practice, the experience of other periodontists and dental hygienists, and published reports.

  15. A 3-Year Longitudinal Study Examining the Effect of Resilience on Suicidality in Veterans

    PubMed Central

    Youssef, Nagy A.; Green, Kimberly T.; Beckham, Jean C.; Elbogen, Eric B.

    2013-01-01

    Background This study evaluated the correlation and role of resilience and resilience factors in predicting suicidal ideation and attempts in veterans. Methods In this 3-year longitudinal study, one hundred and seventy-six Iraq and Afghanistan War veterans were evaluated for a number of clinical and demographic variables. Longitudinal follow-up was performed approximately 3 years. Results Resilience at the initial assessment predicted lower suicidality at follow-up, controlling for suicidality at the initial assessment, suggesting a protective effect for resilience. With respect to specific domains of resilience, secure relationships and positive acceptance of change significantly predicted lower suicidality. Conclusions These findings have important implications for clinical care and for guiding future research efforts to increase resilience among returning soldiers. PMID:23376871

  16. How Grammatical Are 3-Year-Olds?

    ERIC Educational Resources Information Center

    Eisenberg, Sarita L.; Guo, Ling-Yu; Germezia, Mor

    2012-01-01

    Purpose: This study investigated the level of grammatical accuracy in typically developing 3-year-olds and the types of errors they produce. Method: Twenty-two 3-year-olds participated in a picture description task. The percentage of grammatical utterances was computed and error types were analyzed. Results: The mean level of grammatical accuracy…

  17. Evaluating clinical dermatology practice in medical undergraduates.

    PubMed

    Casanova, J M; Sanmartín, V; Martí, R M; Morales, J L; Soler, J; Purroy, F; Pujol, R

    2014-06-01

    The acquisition of competences (the set of knowledge, skills and attitudes required to perform a job to a professional level) is considered a fundamental part of medical training. Dermatology competences should include, in addition to effective clinical interviewing and detailed descriptions of skin lesions, appropriate management (diagnosis, differentiation, and treatment) of common skin disorders and tumors. Such competences can only be acquired during hospital clerkships. As a way of certifying these competences, we propose evaluating the different components as follows: knowledge, via clinical examinations or critical incident discussions; communication and certain instrumental skills, via structured workplace observation and scoring using a set of indicators; and attitudes, via joint evaluation by staff familiar with the student.

  18. [Elaboration and critical evaluation of clinical guidelines].

    PubMed

    García Villar, C

    2015-11-01

    Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written.

  19. [Elaboration and critical evaluation of clinical guidelines].

    PubMed

    García Villar, C

    2015-11-01

    Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written. PMID:26545328

  20. Clinical dilemmas in evaluating the short child.

    PubMed

    Garganta, Melissa D; Bremer, Andrew A

    2014-08-01

    Concerns about a child's growth are one of the most common topics parents voice during general pediatric office visits and are a leading cause for referral to a pediatric endocrinologist. There are a variety of conditions that lead to short stature in children; however, in the absence of true pathology, idiopathic short stature and constitutional delay are the most frequent causes. This article reviews the general approach to evaluating the short child and clinical signs that should prompt further evaluation and referral. We also address the unique psychological issues that these children face and approaches to counseling families with a child with idiopathic short stature.

  1. Clinical outcomes of 3-year experience of targeted temperature management in patients with out-of-hospital cardiac arrest at Songklanagarind Hospital in Southern Thailand: an analysis of the MICU-TTM registry

    PubMed Central

    Vattanavanit, Veerapong; Bhurayanontachai, Rungsun

    2016-01-01

    Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of intensive care unit admission, which results in high hospital mortality. Targeted temperature management (TTM) was introduced several years ago and is considered to improve neurological and mortality outcomes. This management process was implemented in our hospital in 2012, which was expected to improve the standard of care in OHCA patients. Purpose We aimed to report the clinical and mortality outcomes after TTM was introduced to our hospital in 2012. Patients and methods An analysis of data from the Medical Intensive Care Unit-TTM registry between 2012 and 2015 was performed. After successful cardiopulmonary resuscitation, TTM was applied to all OHCA patients regardless of causes if there was no contraindication. The Cerebral Performance Category scale score and other clinical outcomes were recorded and analyzed. Results Out of 23 patients, 87% were male and the mean age was 54.5±18.1 years. The causes of OHCA from cardiac etiology comprised 52.2%. The most common initial cardiac rhythm was ventricular fibrillation (47.8%). The survival rate to hospital discharge was 47.8% (11/23), but neurological outcomes were in a persistent vegetative state (8/11, 72.7%). The group with poor neurological outcomes had a significantly higher Acute Physiologic Assessment and Chronic Health Evaluation II score than the group with good neurological outcomes (22.9±4.2 vs 16.0±3.6, P=0.01). In the multivariate analysis, initial shockable rhythm was associated with survival at hospital discharge (odds ratio 10.1, 95% confidence interval 1.1–94.3, P=0.04). Conclusion TTM in OHCA patients gave better mortality benefits compared to our previous records, despite poor neurological outcomes. Ventilator-associated pneumonia was the major complication of TTM. Therefore, TTM should be considered in OHCA patients, especially in shockable rhythms, after return of spontaneous circulation. PMID:27660500

  2. Clinical Evaluation of Benign Prostatic Hyperplasia

    PubMed Central

    McVary, Kevin T

    2003-01-01

    Benign prostatic hyperplasia (BPH) is the most common neoplastic condition afflicting men and constitutes a major factor impacting male health. Clinical evaluation to assess the presence and degree of voiding dysfunction and/or the role of BPH in its presence has an increasingly broad spectrum of treatment goals. The goals of the evaluation of such men are to identify the patient’s voiding or, more appropriately, urinary tract problems, both symptomatic and physiologic; to establish the etiologic role of BPH in these problems; to evaluate the necessity for and probability of success and risks of various therapeutic approaches; and to present the results of these assessments to the patient so he can make an informed decision about management recommendations and available alternatives. PMID:16985961

  3. Clinical Evaluation of Benign Prostatic Hyperplasia

    PubMed Central

    McVary, Kevin T

    2003-01-01

    Benign prostatic hyperplasia (BPH) is the most common neoplastic condition afflicting men and constitutes a major factor impacting male health. Clinical evaluation to assess the presence and degree of voiding dysfunction and/or the role of BPH in its presence has an increasingly broad spectrum of treatment goals. The goals of the evaluation of such men are to identify the patient’s voiding or, more appropriately, urinary tract problems, both symptomatic and physiologic; to establish the etiologic role of BPH in these problems; to evaluate the necessity for and probability of success and risks of various therapeutic approaches; and to present the results of these assessments to the patient so he can make an informed decision about management recommendations and available alternatives. PMID:16985968

  4. Evaluation of clinical and laboratory correlates of sickle leg ulcers.

    PubMed

    Madu, Anazoeze Jude; Ubesie, Agozie; Madu, Kenechi Anthony; Okwor, Bismarck; Anigbo, Chukwudi

    2013-01-01

    The exact mechanism for the occurrence of sickle leg ulcers (SLUs) has not been fully explained, although, popular opinion supports a multifactorial etio-pathogenetic process. Leg ulceration in sickle cell is a chronic and debilitating condition which is difficult to treat and may worsen the psychosocial impact of this illness. This study aims to evaluate the laboratory and clinical correlates of SLUs. One hundred sixty-seven patients who had been diagnosed with sickle cell anemia (homozygous S) had their steady-state hemoglobin concentration (Hb), hematocrit, white cell count, platelet count, serum bilirubin, and aspartate transaminase (AST) as well as frequency of crisis per annum evaluated with respect to their relationship to the occurrence of leg ulcers. They were aged 6-53 years (mean age 24.3 years), and prevalence of leg ulcer was found to be 2.75 per 1000 (2.54 per 1000 in females and 2.83 per 1000 in males). The independent sample t-test showed a significant difference in the serum AST levels in those with SLU (p = 0.029), though a positive correlation did not exist. Other predictors of disease severity found to have positive relationship with each other were the AST and total serum bilirubin 0.207 (p = 0.012); Hb and age 0.130 (p = 0.035); Hb and white cell count -0.159 (p = 0.010), white cell count and age -0.113 (p = 0.018). SLUs do not occur in patients with severe disease in sickle cell. The clinical and laboratory indicators of severe sickle cell disease do not correlate positively with the occurrence of SLU. Serum AST may have a relationship with leg ulceration in these patients. Environmental factors most likely play a major part in the etiopathogenesis of leg ulcer and this may require further studies in different sociocultural settings.

  5. Critical Evaluation of Oncology Clinical Practice Guidelines

    PubMed Central

    Reames, Bradley N.; Krell, Robert W.; Ponto, Sarah N.; Wong, Sandra L.

    2013-01-01

    Purpose Significant concerns exist regarding the content and reliability of oncology clinical practice guidelines (CPGs). The Institute of Medicine (IOM) report “Clinical Practice Guidelines We Can Trust” established standards for developing trustworthy CPGs. By using these standards as a benchmark, we sought to evaluate recent oncology guidelines. Methods CPGs and consensus statements addressing the screening, evaluation, or management of the four leading causes of cancer-related mortality in the United States (lung, breast, prostate, and colorectal cancers) published between January 2005 and December 2010 were identified. A standardized scoring system based on the eight IOM standards was used to critically evaluate the methodology, content, and disclosure policies of CPGs. All CPGs were given two scores; points were awarded for eight standards and 20 subcriteria. Results No CPG fully met all the IOM standards. The average overall scores were 2.75 of 8 possible standards and 8.24 of 20 possible subcriteria. Less than half the CPGs were based on a systematic review. Only half the CPG panels addressed conflicts of interest. Most did not comply with standards for inclusion of patient and public involvement in the development or review process, nor did they specify their process for updating. CPGs were most consistent with IOM standards for transparency, articulation of recommendations, and use of external review. Conclusion The vast majority of oncology CPGs fail to meet the IOM standards for trustworthy guidelines. On the basis of these results, there is still much to be done to make guidelines as methodologically sound and evidence-based as possible. PMID:23752105

  6. Implementing Peer Evaluation of Clinical Teaching

    ERIC Educational Resources Information Center

    Laske, Rita Ann

    2013-01-01

    Clinical education provides the nursing student opportunities to learn the practice of nursing. In the clinical setting, the nursing student applies classroom knowledge to the real patient care situation. The clinical instructor facilitates this important process by assisting students to integrate knowledge into their practice, improve their…

  7. Clinical evaluation of seven anticalculus dentifrice formulations.

    PubMed

    Scruggs, R R; Stewart, P W; Samuels, M S; Stamm, J W

    1991-01-01

    One hundred ninety-two subjects completed a clinical trial to determine the effects of seven dentifrice formulations on calculus inhibition. The double-blind study involved a ten-day control phase and a ten-day experimental phase. For the control phase, subjects were evaluated for calculus present, received a prophylaxis and had pre-weighed mylar strips attached to the lingual surfaces of the mandibular incisors to harvest mineral deposits. Subjects were then assigned the placebo dentifrice for unsupervised twice-daily use and were required to report once a day for a supervised mouthrinse using a 1:3 dilution of the dentrifice. The experimental phase was identical except that subjects were allocated the experimental dentifices using a stratified random assignment based on age, gender and the initial presence of calculus. Simple linear regression analyses of the dry and ash log weights obtained from the strips were performed. The results showed no statistically significant differences among the test products; however, two formulations containing zinc citrate showed some calculus inhibition-potential suggesting that further research and development of such products may be warranted.

  8. Automatic Evaluations in Clinically Anxious and Nonanxious Children and Adolescents

    ERIC Educational Resources Information Center

    Vervoort, Leentje; Wolters, Lidewij H.; Hogendoorn, Sanne M.; Prins, Pier J. M.; de Haan, Else; Nauta, Maaike H.; Boer, Frits

    2010-01-01

    Automatic evaluations of clinically anxious and nonanxious children (n = 40, aged 8-16, 18 girls) were compared using a pictorial performance-based measure of automatic affective associations. Results showed a threat-related evaluation bias in clinically anxious but not in nonanxious children. In anxious participants, automatic evaluations of…

  9. AID awards 3-year Guatemala contract.

    PubMed

    1984-01-01

    The US Agency for International Development (USAID) has awarded a 3-year US$593,036 grant to the Los Angeles firm of Juarez and Associates, Inc. to help implement a contraceptive social marketing project in Guatemala. The firm will provide marketing assistance to the for-profit organization. Importadora de Productos Farmaceuticos (PROFA), an offshoot of the nonprofit International Planned Parenthood Federation affiliate, Asociacion Pro-Bienestar de la Familia de Guatemala (APROFAM), created specifically to conduct the social marketing project. Juarez and Associates has previous market research experience in family planning in Guatemala. Contraceptive social marketing sales are projected to begin in early 1985. PMID:12313310

  10. AID awards 3-year Guatemala contract.

    PubMed

    1984-01-01

    The US Agency for International Development (USAID) has awarded a 3-year US$593,036 grant to the Los Angeles firm of Juarez and Associates, Inc. to help implement a contraceptive social marketing project in Guatemala. The firm will provide marketing assistance to the for-profit organization. Importadora de Productos Farmaceuticos (PROFA), an offshoot of the nonprofit International Planned Parenthood Federation affiliate, Asociacion Pro-Bienestar de la Familia de Guatemala (APROFAM), created specifically to conduct the social marketing project. Juarez and Associates has previous market research experience in family planning in Guatemala. Contraceptive social marketing sales are projected to begin in early 1985.

  11. Reflective journaling for clinical judgment development and evaluation.

    PubMed

    Lasater, Kathie; Nielsen, Ann

    2009-01-01

    Reflective journaling is a strategy used often in clinical education to gain insight into students' clinical thinking; however, studies indicate that students may benefit from guided reflections. Numerous tools have been used to structure student reflection with varying results. This article describes the outcomes from using the Guide for Reflection based on Tanner's Clinical Judgment Model. The Lasater Clinical Judgment Rubric, created from the Model, is used to evaluate development of clinical judgment and provides language to communicate about clinical thinking with students. Senior immersion course competencies, also developed with language from Tanner's Clinical Judgment Model,offer a comprehensive package that fosters students' clinical judgment development, faculty-student communication about clinical judgment, and evaluation of students' clinical thinking.

  12. Clinical evaluation--difficulties experienced by sessional clinical teachers of nursing: a qualitative study.

    PubMed

    Duke, M

    1996-02-01

    Evaluation of nursing students in the clinical field requires the clinical teacher to make judgements regarding student progress in a number of areas. In this study concepts of role theory, oppressed group behaviour and the ethics of caring emerged and were used as conceptual frameworks to interpret the data relating to the evaluation of undergraduate students. The number of experienced faculty available for clinical teaching and evaluation has become inadequate and a large number of casual or sessional clinical teachers are employed to teach students in the clinical field. Despite the well documented problems associated with clinical teaching and the use of inexperienced clinical teachers, sessional clinical teachers are nevertheless expected to evaluate student success in meeting the clinical requirements of the nursing course, often resulting in disparate decisions for students. A phenomenological study was carried out using unstructured interviews and written clinical scenarios, to explore the evaluation process from the perspective of the sessional clinical teachers. Research findings indicate that although the sessional clinical teachers were skilled at identifying student problems, they were reluctant to make difficult evaluation decisions, due to low self-esteem, role conflict and their ethic of caring. It seems that gender socialization, patriarchal dominance and apprenticeship training had effected their confidence in their own decision making. The implications of such findings are of concern for the ongoing credibility and integrity of nursing courses, as clinical teachers have an influence on the nursing profession through the preparation of its practitioners.

  13. Evaluation systems for clinical governance development: a comparative study.

    PubMed

    Hooshmand, Elaheh; Tourani, Sogand; Ravaghi, Hamid; Ebrahimipour, Hossein

    2014-01-01

    Lack of scientific and confirmed researches and expert knowledge about evaluation systems for clinical governance development in Iran have made studies on different evaluation systems for clinical governance development a necessity. These studies must provide applied strategies to design criteria of implementing clinical governance for hospital's accreditation. This is a descriptive and comparative study on development of clinical governance models all over the world. Data have been gathered by reviewing related articles. Models have been studied in comprehensive review method. The evaluated models of clinical governance development were Australian, NHS, SPOCK and OPTIGOV. The final aspects extracted from these models were Responsiveness, Policies and Strategies, Organizational Structure, Allocating Resources, Education and Occupational Development, Performance Evaluation, External Evaluation, Patient Oriented Approach, Risk Management, Personnel's Participation, Information Technology, Human Resources, Research and Development, Evidence Based Medicine, Clinical Audit, Health Technology Assessment and Quality. These results are applicable for completing the present criteria which evaluating clinical governance application and provide practical framework to evaluate country's hospital on the basis of clinical governance elements.

  14. 3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up.

    PubMed

    Tunchel, Samy; Blay, Alberto; Kolerman, Roni; Mijiritsky, Eitan; Shibli, Jamil Awad

    2016-01-01

    This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26-67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results.

  15. 3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up

    PubMed Central

    2016-01-01

    This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26–67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results. PMID:27313616

  16. 3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up.

    PubMed

    Tunchel, Samy; Blay, Alberto; Kolerman, Roni; Mijiritsky, Eitan; Shibli, Jamil Awad

    2016-01-01

    This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26-67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results. PMID:27313616

  17. Clinical Use and Evaluation of Insulin Pens

    PubMed Central

    Ginsberg, Barry H.

    2015-01-01

    Insulin pens are more accurate and easier to teach than other methods of insulin delivery. They also do not suffer from the risk of mismatch of insulin concentration and type of insulin syringe. The ISO standard used to test insulin pens, however, needs to be updated to reflect their clinical use. PMID:26323484

  18. Changes in Strength Abilities of Adolescent Girls: The Effect of a 3-Year Physical Education Curriculum

    ERIC Educational Resources Information Center

    Czarniecka, Renata; Milde, Katarzyna; Tomaszewski, Pawel

    2012-01-01

    Study aim: To evaluate changes in strength abilities of adolescent girls that underwent a 3-year physical education curriculum. Material and methods: The research participants comprised 141 girls aged 13.3 plus or minus 0.35 years who participated in a 3-year physical education curriculum (PEC). Evaluation was based on the following EUROFIT…

  19. Rubrics for clinical evaluation: objectifying the subjective experience.

    PubMed

    Isaacson, Julie J; Stacy, Annette S

    2009-03-01

    Rubrics have historically been used in secondary and higher education to evaluate specific assignments or tasks. There is little mention of rubrics in the nursing literature, particularly in the area of clinical evaluation. A strong case can be made for expanding the traditional use of a rubric to include its validity with clinical evaluation. Clinical evaluation remains a challenge, even for seasoned faculty. Faculty and students often interpret clinical course objectives differently. Coupled with this concern is the subjectivity of the evaluation. The use of "novice" clinical faculty, who inevitably struggle with discerning and justifying anything but stellar student performance, further compounds these issues. Rubrics also facilitate the grading experience for faculty and students. Faculty often find themselves making repetitive written comments to students. These comments can be incorporated into the rubric, thus shortening grading time while increasing the quality and quantity of instructor feedback. When clarified in a rubric, course objectives become "real". Student benefits include increased critical thinking and a more realistic approach to self-evaluation. Clinical rubrics can be developed from existing course objectives. Though perhaps tedious in initial development, both faculty and student satisfaction with the clinical evaluation process can be enhanced with the use of rubrics. PMID:19083270

  20. Clinical Evaluation of Baccalaureate Nursing Students Using SBAR Format: Faculty versus Self Evaluation

    ERIC Educational Resources Information Center

    Saied, Hala; James, Joemol; Singh, Evangelin Jeya; Al Humaied, Lulawah

    2016-01-01

    Clinical training is of paramount importance in nursing education and clinical evaluation is one of the most challenging responsibilities of nursing faculty. The use of objective tools and criteria and involvement of the students in the evaluation process are some techniques to facilitate quality learning in the clinical setting. Aim: The aim of…

  1. Clinical evaluation of vein contrast enhancement

    NASA Astrophysics Data System (ADS)

    Lovhoiden, Gunnar; Deshmukh, Harshal; Zeman, Herbert D.

    2002-05-01

    A clinical study is underway to compare an experimental infrared (IR) device, OnTarget OnTarget at LeBonheur Children's Medical Center, Methodist Healthcare, in Memphis, TN, while the adult study site is the clinical research center at Bowld Hospital, also in Memphis, TN. Early results on 35 pediatric and 25 adult subjects indicate that OnTarget years' experience in accessing veins in pediatric subjects, and that it could be very helpful to a phlebotomist with limited experience when accessing veins in both adult and pediatric subjects. The study uses monitor based OnTarget area of the patients anatomy enlarged and contrast enhanced on a LCD monitor. The phlebotomist can then compare the OnTarget or feel when examining a subject.

  2. Is the Movement Assessment Battery for Children-2nd Edition a Reliable Instrument to Measure Motor Performance in 3 Year Old Children?

    ERIC Educational Resources Information Center

    Smits-Engelsman, Bouwien C. M.; Niemeijer, Anuschka S.; van Waelvelde, Hilde

    2011-01-01

    Formal testing of 3 year old children is a new feature in the revised version of the Movement Assessment Battery for Children (Movement ABC-2). Our study evaluated the reliability and explored the clinical applicability of the Movement ABC-2 Test in this young age group. A total of 50 typically children were given two trials of the test within a…

  3. A Model for Evaluating Student Clinical Psychomotor Skills.

    ERIC Educational Resources Information Center

    And Others; Fiel, Nicholas J.

    1979-01-01

    A long-range plan to evaluate medical students' physical examination skills was undertaken at the Ingham Family Medical Clinic at Michigan State University. The development of the psychomotor skills evaluation model to evaluate the skill of blood pressure measurement, tests of the model's reliability, and the use of the model are described. (JMD)

  4. Cryoplasty Versus Conventional Angioplasty in Femoropopliteal Arterial Recanalization: 3-Year Analysis of Reintervention-Free Survival by Treatment Received

    SciTech Connect

    Diaz, Maria Lourdes; Urtasun, Fermin Barberena, Javier; Aranzadi, Carlos; Guillen-Grima, Francisco; Bilbao, Jose Ignacio

    2011-10-15

    Purpose: To compare long-term efficacy of cryoplasty therapy versus conventional angioplasty in the treatment of peripheral arterial atherosclerotic stenosis on the basis of our 3-year clinical experience. Materials and Methods: From January 2006 to December 2008, a total of 155 patients with 192 lesions of the femoropopliteal sector were randomized to receive either cryoplasty or conventional balloon angioplasty. The primary study end point was lesion target patency. Follow-up with clinical evaluation of patient's symptoms, ankle-brachial index, and Doppler ultrasound was scheduled at 1, 6, 9, 12, 24, and 36 months. Results: For the cryoplasty group (n = 86), technical immediate success was achieved in 74.4% of lesions. Rate of significant dissection was 13.5% and rate of stent placement of 22%. In the long term, target lesion patency rate at 6 months was 59.4%, with rates of 55.9, 52.6, and 49.1% at 1, 2, and 3 years, respectively. For the conventional angioplasty group (n = 69), the immediate technical success rate was 83.7%. Rate of significant dissection was 19%, and rate of stent placement was 72.9%. Patency rates at 6 months and at 1, 2, and 3 years were 71.5, 61.2, 60, and 56%, respectively. Conclusion: Compared with conventional angioplasty, cryoplasty showed good immediate success rates with lower stent placement rates. During the 3-year follow-up, patency rates tended to equalize between the two modalities.

  5. Clinical laboratory evaluation of the thermonuclease test.

    PubMed

    Shanholtzer, C J; Peterson, L R

    1982-05-01

    Simultaneous testing for clumping factor, coagulase, deoxyribonuclease, and thermonuclease was performed on 189 clinical isolates of gram-positive cocci with strong catalase activity to determine the suitability of the thermonuclease test as a routine procedure for the identification of Staphylococcus aureus. Positive reactions to all four tests were exhibited by 72 of the strains while 88 of the isolates gave uniformly negative results. Although discrepancies were found between the reactions of 29 organisms, differences were found between the reactions of 29 organisms, differences between tube coagulase ant thermonuclease results were rare. Greater than 90% of positive reactions for both tube coagulase and thermonuclease tests were detected within a four-hour incubation period. The thermonuclease test was found to be simple, reliable, inexpensive and rapid. This test gave easily interpretable reactions within an eight-hour workday, even when only one or two isolated colonies were used for testing. The thermonuclease test is well suited for use as a primary clinical laboratory procedure for the identification of Staphylococcus aureus.

  6. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents

    PubMed Central

    Inge, Thomas H.; Courcoulas, Anita P.; Jenkins, Todd M.; Michalsky, Marc P.; Helmrath, Michael A.; Brandt, Mary L.; Harmon, Carroll M.; Zeller, Meg H.; Chen, Mike K.; Xanthakos, Stavra A.; Horlick, Mary; Buncher, C. Ralph

    2016-01-01

    BACKGROUND Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making. METHODS We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated through 3 years after the procedure. RESULTS The mean (±SD) baseline age of the participants was 17±1.6 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 53; 75% of the participants were female, and 72% were white. At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25 to 29) in the total cohort, by 28% (95% CI, 25 to 30) among participants who underwent gastric bypass, and by 26% (95% CI, 22 to 30) among those who underwent sleeve gastrectomy. By 3 years after the procedure, remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of participants who had had the condition at baseline, remission of abnormal kidney function occurred in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to 97), remission of elevated blood pressure in 74% (95% CI, 64 to 84), and remission of dyslipidemia in 66% (95% CI, 57 to 74). Weight-related quality of life also improved significantly. However, at 3 years after the bariatric procedure, hypoferritinemia was found in 57% (95% CI, 50 to 65) of the participants, and 13% (95% CI, 9 to 18) of the participants had undergone one or more additional intraabdominal procedures. CONCLUSIONS In this multicenter, prospective study of bariatric surgery in adolescents, we

  7. A national evaluation of specialists' clinics in primary care settings.

    PubMed Central

    Bowling, A; Bond, M

    2001-01-01

    BACKGROUND: Encouraged by the increased purchasing power of general practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this trend. AIM: To evaluate the costs, processes, and benefits of specialists' outreach clinics held in GPs' surgeries, compared with hospital outpatient clinics. DESIGN OF STUDY: A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with matched outpatient control clinics. SETTING: Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls, covering 14 hospital trust areas across England. METHOD: Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs, and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also given to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and trust accountants (process and costs questionnaire). Evaluation of the costs, processes, and benefits of specialist outreach clinics versus hospital outpatient clinics was carried out by comparing questionnaire responses. RESULTS: In comparison with outpatients, outreach clinic patients spent less time on the waiting lists for appointments to see the specialist, they had shorter waiting times in clinics, fewer follow-up appointments, and were more likely to be completely discharged after the sampled attendance. Outreach patients were more satisfied than outpatients with the range of clinic process items asked about. Most doctors felt that the outreach clinic was 'worthwhile'. While patients' personal costs were lower in outreach than in outpatients

  8. [Analysis on evaluation tool for literature quality in clinical study].

    PubMed

    Liu, Qing; Zhai, Wei; Tan, Ya-qin; Huang, Juan

    2014-09-01

    The tools used for the literature quality evaluation are introduced. The common evaluation tools that are publicly and extensively used for the evaluation of clinical trial literature quality in the world are analyzed, including Jadad scale, Consolidated Standards of Reporting Trials (CONSORT) statement and Grades of Recommendations Assessment, Development and Evaluation (GRADE) system and the others. Additionally, the present development, updates and applications of these tools are involved in analysis.

  9. Evaluation of clinical teaching models for nursing practice.

    PubMed

    Croxon, Lyn; Maginnis, Cathy

    2009-07-01

    Clinical placements provide opportunities for student nurses to learn experientially. To create a constructive learning environment staff need to be friendly, approachable, available and willing to teach. There must be adequate opportunities for students to develop confidence and competence in clinical skills with a focus on student learning needs rather than service needs of facilities. A popular model for clinical teaching of nursing students is the preceptor model. This model involves a student working under the supervision of individual registered nurses who are part of the clinical staff. This model was failing to meet students' needs in acute nursing practice areas, largely due to Registered Nurse staff shortages and demanding workloads. The students' evaluations led to the trial of a 'cluster' or group model of eight students, with a clinical facilitator who is paid by the university, in each acute nursing ward. Evaluation of twenty nursing students' perceptions of their acute nursing practice clinical placements was conducted using a mixed method approach to evaluate the two models of student supervision. Results indicate that the students prefer small groups with the clinical facilitator in one area. Thus evaluation and feedback from students and the perceptions of their clinical placement is essential. PMID:18722161

  10. Clinical Evaluation of Predictive Data for Prospective Home Economics Teachers.

    ERIC Educational Resources Information Center

    Gilbert, Ardyce Lucile

    This investigation, part of a longitudinal study of homemaking teacher effectiveness, was designed to explore the usefulness of clinical judgments to predict teacher success. Clinical judgment is defined as involving the ability to make sound decisions after gathering and evaluating all the pertinent evidence, weighing possible alternatives in…

  11. [Clinical evaluation tools of total hip arthroplasties].

    PubMed

    Hamadouche, M

    2006-10-01

    Total hip arthroplasty is one of the most efficient hip surgery procedures enabling improved function in the vast majority of operated patients. The major long-term complication is aseptic loosening due to an inflammatory response to particle wear debris coming from the bearings. Polyethylene is the key culprit. Currently two solutions are proposed: eliminating polyethylene from the prosthetic articulation or reducing material wear. This leads to the need for reliable tools for evaluating short-term results, predictive of long-term outcome. When the innovation concerns reduction of polyethylene wear, short-term wear should be measured with software methods or radiostereometry. If the innovation concerns improvement of polyethyleneless implants, then short-term migration should be measured with EBRA or radiostereometry. In addition, the long-term retrospective evaluation of large series of patients remains of major interest provided that it is performed with survival analysis. These different methods are detailed in this study, indicating the pros and cons for each solution. PMID:17088755

  12. Early treated hypothyroidism: development at 3 years.

    PubMed Central

    Murphy, G; Hulse, J A; Jackson, D; Tyrer, P; Glossop, J; Smith, I; Grant, D

    1986-01-01

    Eighty children from the North West and North East Thames Regional Health Authorities who had been identified as having congenital hypothyroidism either by neonatal screening (76 cases) or by clinical symptoms (four) were seen for psychological assessments at 1 (60 cases), 3 (58), and/or 5 (20) years of age. Almost all the children's scores were in the normal range, and comparisons with matched controls suggested that they were doing only slightly less well than normal children in overall development. They were significantly slower, however, on a motor skills task. Moreover, a low initial serum thyroxine and triiodothyronine value, considerable delay in initial bone age, and an absence of thyroid tissue on isotope scan seemed to be associated with a somewhat poorer prognosis. PMID:3740924

  13. Interprofessional student clinics: an economic evaluation of collaborative clinical placement education.

    PubMed

    Haines, Terry P; Kent, Fiona; Keating, Jennifer L

    2014-07-01

    Interprofessional student clinics can be used to create clinical education placements for health professional students in addition to traditional hospital-based placements and present an opportunity to provide interprofessional learning experiences in a clinical context. To date, little consideration has been given in research literature as to whether such clinics are economically viable for a university to run. We conducted an economic evaluation based upon data generated during a pilot of an interprofessional student clinic based in Australia. Cost-minimization analyses of the student clinic as opposed to traditional profession-specific clinical education in hospitals were conducted from university, Commonwealth Government, state government and societal perspectives. Cost data gathered during the pilot study and market prices were used where available, while $AUD currency at 2011 values were used. Per student day of clinical education, the student clinic cost an additional $289, whereas the state government saved $49 and the Commonwealth Government saved $66. Overall, society paid an additional $175 per student day of clinical education using the student clinic as opposed to conventional hospital-based placements, indicating that traditional hospital-based placements are a cost-minimizing approach overall for providing clinical education. Although interprofessional student clinics have reported positive patient and student learning outcomes, further research is required to determine if these benefits can justify the additional cost of this model of education. Considerations for clinic sustainability are proposed.

  14. Interprofessional student clinics: an economic evaluation of collaborative clinical placement education.

    PubMed

    Haines, Terry P; Kent, Fiona; Keating, Jennifer L

    2014-07-01

    Interprofessional student clinics can be used to create clinical education placements for health professional students in addition to traditional hospital-based placements and present an opportunity to provide interprofessional learning experiences in a clinical context. To date, little consideration has been given in research literature as to whether such clinics are economically viable for a university to run. We conducted an economic evaluation based upon data generated during a pilot of an interprofessional student clinic based in Australia. Cost-minimization analyses of the student clinic as opposed to traditional profession-specific clinical education in hospitals were conducted from university, Commonwealth Government, state government and societal perspectives. Cost data gathered during the pilot study and market prices were used where available, while $AUD currency at 2011 values were used. Per student day of clinical education, the student clinic cost an additional $289, whereas the state government saved $49 and the Commonwealth Government saved $66. Overall, society paid an additional $175 per student day of clinical education using the student clinic as opposed to conventional hospital-based placements, indicating that traditional hospital-based placements are a cost-minimizing approach overall for providing clinical education. Although interprofessional student clinics have reported positive patient and student learning outcomes, further research is required to determine if these benefits can justify the additional cost of this model of education. Considerations for clinic sustainability are proposed. PMID:24417539

  15. Evaluation of Respiratory Muscle Strength in Mouth Breathers: Clinical Evidences

    PubMed Central

    Andrade da Cunha, Renata; Andrade da Cunha, Daniele; Assis, Roberta Borba; Bezerra, Luciana Ângelo; Justino da Silva, Hilton

    2013-01-01

    Introduction The child who chronically breathes through the mouth may develop a weakness of the respiratory muscles. Researchers and clinical are seeking for methods of instrumental evaluation to gather complementary data to clinical evaluations. With this in mind, it is important to evaluate breathing muscles in the child with Mouth Breathing. Objective To develop a review to investigate studies that used evaluation methods of respiratory muscle strength in mouth breathers. Data Synthesis  The authors were unanimous in relation to manovacuometry method as a way to evaluate respiratory pressures in Mouth Breathing children. Two of them performed with an analog manovacuometer and the other one, digital. The studies were not evaluated with regard to the method efficacy neither the used instruments. Conclusion There are few studies evaluating respiratory muscle strength in Mouth Breathing people through manovacuometry and the low methodological rigor of the analyzed studies hindered a reliable result to support or refuse the use of this technique. PMID:25992108

  16. Evaluation of nonlinear frequency compression: Clinical outcomes

    PubMed Central

    Glista, Danielle; Scollie, Susan; Bagatto, Marlene; Seewald, Richard; Parsa, Vijay; Johnson, Andrew

    2009-01-01

    This study evaluated prototype multichannel nonlinear frequency compression (NFC) signal processing on listeners with high-frequency hearing loss. This signal processor applies NFC above a cut-off frequency. The participants were hearing-impaired adults (13) and children (11) with sloping, high-frequency hearing loss. Multiple outcome measures were repeated using a modified withdrawal design. These included speech sound detection, speech recognition, and self-reported preference measures. Group level results provide evidence of significant improvement of consonant and plural recognition when NFC was enabled. Vowel recognition did not change significantly. Analysis of individual results allowed for exploration of individual factors contributing to benefit received from NFC processing. Findings suggest that NFC processing can improve high frequency speech detection and speech recognition ability for adult and child listeners. Variability in individual outcomes related to factors such as degree and configuration of hearing loss, age of participant, and type of outcome measure. PMID:19504379

  17. [Tinnitus during headache: clinical-instrumental evaluation].

    PubMed

    Farri, A; Enrico, A; Lacilla, M; Sartoris, A

    1999-04-01

    During the five years running from December 1993 to January 1998, 112 patients who had come to our University Clinic suffering from headache were examined. From this group 71 complaining of tinnitus during headache were recruited for the study: 19 patients suffered from migraine without aura, 8 migraine with aura, 15 tension headache, 21 mixed headache, 3 basic migraine and 5 cluster headache. The purpose of this work was to determine the incidence and to identify the frequency of the various types of tinnitus in the study sample. Once cardiovascular and metabolic pathologies, previous cranial or cervical traumas, barotrauma, chronic on-the-job noise exposure, cervical arthritis, ATM malocclusion, use of drugs that damage the hearing apparatus, morbose processes of the external and middle ear, otosclerosis, jugular tympanum paraganglioma, Meniere's disease, acoustic neurinoma were all ruled out, the patients underwent the following battery of instrumental tests: tonal audiometry, impedance measurement, vestibular examination, electronystagmography, ABR, simplified tinnitometry. Only those patients with normal hearing underwent the tinnitometry and, therefore, the type of tinnitus was established only for this group of 53 patients. Tinnitometry showed that 37% of these subjects had tinnitus at the higher frequency tones, 11% at the middle frequencies, 29% complained of tinnitus at the lower frequencies while 23% complained that the bothersome buzzing was a compound noise. In addition, the subjective intensity of the tinnitus was analyzed. The authors devised a tinnitus irritation scale covering a range from 0 (not irritating) to 10 (intolerable). The tinnitus was bilateral in 66% of the cases while it was limited to only one ear in the remaining 34%. In 15% of the cases tinnitus was present even when there was no headache. In the literature, the etiopathogenesis of tinnitus associated with migraine headache has been attributed to vascular and neuropeptide mechanisms

  18. Diagnostic Value of Clinical Findings in Evaluation of Thoracolumbar Blunt Traumas

    PubMed Central

    Shahrami, Ali; Shojaee, Majid; Tabatabaee, Seyed Mohammadreza; Mianehsaz, Elaheh

    2016-01-01

    Introduction: Necessity of imaging for symptom-free conscious patients presented to emergency department (ED) following traumatic thoracolumbar spine injuries has been a matter of debate. The present study was aimed to evaluate the diagnostic value of clinical findings in prediction of traumatic thoracolumbar injuries compared tocomputed tomography (CT) scan. Methods: The present diagnostic value study was carried out using non-random convenience sampling during the time between October 2013 and March 2014. All trauma patients > 15 years old underwent thoracolumbar CT scan were included. Correlation between clinical and CT findings was measured using SPSS 21.0 and screening performance characteristics of clinical findings in prediction of thoracolumbar fracture were calculated. Results: 169 patients with mean age of 37.8 ± 17.3 years (rage: 15-86) were evaluated (69.8% male). All fracture patients had at least 1 positive finding in history and physical examination. The fracture was confirmed in only 24.6% of the patients with positive findings in history or physical examination. In 37.5% of patients the location of fracture, matched the area of positive physical examinations. Sensitivity, specificity, PPV, NPV, PLR, and NLR of clinical findings in comparison to thoracolumbar CT scan were 100 (95% CI: 89 - 100), 1.5 (95% CI: 0.2-6), 24.5 (95% CI: 18.3-31.9), 100 (95% CI: 19.7-100), 32.5 (95% CI: 24.6-43.03), and infinite, respectively. Conclusion: The results of the present study, show the excellent screening performance characteristics of clinical findings in prediction of traumatic thoracolumbar fracture (100% sensitivity). It could be concluded that in conscious patients with stable hemodynamic, who have no distracting pain and are not intoxicated, probability of thoracolumbar fracture is very low and near to zero in case of no positive clinical finding. PMID:27299140

  19. Using simulation to evaluate clinical competence after impairment.

    PubMed

    Raborn, G W; Carter, R M

    1999-01-01

    It is important for individual dentists and the profession to have access to a process for evaluating the clinical competence of practitioners who are professionally impaired as a result of an accident or a medical disability. No common standards for such evaluations currently exist, however, as demand for this type of assessment is still rare. This article reviews the evaluative approach taken by a team of experienced dental educators in examining three dentists who suffered from medical disabilities. An attempt was made to standardize the evaluation process by using clinical simulation to create an environment that would be comfortable for the dentists and acceptable to the lawyers and the insurance companies. Following evaluation, recommendations on individual competence were made, contributing to a faster resolution of legal and insurance issues.

  20. Evaluation of the Olympus AU 400 clinical chemistry analyzer.

    PubMed

    Bilić, A; Alpeza, I; Rukavina, A S

    2000-01-01

    The performance of the Olympus AU 400 clinical chemistry analyzer was evaluated according to the guidelines of the European Committee for Clinical Laboratory Standards. The following analytes were tested: glucose, urea, creatinine, calcium, AST, ALT, CK, LDH, ALP and amylase. The Olympus AU 400 was compared with the Olympus AU 800. Coefficients of correlation showed high correlation between the compared analyzers. Other performances (intra- and inter-assay variation, carry-over and interferences) of the analyzer were satisfactory.

  1. Validation of a virtual preoperative evaluation clinic: a pilot study.

    PubMed

    Zetterman, Corey V; Sweitzer, Bobbie J; Webb, Brad; Barak-Bernhagen, Mary A; Boedeker, Ben H

    2011-01-01

    Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

  2. Diversity in clinical guidelines: the role of repertoires of evaluation.

    PubMed

    Moreira, Tiago

    2005-05-01

    Clinical practice guidelines are one of the main tools by which clinicians, policy makers and patients hope to make health care less variable, more reliable and efficient, but there is little understanding of the processes by which clinical guidance is put together by guideline groups. This paper describes the social organisation of knowledge within clinical practice guideline development processes by drawing on the sociology of situated judgement. Two guideline development processes were observed, and the development group meetings (N = 21) recorded and analysed qualitatively. Data analysis suggested that clinical guidance comes to existence through the combination of repertoires of evaluation, organised around four different epistemic criteria: robustness, usability, acceptability and adequacy. This research provides a detailed and layered understanding of the knowledge dynamics involved in developing recommendations for appropriate health care for specific clinical circumstance.

  3. Comparison of two all-in-one adhesives bonded to non-carious cervical lesions--results at 3 years.

    PubMed

    Burrow, Michael F; Tyas, Martin J

    2012-08-01

    The aim of this study was to evaluate the clinical performance of S(3) Bond (Kuraray Corp., Japan) and G-Bond (GC Corp., Japan) all-in-one bonding agents, over 3 years in non-carious cervical lesions (NCCLs). Ethics Committee approval was obtained, and 60 restorations were placed in 11 patients aged 45-84 years (mean 60.5 years), using either Clearfil ST resin composite (Kuraray) and S(3) Bond or Gradia resin composite (GC) and G-Bond alternately, without phosphoric acid etch on the uncut enamel margins. Patients were recalled at 6 months, 1 year, 2 years and 3 years, and photographs were taken for assessment of colour match and marginal discoloration. One patient was not available at 3 years, resulting in 54 restorations being available for evaluation. One restoration of S(3)/Clearfil ST was lost at 2 years, giving retention rates of 97% for S(3) and 100% for G-Bond. At 3 years, six restorations for S(3)/Clearfil ST showed slight marginal discoloration and one restoration pronounced marginal staining. For G-Bond/Gradia at 3 years, 11 restorations exhibited slight marginal staining and one restoration pronounced marginal staining. Most restorations were bonded to sclerotic dentin. Statistical analysis of marginal staining showed no significant difference between the two restoration groups. The degree of marginal staining was almost identical for both materials and tended to be in larger restorations. Both S(3) and G-Bond all-in-one bonding systems appear to be good adhesives for the restoration of NCCL for the length of the current study. Restoration of NCCLs with the newer all-in-one adhesives appears to be a viable alternative technique to more complicated adhesive materials. PMID:21789590

  4. Longitudinal clinical evaluation of post systems: a literature review.

    PubMed

    Soares, Carlos José; Valdivia, Andréa Dolores Correia Miranda; da Silva, Gisele Rodrigues; Santana, Fernanda Ribeiro; Menezes, Murilo de Souza

    2012-01-01

    In this survey, retrospective and prospective clinical studies dealing with cast-post-and core and fiber posts were reviewed regarding the rate of survival of restorations and the most prevalent failures. Electronic searches of the literature were performed in MEDLINE by crossing the key words: "Fiber post and clinical study", "Fiber post and clinical evaluation", "Cast post-and-core and clinical study", and "Root post and retrospective survival study". The cut-off dates were December 1990 through the end of December 2010. Review of literature showed that several interrelated biological, mechanical, and aesthetic factors are involved in the survival rate of restorative procedures in endodontically treated teeth, and post selection should fulfill and optimize these factors. Data based on long-term clinical studies are essential for the general practitioner when making clinical decisions. An adequate selection of teeth and post system must be made, and a minimal amount of existing tooth substance should be removed. A ferrule must be present for safe indication of the fiber posts. Fiber glass posts have demonstrated good survival in clinical studies, with similar performance to cast-post-and cores. Metallic posts have good clinical survival, but the associated failures are mostly irreversible, unlike what happens with the glass fiber posts.

  5. Evaluation of clinical thermometers for accuracy and reliability.

    PubMed

    Latman, N S; Hans, P; Nicholson, L; DeLee Zint, S; Lewis, K; Shirey, A

    2001-01-01

    The purpose of this study was to examine the accuracy and reliability of a wide range of clinical thermometry instruments and technologies. In a historical sense, the purpose of this study was to determine if the improvements in speed, ease of use, and safety realized in the last 100 years have been offset by a loss of accuracy and/or reliability. In view of current events, the purpose was to determine if the new generation of electronic, digital clinical thermometers could be used to replace the traditional glass/mercury thermometers. Nine clinical thermometers representing electronic, digital oral, and predictive oral; electronic, digital infrared tympanic; and liquid crystal urinary technologies were evaluated. Accuracy was determined by comparing the temperatures obtained from these test instruments with those of the reference, glass/mercury oral thermometer. Reliability was determined by test-retest evaluation. All of the thermometers evaluated were significantly less accurate when compared with the reference thermometer in this study. All of the test instruments significantly underestimated higher temperatures and overestimated lower temperatures. This study indicated that the improvements in safety, speed, and ease of use of the newer clinical thermometers have been offset by a loss in accuracy and reliability. It also indicated that the current generation of electronic, digital clinical thermometers, in general, may not be sufficiently accurate or reliable to replace the traditional glass/mercury thermometers.

  6. Development of an Evaluative Procedure for Clinical Clerkships.

    ERIC Educational Resources Information Center

    And Others; Pancorbo, Salvador

    1980-01-01

    In order to evaluate the clinical competencies of graduate pharmacy students upon the completion of a medicine rotation, an oral examination has been developed that requires students to present data and defend decisions. Objectives, responsibilities, and competencies required by the rotation and nine sample exam questions are appended. (JMD)

  7. Chairside Assisting Skill Evaluation (CASE). Clinical Setting. Health Manpower References.

    ERIC Educational Resources Information Center

    Innovative Programming Systems, Minneapolis, Minn.

    These checklists are designed for use during the dental assistant student's extramural clinical experience assignment. Checklists test students on their knowledge of terminology, equipment, procedures, and patient relations. Objectives are listed outline style with columns to check progress during a first and a second evaluation. Areas included…

  8. A General Framework for the Evaluation of Clinical Trial Quality

    PubMed Central

    Berger, Vance W.; Alperson, Sunny Y.

    2009-01-01

    Flawed evaluation of clinical trial quality allows flawed trials to thrive (get funded, obtain IRB approval, get published, serve as the basis of regulatory approval, and set policy). A reasonable evaluation of clinical trial quality must recognize that any one of a large number of potential biases could by itself completely invalidate the trial results. In addition, clever new ways to distort trial results toward a favored outcome may be devised at any time. Finally, the vested financial and other interests of those conducting the experiments and publishing the reports must cast suspicion on any inadequately reported aspect of clinical trial quality. Putting these ideas together, we see that an adequate evaluation of clinical quality would need to enumerate all known biases, update this list periodically, score the trial with regard to each potential bias on a scale of 0% to 100%, offer partial credit for only that which can be substantiated, and then multiply (not add) the component scores to obtain an overall score between 0% and 100%. We will demonstrate that current evaluations fall well short of these ideals. PMID:19463104

  9. Current status of functional gastrointestinal evaluation in clinical practice

    PubMed Central

    Ang, Daphne; Fock, Kwong Ming; Law, Ngai Moh; Ang, Tiing Leong

    2015-01-01

    Neurogastroenterology and motility disorders of the gastrointestinal (GI) tract encompass a broad spectrum of diseases involving the GI tract and central nervous system. They have varied pathophysiology, clinical presentation and management, and make up a substantial proportion of outpatient clinic visits. Typically, patients experience persistent symptoms referable to the GI tract despite normal endoscopic and radiologic findings. An appropriate evaluation is thus important in the patient’s care. Advances in technology and understanding of the disease pathophysiology have provided better insight into the physiological basis of disease and a more rational approach to patient management. While technological advances serve to explain patients’ persistent symptoms, they should be balanced against the costs of diagnostic tests. This review highlights the GI investigative modalities employed to evaluate patients with persistent GI symptoms in the absence of a structural lesion, with particular emphasis on investigative modalities available locally and the clinical impact of such tools. PMID:25715853

  10. Current status of functional gastrointestinal evaluation in clinical practice.

    PubMed

    Ang, Daphne; Fock, Kwong Ming; Law, Ngai Moh; Ang, Tiing Leong

    2015-02-01

    Neurogastroenterology and motility disorders of the gastrointestinal (GI) tract encompass a broad spectrum of diseases involving the GI tract and central nervous system. They have varied pathophysiology, clinical presentation and management, and make up a substantial proportion of outpatient clinic visits. Typically, patients experience persistent symptoms referable to the GI tract despite normal endoscopic and radiologic findings. An appropriate evaluation is thus important in the patient's care. Advances in technology and understanding of the disease pathophysiology have provided better insight into the physiological basis of disease and a more rational approach to patient management. While technological advances serve to explain patients' persistent symptoms, they should be balanced against the costs of diagnostic tests. This review highlights the GI investigative modalities employed to evaluate patients with persistent GI symptoms in the absence of a structural lesion, with particular emphasis on investigative modalities available locally and the clinical impact of such tools.

  11. Evaluation of clinical ethics support services and its normativity.

    PubMed

    Schildmann, Jan; Molewijk, Bert; Benaroyo, Lazare; Forde, Reidun; Neitzke, Gerald

    2013-11-01

    Evaluation of clinical ethics support services (CESS) has attracted considerable interest in recent decades. However, few evaluation studies are explicit about normative presuppositions which underlie the goals and the research design of CESS evaluation. In this paper, we provide an account of normative premises of different approaches to CESS evaluation and argue that normativity should be a focus of considerations when designing and conducting evaluation research of CESS. In a first step, we present three different approaches to CESS evaluation from published literature. Next to a brief sketch of the well-established approaches of 'descriptive evaluation' and 'evaluation of outcomes', we will give a more detailed description of a third approach to evaluation-'reconstructing quality norms of CESS'-which is explicit about the normative presuppositions of its research (design). In the subsequent section, we will analyse the normative premises of each of the three approaches to CESS evaluation. We will conclude with a brief argument for more sensitivity towards the normativity of CESS and its evaluation research.

  12. Clinical simulation: A method for development and evaluation of clinical information systems.

    PubMed

    Jensen, Sanne; Kushniruk, Andre W; Nøhr, Christian

    2015-04-01

    Use of clinical simulation in the design and evaluation of eHealth systems and applications has increased during the last decade. This paper describes a methodological approach for using clinical simulations in the design and evaluation of clinical information systems. The method is based on experiences from more than 20 clinical simulation studies conducted at the ITX-lab in the Capital Region of Denmark during the last 5 years. A ten-step approach to conducting simulations is presented in this paper. To illustrate the approach, a clinical simulation study concerning implementation of Digital Clinical Practice Guidelines in a prototype planning and coordination module is presented. In the case study potential benefits were assessed in a full-scale simulation test including 18 health care professionals. The results showed that health care professionals can benefit from such a module. Unintended consequences concerning terminology and changes in the division of responsibility amongst healthcare professionals were also identified, and questions were raised concerning future workflow across sector borders. Furthermore unexpected new possible benefits concerning improved communication, content of information in discharge letters and quality management emerged during the testing. In addition new potential groups of users were identified. The case study is used to demonstrate the potential of using the clinical simulation approach described in the paper.

  13. Evaluation Guidelines for the Clinical and Translational Science Awards (CTSAs)

    PubMed Central

    Trochim, William M.; Rubio, Doris M.; Thomas, Veronica G.

    2014-01-01

    The National Center for Advancing Translational Sciences (NCATS), a part of the National Institutes of Health, currently funds the Clinical and Translational Science Awards (CTSAs), a national consortium of 61 medical research institutions in 30 states and the District of Columbia. The program seeks to transform the way biomedical research is conducted, speed the translation of laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train a new generation of clinical and translational researchers.. An endeavor as ambitious and complex as the CTSA program requires high-quality evaluations in order to show that the program is well implemented, efficiently managed, and demonstrably effective. In this article, the Evaluation Key Function Committee of the CTSA Consortium presents an overall framework for evaluating the CTSA program and offers policies to guide the evaluation work. The guidelines set forth are designed to serve as a tool for education within the CTSA community by illuminating key issues and practices that should be considered during evaluation planning, implementation, and utilization. Additionally, these guidelines can provide a basis for ongoing discussions about how the principles articulated in this article can most effectively be translated into operational reality. PMID:23919366

  14. Pathophysiology and clinical evaluation of acute heart failure.

    PubMed

    Mentz, Robert J; O'Connor, Christopher M

    2016-01-01

    Acute heart failure (AHF) is a complex syndrome characterized by worsening heart failure (HF) symptoms that requires escalation of therapy. Intrinsic cardiac abnormalities and comorbid conditions, including lung and renal disease, and sleep-disordered breathing, can contribute to the development of AHF. In this Review, we summarize and discuss the literature on the clinical evaluation and underlying pathophysiology of AHF. Important features of AHF evaluation include identification of precipitating factors to the disease, and assessment of circulatory-renal limitations associated with use of HF medications, prior HF hospitalizations, congestion and perfusion profiles, and end-organ dysfunction. The pathophysiological contributions of endothelial dysfunction, neurohormonal activation, venous congestion, and myocardial injury to the development of AHF are also discussed. These potential causative mechanisms provide a framework for clinicians to evaluate and manage patients with AHF and highlight possible future targets for therapies designed to improve clinical outcomes.

  15. Clinical and translational scientist career success: metrics for evaluation.

    PubMed

    Lee, Linda S; Pusek, Susan N; McCormack, Wayne T; Helitzer, Deborah L; Martina, Camille A; Dozier, Ann M; Ahluwalia, Jasjit S; Schwartz, Lisa S; McManus, Linda M; Reynolds, Brian D; Haynes, Erin N; Rubio, Doris M

    2012-10-01

    Despite the increased emphasis on formal training in clinical and translational research and the growth in the number and scope of training programs over the past decade, the impact of training on research productivity and career success has yet to be fully evaluated at the institutional level. In this article, the Education Evaluation Working Group of the Clinical and Translational Science Award Consortium introduces selected metrics and methods associated with the assessment of key factors that affect research career success. The goals in providing this information are to encourage more consistent data collection across training sites, to foster more rigorous and systematic exploration of factors associated with career success, and to help address previously identified difficulties in program evaluation.

  16. Clinical and Translational Scientist Career Success: Metrics for Evaluation

    PubMed Central

    Lee, Linda S.; Pusek, Susan N.; McCormack, Wayne T.; Helitzer, Deborah L.; Martina, Camille A.; Dozier, Ann; Ahluwalia, Jasjit S.; Schwartz, Lisa; McManus, Linda M.; Reynolds, Brian; Haynes, Erin; Rubio, Doris M.

    2012-01-01

    Despite the increased emphasis on formal training in clinical and translational research and the growth in the number and scope of training programs over the past decade, the impact of training on research productivity and career success has yet to be fully evaluated at the institutional level. In this article, the Education Evaluation Working Group of the Clinical and Translational Science Award Consortium introduces selected metrics and methods associated with the assessment of key factors that affect research career success. The goals in providing this information are to encourage more consistent data collection across training sites, to foster more rigorous and systematic exploration of factors associated with career success, and to help address previously identified difficulties in program evaluation. PMID:23067352

  17. Developing an evaluation framework for clinical redesign programs: lessons learnt.

    PubMed

    Samaranayake, Premaratne; Dadich, Ann; Fitzgerald, Anneke; Zeitz, Kathryn

    2016-09-19

    Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives. PMID:27681027

  18. Developing an evaluation framework for clinical redesign programs: lessons learnt.

    PubMed

    Samaranayake, Premaratne; Dadich, Ann; Fitzgerald, Anneke; Zeitz, Kathryn

    2016-09-19

    Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

  19. Modular stem fixed-bearing total ankle replacement: prospective results of 23 consecutive cases with 3-year follow-up.

    PubMed

    Brigido, Stephen A; Galli, Melissa M; Bleazey, Scott T; Protzman, Nicole M

    2014-01-01

    In the present report, the 3-year outcomes of 23 consecutive patients treated with a modular stem fixed-bearing total ankle replacement are described. Pain, functional impairment, and disability were assessed annually using a visual analog scale. Complications and additional procedures also were recorded. Compared with preoperative pain (8.4 ± 1.4), functional impairment (8.7 ± 2.3), and disability (3.0 ± 2.5), there were statistically significant postoperative improvements at 1 year (pain, 2.6 ± 1.6; functional impairment, 3.1 ± 2.1; disability, 0.9 ± 1.2), 2 years (pain, 1.5 ± 1.3; functional impairment, 1.9 ± 1.4; disability, 0.6 ± 1.4), and 3 years (pain, 1.3 ± 1.3; functional impairment, 1.9 ± 1.9; disability, 0.4 ± 0.9; p ≤ .001). Pain, function, and disability significantly improved postoperatively from 1 to 2 years (p ≤ .008) and from 1 to 3 years (p ≤ .008). The reductions in pain, functional impairment, and disability were maintained from 2 to 3 years (p ≥ .08). Nine complications (39.1%) were encountered: 1 deep infection, 2 pulmonary embolisms, 3 wounds, 1 ectopic bone formation, 1 stiff joint, and 1 talar subsidence. In the 3-year follow-up period, 3 patients (13.0%) required additional procedures after the immediate postoperative phase. Our results have demonstrated that modular stem fixed-bearing prostheses can be implanted in a predictable and consistent fashion with resultant improvements in pain, function, and disability. Future studies evaluating the clinical outcomes after modular stem fixed-bearing total ankle replacement are warranted.

  20. A measure to evaluate deformable registration fields in clinical settings.

    PubMed

    Schreibmann, Eduard; Pantalone, Paul; Waller, Anthony; Fox, Tim

    2012-01-01

    Deformable registration has migrated from a research topic to a widely used clinical tool that can improve radiotherapeutic treatment accuracy by tracking anatomical changes. Although various mathematical formulations have been reported in the literature and implemented in commercial software, we lack a straightforward method to verify a given solution in routine clinical use. We propose a metric using concepts derived from vector analysis that complements the standard evaluation tools to identify unrealistic wrappings in a displacement field. At the heart of the proposed procedure is identification of vortexes in the displacement field that do not correspond to underlying anatomical changes. Vortexes are detected and their intensity quantified using the CURL operator and presented as a vortex map overlaid on the original anatomy for rapid identification of problematic regions. We show application of the proposed metric on clinical scenarios of adaptive radiotherapy and treatment response assessment, where the CURL operator quantitatively detected errors in the displacement field and identified problematic regions that were invisible to classical voxel-based evaluation methods. Unrealistic warping not visible to standard voxel-based solution assessment can produce erroneous results when the deformable solution is applied on a secondary dataset, such as dose matrix in adaptive therapy or PET data for treatment response assessment. The proposed metric for evaluating deformable registration provides increased usability and accuracy of detecting unrealistic deformable registration solutions when compared to standard intensity-based approaches. It is computationally efficient and provides a valuable platform for the clinical acceptance of image-guided radiotherapy. PMID:22955647

  1. Comprehensive non-clinical respiratory evaluation of promising new drugs

    SciTech Connect

    Murphy, Dennis J. . E-mail: dennis.j.murphy@GSK.com

    2005-09-01

    The need to evaluate the potential for new drugs to produce adverse effects on respiratory function in non-clinical safety assessment is based on the known effects of drugs from a variety of pharmacological/therapeutic classes on the respiratory system, the life-threatening consequences of respiratory dysfunction, and compliance with world-wide regulatory safety guidelines. The objective of this article is to provide a brief overview of the functional disorders of the respiratory system and to present the strategy and techniques considered to be most appropriate for detecting and characterizing drug-induced respiratory disorders in non-clinical safety studies.

  2. Clinical Problem Solving Exercises for Pre-Clinical Medical Education: A Design, Implementation and Preliminary Evaluation.

    ERIC Educational Resources Information Center

    Bordage, Georges

    Clinical problem solving exercises for preclinical medical education that were developed at Michigan State University School of Osteopathic Medicine are described. Two types of outcomes were set as priorities in the design and implementation of the problem solving sessions: small group peer interactions as instructional and evaluative resources;…

  3. Growth and Your 2- to 3-Year-Old

    MedlinePlus

    ... to Know About Zika & Pregnancy Growth and Your 2- to 3-Year-Old KidsHealth > For Parents > Growth and Your 2- to 3-Year-Old Print A A A ... 4 pounds (1.8 kilograms) and grow about 2 to 3 inches (5 to 8 centimeters). They' ...

  4. Evaluating the effects of cognitive support on psychiatric clinical comprehension

    PubMed Central

    Dalai, Venkata V.; Khalid, Sana; Gottipati, Dinesh; Kannampallil, Thomas; John, Vineeth; Blatter, Brett; Patel, Vimla L.; Cohen, Trevor

    2014-01-01

    Objective Clinicians’ attention is a precious resource, which in the current healthcare practice is consumed by the cognitive demands arising from complex patient conditions, information overload, time pressure, and the need to aggregate and synthesize information from disparate sources. The ability to organize information in ways that facilitate the generation of effective diagnostic solutions is a distinguishing characteristic of expert physicians, suggesting that automated systems that organize clinical information in a similar manner may augment physicians’ decision-making capabilities. In this paper, we describe the design and evaluation of a theoretically driven cognitive support system (CSS) that assists psychiatrists in their interpretation of clinical cases. The system highlights, and provides the means to navigate to, text that is organized in accordance with a set of diagnostically and therapeutically meaningful higher-level concepts. Methods and Materials To evaluate the interface, 16 psychiatry residents interpreted two clinical case scenarios, with and without the CSS. Think-aloud protocols captured during their interpretation of the cases were transcribed and analyzed qualitatively. In addition, the frequency and relative position of content related to key higher-level concepts in a verbal summary of the case were evaluated. In addition the transcripts from both groups were compared to an expert derived reference standard using latent semantic analysis (LSA). Results Qualitative analysis showed that users of the system better attended to specific clinically important aspects of both cases when these were highlighted by the system, and revealed ways in which the system mediates hypotheses generation and evaluation. Analysis of the summary data showed differences in emphasis with and without the system. The LSA analysis suggested users of the system were more “expert-like” in their emphasis, and that cognitive support was more effective in the

  5. Clinical application of PET for the evaluation of brain tumors

    SciTech Connect

    Coleman, R.E.; Hoffman, J.M.; Hanson, M.W.; Sostman, H.D.; Schold, S.C. )

    1991-04-01

    The combination of FDG and PET has demonstrated clinical utility in the evaluation of patients with brain tumors. At the time of diagnosis, FDG PET provides information concerning the degree of malignancy and patient prognosis. After therapy, FDG PET is able to assess persistence of tumor, determine degree of malignancy, monitor progression, differentiate recurrence from necrosis, and assess prognosis. Other studies using PET provide information that may be clinically useful. Determination of tumor blood flow and permeability of the blood-brain barrier may help in the selection of appropriate therapy. Amino acid imaging using 11C-methionine is being evaluated in patients with brain tumors and provides different information than FDG imaging.52 references.

  6. Epidemiological, clinical and sleep laboratory evaluations of insomnia

    NASA Technical Reports Server (NTRS)

    Bixler, E. O.; Kales, A.; Kales, J. D.

    1975-01-01

    Epidemiological studies have contributed to the understanding of the total scope of the insomnia problem, both in terms of the incidence of sleep difficulties, and the extent and frequency of hypnotic drug use. Clinical studies - at the Sleep Research and Treatment Center - have been used to evaluate the medical, psychological, pharmacological and situational factors contributing to insomnia, and to evaluate the psychotherapy and chemotherapy best suited to treatment of insomnia. The sleep laboratory studies were of two types: (1) the study of sleep induction, sleep maintenance, and sleep stages, and (2) the use of hypnotic drugs, emphasizing their effectiveness in inducing and maintaining sleep, and the duration of this effectiveness.

  7. Liliequist membrane: radiological evaluation, clinical and therapeutic implications*

    PubMed Central

    Dias, Daniel Aguiar; Castro, Fábio Luiz Onuki; Yared, James Henrique; Lucas Júnior, Ademar; Ferreira Filho, Luiz Alves; Ferreira, Nelson Fortes Paes Diniz

    2014-01-01

    In a simplistic and succinct way, Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies. In spite of being well known to neurosurgeons, many radiologists neither know this anatomical structure nor give importance to its study. The imaging evaluation of this membrane is feasible and may be interesting for a better preoperative planning; postoperative evaluation of third ventriculostomies; and understanding of suprasellar arachnoid cysts and perimesencephalic hemorrhage. The present article illustrates the anatomy of the membrane, with emphasis on imaging findings, besides describing its possible clinical and surgical implications. PMID:25741076

  8. Clinical and postextraction evaluation of periodontal disease indicators

    PubMed Central

    Kolte, Rajashri; Kolte, Abhay; Wattamwar, Pooja

    2016-01-01

    Background: Clinical attachment level is the most frequently used and acceptable parameter in monitoring periodontal status in diseased individual and denotes patterns of periodontal destruction. Awareness of root morphology and the condition of the periodontal tissues is essential for reliable periodontal pocket probing and for effective debridement of root surfaces. Clinically, it is challenging to observe exact nature of complex periodontal attachment loss. The aim of the present study was to evaluate patterns of periodontal destruction based on vertical and horizontal attachment loss. Materials and Methods: A total of 200 extracted teeth were obtained from chronic periodontitis patients. Prior to extraction, clinical measurements were recorded and after extraction, the teeth were stained with crystal violet. Root length, vertical and horizontal attachment loss were measured using digital caliper. Results: There was a significant difference between clinical attachment level and vertical attachment loss for both maxillary and mandibular teeth. Mean vertical attachment loss varied between 5.17 mm and 9.17 mm. Interproximal surfaces exhibited statistically significant vertical attachment loss in both maxillary and mandibular dentition. Results indicated that vertical attachment loss was more severe with teeth belonging to the anterior sextant whereas the horizontal attachment loss was more pronounced with posterior teeth. Conclusion: Both vertical and horizontal attachment loss were observed in all periodontally involved teeth. There was a difference in clinical measurements and actual periodontal status denoted by postextraction staining. These findings have an impact on determining the prognosis and appropriate treatment plan for patients. PMID:27143828

  9. Evaluating suspected work-related neurologic disorders (clinical diagnosis).

    PubMed

    Lotti, Marcello; Aminoff, Michael J

    2015-01-01

    The clinical diagnosis of work-related neurologic disorders is essentially one of exclusion because symptoms and signs are often nonspecific. The clinical reasoning requires a three-step approach: (1) establish the characteristics of the presenting disease; (2) ascertain that observed clinical features are consistent with those caused by the suspected agent(s); and (3) assess occupational exposures. A detailed history is of paramount importance in evaluating patients with suspected work-related neurologic disorders as it is in other clinical contexts, especially because in some circumstances it may represent the only criterion to establish causality. Thus, besides characterization of neurologic symptoms, including their location, quality, timecourse, and possible other associated symptoms, the work environment of the patient should be understood in full detail. In this respect, when a neurotoxin is suspected, then the history collection can be guided by the knowledge of the likely syndromes it produces. Similarly, physical examination should be directed to the target of toxicity/entrapment based on information from the work history. Although specific sites and elements of the nervous system may be affected depending on the offending agent, most neurotoxic disorders are characterized by generalized rather than focal neurologic abnormalities. Laboratory toxicologic tests have limited application for the etiologic diagnosis of neurotoxic disorders, except in cases of acute poisoning and in patients exposed to neurotoxic chemicals with prolonged half-life. In most cases examination takes place after the end of exposure, when the offending chemical is no longer detectable in body fluids. Electrophysiologic studies, in particular evoked potentials, electromyography, and conduction velocities, are important to confirm the organic basis of symptoms, particularly to detect subclinical or early neurologic involvement and to reduce the number of disorders to be considered in

  10. One-year clinical evaluation of a Glass Carbomer fissure sealant, a preliminary study.

    PubMed

    Gorseta, K; Glavina, D; Borzabadi-Farahani, A; Van Duinen, R N; Skrinjaric, I; Hill, R G; Lynch, E

    2014-06-01

    Glass Carbomer is a new generation of restorative material developed from glass-ionomer cements with possibility of gradual mineralization into fluorapatite. The aim of this clinical trial was to investigate the retention of Glass Carbomer fissure sealant after 12 months, in comparison to a commonly used conventional resin-based sealant. Forty-eight teeth in 24 patients [mean (SD) = 8 (2.3) years] with well-delineated fissure morphology were randomly divided into two equal groups and sealed with Bis-GMA resin-based Helioseal F (group A, Ivoclar Vivadent, Liechtenstein) and Glass Carbomer (group B, Glass Carbomer Sealant, Glass Carbomer Products, Leiden, Netherlands) using the split mouth design. Materials were placed and set according to the manufacturer's instructions using a polymerization unit Bluephase 16i (Vivadent, Liechtenstein). Complete sealant retentions in both groups were 100% and 75% after 6 and 12 months of clinical service, respectively. There were there were no secondary caries lesions in both groups after 6 months; two new carious lesions were detected in both groups after 12 months. The Mann-Whitney U test revealed no significant difference between the two groups at both evaluations points (P > 0.05). Glass Carbomer material showed a similar retention rate when compared with a resin-based sealant. Future studies are required to examine the long-term performance of Glass Carbomer sealants. PMID:25134364

  11. Evaluation of psychology practitioner competence in clinical supervision.

    PubMed

    Gonsalvez, Craig J; Crowe, Trevor P

    2014-01-01

    There is a growing consensus favouring the development, advancement, and implementation of a competency-based approach for psychology training and supervision. There is wide recognition that skills, attitude-values, and relationship competencies are as critical to a psychologist's competence as are knowledge capabilities, and that these key competencies are best measured during placements, leaving the clinical supervisor in an unparalleled position of advantage to provide formative and summative evaluations on the supervisee's progression towards competence. Paradoxically, a compelling body of literature from across disciplines indicates that supervisor ratings of broad domains of competence are systematically compromised by biases, including leniency error and halo effect. The current paper highlights key issues affecting summative competency evaluations by supervisors: what competencies should be evaluated, who should conduct the evaluation, how (tools) and when evaluations should be conducted, and process variables that affect evaluation. The article concludes by providing research recommendations to underpin and promote future progress and by offering practice recommendations to facilitate a more credible and meaningful evaluation of competence and competencies.

  12. The Madison Clinic: Evaluation of a collaborative outpatient paediatric palliative care clinic

    PubMed Central

    Siden, Harold; Straatman, Lynn; Miller, Tanice; Ham, Jennifer

    2009-01-01

    BACKGROUND A multidisciplinary outpatient clinic at a tertiary care children’s hospital supported and staffed by a children’s hospice was created to enhance and expand the inpatient palliative care services available to families of children with life-limiting conditions. This clinic was created with input from clinicians, program leaders and families in developing the goals and format. METHOD The clinic was evaluated with indicators that included program data from palliative care consultations. This information was collected and recorded on a prospective basis. RESULTS In the first 29 months of operation, 43 clinics were held, 39 individual patients were seen and there were 59 visits. The majority of visits were for pain and symptom management (75%), while 20% were for assessment for the hospice program. The hospice-palliative care team also provided telephone support, videoconference support and inpatient consultations. Patients reported overall satisfaction with their experiences at the clinic. DISCUSSION A major benefit of this outpatient palliative care clinic is its ability to offer continuity of care for patients and their families. It also serves as a preliminary introduction to palliative care, particularly significant for families who are not yet ready to learn about or engage in the full hospice program. PMID:20592973

  13. Pyogenic liver abscess: a retrospective analysis of 107 patients during a 3-year period.

    PubMed

    Chan, Khee-Siang; Chen, Chin-Ming; Cheng, Kuo-Chen; Hou, Ching-Cheng; Lin, Hung-Jung; Yu, Wen-Liang

    2005-12-01

    Pyogenic liver abscess (PLA) is a potentially life-threatening disease, and early diagnosis may be difficult. In order to provide diagnostic clues and to enhance the prompt management of such cases, we retrospectively investigated the clinical characteristics of PLA during a 3-year period in a tertiary-care hospital. The crude incidence rate of PLA in our study was 446.1 per 100,000 hospital admissions. Male predominance and a mean age of 57.6 +/- 14.4 years were observed. Diabetes mellitus was the most common concomitant disease, and biliary pathologies were the most common predisposing cause of this type of abscess. The most common clinical features were fever, chills, and abdominal pain. Leukocytosis was found in 67.3% of the patients, and the observed C-reactive protein (CRP) values were high. The most common pathogen was Klebsiella pneumoniae. The mortality rate was 6.5%. A complete history, physical examination, evaluation of the white blood cell count and CRP, and the prompt arrangement of imaging studies may lead to an earlier diagnosis. The aggressive performance of image-guided catheter drainage and the appropriate administration of antibiotics may reduce the mortality rate of PLA. PMID:16377869

  14. An R package for simulation experiments evaluating clinical trial designs.

    PubMed

    Wang, Yuanyuan; Day, Roger

    2010-01-01

    This paper presents an open-source application for evaluating competing clinical trial (CT) designs using simulations. The S4 system of classes and methods is utilized. Using object-oriented programming provides extensibility through careful, clear interface specification; using R, an open-source widely-used statistical language, makes the application extendible by the people who design CTs: biostatisticians. Four key classes define the specifications of the population models, CT designs, outcome models and evaluation criteria. Five key methods define the interfaces for generating patient baseline characteristics, stopping rule, assigning treatment, generating patient outcomes and calculating the criteria. Documentation of their connections with the user input screens, with the central simulation loop, and with each other faciliates the extensibility. New subclasses and instances of existing classes meeting these interfaces can integrate immediately into the application. To illustrate the application, we evaluate the effect of patient pharmacokinetic heterogeneity on the performance of a common Phase I "3+3" design. PMID:21347151

  15. Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial.

    PubMed

    Huth, Karin Christine; Hajek-Al-Khatar, Niran; Wolf, Petra; Ilie, Nicoleta; Hickel, Reinhard; Paschos, Ekaterini

    2012-08-01

    A pulpotomy is the therapy for management of pulp exposures due to caries in symptom-free primary molars. The aim was to longitudinally compare the relative effectiveness of the Er:YAG laser, calcium hydroxide and ferric sulphate techniques with dilute formocresol in retaining symptom-free molars. Two hundred primary molars in 107 healthy children were included and randomly allocated to one technique. The treated teeth were blindly reevaluated after 6, 12, 18, 24 and 36 months. Descriptive data analysis and logistic regression analysis accounting for multiple observations per patient by generalised estimating equation were used. Additionally, various influences including tooth type, upper and lower jaws, type of anaesthesia, operator and the final restoration on treatment success were evaluated (Wald chi-square test). After 36 months, the following total (considering clinical and clinically symptom-free radiographic failures) and clinical success rates were determined (in percent): Formocresol 72 (92), laser 73 (89), calcium hydroxide 46 (75), ferric sulphate 76 (97). No significant differences were detected between formocresol and any other technique after 36 months. However, the odds ratio of failure appeared to be three times higher for calcium hydroxide than for formocresol. No significant differences in total success rates were seen regarding the aforementioned influencing clinical parameters. The correct diagnosis of the pulpal status, bleeding control and the specific technique are highly important for long-term success of pulpotomies in primary molars. According to the presented long-term data, pulpotomies using ferric sulphate revealed the best treatment outcome among the used techniques, while calcium hydroxide resulted in the lowest success rates after 3 years. Therefore, we can recommend ferric sulphate for easy and successful treatment of primary molars with caries-exposed pulps. PMID:21842145

  16. Cross-system evaluation of clinical trial search engines.

    PubMed

    Jiang, Silis Y; Weng, Chunhua

    2014-01-01

    Clinical trials are fundamental to the advancement of medicine but constantly face recruitment difficulties. Various clinical trial search engines have been designed to help health consumers identify trials for which they may be eligible. Unfortunately, knowledge of the usefulness and usability of their designs remains scarce. In this study, we used mixed methods, including time-motion analysis, think-aloud protocol, and survey, to evaluate five popular clinical trial search engines with 11 users. Differences in user preferences and time spent on each system were observed and correlated with user characteristics. In general, searching for applicable trials using these systems is a cognitively demanding task. Our results show that user perceptions of these systems are multifactorial. The survey indicated eTACTS being the generally preferred system, but this finding did not persist among all mixed methods. This study confirms the value of mixed-methods for a comprehensive system evaluation. Future system designers must be aware that different users groups expect different functionalities.

  17. Design and evaluation of a bacterial clinical infectious diseases ontology.

    PubMed

    Gordon, Claire L; Pouch, Stephanie; Cowell, Lindsay G; Boland, Mary Regina; Platt, Heather L; Goldfain, Albert; Weng, Chunhua

    2013-01-01

    With antimicrobial resistance increasing worldwide, there is a great need to use automated antimicrobial decision support systems (ADSSs) to lower antimicrobial resistance rates by promoting appropriate antimicrobial use. However, they are infrequently used mostly because of their poor interoperability with different health information technologies. Ontologies can augment portable ADSSs by providing an explicit knowledge representation for biomedical entities and their relationships, helping to standardize and integrate heterogeneous data resources. We developed a bacterial clinical infectious diseases ontology (BCIDO) using Protégé-OWL. BCIDO defines a controlled terminology for clinical infectious diseases along with domain knowledge commonly used in hospital settings for clinical infectious disease treatment decision-making. BCIDO has 599 classes and 2355 object properties. Terms were imported from or mapped to Systematized Nomenclature of Medicine, Unified Medical Language System, RxNorm and National Center for Bitechnology Information Organismal Classification where possible. Domain expert evaluation using the "laddering" technique, ontology visualization, and clinical notes and scenarios, confirmed the correctness and potential usefulness of BCIDO. PMID:24551353

  18. Evaluation of RxNorm for Medication Clinical Decision Support

    PubMed Central

    Freimuth, Robert R.; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G.

    2014-01-01

    We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS. PMID:25954360

  19. Performance evaluation and clinical applications of 3D plenoptic cameras

    NASA Astrophysics Data System (ADS)

    Decker, Ryan; Shademan, Azad; Opfermann, Justin; Leonard, Simon; Kim, Peter C. W.; Krieger, Axel

    2015-06-01

    The observation and 3D quantification of arbitrary scenes using optical imaging systems is challenging, but increasingly necessary in many fields. This paper provides a technical basis for the application of plenoptic cameras in medical and medical robotics applications, and rigorously evaluates camera integration and performance in the clinical setting. It discusses plenoptic camera calibration and setup, assesses plenoptic imaging in a clinically relevant context, and in the context of other quantitative imaging technologies. We report the methods used for camera calibration, precision and accuracy results in an ideal and simulated surgical setting. Afterwards, we report performance during a surgical task. Test results showed the average precision of the plenoptic camera to be 0.90mm, increasing to 1.37mm for tissue across the calibrated FOV. The ideal accuracy was 1.14mm. The camera showed submillimeter error during a simulated surgical task.

  20. Neural basis of nonanalytical reasoning expertise during clinical evaluation

    PubMed Central

    Durning, Steven J; Costanzo, Michelle E; Artino, Anthony R; Graner, John; van der Vleuten, Cees; Beckman, Thomas J; Wittich, Christopher M; Roy, Michael J; Holmboe, Eric S; Schuwirth, Lambert

    2015-01-01

    Introduction Understanding clinical reasoning is essential for patient care and medical education. Dual-processing theory suggests that nonanalytic reasoning is an essential aspect of expertise; however, assessing nonanalytic reasoning is challenging because it is believed to occur on the subconscious level. This assumption makes concurrent verbal protocols less reliable assessment tools. Methods Functional magnetic resonance imaging was used to explore the neural basis of nonanalytic reasoning in internal medicine interns (novices) and board-certified staff internists (experts) while completing United States Medical Licensing Examination and American Board of Internal Medicine multiple-choice questions. Results The results demonstrated that novices and experts share a common neural network in addition to nonoverlapping neural resources. However, experts manifested greater neural processing efficiency in regions such as the prefrontal cortex during nonanalytical reasoning. Conclusions These findings reveal a multinetwork system that supports the dual-process mode of expert clinical reasoning during medical evaluation. PMID:25798328

  1. [Clinical diagnosis and standardized evaluation of borderline personality: preliminary report].

    PubMed

    Chaine, F; Guelfi, J D; Monier, C; Brun, A; Seunevel, F

    1995-01-01

    A sample of 36 patients considered by French clinicians as suffering from a borderline personality disorder was evaluated using the International Personality Disorder Examination, the Diagnostic Interview for Borderline-Revised, and the Minnesota Multiphasic Personality Inventory. First, global descriptive analysis of the sample elicited the socio-demographic and standard clinical characteristics of the borderline individuals. After diagnostic evaluation, the sample appeared to be quite homogeneous with 25 of the 36 patients evaluated (69.5%) being defined as borderline by two of the three diagnostic systems: ICD 10, DSM III-R and Gunderson (15/36 = 41.5% of patients were defined as borderline by all three systems). It is the types of BL personality co-diagnoses which differentiated the BL subjects in the sample from those classically described in the international literature, since the most frequent personalities were the Dependent and Avoiding ones, not the Antisocial, Histrionic, Narcissistic or Schizotypic personalities of the DSM III-R. ICD 10 elicited the same significant prevalence of Anxious and Dependent personalities. Lastly, the patients diagnosed as borderline both by clinicians and by all diagnostic systems (forming the sample "core") were compared with the rest of the sample with regard to socio-demographic, clinical and diagnostic characteristics. A few hypotheses are proposed on the type of variables that may permit to discriminate between these two types of patients.

  2. Criteria for clinical translucency evaluation of direct esthetic restorative materials

    PubMed Central

    2016-01-01

    The purpose of this review was to suggest practical criteria for the clinical translucency evaluation of direct esthetic restorative materials, and to review the translucency with these criteria. For the evaluation of reported translucency values, measuring instrument and method, specimen thickness, background color, and illumination should be scrutinized. Translucency parameter (TP) of 15 to 19 could be regarded as the translucency of 1 mm thick human enamel. Visual perceptibility threshold for translucency difference in contrast ratio (ΔCR) of 0.07 could be transformed into ΔTP value of 2. Translucency differences between direct and indirect resin composites were perceivable (ΔTP > 2). Universal and corresponding flowable resin composites did not show perceivable translucency differences in most products. Translucency differed significantly by the product within each shade group, and by the shade group within each product. Translucency of human enamel and perceptibility threshold for translucency difference may be used as criteria for the clinical evaluation of translucency of esthetic restorative materials. PMID:27508156

  3. Criteria for clinical translucency evaluation of direct esthetic restorative materials.

    PubMed

    Lee, Yong-Keun

    2016-08-01

    The purpose of this review was to suggest practical criteria for the clinical translucency evaluation of direct esthetic restorative materials, and to review the translucency with these criteria. For the evaluation of reported translucency values, measuring instrument and method, specimen thickness, background color, and illumination should be scrutinized. Translucency parameter (TP) of 15 to 19 could be regarded as the translucency of 1 mm thick human enamel. Visual perceptibility threshold for translucency difference in contrast ratio (ΔCR) of 0.07 could be transformed into ΔTP value of 2. Translucency differences between direct and indirect resin composites were perceivable (ΔTP > 2). Universal and corresponding flowable resin composites did not show perceivable translucency differences in most products. Translucency differed significantly by the product within each shade group, and by the shade group within each product. Translucency of human enamel and perceptibility threshold for translucency difference may be used as criteria for the clinical evaluation of translucency of esthetic restorative materials. PMID:27508156

  4. Clinical Evaluation of Heart Failure: Agreement among Tests.

    PubMed

    Pandey, Amit K; Penny, William F; Bhargava, Valmik; Lai, N Chin; Xu, Ronghui; Hammond, H Kirk

    2016-01-01

    Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available. PMID:27537778

  5. Clinical Evaluation of Heart Failure: Agreement among Tests

    PubMed Central

    Pandey, Amit K.; Penny, William F.; Bhargava, Valmik; Lai, N. Chin; Xu, Ronghui; Hammond, H. Kirk

    2016-01-01

    Methods commonly used clinically to assess cardiac function in patients with heart failure include ejection fraction (EF), exercise treadmill testing (ETT), and symptom evaluation. Although these approaches are useful in evaluating patients with heart failure, there are at times substantial mismatches between individual assessments. For example, ETT results are often discordant with EF, and patients with minimal symptoms sometimes have surprisingly low EFs. To better define the relationship of these methods of assessment, we studied 56 patients with heart failure with reduced EF (HFrEF) who underwent measurement of ETT duration, EF by echocardiography, quantitative symptom evaluation, and LV peak dP/dt (rate of left ventricular pressure development and decline, measured invasively). Correlations were determined among these four tests in order to assess the relationship of EF, ETT, and symptoms against LV peak dP/dt. In addition, we sought to determine whether EF, ETT, and symptoms correlated with each other. Overall, correlations were poor. Only 15 of 63 total correlations (24%) were significant (p < 0.05). EF correlated most closely with LV peak -dP/dt. Linear regression analysis indicated that EF, ETT, and symptoms taken together predicted LV peak dP/dt better than any one measure alone. We conclude that clinical tests used to assess LV function in patients with HFrEF may not be as accurate or correlate as well as expected. All three clinical measures considered together may be the best representation of cardiac function in HFrEF patients currently available. PMID:27537778

  6. [Clinical evaluation of faropenem against infections in pediatric fields].

    PubMed

    Sunakawa, K; Satoh, Y; Iwata, S; Terashima, I; Meguro, H; Kusumoto, Y; Kato, T; Akita, H; Goshima, T; Yokota, T; Toyonaga, Y; Ishihara, T; Kanemura, H; Iwai, N; Nakamura, H; Nakashima, M

    1997-09-01

    The recent increases in the prevalence of penicillin-resistant Streptococcus pneumoniae becomes a point at issue clinically. We carried out a clinical study in 40 cases in the pediatrics department, as faropenem (FRPM) was proved to have an excellent antimicrobial activity against penicillin-resistant Streptococcus pneumoniae. The study was planned to investigate in detail the movement of stools that had been a problem in a clinical development studies out before. In this study, an observation of the daily movement of stools was one of the principal evaluation items, hence the patients were divided into two groups. One group (S-group) were administered FRPM only, the other group (E-group) were administered FRPM in combination with a medicine for intestinal disorders (Enteronon-R). An observed frequencies of any loose bowel movements were 94.7% in S-group, and 63.2% in E-group, hence the study suggested that the combination drug was effective. The patients observed higher frequencies of development of the movement of stools, all of them were recovered from in the course of administration or within 4 days after administration, however whether or not being treated symptomatic therapy. Clinical efficacy rates of FRPM on mainly respiratory infections were 94.6%. In this study, 4 strains (patients) of penicillin-resistant Streptococcus pneumoniae were isolated. Against penicillin-resistant Streptococcus pneumoniae, FRPM demonstrated more potent antibacterial activity than the oral penicillins and cephems tested here except cefditoren. Clinical efficacies was deemed effective in all of the 4 cases, and bacteriologically, 3 organisms were eradicated. As for side effects including diarrhea and loose stool, no serious side effects were observed. Based on the above results, FRPM is effective against most infections in the pediatric field which Streptococcus pneumoniae are isolated at high frequencies highly, and is considered to cases in be useful an attention will have to be

  7. [Practical assessment. Clinical evaluation of normal-tension glaucoma].

    PubMed

    Valtot, F

    2005-06-01

    Normal-tension glaucoma is a form of primary open-angle glaucoma where the intraocular pressure remains within the normal range. The progression of the disease is usually very slow. The main challenge is to establish the correct diagnosis, with a double risk: the patient might have undetected (and untreated) high intraocular pressure or, the patient might have a nonglaucomatous (possibly treatable) disease looking as a glaucomatous optic neuropathy. The clinical evaluation of the patient suspected of a normal-tension glaucoma must answer two questions: 1) is the intraocular pressure normal?, 2) is it a glaucomatous optic neuropathy or another type of optic neuropathy? PMID:16208237

  8. SU-E-J-34: Clinical Evaluation of Targeting Accuracy and Tractogrphy Delineation of Radiosurgery

    SciTech Connect

    Juh, R; Suh, T; Kim, Y; Han, J; Kim, C; Oh, C; Kim, D

    2014-06-01

    Purpose: Focal radiosurgery is a common treatment modality for trigeminal neuralgia (TN), a neuropathic facial pain condition. Assessment of treatment effectiveness is primarily clinical, given the paucity of investigational tools to assess trigeminal nerve changes. The efficiency of radiosurgery is related to its highly precise targeting. We assessed clinically the targeting accuracy of radiosurgery with Gamma knife. We hypothesized that trigeminal tractography provides more information than 2D-MR imaging, allowing detection of unique, focal changes in the target area after radiosurgery. Methods: Sixteen TN patients (2 females, 4 male, average age 65.3 years) treated with Gamma Knife radiosurgery, 40 Gy/50% isodose line underwent 1.5Tesla MR trigeminal nerve . Target accuracy was assessed from deviation of the coordinates of the target compared with the center of enhancement on post MRI. Radiation dose delivered at the borders of contrast enhancement was evaluated Results: The median deviation of the coordinates between the intended target and the center of contrast enhancement was within 1mm. The radiation doses fitting within the borders of the contrast enhancement the target ranged from 37.5 to 40 Gy. Trigeminal tractography accurately detected the radiosurgical target. Radiosurgery resulted in 47% drop in FA values at the target with no significant change in FA outside the target, suggesting that radiosurgery primarily affects myelin. Tractography was more sensitive, since FA changes were detected regardless of trigeminal nerve enhancement Conclusion: The median deviation found in clinical assessment of gamma knife treatment for TN Is low and compatible with its high rate of efficiency. DTI parameters accurately detect the effects of focal radiosurgery on the trigeminal nerve, serving as an in vivo imaging tool to study TN. This study is a proof of principle for further assessment of DTI parameters to understand the pathophysiology of TN and treatment effects.

  9. 76 FR 9583 - Draft Guidance for Industry on Clinical Pharmacogenomics: Premarketing Evaluation in Early Phase...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-18

    ... guidance for industry entitled ``Clinical Pharmacogenomics: Premarketing Evaluation in Early Phase Clinical Studies.'' The draft guidance is intended to assist the pharmaceutical industry and other investigators... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Clinical...

  10. 75 FR 79446 - Clinical Science Research and Development Service; Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-20

    ... AFFAIRS Clinical Science Research and Development Service; Cooperative Studies Scientific Evaluation... (Federal Advisory Committee Act) that a meeting of the Clinical Science Research and Development Service... Clinical Science Research and Development Service on the relevance and feasibility of proposed projects...

  11. 76 FR 73781 - Clinical Science Research and Development Service; Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-29

    ... AFFAIRS Clinical Science Research and Development Service; Cooperative Studies Scientific Evaluation... (Federal Advisory Committee Act) that a meeting of the Clinical Science Research and Development Service... Clinical Science Research and Development Service on the relevance and feasibility of proposed projects...

  12. 77 FR 31072 - Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-24

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation... (Federal Advisory Committee Act) that a meeting of the Clinical Science Research and Development Service... the Clinical Science Research and Development Service on the relevance and feasibility of...

  13. 76 FR 65781 - Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation... (Federal Advisory Committee Act) that a meeting of the Clinical Science Research and Development Service... Research and Development Officer through the Director of the Clinical Science Research and...

  14. 75 FR 28686 - Clinical Science Research and Development Service; Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-21

    ... AFFAIRS Clinical Science Research and Development Service; Cooperative Studies Scientific Evaluation... (Federal Advisory Committee Act) that a meeting of the Clinical Science Research and Development Service... Committee advises the Chief Research and Development Officer through the Director of the Clinical...

  15. IT-benchmarking of clinical workflows: concept, implementation, and evaluation.

    PubMed

    Thye, Johannes; Straede, Matthias-Christopher; Liebe, Jan-David; Hübner, Ursula

    2014-01-01

    Due to the emerging evidence of health IT as opportunity and risk for clinical workflows, health IT must undergo a continuous measurement of its efficacy and efficiency. IT-benchmarks are a proven means for providing this information. The aim of this study was to enhance the methodology of an existing benchmarking procedure by including, in particular, new indicators of clinical workflows and by proposing new types of visualisation. Drawing on the concept of information logistics, we propose four workflow descriptors that were applied to four clinical processes. General and specific indicators were derived from these descriptors and processes. 199 chief information officers (CIOs) took part in the benchmarking. These hospitals were assigned to reference groups of a similar size and ownership from a total of 259 hospitals. Stepwise and comprehensive feedback was given to the CIOs. Most participants who evaluated the benchmark rated the procedure as very good, good, or rather good (98.4%). Benchmark information was used by CIOs for getting a general overview, advancing IT, preparing negotiations with board members, and arguing for a new IT project.

  16. Complications of acute pancreatitis: clinical and CT evaluation.

    PubMed

    Balthazar, Emil J

    2002-12-01

    Mortality of acute pancreatitis is dependent on the development of potentially lethal complications that can coexist and occur at any time following an acute attack. The nature and clinical relevance of these complications differ, contingent on the time of occurrence following a severe episode of pancreatitis. They can be divided into (1), early complications that manifest at the onset or within the first 2 to 3 days, (2) intermediate complications that occur predominantly during the second to fifth week, and (3) late complications that usually manifest months or years following the resolution of an acute attack. Early complications are systemic in nature with diverse clinical manifestations of the cardiovascular, pulmonary, renal, and/or metabolic systems. Intermediate complications are abdominal, pancreatic, and retroperitoneal, and are mostly septic in nature, associated with pancreatic or peripancreatic fat necrosis and pseudocysts. Late, life-threatening complications are mainly vascular or hemorrhagic in nature or involve the development of chronic pancreatic ascites. The early detection and objective evaluation of these complications by clinical and imaging methods leads to specific treatment options in the continuous attempt to decrease mortality rates in acute pancreatitis.

  17. An integrated evaluation for the performance of clinical engineering department.

    PubMed

    Yousry, Ahmed M; Ouda, Bassem K; Eldeib, Ayman M

    2014-01-01

    Performance benchmarking have become a very important component in all successful organizations nowadays that must be used by Clinical Engineering Department (CED) in hospitals. Many researchers identified essential mainstream performance indicators needed to improve the CED's performance. These studies revealed mainstream performance indicators that use the database of a CED to evaluate its performance. In this work, we believe that those indicators are insufficient for hospitals. Additional important indicators should be included to improve the evaluation accuracy. Therefore, we added new indicators: technical/maintenance indicators, economic indicators, intrinsic criticality indicators, basic hospital indicators, equipment acquisition, and safety indicators. Data is collected from 10 hospitals that cover different types of healthcare organizations. We developed a software tool that analyses collected data to provide a score for each CED under evaluation. Our results indicate that there is an average gap of 67% between the CEDs' performance and the ideal target. The reasons for the noncompliance are discussed in order to improve performance of CEDs under evaluation.

  18. Ongoing evaluation of PACS in a clinical setting

    NASA Astrophysics Data System (ADS)

    Trefler, Martin; Russell, Edward

    1992-05-01

    The radiology department of Jackson Memorial Hospital processes 255,000 clinical examinations each year -- 65,000 of which are portable x rays. Film transportation and loss are major obstacles to the smooth operation of this department. To assist in the solution of these problems we have designed and begun the piecemeal installation of a clinical PACS. This system is based on a platform of IBM RISC/6000 computers and software developed by Genesys Corporation. The initial installation involved the digitization of the portable x rays from three ICUs. The images (in the form of a matrix of 2048 X 1648 pixels) are then entered into the network and can be viewed simultaneously in the radiology department and in the ICU. The second phase of installation, involving the images from two CT scanners and two MRI scanners is currently underway. We have evaluated the system from several standpoints. The first is user acceptance. The users are the radiologists who must make the diagnosis at the workstation and the referring physicians who need the diagnosis quickly but also require the image. The radiologists must be comfortable with their diagnosis based on the images presented at the two viewer workstation. This is compared to the use of a multiviewer which presents many radiographs simultaneously. The second parameter for evaluation involves the impact on patient care in terms of the time elapsed between the taking of the radiograph and the presentation to the physician of the image and the diagnosis.

  19. Evaluating externship programs: impact of program length on clinical productivity.

    PubMed

    Mascarenhas, Ana Karina; Freilich, Sarah R; Henshaw, Michelle M; Jones, Judith A; Mann, Madalyn L; Frankl, Spencer N

    2007-04-01

    Community-based dental education programs such as externship programs have become an integral component of dental school education. Qualitative evaluation of externship programs has captured increased confidence, efficiency, skill, and independence among students. To better understand these findings, quantitative evaluation of the externship experience is necessary. The current study investigated the clinical care (defined as dental procedures) provided by Boston University School of Dental Medicine students who completed six-week general dentistry externships compared to those completing ten-week general dentistry externships. Results indicate that the scope of services provided in the ten-week externship differed from the six-week externship. The longer externships allowed for students to perform more complex procedures toward the latter part of their externships. Students participating in the ten-week externship also provided more procedures per week than students in the six-week externship. Because scheduling of patient appointments is generally a function of the site, number of patient visits and procedures performed per patient did not differ between the two groups. Our findings provide insight into the reason why longer externships increase clinical confidence, efficiency, and skill. In the continuing effort to improve the externship experience in dental schools, these findings should be taken into consideration.

  20. Clinical evaluation strategies for a live attenuated tetravalent dengue vaccine.

    PubMed

    Precioso, Alexander Roberto; Palacios, Ricardo; Thomé, Beatriz; Mondini, Gabriella; Braga, Patrícia; Kalil, Jorge

    2015-12-10

    Butantan Institute is a public Brazilian biomedical research-manufacturer center affiliated to the São Paulo State Secretary of Health. Currently, Butantan is one of the main public producers of vaccines, antivenoms, and antitoxins in Latin America. The partnership between Butantan and the National Institutes of Health (NIH) of the United Sates has been one of the longest and most successful partnerships in the development and manufacturing of new vaccines. Recently, Butantan Institute has developed and manufactured a lyophilized tetravalent live attenuated dengue vaccine with the four dengue viruses attenuated and licensed from the Laboratory of Infectious Diseases at The National Institutes of Allergy and Infectious Diseases (LID/NIAID/NIH). The objective of this paper is to describe the clinical evaluation strategies of a live attenuated tetravalent dengue vaccine (Butantan-DV) developed and manufactured by Butantan Institute. These clinical strategies will be used to evaluate the Butantan-DV Phase III trial to support the Butantan-DV licensure for protection against any symptomatic dengue caused by any serotype in people aged 2 to 59 years.

  1. Ultrasound and clinical evaluation of soft-tissue versus hardware biceps tenodesis: is hardware tenodesis worth the cost?

    PubMed

    Elkousy, Hussein; Romero, Jose A; Edwards, T Bradley; Gartsman, Gary M; O'Connor, Daniel P

    2014-02-01

    This study assesses the failure rate of soft-tissue versus hardware fixation of biceps tenodesis by ultrasound to determine if the expense of a hardware tenodesis technique is warranted. Seventy-two patients that underwent arthroscopic biceps tenodesis over a 3-year period were evaluated using postoperative ultrasonography and clinical examination. The tenodesis technique employed was either a soft-tissue technique with sutures or an interference screw technique using hardware based on surgeon preference. Patient age was 57.9 years on average with ultrasound and clinical examination done at an average of 9.3 months postoperatively. Thirty-one patients had a hardware technique and 41 a soft-tissue technique. Overall, 67.7% of biceps tenodesis done with hardware were intact, compared with 75.6% for the soft-tissue technique by ultrasound (P = .46). Clinical evaluation indicated that 80.7% of hardware techniques and 78% of soft-tissue techniques were intact. Average material cost to the hospital for the hardware technique was $514.32, compared with $32.05 for the soft-tissue technique. Biceps tenodesis success, as determined by clinical deformity and ultrasound, was not improved using hardware as compared to soft-tissue techniques. Soft-tissue techniques are equally efficacious and more cost effective than hardware techniques.

  2. Piezoelectric sensing: Evaluation for clinical investigation of deviated nasal septum.

    PubMed

    Manjunatha, Roopa G; Rajanna, Konandur; Mahapatra, Roy D; Dorasala, Srinivas

    2013-01-01

    Noninvasive objective evaluation of nasal airflow is one of the important clinical aspects. The developed polyvinylidene fluoride (PVDF) sensor enables measurement of airflow through each side of the nose using its piezoelectric property. This study was designed to evaluate the diagnostic capability of the PVDF sensor in assessing the deviated nasal septum (DNS). PVDF nasal sensor uses its piezoelectric property to measure the peak-to-peak amplitude (Vp-p) of nasal airflow in both of the nostrils: right nostril (RN) and left nostril (LN), separately and simultaneously. We have compared the results of PVDF nasal sensor, visual analog scale (VAS), and clinician scale for 34 DNS patients and 28 healthy controls. Additionally, the results were further analyzed by receiver operating characteristic curve and correlation between PVDF nasal sensor and VAS in detecting DNS. We found a significant difference in the peak-to-peak amplitude values of the test group and the control group. The correlation between the PVDF nasal sensor measurements and VAS (RN and LN combined) for test group was statistically significant (-0.807; p < 0.001). Sensitivity and specificity of the PVDF nasal sensor measurements in the detection of DNS (RN and LN combined) was 85.3 and 74.4%, respectively, with optimum cutoff value ≤0.34 Vp-p. The developed PVDF nasal sensor is noninvasive and requires less patient efforts. The sensitivity and specificity of the PVDF nasal sensor are reliable. According to our findings, we propose that the said PVDF nasal sensor can be used as a new diagnostic tool to evaluate the DNS in routine clinical practice.

  3. Piezoelectric sensing: Evaluation for clinical investigation of deviated nasal septum

    PubMed Central

    Manjunatha, Roopa G.; Mahapatra, Roy D.; Dorasala, Srinivas

    2013-01-01

    Noninvasive objective evaluation of nasal airflow is one of the important clinical aspects. The developed polyvinylidene fluoride (PVDF) sensor enables measurement of airflow through each side of the nose using its piezoelectric property. This study was designed to evaluate the diagnostic capability of the PVDF sensor in assessing the deviated nasal septum (DNS). PVDF nasal sensor uses its piezoelectric property to measure the peak-to-peak amplitude (Vp-p) of nasal airflow in both of the nostrils: right nostril (RN) and left nostril (LN), separately and simultaneously. We have compared the results of PVDF nasal sensor, visual analog scale (VAS), and clinician scale for 34 DNS patients and 28 healthy controls. Additionally, the results were further analyzed by receiver operating characteristic curve and correlation between PVDF nasal sensor and VAS in detecting DNS. We found a significant difference in the peak-to-peak amplitude values of the test group and the control group. The correlation between the PVDF nasal sensor measurements and VAS (RN and LN combined) for test group was statistically significant (−0.807; p < 0.001). Sensitivity and specificity of the PVDF nasal sensor measurements in the detection of DNS (RN and LN combined) was 85.3 and 74.4%, respectively, with optimum cutoff value ≤0.34 Vp-p. The developed PVDF nasal sensor is noninvasive and requires less patient efforts. The sensitivity and specificity of the PVDF nasal sensor are reliable. According to our findings, we propose that the said PVDF nasal sensor can be used as a new diagnostic tool to evaluate the DNS in routine clinical practice. PMID:24498519

  4. Interim Outcomes Assessment of the Comprehensive Clinical Performance Grid for Student Evaluation.

    ERIC Educational Resources Information Center

    Tolls, Dorothy Bazzinotti; Carlson, Nancy; Wilson, Roger; Richman, Jack

    2001-01-01

    Assessed the viability of the Comprehensive Clinical Performance Grid for Student Evaluation, introduced at The New England College of Optometry in 1996 in clinical student assessment. Analyzed faculty and student feedback and consistency with previous evaluations, between evaluators, and between clinical sites and tracts. Found satisfaction with…

  5. DNA Damage in Chronic Kidney Disease: Evaluation of Clinical Biomarkers

    PubMed Central

    Schupp, Nicole; Stopper, Helga; Heidland, August

    2016-01-01

    Patients with chronic kidney disease (CKD) exhibit an increased cancer risk compared to a healthy control population. To be able to estimate the cancer risk of the patients and to assess the impact of interventional therapies thereon, it is of particular interest to measure the patients' burden of genomic damage. Chromosomal abnormalities, reduced DNA repair, and DNA lesions were found indeed in cells of patients with CKD. Biomarkers for DNA damage measurable in easily accessible cells like peripheral blood lymphocytes are chromosomal aberrations, structural DNA lesions, and oxidatively modified DNA bases. In this review the most common methods quantifying the three parameters mentioned above, the cytokinesis-block micronucleus assay, the comet assay, and the quantification of 8-oxo-7,8-dihydro-2′-deoxyguanosine, are evaluated concerning the feasibility of the analysis and regarding the marker's potential to predict clinical outcomes. PMID:27313827

  6. Clinical evaluation of Er:YAG laser caries treatment

    NASA Astrophysics Data System (ADS)

    Dostalova, Tatjana; Jelinkova, Helena; Kucerova, Hana; Krejsa, Otakar; Hamal, Karel; Kubelka, Jiri; Prochazka, Stanislav

    1997-05-01

    To prepare the enamel, the energy used was mainly 345 mJ and repetition rate 2 Hz, for dentine the optimal energy of Er:YAG drilling machine was 200 mJ and repetition rate from 1 to 2 Hz, depending on cavity depth. Subject of treatment were caries of enamel and dentine and it was possible to remove the old insufficient fillings. The average number of pulses was 111.22, ranging from 16 to 489. During preparation, vibrations of microexplosions were felt by 8 patients, however, neither pain or unpleasant sensations were experienced. The filling materials used were composite resins and glassionomer cements. Their clinical evaluation 6 months post insertion was similar to that of the classical drilling system.

  7. Similarity Predicts Liking in 3-Year-Old Children

    ERIC Educational Resources Information Center

    Fawcett, Christine A.; Markson, Lori

    2010-01-01

    Two studies examined the influence of similarity on 3-year-old children's initial liking of their peers. Children were presented with pairs of childlike puppets who were either similar or dissimilar to them on a specified dimension and then were asked to choose one of the puppets to play with as a measure of liking. Children selected the puppet…

  8. The Structure of Executive Function in 3-Year-Olds

    ERIC Educational Resources Information Center

    Wiebe, Sandra A.; Sheffield, Tiffany; Nelson, Jennifer Mize; Clark, Caron A. C.; Chevalier, Nicolas; Espy, Kimberly Andrews

    2011-01-01

    Although the structure of executive function (EF) during adulthood is characterized by both unity and diversity, recent evidence suggests that preschool EF may be best described by a single factor. The latent structure of EF was examined in 228 3-year-olds using confirmatory factor analysis. Children completed a battery of executive tasks that…

  9. A Study of Differentiated Instructional Change over 3 Years

    ERIC Educational Resources Information Center

    VanTassel-Baska, Joyce; Feng, Annie Xuemei; Brown, Elissa; Bracken, Bruce; Stambaugh, Tamra; French, Heather; McGowan, Susan; Worley, Bess; Quek, Chwee; Bai, Wenyu

    2008-01-01

    This study examines Title 1 heterogeneous classroom teachers' instructional behavior change through implementing well-designed research-based curriculum units and attending regular professional development activities across 3 years. Employing an experimental design, this study compares experimental and comparison teachers' behavioral changes as…

  10. Developing Dialogic Argumentation Skills: A 3-Year Intervention Study

    ERIC Educational Resources Information Center

    Crowell, Amanda; Kuhn, Deanna

    2014-01-01

    Argumentation is increasingly recognized as a fundamental intellectual skill, but evidence suggests that few adolescents or adults are skilled arguers. This article reports on an extended (3-year, twice weekly) intervention designed to afford dense practice in dialogic argumentation to middle-school students from traditionally academically…

  11. Evaluation of HPV Genotyping Assays for Archival Clinical Samples.

    PubMed

    Lillsunde Larsson, Gabriella; Carlsson, Jessica; Karlsson, Mats G; Helenius, Gisela

    2015-05-01

    Human papillomavirus (HPV) testing and genotyping of FFPE tissue samples is important in epidemiological investigations. Here, we compare four different HPV genotyping methods for use in FFPE clinical samples. Comparative testing was performed on 99 samples with a clinical suspicion of HPV. Specimens were analyzed with Anyplex II HPV28 detecting 28 genotypes using real-time PCR and melting curve analysis, CLART HPV2 detecting 35 genotypes using PCR and microarray detection, and MGP5+/6+ consensus primer system together with pyrosequencing. Results were compared to a real-time PCR reference protocol detecting 14 genotypes. In total, 68% of the samples were positive for an HPV genotype using the reference protocol and MGP5+/6+ primer system. Anyplex II HPV28 analysis and CLART HPV2 had 82% and 72% positive samples, respectively. All four methods showed good agreement when comparing the 14 genotypes included in the reference protocol. When evaluating all genotypes, the Anyplex II HPV28 assay and the CLART assay changed the status of the sample (individually or together) from negative with respect to the reference protocol to positive for either a Group 1 (n = 4) or Group 2 (n = 6) genotype. We conclude from this study that for an extended genotyping approach with a high sensitivity for FFPE specimens, both the Anyplex II HPV28 and CLART HPV2 assays are suitable alternatives despite minor intra-assay differences.

  12. Echocardiographic evaluation of clinically healthy Florida manatees (Trichechus manatus latirostris).

    PubMed

    Gerlach, Trevor J; Estrada, Amara H; Sosa, Ivan S; Powell, Melanie; Maisenbacher, Herbert W; de Wit, Martine; Ball, Ray L; Walsh, Michael T

    2013-06-01

    Antemortem studies pertaining to the manatee cardiovascular and cardiopulmonary systems are limited despite reports of cardiac disease in postmortem specimens. The objective of this project was to develop a technique for echocardiography in the Florida manatee (Trichechus manatus latirostris). Because of their unique anatomy, a ventral approach was employed by use of an echocardiography table designed specifically for this study. Fourteen clinically healthy, free-ranging and captive Florida manatees underwent echocardiography between the fall of 2011 and winter of 2012. Eight females and six males of various age categories were included in the study. Clear visualization of all valves and chambers was accomplished, and length and width measurements of the left atrium, peak aortic flow velocity, and ejection fraction percentage were calculated in most animals. Abnormalities observed during the study included atrioventricular regurgitation and severe right-atrial enlargement. Based on the results of this study, echocardiography in the Florida manatee is possible, which has both clinical and research implications in larger epidemiologic studies evaluating diseases of the cardiopulmonary and cardiovascular systems.

  13. Clinical evaluation of the Vitek Neisseria-Haemophilus Identification card.

    PubMed

    Janda, W M; Malloy, P J; Schreckenberger, P C

    1987-01-01

    A clinical evaluation of the Vitek Neisseria-Haemophilus Identification (NHI) card (Vitek Systems, Inc., Hazelwood, Mo.) was performed with 480 clinical isolates and stock strains of Neisseria spp., Haemophilus spp., and other fastidious microorganisms included in the data base of the system. Identifications obtained with the NHI card were compared with those determined by conventional methods. The card identified 83.2% of 244 Neisseria spp. and Branhamella catarrhalis, 54.9% of 164 Haemophilus spp., and 84.7% of 72 fastidious gram-negative species with no further testing required. Some isolates produced good confidence-marginal separation identifications, in which the correct identification was listed with one or two other possible identifications and extra tests were required and suggested. When isolates producing good confidence-marginal separation identifications were included, correct identifications of these organism groups increased to 97.1, 92.7, and 94.4%, respectively. Among the commonly isolated microorganisms, the NHI card identified 99.1% of 110 N. gonorrhoeae, 98.5% of 68 N. meningitidis, 93.9% of 98 H. influenzae, and 95.6% of 46 H. parainfluenzae strains. All of these organisms produced excellent to very good confidence level identifications except for H. influenzae biotypes II, III, and VII, for which hemolytic reactions were required for differentiation from H. haemolyticus. The NHI card reliably identified other fastidious gram-negative species, including H. aphrophilus, Eikenella corrodens, Gardnerella vaginalis, and Kingella denitrificans.

  14. Clinical evaluation of the Vitek Neisseria-Haemophilus Identification card.

    PubMed Central

    Janda, W M; Malloy, P J; Schreckenberger, P C

    1987-01-01

    A clinical evaluation of the Vitek Neisseria-Haemophilus Identification (NHI) card (Vitek Systems, Inc., Hazelwood, Mo.) was performed with 480 clinical isolates and stock strains of Neisseria spp., Haemophilus spp., and other fastidious microorganisms included in the data base of the system. Identifications obtained with the NHI card were compared with those determined by conventional methods. The card identified 83.2% of 244 Neisseria spp. and Branhamella catarrhalis, 54.9% of 164 Haemophilus spp., and 84.7% of 72 fastidious gram-negative species with no further testing required. Some isolates produced good confidence-marginal separation identifications, in which the correct identification was listed with one or two other possible identifications and extra tests were required and suggested. When isolates producing good confidence-marginal separation identifications were included, correct identifications of these organism groups increased to 97.1, 92.7, and 94.4%, respectively. Among the commonly isolated microorganisms, the NHI card identified 99.1% of 110 N. gonorrhoeae, 98.5% of 68 N. meningitidis, 93.9% of 98 H. influenzae, and 95.6% of 46 H. parainfluenzae strains. All of these organisms produced excellent to very good confidence level identifications except for H. influenzae biotypes II, III, and VII, for which hemolytic reactions were required for differentiation from H. haemolyticus. The NHI card reliably identified other fastidious gram-negative species, including H. aphrophilus, Eikenella corrodens, Gardnerella vaginalis, and Kingella denitrificans. PMID:3539996

  15. Echocardiographic evaluation of clinically healthy Florida manatees (Trichechus manatus latirostris).

    PubMed

    Gerlach, Trevor J; Estrada, Amara H; Sosa, Ivan S; Powell, Melanie; Maisenbacher, Herbert W; de Wit, Martine; Ball, Ray L; Walsh, Michael T

    2013-06-01

    Antemortem studies pertaining to the manatee cardiovascular and cardiopulmonary systems are limited despite reports of cardiac disease in postmortem specimens. The objective of this project was to develop a technique for echocardiography in the Florida manatee (Trichechus manatus latirostris). Because of their unique anatomy, a ventral approach was employed by use of an echocardiography table designed specifically for this study. Fourteen clinically healthy, free-ranging and captive Florida manatees underwent echocardiography between the fall of 2011 and winter of 2012. Eight females and six males of various age categories were included in the study. Clear visualization of all valves and chambers was accomplished, and length and width measurements of the left atrium, peak aortic flow velocity, and ejection fraction percentage were calculated in most animals. Abnormalities observed during the study included atrioventricular regurgitation and severe right-atrial enlargement. Based on the results of this study, echocardiography in the Florida manatee is possible, which has both clinical and research implications in larger epidemiologic studies evaluating diseases of the cardiopulmonary and cardiovascular systems. PMID:23805547

  16. Evaluation of the Konelab 20XT clinical chemistry analyzer.

    PubMed

    Stojanović, Natasa; Rogić, Dunja; Stavljenić-Rukavina, Ana

    2005-01-01

    The Konelab 20XT (Thermo Electron Oy, Finland) is a clinical chemistry analyzer for colorimetric, immunoturbidimetric and ion-selective electrode measurements. The aim of our work was to evaluate the analytical performances of the Konelab 20XT according to the European Clinical Chemistry Laboratory Standards Guidelines. A total of 30 analytes including substrates, enzymes, electrolytes and specific proteins were tested. Investigation results showed low imprecision (within-run coefficient of variation was below 3.5% and between-day coefficient of variation was less than 2.5% for most analytes at all three levels studied) and acceptable accuracy of the analyzer. No significant sample- or reagent-related carry-over was found. It was demonstrated that the analytical system operates within the claimed linearity ranges. The results compared well with those obtained by instruments routinely used in our laboratory (Olympus AU2700, Behring Nephelometer II). In general, the data on interference by hemoglobin, hyperbilirubinemia and turbidity are in accordance with known facts. However, slight hemolysis was found to interfere with the alkaline phosphatase (ALP) assay and mild lipemia affected the glucose assay. The Konelab 20XT is an easy-to-use analyzer that is suitable for routine and emergency analyses in small laboratories.

  17. Clinical performance evaluation of the prototype digital breast tomosynthesis system

    NASA Astrophysics Data System (ADS)

    Kim, Y.; Kim, H.; Park, H.; Choi, J.; Choi, Y.

    2012-03-01

    The rapid development and clinical use of digital mammography in the past decade has made possible the development of digital breast tomosynthesis (DBT), which can overcome the limitation of conventional mammography and improve the specificity of mammography with improved marginal visibility of lesion and early breast cancer detection, especially for women with dense breast. The purpose of this study is to characterize the physical properties of DBT system and to optimize the exposure condition using effective modulation transfer function (eMTF), effective noise power spectrum (eNPS), and effective detective quantum efficiency (eDQE). The first generation KERI prototype digital tomosyntesis system for breast imaging using CMOS flat panel detector was used in this study. It was found that the spatial frequency dependent metrics depend on both the inherent properties of the detector and imaging geometry including breast thickness. For thicker breast, eDQE decreases as scatter fraction increases at fixed tube voltage. Moreover, eMTF shows no significant difference as changing tube voltage while eDQE at 27 kVp is relatively degraded. Consequently, the quantitative evaluation of the DBT system with different exposure condition and breast thickness should be fully considered before building the system and application in clinical hospital.

  18. Evaluation of electronic biopsy for clinical diagnosis in virtual colonoscopy

    NASA Astrophysics Data System (ADS)

    Marino, Joseph; Du, Wei; Barish, Matthew; Li, Ellen; Zhu, Wei; Kaufman, Arie

    2011-03-01

    Virtual colonoscopy provides techniques not available in optical colonoscopy, an exciting one being the ability to perform an electronic biopsy. An electronic biopsy image is created using ray-casting volume rendering of the CT data with a translucent transfer function mapping higher densities to red and lower densities to blue. The resulting image allows the physician to gain insight into the internal structure of polyps. Benign tissue and adenomas can be differentiated; the former will appear as homogeneously blue and the latter as irregular red structures. Although this technique is now common, is included with clinical systems, and has been used successfully for computer aided detection, there has so far been no study to evaluate the effectiveness of a physician using electronic biopsy in determining the pathological state of a polyp. We present here such a study, wherein an experienced radiologist ranked polyps based on electronic biopsy alone per scan (supine and prone), as well as both combined. Our results show a correct identification 77% of the time using prone or supine images alone, and 80% accuracy using both. Using ROC analysis based on this study with one reader and a modest sample size, the combined score is not significantly higher than using a single electronic biopsy image alone. However, our analysis indicates a trend of superiority for the combined ranking that deserves a follow-up confirmatory study with a larger sample and more readers. This study yields hope that an improved electronic biopsy technique could become a primary clinical diagnosis method.

  19. [Clinical evaluation of a novel HBsAg quantitative assay].

    PubMed

    Takagi, Kazumi; Tanaka, Yasuhito; Naganuma, Hatsue; Hiramatsu, Kumiko; Iida, Takayasu; Takasaka, Yoshimitsu; Mizokami, Masashi

    2007-07-01

    The clinical implication of the hepatitis B surface antigen (HBsAg) concentrations in HBV-infected individuals remains unclear. The aim of this study was to evaluate a novel fully automated Chemiluminescence Enzyme Immunoassay (Sysmex HBsAg quantitative assay) by comparative measurements of the reference serum samples versus two independent commercial assays (Lumipulse f or Architect HBsAg QT). Furthermore, clinical usefulness was assessed for monitoring of the serum HBsAg levels during antiviral therapy. A dilution test using 5 reference-serum samples showed linear correlation curve in range from 0.03 to 2,360 IU/ml. The HBsAg was measured in total of 400 serum samples and 99.8% had consistent results between Sysmex and Lumipulse f. Additionally, a positive linear correlation was observed between Sysmex and Architect. To compare the Architect and Sysmex, both methods were applied to quantify the HBsAg in serum samples with different HBV genotypes/subgenotypes, as well as in serum contained HBV vaccine escape mutants (126S, 145R). Correlation between the methods was observed in results for escape mutants and common genotypes (A, B, C) in Japan. Observed during lamivudine therapy, an increase in HBsAg and HBV DNA concentrations preceded the aminotransferase (ALT) elevation associated with drug-resistant HBV variant emergence (breakthrough hepatitis). In conclusion, reliability of the Sysmex HBsAg quantitative assay was confirmed for all HBV genetic variants common in Japan. Monitoring of serum HBsAg concentrations in addition to HBV DNA quantification, is helpful in evaluation of the response to lamivudine treatment and diagnosis of the breakthrough hepatitis.

  20. A Formative Program Evaluation of Electronic Clinical Tracking System Documentation to Meet National Core Competencies.

    PubMed

    Smith, Lynette S; Branstetter, M Laurie

    2016-09-01

    Electronic clinical tracking systems are used in many educational institutions of higher learning to document advanced practice registered nursing students' clinical experiences. Students' clinical experiences are constructed according to the National Organization of Nurse Practitioner Faculties core competencies. These competencies form a basis for evaluation of advanced practice registered nursing programs. However, no previous studies have evaluated the use of electronic clinical tracking systems to validate students' clinical experiences in meeting national core competencies. Medatrax, an electronic clinical tracking system, is evaluated using a formative program evaluation approach to determine if students' clinical documentations meet Family/Across the Lifespan Nurse Practitioner Competencies in a midsouthern family nurse practitioner program. This formative program evaluation supports the use of an electronic clinical tracking system in facilitating accreditation and program outcome goals. The significance of this study is that it provides novel evidence to support the use of an electronic clinical tracking system to assist a midsouthern school of nursing in meeting national core competencies.

  1. The Varicocele: Clinical Presentation, Evaluation, and Surgical Management.

    PubMed

    Lomboy, Jason R; Coward, Robert M

    2016-09-01

    A varicocele is an abnormal dilatation and tortuosity of the veins of the spermatic cord. Although varicoceles are common in the general population and are frequently found on routine physical examinations, they represent the most common correctable cause of male factor infertility. Varicoceles are also often incidental findings on imaging studies, particularly scrotal ultrasound. Importantly, not all varicoceles should be treated equally (or at all), and basic guidelines on the evaluation and indications for treatment of adult varicoceles should be reviewed before counseling and treatment. A semen analysis should be obtained for any male patient of reproductive age considering intervention. The adolescent varicocele is managed much differently than the adult varicocele and remains a source of controversy. This review describes the clinical presentation and the evaluation of adult and pediatric varicoceles, and provides guidance on their diagnosis and workup. It also describes options for surgical repair and the success and complication rates associated with each surgical approach, ultimately supporting microsurgical subinguinal varicocele repair as the current surgical standard. PMID:27582602

  2. Evaluation of the clinical chemistry analyser Olympus AU400.

    PubMed

    Lasnier, E; Mario, N; Boque, M C; You, S N; Vaubourdolle, M

    2000-10-01

    The Olympus AU400 analyser (Olympus, Tokyo, Japan) is an automated chemistry instrument for turbidimetric, spectrophotometric and ion selective electrode measurements. Overall analytical performances of the AU400 and the reagents provided by Olympus were evaluated according to the French Society of Clinical Biology guidelines. Twenty parameters including specific proteins, substrates, enzyme activities and electrolytes were tested. The linearity exceeded the specifications given by the manufacturer. Within- and between-run imprecision (CV%), evaluated at two levels, was below 1.5% for ion selective electrode parameters and 3% for other analytes, except for CO2, alkaline phosphatase at low levels and magnesium. Results compared well with those obtained with the analysers routinely used in our laboratory (Behring BNII, Olympus AU800 and Beckman CX3 Delta). The usual positive interferences from lipaemia and haemoglobin on total protein measurement were observed. Creatine kinase and alkaline phosphatase assays were the subject of positive and negative interference by haemoglobin, respectively. There was a negative interference by bilirubin in the uric acid, aspartate-amino transferase, creatine kinase and lactate dehydrogenase assays and a positive interference in the calcium assay. The system was found to be very easy to use and the workstation is user-friendly. PMID:11140621

  3. Evaluation of Clinical Biomaterial Surface Effects on T Lymphocyte Activation

    PubMed Central

    Rodriguez, Analiz; Anderson, James M.

    2009-01-01

    Previous in vitro studies in our laboratory have shown that lymphocytes can influence macrophage adhesion and fusion on biomaterial surfaces. However, few studies have evaluated how material adherent macrophages can influence lymphocyte behavior, specifically T cells. In this study, we cultured human peripheral blood mononuclear cells from healthy donors on three synthetic non-biodegradable biomedical polymers: Elasthane 80A (PEU), Silicone rubber (SR), or polyethylene terephthalate (PET) and tissue culture polystyrene (TCPS). Upregulation of T cell surface activation markers (CD69 and CD25), lymphocyte proliferation, and interleukin-2 (IL-2) and interferon-γ (IFNγ) concentrations were evaluated by flow cytometry, carboxy-fluorescein diacetate, succinimydyl ester (CFSE) incorporation, and multiplex cytokine immunoassay, respectively, to assess T cell activation. Following 3 and 7 days of culture, CD4+ helper T cells from cultures of any of the material groups did not express the activation markers CD69 and CD25 and lymphocyte proliferation was not present. IL-2 and IFNγ levels were produced, but dependent on donor. These data indicate that T cells are not activated in response to clinically relevant synthetic biomaterials. The data also suggest that lymphocyte subsets exclusive of T cells are the source of the lymphokines, IL-2 and IFN-γ, in certain donors. PMID:19172618

  4. Thyrotoxicosis after a massive levothyroxine ingestion in a 3-year-old patient.

    PubMed

    Hays, Hannah L; Jolliff, Heath A; Casavant, Marcel J

    2013-11-01

    Most children with exploratory levothyroxine ingestions remain asymptomatic or suffer only minor effects, and most patients can be managed in the home or with supportive care in the hospital. We present a case of a 3-year-old girl who was found after a witnessed massive ingestion of levothyroxine. The patient was initially seen in an emergency department and discharged in stable condition, only to return 4 days after ingestion with thyrotoxicosis, hypertension, tachycardia, 24 hours of persistent vomiting, and clinical and laboratory evidence of dehydration. On the day of hospital admission, her thyroid-stimulating hormone was 0.018 µIU/mL (reference range, 0.6-4.5 µIU/mL); free T4 (tetraiodothyronine) was greater than 6.0 ng/dL (reference range, 0.7-2.1 ng/dL); and T3 (triiodothyronine) total was 494 ng/dL (reference range, 100-200 ng/dL). During a 3-day hospital admission, she was managed with supportive care, including intravenous fluid rehydration and antiemetics, and was ultimately discharged in good condition. The patient was followed up until 2 months after ingestion and remained asymptomatic. Although most exploratory levothyroxine ingestions suffer little to no clinical effects, serious symptoms can occur. Because serious symptoms can occur in a delayed fashion, it is important for clinicians to give proper anticipatory guidance regarding home symptom monitoring, follow-up, and reasons to return to the emergency department when patients present for medical evaluation. PMID:24196094

  5. Health Blogging and Social Support: A 3-Year Panel Study.

    PubMed

    Keating, David M; Rains, Stephen A

    2015-01-01

    The reported study explored the implications of informal computer-mediated social support for the well-being of individuals coping with illness over the course of 3 years. A panel study was conducted in which respondents--bloggers writing about their experiences living with a health condition--reported on their perceptions of social support and well-being during 2010 and again during 2013. Among respondents who completed both questionnaires (n = 49), increases in support availability from family and friends were related to improvements in bloggers' health self-efficacy as well as improvements in bloggers' loneliness, particularly among those who also experienced increased support availability from blog readers. Increased blog reader support availability was associated with improvements in bloggers' health-related uncertainty. Among respondents who completed the initial questionnaire (N = 121), a survival analysis showed that neither support available from family and friends nor support from blog readers predicted continued health blogging over the 3-year period.

  6. [Dermatobia hominis infection in a 3-year-old child].

    PubMed

    Meissner, M; Kippenberger, S; Valesky, E M; Kaufmann, R

    2012-04-01

    In the context of increasing travel to the tropics, outpatient services are more frequently confronted with non-domestic diseases in Europe. A 3-year old child presented with a painful tumor of the scalp. After incision of the furuncle-like lesion, we extracted a larva of the botfly Dermatobia hominis. Botflies are mainly encountered in Central and South America; they should be considered if patients demonstrate a furuncle-like lesion and have returned from a holiday in these endemic regions.

  7. [Clinical effectiveness and economical evaluation of preventive vaccination].

    PubMed

    Vaz Carneiro, António; Belo, Ana Isabel; Gouveia, Miguel; Costa, João; Borges, Margarida

    2011-01-01

    The value of mass vaccination as a preventive measure for infectious diseases is one of the most important advances of modern Medicine. The impact on incidence of several infectious diseases, until recently responsible for significant morbidity and mortality at world level, is well proved in a series of high quality epidemiological studies. In this scientific review we aimed firstly to briefly resume the history of mass vaccination and its scientists, responsible for synthesis and marketing of these drugs. In second place we present a group of a few disease preventable by vaccines as well as the Portuguese National Vaccination Plan and its benefits. In third place we identified groups of subjects in which a well structured vaccination plan is particularly important, as well as the correspondent diseases to be covered by vaccination. Fourthly, we discussed the ethical considerations of vaccination, and its tensions between subject autonomy and society advantages in com pulsive programs. Fifthly, we analyzed clinical effectiveness of vaccines through the concept of herd immunity, clinical evaluation of immune response to vaccines and some examples of systematic reviews on three relevant diseases (influenza, meningococcal and pneumococcal infections). In sixth place we discussed vaccine safety presenting monitoring methods of vaccination risks, as well as discussing the public myths concerning vaccines. Finally we present a economic analysis of preventive vaccination with a review of some published literature on specific diseases. We conclude that mass vaccination is a efficacious preventive measure, as well as a economic rational choice, and that this public health intervention should be a pillar of a modern preventive system.

  8. Laser resistant stainless steel endotracheal tube: experimental and clinical evaluation.

    PubMed

    Fried, M P; Mallampati, S R; Liu, F C; Kaplan, S; Caminear, D S; Samonte, B R

    1991-01-01

    A fire due to endotracheal tube (ET) ignition is a catastrophic event that may occur during laser surgery of the upper airway, regardless of the wavelength utilized. Although methods exist that permit laser surgery without an ET, this is frequently not feasible. The current investigation was undertaken to evaluate the efficacy of a double-cuffed stainless steel ET, first in the laboratory and subsequently in a clinical setting. Bench testing was performed using CO2 (both standard and milliwatt) and KTP/532 lasers. Only the distal polyvinyl chloride cuffed end of the tube was potentially ignitable, however, the appropriate use of saline to fill the cuffs allowed only for cuff perforation without ignition. Canine testing was performed in 10 animals: 4 dogs were intubated from 3 to 4.5 hours with the laser resistant stainless steel endotracheal tube (LRSS-ET) (Laser-Flex Tracheal Tube; Mallinckrodt Anesthesia Products, St. Louis, MO) and 2 with an aluminum tape wrapped red rubber ET. Visual and histological examination were performed in both groups at 3 and 7 days. Four dogs underwent CO2 laser laryngeal surgery with visual and histological examination performed at 7 days postoperatively. No untoward effects could be demonstrated due to the LRSS-ET. A clinical study was then performed in 24 patients who underwent laser surgery of the upper aerodigestive tract with either a CO2 or KTP/532 laser. In all cases ventilation was adequate, the shaft of the LRSS-ET proved impervious to the laser, and the distal end of the tube protected the tracheobronchial tree safely.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1861569

  9. A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy.

    PubMed

    Scholz, Joachim; Rathmell, James P; David, William S; Chad, David A; Broderick, Alithia C; Perros, Stephen G; Shin, Naomi S; Wells, Jenna L; Davis, John B; DiMaggio, Charles J; Wang, Shuang; Tate, Simon N

    2016-10-01

    Diabetic polyneuropathy (DPN) is a major cause of neuropathic pain and a frequent target condition in analgesic treatment trials. Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely to have therapeutic relevance. The aim of this study was to develop a tool for the bedside assessment of painful neuropathies such as DPN that captures the diversity of phenotypes. Sixty-one patients with type 2 diabetes and painful neuropathy, 19 patients with painless DPN, 25 patients with type 2 diabetes but no clinical evidence of neuropathy, and 20 healthy control subjects completed a structured interview (47 items) and a standardized physical examination (39 items). After analyzing critical features of pain and painless symptoms and examining the outcome of physical tests of sensory function, we determined principal components of the phenotypic variance among patients. Increased sensitivity to mechanical or thermal stimuli and, to a lesser extent, the sensory quality of pain or paresthesia were the most discriminating elements of DPN phenotypes. Correlation patterns of symptoms and signs indicated the involvement of functionally distinct nerve fiber populations. We combined interview questions and physical tests identifying these differences in a shortened assessment protocol that we named Standardized Evaluation of Pain and Somatosensory Function (StEPS). The protocol StEPS generates a phenotypic profile of patients with neuropathy. Separate intensity ratings for spontaneous painful symptoms and pain evoked by standard stimuli support a detailed documentation of neuropathic pain and its response to analgesic treatment. PMID:27322439

  10. Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings.

    PubMed

    Edelman, Emily A; Lin, Bruce K; Doksum, Teresa; Drohan, Brian; Edelson, Vaughn; Dolan, Siobhan M; Hughes, Kevin; O'Leary, James; Vasquez, Lisa; Copeland, Sara; Galvin, Shelley L; DeGroat, Nicole; Pardanani, Setul; Gregory Feero, W; Adams, Claire; Jones, Renee; Scott, Joan

    2014-07-01

    "The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83% (513/618) of patients that provided feedback, 97% felt PHP was easy to use and 98% easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.

  11. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... and evaluation of clinical trials. For drugs covered under this section, the Commissioner and other agency officials will monitor the progress of the conduct and evaluation of clinical trials and...

  12. Effects of tafluprost treatment for 3 years in patients with normal-tension glaucoma

    PubMed Central

    Inoue, Kenji; Tanaka, Ayumi; Tomita, Goji

    2013-01-01

    Purpose To evaluate the effects of tafluprost treatment for 3 years on intraocular pressure (IOP) and visual field performance. Methods The IOP of 55 patients with normal-tension glaucoma was monitored every 1–3 months for 3 years. The Humphrey visual field test was performed every 6 months after treatment and results compared with before-treatment results. Visual field performance was also evaluated by trend and event analysis. Results After 3 years’ tafluprost single-use vials treatment, the IOP (12.8 ± 2.8 mmHg [mean ± standard deviation]) was significantly lower than before treatment (15.7 ± 2.2 mmHg; P < 0.0001). When comparing before-treatment Humphrey visual field test findings with those after 3 years of treatment, no change was found in the mean deviation and pattern standard deviation. Visual field performance had worsened in four patients and three patients according to trend analysis and event analysis, respectively. Adverse reactions appeared in ten cases and one patient (1.8%) discontinued treatment due to an adverse reaction. Conclusion Tafluprost single-use vials treatment was effective in reducing IOP over the 3 years of this study, but visual field performance worsened by 10.3%–13.8% in patients with normal-tension glaucoma. Safety was satisfactory. PMID:23874082

  13. Clinical evaluation of the failure rates of metallic brackets

    PubMed Central

    ROMANO, Fábio Lourenço; CORRER, Américo Bortolazzo; CORRER-SOBRINHO, Lourenço; MAGNANI, Maria Beatriz Borges de Araújo; RUELLAS, Antônio Carlos de Oliveira

    2012-01-01

    Objectives The aim of this study was to evaluate in vivo the bonding of metallic orthodontic brackets with different adhesive systems. Material and Methods Twenty patients (10.5-15.1 years old) who had sought corrective orthodontic treatment at a University Orthodontic Clinic were evaluated. Brackets were bonded from the right second premolar to the left second premolar in the upper and lower arches using: Orthodontic Concise, conventional Transbond XT, Transbond XT without primer, and Transbond XT associated with Transbond Plus Self-etching Primer (TPSEP). The 4 adhesive systems were used in all patients using a split-mouth design; each adhesive system was used in one quadrant of each dental arch, so that each group of 5 patients received the same bonding sequence. Initial archwires were inserted 1 week after bracket bonding. The number of bracket failures for each adhesive system was quantified over a 6-month period. Results The number of debonded brackets was: 8- Orthodontic Concise, 2- conventional Transbond XT, 9- Transbond XT without primer, and 1- Transbond XT + TPSEP. By using the Kaplan-Meier methods, statistically significant differences were found between the materials (p=0.0198), and the Logrank test identified these differences. Conventional Transbond XT and Transbond XT + TPSEP adhesive systems were statistically superior to Orthodontic Concise and Transbond XT without primer (p<0.05). There was no statistically significant difference between the dental arches (upper and lower), between the dental arch sides (right and left), and among the quadrants. Conclusions The largest number of bracket failures occurred with Orthodontic Concise and Transbond XT without primer systems and few bracket failures occurred with conventional Transbond XT and Transbond XT+TPSEP. More bracket failures were observed in the posterior region compared with the anterior region. PMID:22666842

  14. A clinical evaluation denture adhesives used by patients with xerostomia.

    PubMed

    Bogucki, Zdzislaw A; Napadlek, Piotr; Dabrowa, Tomasz

    2015-02-01

    The purpose of study was to analyze the participants' opinions concerning the effectiveness of 6 denture adhesives (DA). The study group included 60 participants. Criteria for selecting the patients were as follows: reduced retention and stabilization of maxillary complete dentures and xerostomia. These features were evaluated on basis of clinical examination and standard sialometry tests (u-SFR). Retention of maxillary dentures was scored by modified Kapur index before application of DA. All participants were divided randomly into 6 groups regarding the use of the 6 DA during a 6-month period. After this time, participants completed an HRQL questionnaire. DA noticeably improved retention and stabilization of maxillary complete dentures. DA in the glue form had the best retention effectiveness in participants with xerostomia. These materials are difficult to clean from the denture base. The data are presented in tables and figures. The results of the study collected positive influence of adhesives on retention of dentures in xerostomia patients. The cleaning dentures and denture bearing tissues was difficult. DA help in the use of prostheses, but it is also necessary for the treatment of the causes and symptoms of xerostomia.

  15. Economic evaluation in long-term clinical trials.

    PubMed

    Hlatky, Mark A; Boothroyd, Derek B; Johnstone, Iain M

    2002-10-15

    Economic endpoints have been increasingly included in long-term clinical trials, but they pose several methodologic challenges, including how best to collect, describe, analyse and interpret medical cost data. Cost of care can be measured by converting billed charges, performing detailed micro-costing studies, or by measuring use of key resources and assigning cost weights to each resource. The latter method is most commonly used, with cost weights based either on empirical regression models or administratively determined reimbursement rates. In long-term studies, monetary units should be adjusted to reflect cost inflation and discounting. The temporal pattern of accumulating costs can be described using a modification of the Kaplan-Meier curve. Regression analyses to evaluate factors associated with cost are best performed on the log of costs due to their typically skewed distribution.Cost-effectiveness analysis attempts to measure the value of a new therapy by calculating the difference in cost between the new therapy and the standard therapy, divided by the difference in benefit between the new therapy and the standard therapy. The cost-effectiveness ratio based on the results of a randomized trial may change substantially with longer follow-up intervals, particularly for therapies that are initially expensive but eventually improve survival. A model that projects long-term patterns of cost and survival expected beyond the end of completed follow-up can provide an important perspective in the setting of limited trial duration.

  16. Economic evaluation in long-term clinical trials.

    PubMed

    Hlatky, Mark A; Boothroyd, Derek B; Johnstone, Iain M

    2002-10-15

    Economic endpoints have been increasingly included in long-term clinical trials, but they pose several methodologic challenges, including how best to collect, describe, analyse and interpret medical cost data. Cost of care can be measured by converting billed charges, performing detailed micro-costing studies, or by measuring use of key resources and assigning cost weights to each resource. The latter method is most commonly used, with cost weights based either on empirical regression models or administratively determined reimbursement rates. In long-term studies, monetary units should be adjusted to reflect cost inflation and discounting. The temporal pattern of accumulating costs can be described using a modification of the Kaplan-Meier curve. Regression analyses to evaluate factors associated with cost are best performed on the log of costs due to their typically skewed distribution.Cost-effectiveness analysis attempts to measure the value of a new therapy by calculating the difference in cost between the new therapy and the standard therapy, divided by the difference in benefit between the new therapy and the standard therapy. The cost-effectiveness ratio based on the results of a randomized trial may change substantially with longer follow-up intervals, particularly for therapies that are initially expensive but eventually improve survival. A model that projects long-term patterns of cost and survival expected beyond the end of completed follow-up can provide an important perspective in the setting of limited trial duration. PMID:12325104

  17. Primitive reflex evaluation in the clinical assessment of extrapyramidal syndromes.

    PubMed

    Borroni, B; Broli, M; Costanzi, C; Gipponi, S; Gilberti, N; Agosti, C; Padovani, A

    2006-09-01

    The aim of the present study was to evaluate the role of primitive reflexes (PRs) as additional alert sign in routine clinical practice in patients with extrapyramidal syndrome. We considered glabellar, snout, palmomental and grasp reflexes in patients with mild stage of Lewy body dementia (LBD), corticobasal degeneration, progressive supranuclear palsy or Parkinson disease (PD). We also enrolled mild Alzheimer disease (AD) patients, and healthy subjects, as controls. LBD patients showed the highest prevalence of PRs compared with the other groups. The odds ratio of the risk of LBD in PRs > or = 2 was 27.9 (95% CI 2.9-269.0) compared with control group, 14.6 (95% CI 2.7-79.6) compared with mild AD, and 19.7 (95% CI 3.7-104.3) compared with PD. These data suggest that the occurrence of combination of PRs might be an useful additional warning sign of possible diffuse Lewy body pathology more than other causes of extrapyramidal syndrome.

  18. Clinical use of noninvasive evaluation of the carotid artery.

    PubMed

    Persson, A V; O'Leary, D H; Kovacs, A; Dyer, V E

    1980-06-01

    The noninvasive evaluation of carotid artery disease should include a battery of tests that includes one direct and one indirect assessment of the extracranial carotid arteries. The resulting data should be correlated with the clinical findings and the patient's general status so the risks and benefits of carotid endarterectomy may be determined. These studies are usually outpatient procedures and allow one to determine in the office which patients would benefit from carotid surgery and who should be followed serially. Carotid arteriography is reserved for those patients who will be subjected to surgery. In our hands, the combination of CPA, Kartchner-McRae OPG, and Echoflow fulfill these requirements. In a small number of patients the history, physical examination, and noninvasive studies are inconclusive. For most patients, we are able to make decisions as to the best therapy in the office and can discuss risks and benefits with patients and their families with an accuracy of approximately 95 per cent before hospitalization and arteriography are considered.

  19. Axon clinical chemistry analyzer evaluated according to ECCLS protocol.

    PubMed

    Brenna, S; Prencipe, L

    1992-10-01

    We assessed the analytical performance of the Axon system (Bayer Diagnostici), according to the European Committee for Clinical Laboratory Standards guidelines, for assay of 12 analytes: cholesterol, creatinine, glucose, total protein, urea, uric acid, alkaline phosphatase, alpha-amylase, aspartate aminotransferase, creatine kinase, sodium, and potassium. The field evaluation lasted approximately 5 months and involved the collection of approximately 10,000 data points with the Axon. The following results were obtained: The highest CVs for controls and human sera at different concentration/activity values were 2.2% for within-run imprecision (n = 60; 3 days, pooled estimate) and 3.5% for the between-day imprecision (n = 20 days). Close correlation was found with results for patients' specimens assayed with comparative instruments (Hitachi 717 for substrates and enzymes, Beckman Synchron EL/E4A for electrolytes). No drift was observed during 8 h of operation. The linearity range was broad, sometimes exceeding the manufacturer's claims. No sample-, reagent-, or cuvette-related carryover was found. Measurement of control sera gave results within +/- 5% of the assigned values. We conclude that good reliability and practicability make the Axon system suitable for laboratories with various needs.

  20. European multicentre evaluation of the ABBOTT Spectrum clinical chemistry analyzer.

    PubMed

    Blijenberg, B G; Braconnier, F; Vallez, J M; Burlina, A; Plebani, M; Celadin, M; Haeckel, R; Römer, M; Hänseler, E; De Schrijver, G

    1989-06-01

    The analytical performance of the selective multitest ABBOTT Spectrum analyser was studied according to the ECCLS guidelines and partly the CERMAB protocol in a multicentre evaluation involving laboratories from six European countries. Fifteen analytes, including the electrolytes sodium, potassium and chloride, were measured each in at least 3 laboratories, all at 37 degrees C, except the electrolytes, which are measured at room temperature. The trial lasted approximately three months and involved the collection of over 60,000 data points. It yielded the following results: 1. The precision was at least as good as the precision obtained with the comparison instruments. The majority of the coefficients of variation were between 1 and 4%. 2. The recovery for method assigned control sera values was, with few exceptions, within 10%. 3. Good agreement with respect to the method assigned values of control materials and method comparison with patient specimens to different instruments (e.g. SMAC, Hitachi 737, RA 1000) was found. 4. No drift was observed. 5. Reagent-related carry-over was not found. Specimen-related carry-over was detected in some cases, the deviation being of little or no clinical significance. 6. The manufacturer's claims regarding method linearity were as stated or exceeded. 7. The open system capability was tested and rated as very convenient. 8. The practicability of the instrument was very good.

  1. Clinical evaluation of therapeutic success in rabbits with suspected encephalitozoonosis.

    PubMed

    Sieg, Jessica; Hein, Jutta; Jass, Ariane; Sauter-Louis, Carola; Hartmann, Katrin; Fischer, Andrea

    2012-06-01

    Between 2000 and 2008, 95 rabbits with suspected encephalitozoonosis and neurological symptoms were treated at the Clinic of Small Animal Medicine, Ludwig Maximilian University Munich. Standard treatment consisted of oxytetracycline (from 2000 to 2003; n=50) or fenbendazole and oxytetracycline (from 2004 to 2008; n=45), and the rabbits were randomly assigned to treatment groups with or without dexamethasone. Each therapeutic regime was given for 10 days, with fluids, B vitamins and nutritional support added as needed. Therapeutic success was evaluated by assessing the survival rate on day 10, the neurological score of the surviving rabbits and Kaplan-Meier curves for long-term survival past 10 days. Inclusion of fenbendazole in the treatment protocol was associated with increased survival rates on day 10 (p=0.043), better neurological scores (p=0.008), and improved long-term survival (p=0.025) based on the results of univariate analyses. Treatment with dexamethasone showed no effect on neurological score or on short- or long-term survival. The study did not provide any evidence that dexamethasone is an effective component of the treatment scheme.

  2. Clinical Evaluation of Shilajatu Rasayana in patients with HIV Infection

    PubMed Central

    Gupta, G. D.; Sujatha, N.; Dhanik, Ajay; Rai, N. P.

    2010-01-01

    AIDS is one of the serious global health concerns caused by Human Immuno Deficiency(HIV) virus and is predominantly a sexually transmitted disease. Currently there is no vaccine or cure for AIDS still Anti Retroviral Therapy (ART) is successful. It reduces both the mortality and the morbidity of HIV infection, but is expensive and inaccessible in many countries. However intense the therapy may be, HIV virus is rarely eliminated, and drug resistance is a major setback during long-term therapy. The development of new drugs and strategies and exploring alternative systems of medicine for antiviral herbs or drugs is the need of the age to improve treatment outcomes. Ayurveda describes many diseases which incorporate HIV like illness e.g. Rajayakshma, Ojo Kshaya, Sannipata jwara etc. HIV infection affects multisystems, chiefly the Immune System which can be correlated to Ojo Kshaya. Rasayana Chikitsa is the frontline therapy employed to treat Ojus disorders. Therefore Shilajatu (Mineral pitch), Centella asiatica (Mandukaparni), Tinospora cordifolia (Guduchi) and Emblica officinalis (Amalaki), well known for their Immuno-modulator and antioxidant properties were selected to evaluate their role on immune system. The study was carried on 20 patients from OPD and IPD of Kayachikitsa, S.S.Hospital, IMS, BHU and was randomly allocated into Treated group (Shilajatu+ART) and Control group (ART). Treated Group responded better to ART both clinically and biochemically. The results show that Shilajatu decreases the recurrent resistance of HIV virus to ART and improves the outcome of the therapy PMID:22131681

  3. Clinical evaluations of mineralized collagen in the extraction sites preservation

    PubMed Central

    Feng, Lu; Zhang, Liang; Cui, Yun; Song, Tian-Xi; Qiu, Zhi-Ye; Wang, Xiu-Mei; Tan, Bao-Sheng

    2016-01-01

    The purpose of this study was to explore the different effects between biomimetic mineralized collagen (MC) and ordinary physically blended hydroxyapatite/collagen (HA/Col) composite in evaluating new bone formation and regenerated bone height in human extraction sockets. Thirty-four patients who cannot retain teeth caused by trauma or decay were randomly selected from Department of Stomatology of Dongzhimen Hospital from December 2013 to December 2014. The patients were randomly divided into two groups. After the operation of tooth extraction, 17 patients were implanted with biomimetic MC (MC group), and other 17 patients were implanted with ordinary physically blended nHA/Col composite (nHA/Col group). X-ray positioning projection by auto-photographing was taken to test the distance between the lowest position and the neighboring CEJm-CEJd immediately, 1 month and 3 months after the operation. The height of new bone formation of the MC group was significantly higher than the nHA/Col group. Biomimetic MC showed better clinical outcomes in the bone formation for extraction site preservation and would have broad application prospect in the field of oral and maxillofacial surgeries. PMID:26815224

  4. Patterns of injuries in athletes evaluated in an interdisciplinary clinic.

    PubMed

    Frontera, W R; Micheo, W F; Amy, E; Meléndez, E; Aguirre, G; Correa, J J; Camuñas, J F

    1994-09-01

    The pattern of sports injuries appears to be population-specific. The purpose of the present study is to describe 1750 injuries evaluated between April 1988 and April 1994 in our Olympic Training Center Interdisciplinary Sports Injury Clinic. Our patient population included elite and recreational athletes of both sexes between the ages of 7 and 71 years. Males comprised 73% of the patient population and approximately 80% of the injuries corresponded to the 10 to 29 age range. The most frequent sports in males were baseball (21.9%) and basketball (15.9%) and in females were track and field (17.1%) and gymnastics (15.1%). Most injuries (52%) were traumatic in nature, chronic (71.6%), and occurred during training sessions (57.4%). The most commonly affected anatomical areas were the knee (31.2%) and shoulder (15.5%). The most common diagnoses were tendinitis (25.4%), and first degree strains (11.8%) and sprains (9.3%). Finally, treatment strategies included medications (61.0%), physical therapy (48.9%), relative rest (35.7%), and home exercise programs (35.2%). The variety of musculoskeletal disorders seen in combination with the frequent use of conservative treatment confirms the importance of an interdisciplinary approach to sports injuries.

  5. 76 FR 19189 - Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation... (Federal Advisory Committee Act) that a meeting of the Clinical Science Research and Development Service... Science Research and Development Service on the relevance and feasibility of proposed projects and...

  6. Pulmonary nocardiosis in a 3-year-old child

    PubMed Central

    Holdaway, M. D.; Kennedy, J.; Ashcroft, T.; Kay-Butler, J. J.

    1967-01-01

    Until 1960, 179 cases of infection with Nocardia asteroides had been described in the world literature. Seventeen cases in children were reported by 1963. The organism is a common saprophyte in nature with probably a world-wide distribution. Infection can be primary but is more common in patients with underlying malignancy, auto-immune disease or preceding tuberculosis. Sulphonamides, particularly sulphadiazine, are the drugs of choice in treatment; the value of antibiotics is less clearly established. The indications for surgical treatment have not yet been defined. We record a further case of primary pulmonary nocardiosis in a 3-year-old child. Images PMID:6035802

  7. Evaluating the clinical quality of departments as viewed by juniors and seniors of Shiraz dental school

    PubMed Central

    Danaei, Shahla Momeni; Mazareie, Elham; Hosseininezhad, Sahar; Nili, Mahsa

    2015-01-01

    Introduction: Assessment of students’ perspective is an essential element in effective educational quality evaluation. By identifying strengths and weaknesses, it leads to improvement in future performance. Methods: This cross-sectional study was performed through a questionnaire comprising 23 questions. Reliability was assessed using α-Chronbach (α =0.87), and validity was confirmed by a group of five experts. Tukey test, Pearson correlation coefficient, and two sample t-tests were used for data analysis. Methods: This cross-sectional study was performed through a questionnaire comprising 23 questions. Reliability was assessed using α-Chronbach (α =0.87), and validity was confirmed by a group of five experts. Tukey test, Pearson correlation coefficient, and two sample t-tests were used for data analysis. Results: A total of 168 answered questionnaires were entered in our study. Maximum satisfaction in most items was shown in removable prosthodontics and orthodontics departments whereas oral surgery and comprehensive treatment departments acquired the least scores. In all departments, personnels’ respectful attitude had the highest score whereas minimum grade was given to stressful workload and overall satisfaction in each department. In comparison with a similar study, conducted 3 years ago, level of satisfaction was raised for orthodontics and removable prosthodontics departments though it was declined for the pediatrics department. Conclusion: The special cadre of clinical instructors comprising both experienced and young members is considered as an important factor leading to high student satisfaction in the orthodontics department. Promotion of a removable prosthodontics department is related to the high relevance between the implemented educational program and the curriculum. The moderate performance of oral surgery and restorative departments is indicative of the need for more attention from ministry authorities to major dental departments such as

  8. Clinical Evaluation of Efficacy of CIA and CNA Intrusion Arches

    PubMed Central

    Vora, Sambhav; Pandey, Vinisha

    2015-01-01

    Background and Objectives Excessive overbite is one of the most common problems that confront the orthodontist. Deep bite can be due to infraocclusion of posterior teeth, supraocclusion of anterior teeth or a combination of the two. Correction of same can be carried out by extrusion of molars, intrusion of incisors or by a combination of both respectively. Various intrusion arches are recommended for correcting deep bite by true intrusion of anterior teeth, Utility arches, Segmental arch, Connecticut Intrusion Arch (CIA) and Connecticut New Arch (CNA). The purpose of this study was to evaluate clinical efficacy of CIA and CNA intrusion arches. Materials and Methods Tracings recorded from pre and post-treatment lateral cephalograms of 25 patients treated by CIA (Group I) and another 25 patients treated by CNA (Group II) intrusion arches in deep bite cases after four months of treatment were analysed and findings were recorded. Statistical Analysis Paired t-test was used to compare pre and post-treatment changes within Groups I and II and unpaired t-test was used to compare treatment changes between Group I and Group II. A P-value of < 0.05 was set for statistical significance. Results Findings of this study demonstrate that an average of 1mm of intrusion takes place with CIA intrusion arch and 1.3mm with CNA intrusion arch in a period of 4 months. Both intrusion arches do not affect the position of molar in vertical or anteroposterior plane. Interpretation & Conclusion Both CIA and CNA intrusion arches are effective in bringing about intrusion of lower incisors. PMID:26501008

  9. A 3 Year-Old Male Child Ingested Approximately 750 Grams of Elemental Mercury

    PubMed Central

    Uysalol, Metin; Parlakgül, Güneş; Yılmaz, Yasin; Çıtak, Agop; Uzel, Nedret

    2016-01-01

    Background: The oral ingestion of elemental mercury is unlikely to cause systemic toxicity, as it is poorly absorbed through the gastrointestinal system. However, abnormal gastrointestinal function or anatomy may allow elemental mercury into the bloodstream and the peritoneal space. Systemic effects of massive oral intake of mercury have rarely been reported. Case Report: In this paper, we are presenting the highest single oral intake of elemental mercury by a child aged 3 years. A Libyan boy aged 3 years ingested approximately 750 grams of elemental mercury and was still asymptomatic. Conclusion: The patient had no existing disease or abnormal gastrointestinal function or anatomy. The physical examination was normal. His serum mercury level was 91 µg/L (normal: <5 µg/L), and he showed no clinical manifestations. Exposure to mercury in children through different circumstances remains a likely occurrence. PMID:27606146

  10. A 3 Year-Old Male Child Ingested Approximately 750 Grams of Elemental Mercury

    PubMed Central

    Uysalol, Metin; Parlakgül, Güneş; Yılmaz, Yasin; Çıtak, Agop; Uzel, Nedret

    2016-01-01

    Background: The oral ingestion of elemental mercury is unlikely to cause systemic toxicity, as it is poorly absorbed through the gastrointestinal system. However, abnormal gastrointestinal function or anatomy may allow elemental mercury into the bloodstream and the peritoneal space. Systemic effects of massive oral intake of mercury have rarely been reported. Case Report: In this paper, we are presenting the highest single oral intake of elemental mercury by a child aged 3 years. A Libyan boy aged 3 years ingested approximately 750 grams of elemental mercury and was still asymptomatic. Conclusion: The patient had no existing disease or abnormal gastrointestinal function or anatomy. The physical examination was normal. His serum mercury level was 91 µg/L (normal: <5 µg/L), and he showed no clinical manifestations. Exposure to mercury in children through different circumstances remains a likely occurrence.

  11. Extrinsic Rewards Diminish Costly Sharing in 3-Year-Olds.

    PubMed

    Ulber, Julia; Hamann, Katharina; Tomasello, Michael

    2016-07-01

    Two studies investigated the influence of external rewards and social praise in young children's fairness-related behavior. The motivation of ninety-six 3-year-olds' to equalize unfair resource allocations was measured in three scenarios (collaboration, windfall, and dictator game) following three different treatments (material reward, verbal praise, and neutral response). In all scenarios, children's willingness to engage in costly sharing was negatively influenced when they had received a reward for equal sharing during treatment than when they had received praise or no reward. The negative effect of material rewards was not due to subjects responding in kind to their partner's termination of rewards. These results provide new evidence for the intrinsic motivation of prosociality-in this case, costly sharing behavior-in preschool children. PMID:27084549

  12. GRB 030329: 3 years of radio afterglow monitoring.

    PubMed

    van der Horst, A J; Kamble, A; Wijers, R A M J; Resmi, L; Bhattacharya, D; Rol, E; Strom, R; Kouveliotou, C; Oosterloo, T; Ishwara-Chandra, C H

    2007-05-15

    Radio observations of gamma-ray burst (GRB) afterglows are essential for our understanding of the physics of relativistic blast waves, as they enable us to follow the evolution of GRB explosions much longer than the afterglows in any other wave band. We have performed a 3-year monitoring campaign of GRB 030329 with the Westerbork Synthesis Radio Telescopes and the Giant Metrewave Radio Telescope. Our observations, combined with observations at other wavelengths, have allowed us to determine the GRB blast wave physical parameters, such as the total burst energy and the ambient medium density, as well as to investigate the jet nature of the relativistic outflow. Further, by modelling the late-time radio light curve of GRB 030329, we predict that the Low-Frequency Array (30-240 MHz) will be able to observe afterglows of similar GRBs, and constrain the physics of the blast wave during its non-relativistic phase.

  13. Severe hypercholesterolemia and liver disease in a 3-year old.

    PubMed

    Patel, Amol M; Brautbar, Ariel; Desai, Nirav K; Wilson, Don P

    2016-01-01

    Lipoprotein-X, which is composed of phospholipids and non-esterified cholesterol, is an abnormal lipoprotein with a density range similar to LDL-C. The two most common ways which lipoprotein-X accumulates is from reflux of bile salts into plasma or deficiency in lecithin cholesterol acyltransferase. This is a case of severe hypercholesterolemia and liver disease in a 3- year old male that presented with pruritus, pale stool, scleral ictus, and abdominal distention. He was diagnosed with primary sclerosing cholangitis which was confirmed by liver biopsy. Our patient was treated with steroids and immunomodulator therapy which was associated with significant reduction in cholestasis and LDL-C levels. Lipoprotein-X has several properties that make it anti-atherogenic, which raises the question if treatment for hypercholesterolemia should be initiated. PMID:27206954

  14. GRB 030329: 3 years of radio afterglow monitoring.

    PubMed

    van der Horst, A J; Kamble, A; Wijers, R A M J; Resmi, L; Bhattacharya, D; Rol, E; Strom, R; Kouveliotou, C; Oosterloo, T; Ishwara-Chandra, C H

    2007-05-15

    Radio observations of gamma-ray burst (GRB) afterglows are essential for our understanding of the physics of relativistic blast waves, as they enable us to follow the evolution of GRB explosions much longer than the afterglows in any other wave band. We have performed a 3-year monitoring campaign of GRB 030329 with the Westerbork Synthesis Radio Telescopes and the Giant Metrewave Radio Telescope. Our observations, combined with observations at other wavelengths, have allowed us to determine the GRB blast wave physical parameters, such as the total burst energy and the ambient medium density, as well as to investigate the jet nature of the relativistic outflow. Further, by modelling the late-time radio light curve of GRB 030329, we predict that the Low-Frequency Array (30-240 MHz) will be able to observe afterglows of similar GRBs, and constrain the physics of the blast wave during its non-relativistic phase. PMID:17293318

  15. 3-year experience with US QML: lessons learned

    NASA Astrophysics Data System (ADS)

    Leseur, M.

    2002-12-01

    Based on its 20 years experience in manufacturing semiconductor devices, Atmel Nantes has chosen to apply QML concept to move from Product Qualification to Technology Qualification. Defense Supply Center Colombus granted Atmel Nantes QML Q & V (class Q = military quality level , class V = space quality level), in December 1999. A demonstration phase is on-going with draft ESA/SCC 25400 and 2549000 basic specifications for the definition of a European QML. Atmel is a candidate as an integrated microcircuits manufacturer. After 3 years producing QML devices, some optimisations of screening tests have been implemented. This appears to be a valid solution for reducing both cost and cycle time with no impact on product reliability.

  16. ISS ECLSS: 3 Years of Logistics for Maintenance

    NASA Technical Reports Server (NTRS)

    Shkedi, Brienne; Thompson, Dean

    2004-01-01

    The International Space Station (ISS) Environmental Control and Life Support System (ECLSS) is designed to be maintainable. During the 3 years since the ISS US Lab became operational, there have been numerous ECLSS Orbital Replacement Units (ORUs) launched and returned to Maintain the ECLSS operation in the US segments. The maintenance logistics have provided tools for maintenance, replaced limited life ORUs and failed ORUs, upgraded ECLSS hardware to improve reliability and placed critical spares onboard prior to need. In most cases, the removed ORUs have been returned for either failure analysis and repair or refurbishment. This paper describes the ECLSS manifesting history and maintenance events and quantifies the numbers of ECLSS items, weights, and volumes.

  17. A laboratory and clinical evaluation of three dental luting cements.

    PubMed

    Knibbs, P J; Walls, A W

    1989-09-01

    The loss of material from specimens of three luting cements was measured after continuous erosion cycling in the laboratory. The glass ionomer luting cement showed significantly less material loss than the zinc polycarboxylate and zinc phosphate luting cements. Two hundred and fifty restorations cemented with one of the three materials were studied clinically for marginal integrity and retention over 3.5 years. The data were tested using survival analysis. Zinc phosphate cement gave the best clinical performance. Possible explanations for the poor correlation between the findings in the laboratory and clinical study are discussed.

  18. 78 FR 41198 - Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation... Committee Act, 5 U.S.C. App. 2, that the Clinical Science Research and Development Service Cooperative... Research and Development Officer through the Director of the Clinical Science Research and...

  19. 78 FR 53015 - Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-27

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation... Committee Act, 5 U.S.C. App. 2, that the Clinical Science Research and Development Service Cooperative... Chief Research and Development Officer through the Director of the Clinical Science Research...

  20. 78 FR 70102 - Clinical Science Research and Development Service Cooperative Studies; Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-22

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies; Scientific Evaluation... Committee Act, 5 U.S.C. App. 2, that the Clinical Science Research and Development Service Cooperative... the Director of the Clinical Science Research and Development Service on the relevance and...

  1. 77 FR 72438 - Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-05

    ... AFFAIRS Clinical Science Research and Development Service Cooperative Studies Scientific Evaluation... Committee Act, 5 U.S.C. App. 2, that the Clinical Science Research and Development Service Cooperative... Clinical Science Research and Development Service on the relevance and feasibility of proposed projects...

  2. Psychometric Evaluation of the Restructured Clinical Scales of the MMPI-2

    ERIC Educational Resources Information Center

    Simms, Leonard J.; Casillas, Alex; Clark, Lee Anna; Watson, David; Doebbeling, Bradley N.

    2005-01-01

    Conceptual overlap and heterogeneity have long been noted as weaknesses of the Minnesota Multiphasic Personality Inventory's clinical scales. Restructured clinical (RC) scales recently were developed to address these concerns (A. Tellegen et al., 2003). The authors evaluated the psychometric properties of the RC scales in psychology clinic clients…

  3. Evaluating clinical competence during nursing education: A comprehensive integrative literature review.

    PubMed

    Lejonqvist, Gun-Britt; Eriksson, Katie; Meretoja, Riitta

    2016-04-01

    This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident. PMID:26369943

  4. Evaluating Faculty Development and Clinical Training Programs in Substance Abuse: A Guide Book.

    ERIC Educational Resources Information Center

    Klitzner, Michael; Stewart, Kathryn

    Intended to provide an overview of program evaluation as it applies to the evaluation of faculty development and clinical training programs in substance abuse for health and mental health professional schools, this guide enables program developers and other faculty to work as partners with evaluators in the development of evaluation designs that…

  5. [The importance of clinical data management in improvement of drug evaluation].

    PubMed

    Huang, Qin; Wang, Jun

    2015-11-01

    Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment. PMID:26911033

  6. [The importance of clinical data management in improvement of drug evaluation].

    PubMed

    Huang, Qin; Wang, Jun

    2015-11-01

    Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment.

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

    PubMed

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

    2016-05-13

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

  8. Do Student Evaluations Influence the Teaching Skills of Clerkship Clinical Faculty?

    ERIC Educational Resources Information Center

    Chandrasekhar, Arcot J.; Durazo-Arvizu, Ramon; Hoyt, Amy; McNulty, John A.

    2013-01-01

    Web-based student evaluations of clinical faculty were collected over an 8-year period. There were 19,881 medical student evaluations over the 8-year period for all clinical clerkships, representing a total of 952 faculty. Students used a 5-point Likert scale to rate the teaching effectiveness of faculty. Criterion-based methods and standard…

  9. Clinical Observed Performance Evaluation: A Prospective Study in Final Year Students of Surgery

    ERIC Educational Resources Information Center

    Markey, G. C.; Browne, K.; Hunter, K.; Hill, A. D.

    2011-01-01

    We report a prospective study of clinical observed performance evaluation (COPE) for 197 medical students in the pre-qualification year of clinical education. Psychometric quality was the main endpoint. Students were assessed in groups of 5 in 40-min patient encounters, with each student the focus of evaluation for 8 min. Each student had a series…

  10. Clinical evaluation and grading practices in schools of nursing: national survey findings part II.

    PubMed

    Oermann, Marilyn H; Yarbrough, Suzanne S; Saewert, Karen J; Ard, Nell; Charasika, Margie E

    2009-01-01

    To better understand how nurse educators evaluate and grade students' clinical practice, the Evaluation of Learning Advisory Council of the National League for Nursing conducted a survey of faculty (N = 1,573) in all types of prelicensure RN programs. This article describes the findings of that survey in relation to clinical evaluation and grading clinical practice. Nearly all faculty used a clinical evaluation tool to rate students' performance in the clinical setting (n = 1,534, 98 percent); most programs had the same basic tool in all courses, but modified to reflect the unique aspects of each course (n = 1,095, 70 percent). Faculty (n = 1,116, 83 percent) reported using pass/fail for grading in clinical courses rather than a letter or numerical grade.

  11. The relation between personality and anxiety: findings from a 3-year prospective study.

    PubMed

    Gershuny, B S; Sher, K J

    1998-05-01

    The authors tested the extent to which the personality dimensions of neuroticism, extraversion, and psychoticism (H. J. Eysenck & S. B. G. Eysenck, 1975) prospectively predicted global anxiety (assessed by items from the Brief Symptom Inventory: L. R. Derogatis & M. S. Spencer, 1982). The authors also examined prospective relations among these personality dimensions and depression to evaluate the specificity of findings. Participants were 466 young adults, primarily undergraduate students, assessed twice over a 3-year interval. An interaction between neuroticism and extraversion predicted both global anxiety and depression 3 years later. Findings indicated that personality, in particular the combination of high neuroticism and low extraversion, may play an important predisposing, etiological role in anxiety. Interpretations and implications of the predictive importance of the Neuroticism x Extraversion interaction in anxiety are discussed, and further speculations about the relation between anxiety and depression are put forth.

  12. Malignant hyperthermia in a 3-year-old child with microstomia.

    PubMed

    Evans, Tyler A; Flores, Roberto L; Tholpady, Sunil S; Dierdorf, Stephen

    2015-01-01

    Freeman-Sheldon syndrome is a congenital disorder that has been suggested to be associated with malignant hyperthermia. Clinical features of the Freeman-Sheldon syndrome include flexion contractures and characteristic facial features, including microstomia and a whistling shape to the lips. We report a case of malignant hyperthermia in a 3-year-old girl with microstomia but no other features of Freeman-Sheldon syndrome. The purpose of this report was to review the diagnosis and treatment of malignant hyperthermia as craniofacial surgeons have an increased exposure to this rare and potentially fatal condition. PMID:25478978

  13. Early epileptic encephalopathies including West syndrome: a 3-year retrospective study from Klang Hospital, Malaysia.

    PubMed

    Thambyayah, M

    2001-11-01

    It is difficult to give a country report from Malaysia. A study done in 1999 reported the incidence of West Syndrome to be 3% among newly diagnosed cases of epilepsy. In this 3 year retrospective hospital-based study (1997-1999), the prevalence of early epileptic encephalopathy (EEE) and West Syndrome were 4.1 and 2.5% respectively. There is difficulty classifying EEE cases into distinct sub-groups of EIEE (early infantile epileptic encephalopathy), WS (West Syndrome) and SMEI (severe myoclonic epilepsy of infancy), using a combination of clinical features, EEG and CT/MRI findings.

  14. Status of natural disaster victims' health and recovery 1 and 3 years later.

    PubMed

    Murphy, S A

    1986-12-01

    Bereaved, property loss, and control groups (N = 155) studied 11 months following the 1980 volcanic eruption of Mt. St. Helens were recontacted 35 months postdisaster to test the hypotheses that the greater the loss experienced, the higher the stress, and the poorer the health. In general, the hypotheses were supported. Even though mental distress decreased between the two data collection periods, the mental health of the bereaved group remained poorer than both the property loss and control groups. At 3 years postdisaster, only 4% of the study participants reported complete recovery from disaster loss. Findings are compared with those of other recent disasters and clinical and theoretical implications are discussed.

  15. Acute dapsone poisoning in a 3-year-old child: Case report with review of literature

    PubMed Central

    Sunilkumar, Menon Narayanankutty; Ajith, Thekkuttuparambil Ananthanarayanan; Parvathy, Vadakut Krishnan

    2015-01-01

    Dapsone (DDS-diamino diphenyl sulphone) is a sulfone antibiotic being used for a variety of clinical conditions. Poisoning in children by DDS is rarely reported. Poisoning in acute cases will be frequently unrecognized due to relative lack of severe signs and symptoms. Methemoglobinemia is the major life-threatening situation associated with poisoning of DDS. Hence, any delay for medical attention can lead to increased rate of mortality. In this case, we describe acute DDS poisoning in a 3-year-old child and the successful management using intravenous methylene blue. PMID:26488029

  16. Discoid medial meniscus with a horizontal cleavage tear: a juvenile who suffered for 3 years.

    PubMed

    Chen, Jingqing; Gao, Shijun; Chen, Baicheng

    2012-09-01

    It is very rare to see medial discoid meniscus, and there have been only 82 knees in 61 cases reported to date. The investigators found discoid medial meniscus with horizontal cleavage tear in a 13-year-old juvenile who had been injured while playing basketball, and endured for 3 years. Both magnetic resonance images and the arthroscopic findings were presented. Saucerization of the torn discoid medial meniscus was performed successfully, and the clinical outcomes were satisfying according to the follow-up of 14 months.

  17. SMOS Instrument Performance and Calibration after 3 Years in Orbit

    NASA Astrophysics Data System (ADS)

    Martin-Neira, Manuel; Corbella, Ignasi; Torres, Francesc; Kainulainen, Juha; Oliva, Roger; Closa, Josep; Cabot, François; Castro, Rita; Barbosa, Jose; Gutierrez, Antonio; Anterrieu, Eric; Tenerelli, Joe; Martin-Porqueras, Fernando; Buenadicha, Guillermo; Delwart, Steven; Crapolicchio, Raffaele; Suess, Martin

    2013-04-01

    ESA's Soil Moisture and Ocean Salinity (SMOS) mission has been in orbit for already over 3 years which has allowed the calibration and data processing team consolidating both the calibration strategy and the Level-1 processor which transforms the raw visibility samples into polarimetric brightness temperature images. The payload on board SMOS, MIRAS, is quite unique in that it is the first microwave radiometer in space ever capable to generate wide field of view images at every snapshot measurement. This means that most of the calibration as well as image processing techniques are being developed for the first time with little heritage from any previous space mission. Issues intrinsically attached to its wide field of view such as spatial ripples across the snapshot images are particular to MIRAS and to no other earlier radiometer. Even the fundamental theory behind the instrument was put at test, first on ground inside an electromagnetic compatibility chamber, and now in orbit when imaging the Cosmic Microwave Background Radiation of the cold sky. A groundbreaking effort is being carried out by the SMOS project team to understand and master all calibration and image reconstruction issues of this novel microwave interferometer payload. MIRAS in-orbit performance is driven by the amplitude of spatial ripples across the image and orbital and seasonal radiometer stability. Spatial ripples are unique to interferometric radiometers and are produced by (a) a limited knowledge of the antenna patterns and, in general, of the model of the instrument, (b) some fundamental limitations related to the inverse problem of image reconstruction in undetermined conditions and (c) subtle data processing inconsistencies which are discovered and corrected. To reduce the spatial ripples sea surface salinity retrievals are performed by first removing the brightness temperature spatial errors using a uniform region of the Pacific Ocean. However soil moisture retrievals cannot benefit of

  18. Very low birth weight infants: effects of brain growth during infancy on intelligence quotient at 3 years of age.

    PubMed

    Hack, M; Breslau, N

    1986-02-01

    To evaluate the role of postnatal growth on IQ at 3 years of age, 139 appropriate for gestational age, very low birth weight infants (less than 1.5 kg) born in 1977 and 1978 were studied at 40 weeks (term), and at 8, 20, and 33 months (corrected) of age. Weight, height, and head circumference were measured at each age, neurologic status was measured at 20 months, and Stanford Binet IQ at 33 months. Multiple regression analysis revealed that head circumference at 8 months of age is the best growth predictor of IQ at 3 years of age. Path analysis was performed to measure the effects of biologic and social factors measured earlier in life on IQ at 3 years. These factors explained 43% of the variance in IQ at 3 years of age. Head circumference at 8 months had a direct effect on IQ at 3 years, controlling for all other variables in the model. Neonatal risk had an indirect effect via head circumference. Neurologic impairment had direct and indirect (via head circumference) effects; race and socioeconomic status had direct effects on IQ but no effects on growth at 8 months of age. Thus, brain growth at 8 months significantly influenced 3 year IQ at 3 years of age among very low birth weight infants, even when medical and sociodemographic variables were controlled.

  19. The Clinical Evaluation of Parkinson’s Tremor

    PubMed Central

    Zach, Heidemarie; Dirkx, Michiel; Bloem, Bastiaan R.; Helmich, Rick C.

    2015-01-01

    Abstract Parkinson’s disease harbours many different tremors that differ in distribution, frequency, and context in which they occur. A good clinical tremor assessment is important for weighing up possible differential diagnoses of Parkinson’s disease, but also to measure the severity of the tremor as a basis for further tailored treatment. This can be challenging, because Parkinson’s tremor amplitude is typically very variable and context-dependent. Here, we outline how we investigate Parkinson’s tremor in the clinic. We describe a simple set of clinical tasks that can be used to constrain tremor variability (cognitive and motor co-activation, several specific limb postures). This may help to adequately characterize the tremor(s) occurring in a patient with Parkinson’s disease. PMID:26406126

  20. Clinical Trials Methods for Evaluation of Potential Reduced Exposure Products

    PubMed Central

    Hatsukami, Dorothy K.; Hanson, Karen; Briggs, Anna; Parascandola, Mark; Genkinger, Jeanine M.; O'Connor, Richard; Shields, Peter

    2009-01-01

    Potential reduced exposure tobacco products (PREPs) may have promise in reducing tobacco-related morbidity or mortality or may promote greater harm to individuals or the population. Critical to determining the risks or benefits from these products are valid human clinical trial PREP assessment methods. Assessment involves determining the effects of these products on biomarkers of exposure and of effect, which serve as proxies for harm, and assessing the potential for consumer uptake and abuse of the product. This article raises the critical methodological issues associated with PREP assessment, reviews the methods that have been used to assess PREPs, and describes the strengths and limitations of these methods. Additionally, recommendations for clinical trials PREP assessment methods and future research directions in this area based on this review and on the deliberations from a National Cancer Institute sponsored Clinical Trials PREP Methods Workshop are provided. PMID:19959672

  1. Traumatic brain injury in infants and toddlers, 0–3 years old

    PubMed Central

    Gorgan, MR; Tascu, A; Sandu, AM; Rizea, RE

    2011-01-01

    Object: Children 0–3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0–3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed (‘ping–pong’) skull fracture, and extradural hematoma. Methods: We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0–3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management. Results: We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed (‘ping–pong’) skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia (‘black–brain’). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT–scan, and for follow–up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia (‘black–brain’) had a poor outcome, death occurring in all 7 cases. Conclusion: Children 0–3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in

  2. Changes in body composition in apparently healthy urban Indian women up to 3 years postpartum

    PubMed Central

    Kajale, Neha A.; Khadilkar, Anuradha V.; Chiplonkar, Shashi A.; Khadilkar, Vaman

    2015-01-01

    Introduction: Dietary and life style practices differ in postpartum (PP) and nonpregnant Indian women. Effect of these practices on postpartum weight retention (PPWR) and development of cardio-metabolic risk (CMR) has been scarcely studied in urban women. Aims of this study were to (i) compare anthropometry, biochemical parameters and body composition up to 3 years PP (ii) effect of PPWR, dietary fat intake and physical activity on CMR factors. Methods: Design: Cross-sectional, 300-fullterm, apparently healthy primi-parous women (28.6 ± 3.4 years) randomly selected. 128 women within 7-day of delivery (Group-A), 88 with 1–2 years (Group-B) and 84 with 3–4-year-old-children (Group-C) were studied. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, body composition, at total body (TB), by dual energy X-ray absorptiometry (GE-Lunar DPX) were collected. Results: Women at 3-year PP showed higher weight retention (6.5[10] kg) than at 1-year (3.0[7] kg) (median [IQR]). Android fat % (central obesity) increased (P < 0.05) at 1-year PP (47 ± 10.0%) when compared to 1-week PP (44.3 ± 6.7%) and remained elevated at 3-year PP (45.6 ± 10.2%). Regression analysis revealed that at 1-year PP, increase in PPWR (Odd Ratio [OR] 1.8, 95% confidence interval [CI] = [1.2, 2.5], P < 0.001) and inactivity (OR 1.4, 95% CI= (0.97, 2.0), P < 0.1) were predictors for CMR. At 3-year PP, only PPWR was responsible for increase in CMR parameters (OR 1.6, 95% CI = (1.3, 2.3), P < 0.001) and not inactivity (P > 0.1). Conclusion: Postdelivery, low physical activity and higher PPWR may increase CMR in Indian women. PMID:26180762

  3. Sun tanning-related burns--a 3-year experience.

    PubMed

    Piccolo-Lobo, M S; Piccolo, N S; Piccolo-Daher, M T; Cardoso, V M

    1992-04-01

    A retrospective study has analyzed 562 sun-related burns out of 19,643 patients treated at our institution from 1 March 1988 to 28 February 1991. These patients were analysed according to sex, age, burn area, mode and length of treatment and outcome. Females, mainly adults, represented 60.8 per cent of all patients presenting burned due to sun bathing. There is a marked seasonal incidence, proportionally constant throughout these 3 years. The main causes of injury were sun only (36.7 per cent), sun plus fig leaf 'tea' tanning lotion (17.7 per cent) and lemon juice (17.7 per cent). Healing to normal skin appearance was achieved in 99.1 per cent, 0.7 per cent healed with scarring and one patient died due to massive sepsis. The effect of sunlight on skin and the process of 'sunburn' when using homemade plant-derived tanning lotions containing substances which can induce a photodermatitis reaction is also discussed.

  4. Enhancing Clinical Evaluation Skills: Palpation as the Principal Skill

    ERIC Educational Resources Information Center

    Eberman, Lindsey E.; Finn, Megan E.

    2010-01-01

    Context: Recognition and evaluation of injuries/illnesses accounts for the greatest percentage (24%) of an athletic trainer's responsibilities as a clinician. When teaching orthopedic evaluation, we often emphasize history taking and special/ligamentous tests to achieve a diagnosis. Because of its complexity and variability, palpation becomes an…

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

    ERIC Educational Resources Information Center

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

    2016-01-01

    The Mobile Autism Risk Assessment (MARA) is a new, electronically administered, 7-question autism spectrum disorder (ASD) screen to triage those at highest risk for ASD. Children 16 months-17 years (N = 222) were screened during their first visit in a developmental-behavioral pediatric clinic. MARA scores were compared to diagnosis from the…

  6. Clinical characteristics and therapeutic evaluation of childhood myasthenia gravis

    PubMed Central

    YANG, ZHI-XIAO; XU, KAI-LI; XIONG, HUI

    2015-01-01

    This study aimed to analyze the clinical characteristics, classification and treatment of childhood myasthenia gravis (MG) and address the prognosis through follow-up. The clinical data of 135 children with MG were grouped according to clinical type and therapeutic drugs, retrospectively analyzed and prospectively monitored. Of the 135 MG patients, 85.2% had type I (ocular type), with only 4.2% progressing to systemic MG; 13.4% had type II (general type); and 1.5% had type III (fulminating type). Relapse occurred in 46.1% of the 102 patients that were followed up. The positive rate for the primary acetylcholine receptor antibody was 40.19%, without significant differences among clinical subtypes. The positive rate of the repetitive nerve stimulation frequency test by electromyography was 37.97%. Decreased expression of CD4+, CD8+, or CD3+ was present in 71% of the patients. Thymic hyperplasia was present in 5.93% of the patients, while 1.48% had thymoma. Steroid treatment was effective in the majority of the patients. Ocular type MG was common in this cohort of patients. The incidence and mortality of myasthenia crisis were low, the presence of concurrent thymoma was rare and only a limited number of children developed neurological sequelae. PMID:25780436

  7. Translating diagnostic assays from the laboratory to the clinic: analytical and clinical metrics for device development and evaluation.

    PubMed

    Borysiak, Mark D; Thompson, Matthew J; Posner, Jonathan D

    2016-04-21

    As lab-on-a-chip health diagnostic technologies mature, there is a push to translate them from the laboratory to the clinic. For these diagnostics to achieve maximum impact on patient care, scientists and engineers developing the tests should understand the analytical and clinical statistical metrics that determine the efficacy of the test. Appreciating and using these metrics will benefit test developers by providing consistent measures to evaluate analytical and clinical test performance, as well as guide the design of tests that will most benefit clinicians and patients. This paper is broken into four sections that discuss metrics related to general stages of development including: (1) laboratory assay development (analytical sensitivity, limit of detection, analytical selectivity, and trueness/precision), (2) pre-clinical development (diagnostic sensitivity, diagnostic specificity, clinical cutoffs, and receiver-operator curves), (3) clinical use (prevalence, predictive values, and likelihood ratios), and (4) case studies from existing clinical data for tests relevant to the lab-on-a-chip community (HIV, group A strep, and chlamydia). Each section contains definitions of recommended statistical measures, as well as examples demonstrating the importance of these metrics at various stages of the development process. Increasing the use of these metrics in lab-on-a-chip research will improve the rigor of diagnostic performance reporting and provide a better understanding of how to design tests that will ultimately meet clinical needs. PMID:27043204

  8. Challenges in Evaluating Clinical Governance Systems in Iran: A Qualitative Study

    PubMed Central

    Hooshmand, Elaheh; Tourani, Sogand; Ravaghi, Hamid; Ebrahimipour, Hossein

    2014-01-01

    Background: In spite of the pivotal role of clinical governance in enhancing quality of services provided by hospitals across the country, a scientific framework with specific criteria for evaluating hospitals has not been developed so far. Objectives: This study was conducted with the aim to identify the challenges involved in evaluating systems of clinical governance in Iran. Materials and Methods: For the purposes of this qualitative study, 15 semi-structured interviews with experts in the field were conducted in 2011 and the data were analyzed using framework analysis method. Results: Five major challenges in evaluating clinical governance include managing human resources, improving clinical quality, managing development, organizing clinical governance, and providing patient-oriented healthcare system. Conclusions: Healthcare system in Iran requires a clinical governance program which has a patient-oriented approach in philosophy, operation, and effectiveness in order to meet the challenges ahead. PMID:24910799

  9. Clinical evaluation of a water-in-oil emulsion with protective and regenerative properties for the anogenital area

    PubMed Central

    Küppers, Volkmar; Kemper, Michael; Abels, Christoph

    2015-01-01

    Inadequate hygiene, aggressive cleansing, and chafing skin folds, as well as urine, feces, and sweat may trigger irritative contact dermatitis in the anogenital area. Serious recommendations for protection of the skin toward irritants include hygienic aspects and the use of appropriate skin care. Furthermore, preventing an accumulation of irritants on unprotected skin is mandatory. An intraindividual comparison study with 30 participants (17 female, 13 male; age: 44.2±8.3 years) was performed to evaluate the properties of a newly developed water-in-oil (W/O) balm on artificial sodium dodecyl sulfate-damaged epidermal barrier. The balm was applied 14 days twice daily, and transepidermal water loss and erythema were investigated. A significant improvement of both parameters after 12 days and even after 21 days could be confirmed. Two major clinical trials were performed to evaluate the safety and efficacy regarding protective and regenerative properties of the W/O balm on irritated skin in the anogenital area. Therefore, 29 children were enrolled (14 male, 15 female, age: 15.5±7.8 months) in an open-labeled 4-week clinical study. The balm was used in the area under disposable diapers at least after diaper change or if required. Furthermore, in a second open, multicenter study, 43 women (mean age: 46.2±16.9) with predisposition to skin irritation in the outer anogenital region were included. The product was applied for 4 weeks 1–2 times daily. In both studies, skin tolerability, applicability, scent, spreadability, and removability of the balm were evaluated by participants and practitioners predominantly as good or even very good, also skin hydration, protection, and regeneration were judged positively. The studies confirmed that the newly developed W/O balm exhibits excellent tolerability and is easy to remove. At the same time, excellent properties with respect to efficacy regarding regeneration and protection could be observed, without any undesired effects

  10. The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples

    PubMed Central

    2013-01-01

    Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical

  11. Combined Individual Cognitive Behavior Therapy and Parent Training for Childhood Depression: 2- to 3-Year Follow-up

    ERIC Educational Resources Information Center

    Eckshtain, Dikla; Gaynor, Scott T.

    2013-01-01

    Fourteen children with significant depressive symptoms from an open clinical trial of Primary and Secondary Control Enhancement Training augmented with Caregiver-Child Relationship Enhancement Training, participated in a 2- to 3-year follow-up assessment. The results suggested that the significant decreases in depressive symptoms observed at…

  12. Clinical evaluation of cytological diagnosis of nasopharyngeal malignancies.

    PubMed

    Molinari, R; Pilotti, S; Rilke, F

    1978-01-01

    Between 1970 and 1975 cytological examination was applied to the diagnosis of nasopharyngeal malignancies in a series of 216 consecutive patients who had either a tumour in the nasopharynx or clinical signs of nasopharyngeal carcinoma, or who were locally asymptomatic but had enlarged cervical lymph nodes. Smears were taken by introducing a small rough pad of compressed gauze through the mouth into the nasopharynx with an upward-angled forceps. In each case the cytological smear was taken immediately before biopsy; often, a lymph node was removed subsequently. When morphological diagnoses were doubtful and histological findings were at variance with positive cytological findings, the patients were reexamined clinically, and diagnosis was postponed. The case material was made up of 90 nasopharyngeal carcinomas, 24 lymphomas, one malignant melanoma, one adenoid cystic carcinoma and 100 patients without malignancies. Cytological findings from the first smear were positive in 77.8% of nasopharyngeal carcinomas, in 66.6% of lymphomas and in the cases of melanoma and adenoid cystic carcinoma. There were no false-positive results. When the nasopharyngeal carcinomas were subdivided into undifferentiated carcinomas of the nasopharyngeal type and squamous-cell carcinomas, cytological findings were positive in ,0% and 73%, respectively. Positivity of histological findings was distributed as follows: 91.7% for malignant lymphomas, 86.6% for undifferentiated carcinomas and 86.6% for squamous-cell carcinomas. With respect to clinical suspicion of malignancy, positive cytological findings were obtained in 50% of clinically occult cases and in 84.6% of patients with obvious malignancies; intermediate figures were found for clinically doubtful (64.3%) and for highly suspicious (77.8%) cases. Cyto-histological concordance was shown in 70% of cases; false-negative histological results were obtained in 7.8% and false-negative cytological results in 16.6% of cases. Combined cyto

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

    PubMed

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

    PubMed Central

    Attridge, Rebecca L.; Tovar, John M.; Witte, Amy P.

    2015-01-01

    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. PMID:26690286

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  16. [Systematic evaluation of clinical application of Dingkun Dan].

    PubMed

    Chen, Yan-xia; Ma, Kun

    2015-10-01

    Dingkun Dan is a representative of the classic gynecological medicine. With Tonifying the liver and kidney, supplementing Qi and nourishing blood, regulating menstruation Shuyu, promoting the role of pain. Used in treatment of liver and kidney deficiency, deficiency of both qi and blood, Qi stagnation and blood stasis caused by irregular menstruation, menstrual pain, uterine bleeding, leukorrhea with reddish discharge, bruise blood removal, infertility, and various postpartum deficiency and bone steaming hot flashes of gynecological common disease. In recent years, Dingkun Dan's new uses have been reported, the clinical application value is worth further digging. In this paper, clinical application and research progress of Dingkun Dan since the founding of new China were briefly discussed, and summarize for the randomized controlled trials. PMID:27062801

  17. Evaluation of a clinically intuitive quality assurance method

    PubMed Central

    Norris, H; Thomas, A; Oldham, M

    2013-01-01

    There is a pressing need for clinically intuitive quality assurance methods that report metrics of relevance to the likely impact on tumor control of normal tissue injury. This paper presents a preliminary investigation into the accuracy of a novel “transform method” which enables a clinically relevant analysis through dose-volume-histograms (DVHs) and dose overlays on the patient’s CT data. The transform method was tested by inducing a series of known mechanical and delivery errors onto simulated 3D dosimetry measurements of six different head-and-neck IMRT treatment plans. Accuracy was then examined through the comparison of the transformed patient dose distributions and the known actual patient dose distributions through dose-volume histograms and normalized dose difference analysis. Through these metrics, the transform method was found to be highly accurate in predicting measured patient dose distributions for these types of errors. PMID:24454519

  18. Canine hyperadrenocorticism: pretreatment clinical and laboratory evaluation of 117 cases.

    PubMed

    Ling, G V; Stabenfeldt, G H; Comer, K M; Gribble, D H; Schechter, R D

    1979-06-01

    The physical findings, clinical signs, age, breed and sex distributions, and laboratory data of 117 dogs with untreated Cushing's syndrome were reviewed. Poodles, Dachshunds, and Boxers of all ages were found to be at increased risk, as were dogs of all breeds greater than or equal to 6 years old. Polydipsia, polyuria, progressive bilaterally symmetric alopecia, and abdominal distention were the most frequently observed clinical signs and physical findings. Lymphopenia, eosinopenia, above normal values of serum alkaline phosphatase, serum cholesterol, and sulfobromphthalein dye retention, and below normal urine specific gravity were the most frequent abnormalities found in the laboratory data. About 50% of the dogs had urinary tract infections. Final diagnosis was established on the basis of abnormally high plasma corticosteroid values in response to an intramuscular injection of adrenocorticotropic hormone.

  19. Ligand-targeted particulate nanomedicines undergoing clinical evaluation: current status.

    PubMed

    van der Meel, Roy; Vehmeijer, Laurens J C; Kok, Robbert J; Storm, Gert; van Gaal, Ethlinn V B

    2013-10-01

    Since the introduction of Doxil® on the market nearly 20years ago, a number of nanomedicines have become part of treatment regimens in the clinic. With the exception of antibody-drug conjugates, these nanomedicines are all devoid of targeting ligands and rely solely on their physicochemical properties and the (patho)physiological processes in the body for their biodistribution and targeting capability. At the same time, many preclinical studies have reported on nanomedicines exposing targeting ligands, or ligand-targeted nanomedicines, yet none of these have been approved at this moment. In the present review, we provide a concise overview of 13 ligand-targeted particulate nanomedicines (ligand-targeted PNMs) that have progressed into clinical trials. The progress of each ligand-targeted PNM is discussed based on available (pre)clinical data. Main conclusions of these analyses are that (a) ligand-targeted PNMs have proven to be safe and efficacious in preclinical models; (b) the vast majority of ligand-targeted PNMs is generated for the treatment of cancer; (c) contribution of targeting ligands to the PNM efficacy is not unambiguously proven; and (d) targeting ligands do not cause localization of the PNM within the target tissue, but rather provide benefits in terms of target cell internalization and target tissue retention once the PNM has arrived at the target site. Increased understanding of the in vivo fate and interactions of the ligand-targeted PNMs with proteins and cells in the human body is mandatory to rationally advance the clinical translation of ligand-targeted PNMs. Future perspectives for ligand-targeted PNM approaches include the delivery of drugs that are unable or inefficient in passing cellular membranes, treatment of drug resistant tumors, targeting of the tumor blood supply, the generation of targeted vaccines and nanomedicines that are able to cross the blood-brain barrier.

  20. Evaluating the students' perspectives of a clinic mentoring programme.

    PubMed

    Schwartz, B; Saad, M N; Goldberg, D

    2014-08-01

    The purpose of this article is to describe and examine the effectiveness of a mentoring program for third and fourth year clinical dental students. This is an educational intervention for the pre-doctoral students at the Schulich School of Dentistry. We have recently instituted this program and have developed a questionnaire to assess the student perspectives using a SWOT analysis of the strengths, weaknesses, opportunities and threats of this intervention by analyzing the quantitative and qualitative responses of the students towards their clinical education and patient management. Our findings, both quantitative and qualitative, indicated that the mentoring program was well received by most students who would like to see the program expanded. The majority of students felt that the mentoring program aligned well with comprehensive care of their patients while enhancing their clinical experience. One of the strongest areas of agreement involved the ability to discuss cases in a non-threatening environment. The SWOT analysis identified key areas for future improvements. We offer steps to successfully implement a similar program based on our findings. It is our hope that our results might be instrumental for other schools wishing to adopt a similar model which supports patient-based comprehensive care.

  1. Beyond the "acid test": a conceptual review and reformulation of outcome evaluation in clinical supervision.

    PubMed

    Milne, Derek

    2014-01-01

    Theoretical models abound within clinical supervision, but these rarely have been applied to supervision evaluation. Instead, it appears that reviewers and researchers have simply transferred to supervision the conceptual frameworks used within medicine, especially the idea that clinical outcomes are the "acid test" of supervisory effectiveness or quality. Following a careful examination of the key literature, in this paper I argue that this has led to an over-emphasis on clinical outcomes, with the net effect of reducing scientific confidence, understanding, and the effectiveness of supervision. To begin to rectify this bias, an augmented fidelity framework is used to reformulate evaluation, drawing on some of the key concepts guiding evaluation within related fields (i.e. service evaluation; staff development; psychotherapy; applied research). The resulting evaluation model is specific to clinical supervision and can help to increase our understanding, enhance our practice, re-prioritise research, and inspire confidence in supervision.

  2. Beyond the "acid test": a conceptual review and reformulation of outcome evaluation in clinical supervision.

    PubMed

    Milne, Derek

    2014-01-01

    Theoretical models abound within clinical supervision, but these rarely have been applied to supervision evaluation. Instead, it appears that reviewers and researchers have simply transferred to supervision the conceptual frameworks used within medicine, especially the idea that clinical outcomes are the "acid test" of supervisory effectiveness or quality. Following a careful examination of the key literature, in this paper I argue that this has led to an over-emphasis on clinical outcomes, with the net effect of reducing scientific confidence, understanding, and the effectiveness of supervision. To begin to rectify this bias, an augmented fidelity framework is used to reformulate evaluation, drawing on some of the key concepts guiding evaluation within related fields (i.e. service evaluation; staff development; psychotherapy; applied research). The resulting evaluation model is specific to clinical supervision and can help to increase our understanding, enhance our practice, re-prioritise research, and inspire confidence in supervision. PMID:25122986

  3. A 3-year follow-up of temporomandibular disorders in rheumatoid arthritis and ankylosing spondylitis.

    PubMed

    Tegelberg, A; Kopp, S

    1996-02-01

    Sixteen individuals with rheumatoid arthritis (RA) and 19 individuals with ankylosing spondylitis (AS) participated in this 3-year follow-up study. The individuals in each disease group were allocated to an experimental group (E group) and a comparison group (C group). They were investigated by questionnaire, clinical examination of the stomatognathic system, and laboratory tests. The individuals of the two E groups had performed a physical training program of the stomatognathic system during 3 weeks. After 3 years most of the patients in the E groups reported an unaltered or decreased severity of symptoms and signs from the stomatognathic system compared with the initial status. The clinical dysfunction score according to Helkimo (CDS) was lower in the RA group, and the mouth opening capacity was larger than before training. In the AS group there was no long-term change in the CDS but an increase of mouth opening capacity. The general inflammatory disease process in the RA group showed an increased activity during this follow-up period as assessed by erythrocyte sedimentation rate. This study suggests that local physical training of the stomatognathic system has a positive effect in individuals with RA.

  4. Evaluating various areas of process improvement in an effort to improve clinical research: discussions from the 2012 Clinical Translational Science Award (CTSA) Clinical Research Management workshop.

    PubMed

    Strasser, Jane E; Cola, Philip A; Rosenblum, Daniel

    2013-08-01

    Emphasis has been placed on assessing the efficiency of clinical and translational research as part of the National Institutes of Health (NIH) goal to "improve human health." Improvements identified and implemented by individual organizations cannot address the research infrastructure needs of all clinical and translational research conducted. NIH's National Center for Advancing Translational Sciences (NCATS) has brought together 61 Clinical and Translational Science Award (CTSA) sites creating a virtual national laboratory that reflects the diversity and breadth of academic medical centers to collectively improve clinical and translational science. The annual Clinical Research Management workshop is organized by the CTSA consortium with participation from CTSA awardees, NIH, and others with an interest in clinical research management. The primary objective of the workshop is to disseminate information that improves clinical research management although the specific objectives of each workshop evolve within the consortium. The fifth annual workshop entitled "Learning by doing; applying evidence-based tools to re-engineer clinical research management" took place in June 2012. The primary objective of the 2012 workshop was to utilize data to evaluate, modify, and improve clinical research management. This report provides a brief summary of the workshop proceedings and the major themes discussed among the participants. PMID:23919369

  5. Evaluating various areas of process improvement in an effort to improve clinical research: Discussions from the 2012 Clinical Translational Science Award (CTSA) Clinical Research Management Workshop

    PubMed Central

    Rosenblum, Daniel

    2013-01-01

    Emphasis has been placed on assessing the efficiency of clinical and translational research as part of the National Institutes of Health (NIH) goal to “improve human health”. Improvements identified and implemented by individual organizations cannot address the research infrastructure needs of all clinical and translational research conducted. NIH’s National Center for Advancing Translational Sciences (NCATS) has brought together 61 Clinical and Translational Science Award (CTSA) sites creating a virtual national laboratory that reflects the diversity and breadth of academic medical centers to collectively improve clinical and translational science. The annual Clinical Research Management workshop is organized by the CTSA consortium with participation from CTSA awardees, NIH, and others with an interest in clinical research management. The primary objective of the workshop is to disseminate information that improves clinical research management although the specific objectives of each workshop evolve within the consortium. The fifth annual workshop entitled “Learning by doing; applying evidence-based tools to re-engineer clinical research management” took place in June 2012. The primary objective of the 2012 workshop was to utilize data to evaluate, modify, and improve clinical research management. This report provides a brief summary of the workshop proceedings and the major themes discussed among the participants. PMID:23919369

  6. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism.

    PubMed

    Baskin, H Jack; Cobin, Rhoda H; Duick, Daniel S; Gharib, Hossein; Guttler, Richard B; Kaplan, Michael M; Segal, Robert L

    2002-01-01

    These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.

  7. A case of localized juvenile periodontitis: treatment and 3 years follow-up with superimposable radiographs.

    PubMed

    Dubrez, B; Baehni, P; Cimasoni, G

    1996-06-01

    A 17-year-old male patient with localized juvenile periodontitis was treated by subgingival instrumentation with full thickness flap on the lower molars, combined with a 3-week course of systemic tetracycline, and a programme of supervised oral hygiene. The treatment was rapidly followed by dramatic clinical and microbiological improvement. However, despite good oral hygiene, gingival inflammation recurred at regular intervals. It was necessary to maintain the clinical results by periodic subgingival instrumentation with an ultrasonic scaler. Healing of alveolar bone was monitored in the lower 1st molar regions over 3 years by using superimposable radiographs. Quantitative analysis of bone density performed with a high-resolution digitalisation technique showed a considerable improvement 1 year after therapy. However, continuous remodelling, probably related to variations in inflammation, occurred during the 3 postoperative years. PMID:8811475

  8. Polymer therapeutics - Sixth International Symposium: from laboratory to clinical practice. Industrial development and clinical evaluation.

    PubMed

    Kochendoerfer, Gerd

    2004-02-01

    This biannual conference was organized, as is now customary, by Professor Ruth Duncan of the Welsh School of Pharmacy and focused on novel technology and pharmaceutical compounds in the area of polymer therapeutics. This meeting has established itself as an important interface between discovery research and preclinical and clinical development in this field. Sufficient time was allocated for informal interaction between the delegates, which allowed for plenty of discussion and initiation of collaboration. The emphasis in most presentations was on the use of polymers and dendrimers as active ingredients, or for conjugation with other entities for the purpose of improving drug properties such as pharmacodynamic (PD) and pharmacokinetic (PK) profile, drug handling, or targeting and delivery. Several talks and posters focused on novel and proven techniques for the biophysical characterization of polymer constructs and their metabolites. To date, the most successful therapeutic class are conjugates of polymers to protein drugs; six drugs are approved and approximately a dozen are in various stages of clinical development. However, several covalent and non-covalent conjugates of small-molecule cancer chemotherapy agents are now in more advanced clinical trials, and several other polymer constructs and dendrimers are in early clinical trials. This meeting clearly demonstrated that there are many promising approaches for the application of a variety of polymers, but that the viability of many of the approaches still needs to be proven in late-stage clinical trials as well as in the market place.

  9. Evaluation of Chemotherapy-Induced Peripheral Neuropathy using Current Perception Threshold and Clinical Evaluations

    PubMed Central

    Griffith, Kathleen A.; Couture, Darren J.; Zhu, Shijun; Pandya, Naimish; Johantgen, Mary E.; Cavaletti, Guido; Davenport, Joan M.; Tanguay, Lori J.; Choflet, Amanda; Milliron, Todd; Glass, Erica; Gambill, Nancy; Renn, Cynthia L.; Dorsey, Susan G.

    2014-01-01

    Purpose Chemotherapy-induced peripheral neuropathy (CIPN) is increasing with introduction of new and combination cancer pharmacotherapies. This study evaluated associations between clinical and self-report measurements and current perception threshold (CPT), a neuroselective measure of sensory nerve function that may detect asymptomatic CIPN damage. Methods Data for this secondary analysis were from a prospective, observational study using CPT to evaluate CIPN. Bivariate mixed models, accounting for the intra-class correlation between repeated patient assessments, were used to assess the relationship between CPT at each frequency (5Hz, 250Hz and 2000 Hz) and each subjective measure (Neuropathic Pain Scale, FACT-GOGntx) and objective measurement (quantitative sensory testing, deep tendon reflexes, grip strength). Results A total of 29 chemotherapy-naïve subjects with various cancer types had a mean age of 56.7 (SD 10.4); 9 subjects developed CIPN grade > 1 using NCI CTC-AE criteria. Cold detection thresholds were inversely associated with CPT 5 [b(95% CI) =−2.5(−4.5, −0.5)] and CPT 2000 [−7.5(−11.8, −3.3)] frequencies. FACT GOG-ntx quality of life (QoL) scale and neurotoxicity and function subscales were inversely associated with CPT 2000 [−1.8 (−3.5, −0.05), −2.2 (−4.2, −0.2), and −5.4(−9.8, −0.9), respectively], indicating worsening QoL, impairment, and function as hypoesthesia increases. Conclusions CPT 2000 may identify impending worsening of patient-reported outcomes, such as QoL. PMID:24362842

  10. [Evaluation of clinical competence in the nursing profession].

    PubMed

    Solà Pola, Montserrat; Molins Mesalles, Ainhoa; Martínez Carretero, Josep Maria

    2005-01-01

    The quality of health services depends on the competence of the health service professionals. It is essential to define and evaluate professional competences in order to improve professional development, ensure the quality of, and manage, professionals in terms of their competences. To do so, it is necessary to utilize a combination of different methods. The evaluation of the diverse stages related to nursing--at the end of undergraduate studies, postgraduate studies or specialization, and during independent work--has different proposals, content and methods; and the institutions implicated in these stages should make themselves responsible to acquire the professional which society needs. Since 1994, more than 150 projects have been carried out in Catalonia which confirm the validity, trustworthiness, acceptability and utility of these evaluative methods in undergraduate and postgraduate studies and in the selection and accreditation of professionals.

  11. Evaluating a Web-Based Clinical Decision Support System for Language Disorders Screening in a Nursery School

    PubMed Central

    Valero Duboy, Miguel Ángel; Torcal Loriente, Carmen; Pau de la Cruz, Iván

    2014-01-01

    Background Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods This paper details the evaluation results of the “Gades” CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child’s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic

  12. Evaluating outpatient transition clinics: a mixed-methods study protocol

    PubMed Central

    Sattoe, Jane N T; Peeters, Mariëlle A C; Hilberink, Sander R; Ista, Erwin; van Staa, AnneLoes

    2016-01-01

    Introduction To support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC). Methods and analysis We propose a mixed-methods study with a retrospective controlled design consisting of semistructured interviews among healthcare professionals, observations of consultations with young people, chart reviews of young people transferred 2–4 years prior to data collection and questionnaires among the young people included in the chart reviews. Qualitative data will be analysed through thematic analysis and results will provide insights into structures and daily routines of TCs, and experienced barriers and facilitators in transitional care. Quantitatively, within-group differences on clinical outcomes and healthcare use will be studied over the four measurement moments. Subsequently, comparisons will be made between intervention and control groups on all outcomes at all measurement moments. Primary outcomes are ‘no-show after transfer’ (process outcome) and ‘experiences and satisfaction with the transfer’ (patient-reported outcome). Secondary outcomes consider clinical outcomes, healthcare usage, self-management outcomes and perceived quality of care. Ethics The Medical Ethical Committee of the Erasmus Medical Centre approved the study protocol (MEC-2014-246). Dissemination Study results will be disseminated through peer-reviewed journals and conferences. The study started in September 2014 and will continue until December 2016. The same study design will be used in a national study in 20 diabetes settings (2016

  13. Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

    PubMed

    Weidner, Thomas G.; Laurent, Tim

    2001-03-01

    OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed. PMID:12937517

  14. Selection and Evaluation Guidelines for Clinical Education Settings in Athletic Training.

    PubMed

    Weidner, Thomas G.; Laurent, Tim

    2001-03-01

    OBJECTIVE: To develop and test standards and associated criteria for the selection and evaluation of a clinical education setting in athletic training. DESIGN AND SETTING: A previously validated set of 20 standards for physical therapy clinical education settings, the associated criteria, and 2 related evaluation forms were systematically judged, revised, and adapted through a survey process. SUBJECTS: Program directors, clinical instructors, and students involved with athletic training clinical education from 28 athletic training education programs approved by the National Athletic Trainers' Association or accredited by the Commission on Accreditation of Allied Health Education Programs. MEASUREMENTS: We tabulated respondents' critiques and ratings by type of respondent. Items were judged as to whether they were relevant, practical, and suggestive of high-quality clinical education settings. RESULTS: We accepted a final set of 12 standards and 31 associated criteria to measure these standards. The student form lists 23 criteria relevant to these accepted standards. The accepted standards include the following: learning environment, program planning, ethical standards, administrative support, and Setting Coordinator of Clinical Education. CONCLUSIONS: The 12 standards, criteria, and related forms developed in this research project should be used as guidelines rather than as minimal requirements. They could be helpful in forming an impression not only about a particular clinical setting but also about the requirements of clinical education in general. Further research should include evaluating and comparing perceptions between sexes and among ethnic groups concerning their clinical education experiences. Also, standards and criteria for clinical instruction in athletic training should be systematically developed.

  15. Vascular Calcification in Patients with Nondialysis CKD over 3 Years

    PubMed Central

    Molina, Pablo; Cerverón, M. Jesús; Vila, Rocío; Bover, Jordi; Nieto, Javier; Barril, Guillermina; Martínez-Castelao, Alberto; Fernández, Elvira; Escudero, Verónica; Piñera, Celestino; Adragao, Teresa; Navarro-Gonzalez, Juan F.; Molinero, Luis M.; Castro-Alonso, Cristina; Pallardó, Luis M.; Jamal, Sophie A.

    2015-01-01

    Background and objectives Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed. Design, setting, participants, & measurements The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3–5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop >30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models. Results VC was present in 79% of patients and prominent in 47% (AS≥3 or KS>6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P<0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P<0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS≥3. After a median follow-up of 35 months (interquartile range=17–36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS≥3 but not KS>6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event–free period (HR, 1.14; 95% CI, 1.06 to 1.22; P<0.001). VC did not predict renal progression. Conclusions VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful

  16. Deep Space 1 Ion Engine Completed a 3-Year Journey

    NASA Technical Reports Server (NTRS)

    Sovey, James S.; Patterson, Michael J.; Rawlin, Vincent K.; Hamley, John A.

    2001-01-01

    A xenon ion engine and power processor system, which was developed by the NASA Glenn Research Center in partnership with the Jet Propulsion Laboratory and Boeing Electron Dynamic Devices, completed nearly 3 years of operation aboard the Deep Space 1 spacecraft. The 2.3-kW ion engine, which provided primary propulsion and two-axis attitude control, thrusted for more than 16,000 hr and consumed more than 70 kg of xenon propellant. The Deep Space 1 spacecraft was launched on October 24, 1998, to validate 12 futuristic technologies, including the ion-propulsion system. After the technology validation process was successfully completed, the Deep Space 1 spacecraft flew by the small asteroid Braille on July 29, 1999. The final objective of this mission was to encounter the active comet Borrelly, which is about 6 miles long. The ion engine was on a thrusting schedule to navigate the Deep Space 1 spacecraft to within 1400 miles of the comet. Since the hydrazine used for spacecraft attitude control was in short supply, the ion engine also provided two-axis attitude control to conserve the hydrazine supply for the Borrelly encounter. The comet encounter took place on September 22, 2001. Dr. Marc Rayman, project manager of Deep Space 1 at the Jet Propulsion Laboratory said, "Deep Space 1 plunged into the heart of the comet Borrelly and has lived to tell every detail of its spinetingling adventure! The images are even better than the impressive images of comet Halley taken by Europe's Giotto spacecraft in 1986." The Deep Space 1 mission, which successfully tested the 12 high-risk, advanced technologies and captured the best images ever taken of a comet, was voluntarily terminated on December 18, 2001. The successful demonstration of the 2-kW-class ion propulsion system technology is now providing mission planners with off-the-shelf flight hardware. Higher power, next generation ion propulsion systems are being developed for large flagship missions, such as outer planet

  17. Determinants of physician antibiotic prescribing behavior: a 3 year cohort study in Portugal.

    PubMed

    Teixeira Rodrigues, António; Ferreira, Mónica; Piñeiro-Lamas, Maria; Falcão, Amílcar; Figueiras, Adolfo; Herdeiro, Maria T

    2016-05-01

    Objectives Antibiotic misprescription is a major driver of resistance, which is a worldwide public health problem. Therefore, our aim is to assess the influence of the determinants of physician prescribing on the quality of antibiotic use. Methods A 3 year cohort study including all primary-care physicians working in Portugal's Central Regional Health Administration (n = 1094) was conducted. We assessed the determinants of prescribing using a pre-validated, personally addressed, reply-paid, self-administered questionnaire (sent four times to non-responders, between September 2011 and February 2012) designed to collect information on physicians' attitudes to and knowledge of antibiotic prescribing as well as their socio-demographic and professional data. To evaluate antibiotic prescribing, we've calculated ESAC 12 quality indicators per physician per year, allowing us to stratify them as good or poor prescribers according to their performance on those indicators. Associations between determinants and outcomes were fitted with generalized linear mixed models. Results The overall response rate was 46.1%. Emergency activity (OR [95% CI] = 0.29 [0.16-0.54]; p < 0.05) and workload (number of patients seen per day: OR [95% CI] = 0.97 [0.94-1.00]; p < 0.05; number of patients seen per week in emergencies: OR [95% CI] = 0.98 [0.97-0.99]; p < 0.05) were both related to poor quality of antibiotic prescribing. Statistically significant odds ratios were also obtained for ignorance (IqOR [95% CI] = 2.14 [1.31-3.52]), complacency (1/IqOR [95% CI] = 1.19 [1.01-1.41]) and responsibility of others (1/IqOR [95% CI] = 1.78 [1.10-3.06]). Conclusions The above results serve to emphasize workload, working at emergency departments and physicians' attitudes identified as critical factors affecting antibiotic prescribing. This provides new insights for clinicians, researchers and policy makers when it comes to developing and improving the clinical and

  18. Non-Clinical Safety Evaluation of Intranasal Iota-Carrageenan

    PubMed Central

    Hebar, Alexandra; Koller, Christiane; Seifert, Jan-Marcus; Chabicovsky, Monika; Bodenteich, Angelika; Bernkop-Schnürch, Andreas; Grassauer, Andreas; Prieschl-Grassauer, Eva

    2015-01-01

    Carrageenan has been widely used as food additive for decades and therefore, an extended oral data set is available in the public domain. Less data are available for other routes of administration, especially intranasal administration. The current publication describes the non-clinical safety and toxicity of native (non-degraded) iota-carrageenan when applied intranasally or via inhalation. Intranasally applied iota-carrageenan is a topically applied, locally acting compound with no need of systemic bioavailability for the drug’s action. Animal experiments included repeated dose local tolerance and toxicity studies with intranasally applied 0.12% iota-carrageenan for 7 or 28 days in New Zealand White rabbits and nebulized 0.12% iota-carrageenan administered to F344 rats for 7 days. Permeation studies revealed no penetration of iota-carrageenan across nasal mucosa, demonstrating that iota-carrageenan does not reach the blood stream. Consistent with this, no relevant toxic or secondary pharmacological effects due to systemic exposure were observed in the rabbit or rat repeated dose toxicity studies. Data do not provide any evidence for local intolerance or toxicity, when carrageenan is applied intranasally or by inhalation. No signs for immunogenicity or immunotoxicity have been observed in the in vivo studies. This is substantiated by in vitro assays showing no stimulation of a panel of pro-inflammatory cytokines by iota-carrageenan. In conclusion, 0.12% iota-carrageenan is safe for clinical use via intranasal application. PMID:25875737

  19. Evaluation of Bacterial Contamination in a Clinical Environment

    PubMed Central

    Umar, Dilshad; Basheer, Bahija; Husain, Akther; Baroudi, Kusai; Ahamed, Fareed; Kumar, Amit

    2015-01-01

    Background: Although the contamination of the dental environment and personnel through aerosol contamination is a definite source of cross contamination; there is little data on the microbial involvement of the dental environment. Materials and Methods: A total of 100 samples were taken from various inanimate surfaces in the clinical dental setting were collected aseptically by rotating sterile swabs moistened with peptone water over the surfaces of the samples and then inoculated into brain heart infusion broth and incubated at 37°C aerobically overnight. Subcultures were made on 5% sheep blood agar and MacConkey agar plates and incubated at 37°C for 24 h. Growth in the plates was observed. Results: Out of the 100 samples screened in this study, a bacterial agent was observed in 38 samples, and 62 samples showed no growth. A higher percentage of contamination was seen on the dental chair light handles, suction tips and the pens used by the dental health care personnel’s, followed by the instruments and the laboratory equipment. Conclusion: Establishing an effective preventive strategies for well-practiced infection control is essential to prevent nosocomial infections and promote a safe environment in the dental clinics. PMID:25709369

  20. Use of computers in clinical electrocardiography: an evaluation.

    PubMed Central

    Wolf, H. K.; Gregor, R. D.; Chandler, B. M.

    1977-01-01

    The use of computers in clinical electrocardiography is increasing rapidly; however, the role of computers with respect to the electrocardiographer has not been established. At present all electrocardiograms (ECGs) processed by computer are also interpreted by electrocardiographers; hense effort is duplicated. In an investigation of whether conditions can be defined under which the electrocardiographer can use the computer more profitably by eliminating some of the duplication, ECGs recorded in a university teaching hospital were processed by a computer program and subsequently reviewed by 1 of 10 electrocardiographers. For ECGs interpreted as showing normal sinus rhythm the rate of agreement between computer and human reviewer was 99%. For those showing a normal ECG pattern (contour) the rate of direct agreement was only 88%. However, the rate of occurrence of clinically significant differences was only 1.64%; hence the rate of essential agreement for this classification was 98.36%. Other classifications with good agreement were myocardial infarction, sinus bradycardia and sinus tachycardia. Therefore, in circumstances comparable to those of this investigation it is feasible for electrocardiographers to use computers to reduce greatly their workload without compromising the quality of the service provided. PMID:334353

  1. A "three-plus-one" evaluation model for clinical research management.

    PubMed

    Dilts, David M

    2013-12-01

    Clinical research management (CRM) is a critical resource for the management of clinical trials and it requires proper evaluation. This article advances a model of evaluation that has three local levels, plus one global level, for evaluating the value of CRM. The primary level for evaluation is that of the study or processes level. The managerial or aggregate level concerns management of the portfolio of trials under the control of the CRM office. The third, often overlooked level of evaluation, is the strategic level, whose goal is encapsulated in the phrase, "doing the right trials, while doing trials right." The global ("plus one") evaluation level concerns the need to evaluate the ever-increasing number of multi-institutional and multinational studies. As there are host of evaluation metrics, this article provides representative examples of metrics at each level and provides methods that can aid in the selecting appropriate metrics for an organization.

  2. Autosomal dominant polycystic kidney disease: the last 3 years

    PubMed Central

    Torres, Vicente E.; Harris, Peter C.

    2010-01-01

    Autosomal dominant polycystic kidney disease is the most prevalent, potentially lethal monogenic disorder. It has large inter- and intra-familial variability explained to a large extent by its genetic heterogeneity and modifier genes. An increased understanding of its underlying genetic, molecular, and cellular mechanisms and a better appreciation of its progression and systemic manifestations have laid out the foundation for the development of clinical trials and potentially effective therapies. The purpose of this review is to update the core of knowledge in this area with recent publications that have appeared during 2006–2009. PMID:19455193

  3. Clinical evaluation of /sup 99m/Tc-DMSA renogram

    SciTech Connect

    Van Poppel, H.; Vereecken, R.; Vekemans, K.; Verduyn, H.; Mortelmans, L.; de Roo, M.

    1985-04-01

    Two hundred-two /sup 99m/Tc-DMSA renograms for urologic problems were evaluated. Some technical aspects of the examination and the value of the scintigraphic depth estimation are discussed. Pre- and postoperative uptake values in patients with renal surgery and sequential postoperative examinations are considered. The value of DMSA renograms in predicting recovery in obstructive uropathy and in deciding to opt for conservative therapy or nephrectomy is discussed.

  4. Clinical Evaluation of Red Eyes in Pediatric Patients.

    PubMed

    Beal, Casey; Giordano, Beverly

    2016-01-01

    Patients with the primary symptom of a red eye are commonly seen in pediatric primary care clinics. The differential diagnoses of a red eye are broad, but with a succinct history and physical examination, the diagnosis can be readily identified in many patients. Identifying conditions that threaten vision and understanding the urgency of referral to an ophthalmologist is paramount. Some systemic diseases such as leukemia, sarcoidosis, and juvenile idiopathic arthritis can present with the chief symptom of a red eye. Finally, trauma, ranging from mild to severe, often precipitates an office visit with a red eye, and thus understanding the signs that raise concern for a ruptured globe is essential. In the primary care setting, with a focused history, a few simple examination techniques, and an appreciation of the differential diagnosis, one can feel confident in managing patients with acute red eyes. PMID:26948259

  5. Clinical evaluation of amitraz for treatment of canine scabies.

    PubMed

    Folz, S D; Kakuk, T J; Henke, C L; Rector, D L; Tesar, F B

    1984-08-01

    A liquid concentrate formulation of amitraz (Mitaban: Upjohn) was used to topically treat 181 dogs with scabies, at an active drug level of 250 ppm, or 10.6 ml of concentrate in 2 gal water. After the dogs were clipped and bathed, the diluted medication was applied and allowed to dry on the animal. All treated dogs were clinically improved and 97.8% cured after a single treatment; 3 dogs required 2 treatments and 1 dog 3 treatments. Otodectes cynotis and Cheyletiella yasguri in several dogs were also cleared after 1 treatment. Mild, transient sedation occurred in 12.4% of treated dogs, with transient vomiting, increased appetite and diarrhea in less than 1%.

  6. Clinical value of coronary bypass graft evaluation with CT

    SciTech Connect

    Godwin, J.D.; Califf, R.M.; Korobkin, M.; Moore, A.V.; Breiman, R.S.; Kong, Y.

    1983-04-01

    Computed tomography (CT) has a reported accuracy of 45%-97% in assessment of patency of coronary artery bypass grafts. Dynamic CT was done in 26 patients (47 grafts) with recurrent cardiac symptoms after graft surgery. Although CT was 79% accurate (with selective angiography as the standard), the authors do not believe that it provides sufficient information for the assessment of symptomatic patients. Four patients had high-grade stenoses in their grafts, and 50% of patients had significant progression of atherosclerosis in their native coronary arteries. Neither of these conditions could be detected by CT. The clinical contribution of CT will probably be greatest for routine screening of asymptomatic patients soon after operation. Technical problems with CT scanning for graft patency are discussed.

  7. Evaluation of usefulness of 3D views for clinical photography.

    PubMed

    Jinnin, Masatoshi; Fukushima, Satoshi; Masuguchi, Shinichi; Tanaka, Hiroki; Kawashita, Yoshio; Ishihara, Tsuyoshi; Ihn, Hironobu

    2011-01-01

    This is the first report investigating the usefulness of a 3D viewing technique (parallel viewing and cross-eyed viewing) for presenting clinical photography. Using the technique, we can grasp 3D structure of various lesions (e.g. tumors, wounds) or surgical procedures (e.g. lymph node dissection, flap) much more easily even without any cost and optical aids compared to 2D photos. Most recently 3D cameras started to be commercially available, but they may not be useful for presentation in scientific papers or poster sessions. To create a stereogram, two different pictures were taken from the right and left eye views using a digital camera. Then, the two pictures were placed next to one another. Using 9 stereograms, we performed a questionnaire-based survey. Our survey revealed 57.7% of the doctors/students had acquired the 3D viewing technique and an additional 15.4% could learn parallel viewing with 10 minutes training. Among the subjects capable of 3D views, 73.7% used the parallel view technique whereas only 26.3% chose the cross-eyed view. There was no significant difference in the results of the questionnaire about the efficiency and usefulness of 3D views between parallel view users and cross-eyed users. Almost all subjects (94.7%) answered that the technique is useful. Lesions with multiple undulations are a good application. 3D views, especially parallel viewing, are likely to be common and easy enough to consider for practical use in doctors/students. The wide use of the technique may revolutionize presentation of clinical pictures in meetings, educational lectures, or manuscripts. PMID:22101377

  8. Do Clinical Evaluations in a Psychiatry Clerkship Favor Students with Positive Personality Characteristics?

    ERIC Educational Resources Information Center

    Chibnall, John T.; Blaskiewicz, Robert J.

    2008-01-01

    Objective: The authors examine associations of personality characteristics, National Board of Medical Examiners subject examination performance, and Objective Structured Clinical Examination performance with clinical evaluations of third-year medical students in a psychiatry clerkship. Methods: Students completed the Revised NEO Personality…

  9. Effects of PBBs on cattle. I. Clinical evaluations and clinical chemistry.

    PubMed

    Durst, H I; Willett, L B; Schanbacher, F L; Moorhead, P D

    1978-04-01

    Toxicosis was induced in pregnant heifers by feeding 25,000 mg/head/day of FireMaster BP-6, a commercial blend of polybrominated biphenyls (PBB). The PBB feeding decreased dry matter intake approximately 50% by 4 days exposure. Emaciated animals became anorexic a few days prior to death at 33 to 66 days. Weight losses of heifers average 80 kg. Other clinical signs observed were dehydration, diarrhea, excessive salivation and lacrimation, fetal death, abortion, and general depression as evidenced by depressed heart and respiratory rates. Clinical signs were apparent after 10 days exposure and progressively intensified along with loss of condition until death. Clinicopathologic changes included significantly increased serum glutamic-oxaloacetic transaminase and decreased serum calcium by 30 days exposure. Lactate dehydrogenase, urea nitrogen, and bilirubin were elevated, and serum albumin decreased by 36 to 40 days. Principal urine changes were decreased specific gravity and moderate proteinuria. Pregnant heifers fed 0.25 or 250 mg/head/day for 60 days and nonpregnant heifers fed 250 mg/head/day for 180 days displayed neither clinical signs nor clinicopathologic changes indicating adverse effects from PBB exposure. Post-exposure, all heifers exposed to PBB for 60 days calved normally with zero calf mortality and were successfully rebred. Milk production was not different from control animals. Birth weights of calves from dams exposed to 250 mg PBB/head/day were significantly greater than calves of dams exposed to 0 mg or 0.25 mg/head/day. PBB exposure of dams produced no detrimental effects on calves as indicated by clinical signs, clinicopathologic changes, or performance.

  10. Effects of PBBs on cattle. I. Clinical evaluations and clinical chemistry.

    PubMed Central

    Durst, H I; Willett, L B; Schanbacher, F L; Moorhead, P D

    1978-01-01

    Toxicosis was induced in pregnant heifers by feeding 25,000 mg/head/day of FireMaster BP-6, a commercial blend of polybrominated biphenyls (PBB). The PBB feeding decreased dry matter intake approximately 50% by 4 days exposure. Emaciated animals became anorexic a few days prior to death at 33 to 66 days. Weight losses of heifers average 80 kg. Other clinical signs observed were dehydration, diarrhea, excessive salivation and lacrimation, fetal death, abortion, and general depression as evidenced by depressed heart and respiratory rates. Clinical signs were apparent after 10 days exposure and progressively intensified along with loss of condition until death. Clinicopathologic changes included significantly increased serum glutamic-oxaloacetic transaminase and decreased serum calcium by 30 days exposure. Lactate dehydrogenase, urea nitrogen, and bilirubin were elevated, and serum albumin decreased by 36 to 40 days. Principal urine changes were decreased specific gravity and moderate proteinuria. Pregnant heifers fed 0.25 or 250 mg/head/day for 60 days and nonpregnant heifers fed 250 mg/head/day for 180 days displayed neither clinical signs nor clinicopathologic changes indicating adverse effects from PBB exposure. Post-exposure, all heifers exposed to PBB for 60 days calved normally with zero calf mortality and were successfully rebred. Milk production was not different from control animals. Birth weights of calves from dams exposed to 250 mg PBB/head/day were significantly greater than calves of dams exposed to 0 mg or 0.25 mg/head/day. PBB exposure of dams produced no detrimental effects on calves as indicated by clinical signs, clinicopathologic changes, or performance. PMID:210005

  11. MyoRing Implantation in Keratoconic Patients: 3 years Follow-up Data

    PubMed Central

    Janani, Leila; Jadidi, Khosrow; Mosavi, Seyed Aliasghar; Nejat, Farhad; Naderi, Mostafa; Nourijelyani, Keramat

    2016-01-01

    Purpose: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. Methods: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. Results: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. Conclusion: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus. PMID:27195081

  12. Clinical trial of pantomography for the evaluation of mandibular trauma.

    PubMed

    Johnston, C C; Doris, P E

    1980-08-01

    A trial study was conducted comparing the standard "four view" mandibular series and pantomography for th evaluation of mandibular trauma. During the six-month trial period a series of 17 patients with a total of 24 mandibular fractures was compiled. The pantomographs were more easily interpreted than the standard views because overlapping structures were blurred and spatial orientation was clear. In eight of the 17 patients the fractures were more clearly visualized by pantomography. Because the entire mandibule was seen so well on the pantomographs, no special views were required. Eleven patients had single fractures, which are in fact quite common.

  13. Clinical value of DNA fragmentation evaluation tests under ART treatments

    PubMed Central

    Tavukçuoğlu, İlkay Şafak; Al-Azawi, Tahani; Khaki, Amir Afshin; Khaki, Arash; Khalil, Ahmed; Al-Hasani, Safaa

    2012-01-01

    Male reproductive health has been under scrutiny recently. Many studies in the literature have concluded that semen quality is declining and that the incidence of testicular cancers is increasing. The reason for this change has been attributed to damage in sperm chromatin. During in vivo reproduction, the natural selection process ensures that only a spermatozoon with normal genomic material can fertilize an oocyte. However, the assisted reproduction technique (ART) is our selection process, leading to the possibility that abnormal spermatozoa could be used to fertilize an oocyte. We could avoid this by quantifying the amount and type of genomic damage in sperm using well-accepted laboratory methods. The sperm deoxyribonucleic acid (DNA) integrity is important for success of natural or assisted fertilization as well as normal development of the embryo, fetus and child. Intra cytoplasmic sperm injection (ICSI) is bypassing natural sperm selection mechanisms, which increases the risk of transmitting damaged DNA. The significance of required investigations and multiple techniques is that they could evaluate DNA defects in human spermatozoa. The ability of these techniques to accurately estimate sperm DNA damage depends on many technical and biological aspects. The aim of this review is to evaluate the most commonly used methods. PMID:24592055

  14. Initial clinical evaluation of stationary digital chest tomosynthesis

    NASA Astrophysics Data System (ADS)

    Hartman, Allison E.; Shan, Jing; Wu, Gongting; Lee, Yueh Z.; Zhou, Otto; Lu, Jianping; Heath, Michael; Wang, Xiaohui; Foos, David

    2016-03-01

    Computed Tomography (CT) is the gold standard for image evaluation of lung disease, including lung cancer and cystic fibrosis. It provides detailed information of the lung anatomy and lesions, but at a relatively high cost and high dose of radiation. Chest radiography is a low dose imaging modality but it has low sensitivity. Digital chest tomosynthesis (DCT) is an imaging modality that produces 3D images by collecting x-ray projection images over a limited angle. DCT is less expensive than CT and requires about 1/10th the dose of radiation. Commercial DCT systems acquire the projection images by mechanically scanning an x-ray tube. The movement of the tube head limits acquisition speed. We recently demonstrated the feasibility of stationary digital chest tomosynthesis (s-DCT) using a carbon nanotube (CNT) x-ray source array in benchtop phantom studies. The stationary x-ray source allows for fast image acquisition. The objective of this study is to demonstrate the feasibility of s-DCT for patient imaging. We have successfully imaged 31 patients. Preliminary evaluation by board certified radiologists suggests good depiction of thoracic anatomy and pathology.

  15. Clinical evaluation of patients with complaints related to formaldehyde exposure

    SciTech Connect

    Imbus, H.R.

    1985-12-01

    Formaldehyde is a very widely used chemical in our present society and one with which every physician has had a first-hand experience in his early days of training in the anatomy laboratory. The National Institute of Occupational Safety and Health lists 52 occupations that expose people to formaldehyde. In recent years, however, the increasing use of formaldehyde resins in the production of building materials such as particleboard and urea-formaldehyde foam insulation has resulted in exposures of large numbers of people in nonoccupational settings. Consumer products such as cosmetics, cigarettes, textiles, furniture, draperies, and preservatives release formaldehyde. It is present in the outdoor atmosphere from products of combustion and automobile exhaust and likewise in the home from such things as gas cooking. These more widespread and increased exposures have resulted in concern regarding potential health effects. Therefore, it is likely that physicians have or will encounter patients who wish evaluations of a present or potential health effect from formaldehyde. This article is for the purpose of providing assistance in such evaluation.110 references.

  16. Clinical evaluation of patients with complaints related to formaldehyde exposure.

    PubMed

    Imbus, H R

    1985-12-01

    Formaldehyde is a very widely used chemical in our present society and one with which every physician has had a first-hand experience in his early days of training in the anatomy laboratory. The National Institute of Occupational Safety and Health lists 52 occupations that expose people to formaldehyde. In recent years, however, the increasing use of formaldehyde resins in the production of building materials such as particleboard and urea-formaldehyde foam insulation has resulted in exposures of large numbers of people in nonoccupational settings. Consumer products such as cosmetics, cigarettes, textiles, furniture, draperies, and preservatives release formaldehyde. It is present in the outdoor atmosphere from products of combustion and automobile exhaust and likewise in the home from such things as gas cooking. These more widespread and increased exposures have resulted in concern regarding potential health effects. Therefore, it is likely that physicians have or will encounter patients who wish evaluations of a present or potential health effect from formaldehyde. This article is for the purpose of providing assistance in such evaluation.

  17. Clinical Evaluation of CAIPIRINHA: Comparison Against a GRAPPA Standard

    PubMed Central

    Wright, Katherine L.; Harrell, Michael W.; Jesberger, John A.; Landeras, Luis; Nakamoto, Dean A.; Thomas, Smitha; Nickel, Dominik; Kroeker, Randall; Griswold, Mark A.; Gulani, Vikas

    2013-01-01

    Purpose To evaluate image quality when using a CAIPIRINHA sampling pattern in comparison to a standard GRAPPA sampling pattern in patients undergoing a routine 3D breath-held liver exam. CAIPIRINHA uses an optimized phase encoding sampling strategy to alter aliasing artifacts in 3D acquisitions to improve parallel imaging reconstruction. Methods Twenty patient volunteers were scanned using a 3D VIBE acquisition with an acceleration factor of four using a CAIPIRINHA and standard GRAPPA sampling pattern. CAIPIRINHA and GRAPPA images were evaluated by three radiologists in a two alternative forced choice test, and the Wilcoxon signed rank test was performed. Results The CAIPIRINHA sampling pattern was preferred in an average of 68% of the comparisons, and the Wilcoxon signed rank test showed a significant improvement in CAIPIRINHA images (p=0.014). This analysis indicates that in the given sample set, CAIPIRINHA preference over the GRAPPA standard was statistically significant. Conclusion This work shows that for an acceleration factor of four, a CAIPIRINHA accelerated VIBE acquisition provides significantly improved image quality in comparison to the current GRAPPA standard. This allows a further reduction in imaging time for similar spatial resolutions, which can reduce long breath-hold requirements in abdominal imaging, and may be particularly helpful in patients who cannot provide requisite breath-holds with current protocols. PMID:24123420

  18. Evaluation of measurement uncertainty of glucose in clinical chemistry.

    PubMed

    Berçik Inal, B; Koldas, M; Inal, H; Coskun, C; Gümüs, A; Döventas, Y

    2007-04-01

    The definition of the uncertainty of measurement used in the International Vocabulary of Basic and General Terms in Metrology (VIM) is a parameter associated with the result of a measurement, which characterizes the dispersion of the values that could reasonably be attributed to the measurand. Uncertainty of measurement comprises many components. In addition to every parameter, the measurement uncertainty is that a value should be given by all institutions that have been accredited. This value shows reliability of the measurement. GUM, published by NIST, contains uncertainty directions. Eurachem/CITAC Guide CG4 was also published by Eurachem/CITAC Working Group in the year 2000. Both of them offer a mathematical model, for uncertainty can be calculated. There are two types of uncertainty in measurement. Type A is the evaluation of uncertainty through the statistical analysis and type B is the evaluation of uncertainty through other means, for example, certificate reference material. Eurachem Guide uses four types of distribution functions: (1) rectangular distribution that gives limits without specifying a level of confidence (u(x)=a/ radical3) to a certificate; (2) triangular distribution that values near to the same point (u(x)=a/ radical6); (3) normal distribution in which an uncertainty is given in the form of a standard deviation s, a relative standard deviation s/ radicaln, or a coefficient of variance CV% without specifying the distribution (a = certificate value, u = standard uncertainty); and (4) confidence interval.

  19. Breast imaging with SoftVue: initial clinical evaluation

    NASA Astrophysics Data System (ADS)

    Duric, Neb; Littrup, Peter; Li, Cuiping; Roy, Olivier; Schmidt, Steven; Cheng, Xiaoyang; Seamans, John; Wallen, Andrea; Bey-Knight, Lisa

    2014-03-01

    We describe the clinical performance of SoftVue, a breast imaging device based on the principles of ultrasound tomography. Participants were enrolled in an IRB-approved study at Wayne State University, Detroit, MI. The main research findings indicate that SoftVue is able to image the whole uncompressed breast up to cup size H. Masses can be imaged in even the densest breasts with the ability to discern margins and mass shapes. Additionally, it is demonstrated that multi-focal disease can also be imaged. The system was also tested in its research mode for additional imaging capabilities. These tests demonstrated the potential for generating tissue stiffness information for the entire breast using through-transmission data. This research capability differentiates SoftVue from the other whole breast systems on the market. It is also shown that MRI-like images can be generated using alternative processing of the echo data. Ongoing research is focused on validating and quantifying these findings in a larger sample of study participants and quantifying SoftVue's ability to differentiate benign masses from cancer.

  20. Comparative clinical efficacy evaluation of three gingival displacement systems

    PubMed Central

    Shrivastava, Kirti Jajoo; Bhoyar, Anjali; Agarwal, Surendra; Shrivastava, Saurabh; Parlani, Swapnil; Murthy, Varsha

    2015-01-01

    Aim: We compared the clinical efficacy of three gingival displacement systems to accurately record intra-crevicular margins of tooth preparation. Materials and Methods: One mechanical (magic foam cord) and two chemico-mechanical (expasyl paste and retraction cord impregnated with 15% aluminum chloride) gingival displacement systems were used. This study was conducted on the maxillary central incisors of 20 patients (20-60 years old) requiring full coverage restoration. All the three gingival displacement systems were tested in three sessions at an interval of 14 days in same order. The casts were sectioned and viewed under an optical microscope, followed by quantitative measurements of the width of the pre and postretracted sulci. Results: All the three displacement systems produced highly significant horizontal gingival displacement. Retraction cord soaked in 15% aluminum chloride produced maximum displacement (0.74 mm), followed by expasyl paste (0.48 mm) whereas magic foam cord produced the least displacement (0.41 mm). Conclusions: Gingival displacement shown by each displacement system was found to be more than the accepted value necessary for elastomeric impression accuracy (0.2 mm) to record intra-crevicular margins of tooth preparation. PMID:26604620

  1. [Clinical evaluation of the severity of hidradenitis suppurativa].

    PubMed

    Revuz, J

    2015-12-01

    Treatment and long-term management of patients with chronic diseases require the use of instruments to measure severity and outcome. In the case of hidradenitis suppurativa, such instruments are currently poorly understood and utilised. Herein, we describe the main instruments, their scope of application, their qualities and their shortcomings. The Hurley classification, which was devised for surgical assessment and is limited to description of impairment at a given site, is too often used to assess overall severity in individual patients. The Sartorius score (and variants thereof) combines global and local measurements; it is widely used, but because of its hybrid nature, the global score, or PGA-HS, is currently used; the latter, focusing on inflammatory signs, is perfectly suitable for daily assessment of pharmaceutical treatment. The HiSCR score, derived from the foregoing grading system, is used as a global criterion in clinical trials. Patient-based instruments, such as pain or suppuration score, and, to a lesser extent, quality-of-life score constitute very useful supplements. Since the disease is extremely heterogeneous, no instruments cover the entire array of situations and the requirements of medical and surgical practitioners involved in the management of this patient population.

  2. Cytogenetic evaluation of patients with clinical spectrum of Turner syndrome

    PubMed Central

    Moka, Rajasekhar; Sreelakshmi, Kodandapani; Gopinath, Puthiya Mundyat; Satyamoorthy, Kapettu

    2013-01-01

    AIM: The objective of this study was to correlate the genotype, of female patients, withshort stature and primary amenorrhea. MATERIALS AND METHODS: One hundred and forty-six subjects were recruited during 2005-2012. Microscopic and automated karyotyping analyses were done by using chromosomes isolated from the lymphocytes using Giemsa banding (GTG) to identify chromosome abnormalities. RESULTS: A total of 146 clinically suspected Turner syndrome (TS) subjects were recruited for the study, of which, 61 patients were identified to have chromosome abnormalities. The chromosomal abnormalities detected were as follows: Monosomy X (n = 19, 13.01%), triple X syndrome (n = 4, 2.7%), mosaic TS (n = 12, 8.21%), XY gonadal dysgenesis (n = 13, 8.9%), and structural abnormalities including X chromosome (n = 15, 10.27%) and one patient each with autosomal changes involving 9qh inversion and translocation of chromosomes 12 and 14. CONCLUSION: Karyotype abnormalities accounting for 46% in this study emphasize the need for karyotype testing in cases of short stature with primary amenorrhea. PMID:24082654

  3. Several strategies for evaluating the objectivity of measurements in clinical research and practice

    PubMed Central

    Keating, Joseph C

    1988-01-01

    The objectivity (interexaminer reliability) of measurement in chiropractic provides a basis for judging the quality of information in clinical research and practice. Objectivity may be determined by formal measurement evaluation studies and by sampling within clinical trials. Interpretation of inter-examiner reliability requires descriptive and inferential statistics selected on the basis of the mathematical properties of data, appreciation of the clinical meaning of a particular measure, and recognition of the role of chance. Methods of data analysis include scatter-plots, contingency tables, time-series graphs, and correlational and concordance coefficients. Many kinds of objectivity evaluations are well within the capacities of private practitioners and student clinicians.

  4. Clinical behavioral pharmacology: methods for evaluating medications and contingency management.

    PubMed Central

    Burgio, L D; Page, T J; Capriotti, R M

    1985-01-01

    We evaluated methods for comparing the effects of dextroamphetamine (Dexedrine), thioridazine (Mellaril), and contingency management in the control of severe behavior problems. A reversal design was used in which medications were systematically titrated and assessed in unstructured as well as structured settings with three clients. Subsequently, behavioral procedures including timeout, differential reinforcement of other behavior, and visual screening, were used in a multiple-baseline design across settings. The assessment and design methods were useful in comparing the interventions. Dextroamphetamine decreased inappropriate behaviors and improved academic behaviors in one client, but no reliable effects were observed in the other two clients. Thioridazine was variable across clients, settings, behaviors, and dosages. Contingency management produced consistent decreases in inappropriate behaviors and small improvements in academic performance. PMID:3997697

  5. Nutritional effects of postgastrectomy reconstruction: a clinical evaluation.

    PubMed

    Zelnick, R; Auguste, L J; Wise, L

    1989-04-01

    To evaluate the nutritional benefits of a jejunal pouch vs. esophagojejunostomy following total gastrectomy, we reviewed 24 consecutive cases of total gastrectomy: 14 males and 10 females, 39 to 85 years of age (mean 66.6 y.) undergoing 9 jejunal pouches (JP) and 15 Roux-en-Y esophagojejunostomy (EJ). Indications for surgery included 15 adenocarcinomas, 3 lymphomas, 1 leiomyoma, and 5 hemorrhagic gastritis. The operative mortality was 12.5%. One JP patient was lost to follow-up. The mean survival for EJ was 13.3 months and for JP 36 months. Total gastrectomy resulted in persistent weight loss and hypoalbuminemia, and the creation of a jejunal pouch did not seem to improve significantly the nutritional status following total gastrectomy.

  6. Postural effects on intracranial pressure: modeling and clinical evaluation.

    PubMed

    Qvarlander, Sara; Sundström, Nina; Malm, Jan; Eklund, Anders

    2013-11-01

    The physiological effect of posture on intracranial pressure (ICP) is not well described. This study defined and evaluated three mathematical models describing the postural effects on ICP, designed to predict ICP at different head-up tilt angles from the supine ICP value. Model I was based on a hydrostatic indifference point for the cerebrospinal fluid (CSF) system, i.e., the existence of a point in the system where pressure is independent of body position. Models II and III were based on Davson's equation for CSF absorption, which relates ICP to venous pressure, and postulated that gravitational effects within the venous system are transferred to the CSF system. Model II assumed a fully communicating venous system, and model III assumed that collapse of the jugular veins at higher tilt angles creates two separate hydrostatic compartments. Evaluation of the models was based on ICP measurements at seven tilt angles (0-71°) in 27 normal pressure hydrocephalus patients. ICP decreased with tilt angle (ANOVA: P < 0.01). The reduction was well predicted by model III (ANOVA lack-of-fit: P = 0.65), which showed excellent fit against measured ICP. Neither model I nor II adequately described the reduction in ICP (ANOVA lack-of-fit: P < 0.01). Postural changes in ICP could not be predicted based on the currently accepted theory of a hydrostatic indifference point for the CSF system, but a new model combining Davson's equation for CSF absorption and hydrostatic gradients in a collapsible venous system performed well and can be useful in future research on gravity and CSF physiology.

  7. Evaluation of a Potential Clinical Interaction between Ceftriaxone and Calcium▿

    PubMed Central

    Steadman, Emily; Raisch, Dennis W.; Bennett, Charles L.; Esterly, John S.; Becker, Tischa; Postelnick, Michael; McKoy, June M.; Trifilio, Steve; Yarnold, Paul R.; Scheetz, Marc H.

    2010-01-01

    In April 2009, the FDA retracted a warning asserting that ceftriaxone and intravenous calcium products should not be coadministered to any patient to prevent precipitation events leading to end-organ damage. Following that announcement, we sought to evaluate if the retraction was justified. A search of the FDA Adverse Event Reporting System was conducted to identify any ceftriaxone-calcium interactions that resulted in serious adverse drug events. Ceftazidime-calcium was used as a comparator agent. One hundred four events with ceftriaxone-calcium and 99 events with ceftazidime-calcium were identified. Adverse drug events were recorded according to the listed description of drug involvement (primary or secondary suspect) and were interpreted as probable, possible, unlikely, or unrelated. For ceftriaxone-calcium-related adverse events, 7.7% and 20.2% of the events were classified as probable and possible for embolism, respectively. Ceftazidime-calcium resulted in fewer probable embolic events (4%) but more possible embolic events (30.3%). Among cases that considered ceftriaxone or ceftazidime and calcium as the primary or secondary drug, one case was classified as a probable embolic event. That patient received ceftriaxone-calcium and died, although an attribution of causality was not possible. Our analysis suggests a lack of support for the occurrence of ceftriaxone-calcium precipitation events in adults. The results of the current analysis reinforce the revised FDA recommendations suggesting that patients >28 days old may receive ceftriaxone and calcium sequentially and provide a transparent and reproducible methodology for such evaluations. PMID:20086152

  8. Initial clinical evaluation of stationary digital breast tomosynthesis

    NASA Astrophysics Data System (ADS)

    Calliste, Jabari; Tucker, Andrew W.; Gidcumb, Emily; Kuzmiak, Cherie M.; Lu, Jianping; Zhou, Otto; Lee, Yueh Z.

    2015-03-01

    Full field digital mammography (FFDM) has been the gold standard for mammography. It detects the presence, distribution, and morphology of microcalcifications (MCs), helping predict malignancy. Digital breast tomosynthesis (DBT) has overcome some limitations of FFDM such as poor sensitivity, specificity, and positive predictive values, due to superimposition of tissue, especially in dense breasts. Current DBT systems move an x-ray tube in either continuous (CM), or step-and-shoot motion (SSM). These systems are less effective than FFDM in MC detection due to lower spatial resolution. Motion of the x-ray source and system mechanical instability cause image blur. The image quality is further affected by patient motion due to the relatively long scan time. We developed a stationary DBT (s-DBT) system using a carbon nanotube (CNT) X-ray source array. The CNT array is electronically controlled, rapidly acquiring projection images over a large angular span, with zero tube motion. No source motion, coupled with a large angular span, results in improved in-plane and depth resolution. Using physical phantoms and human specimens, this system demonstrated higher spatial resolution than CM DBT. The objective of this study is to compare the diagnostic clinical performance of s-DBT to that of FFDM. Under UNC's IRB regulations, 100 patients with breast lesions are being recruited and imaged with both modalities. A reader study will compare the diagnostic accuracy of the modalities. We have successfully imaged the first 30 patients. Initial results indicate that s-DBT alone produces comparable MC sharpness, and increased lesion conspicuity compared to FFDM.

  9. MARIA M4: clinical evaluation of a prototype ultrawideband radar scanner for breast cancer detection.

    PubMed

    Preece, Alan W; Craddock, Ian; Shere, Mike; Jones, Lyn; Winton, Helen L

    2016-07-01

    A microwave imaging system has been developed as a clinical diagnostic tool operating in the 3- to 8-GHz region using multistatic data collection. A total of 86 patients recruited from a symptomatic breast care clinic were scanned with a prototype design. The resultant three-dimensional images have been compared "blind" with available ultrasound and mammogram images to determine the detection rate. Images show the location of the strongest signal, and this corresponded in both older and younger women, with sensitivity of [Formula: see text], which was found to be maintained in dense breasts. The pathway from clinical prototype to clinical evaluation is outlined.

  10. MARIA M4: clinical evaluation of a prototype ultrawideband radar scanner for breast cancer detection.

    PubMed

    Preece, Alan W; Craddock, Ian; Shere, Mike; Jones, Lyn; Winton, Helen L

    2016-07-01

    A microwave imaging system has been developed as a clinical diagnostic tool operating in the 3- to 8-GHz region using multistatic data collection. A total of 86 patients recruited from a symptomatic breast care clinic were scanned with a prototype design. The resultant three-dimensional images have been compared "blind" with available ultrasound and mammogram images to determine the detection rate. Images show the location of the strongest signal, and this corresponded in both older and younger women, with sensitivity of [Formula: see text], which was found to be maintained in dense breasts. The pathway from clinical prototype to clinical evaluation is outlined. PMID:27446970

  11. Feasibility of Automatic Extraction of Electronic Health Data to Evaluate a Status Epilepticus Clinical Protocol.

    PubMed

    Hafeez, Baria; Paolicchi, Juliann; Pon, Steven; Howell, Joy D; Grinspan, Zachary M

    2016-05-01

    Status epilepticus is a common neurologic emergency in children. Pediatric medical centers often develop protocols to standardize care. Widespread adoption of electronic health records by hospitals affords the opportunity for clinicians to rapidly, and electronically evaluate protocol adherence. We reviewed the clinical data of a small sample of 7 children with status epilepticus, in order to (1) qualitatively determine the feasibility of automated data extraction and (2) demonstrate a timeline-style visualization of each patient's first 24 hours of care. Qualitatively, our observations indicate that most clinical data are well labeled in structured fields within the electronic health record, though some important information, particularly electroencephalography (EEG) data, may require manual abstraction. We conclude that a visualization that clarifies a patient's clinical course can be automatically created using the patient's electronic clinical data, supplemented with some manually abstracted data. Future work could use this timeline to evaluate adherence to status epilepticus clinical protocols.

  12. 3 Year simvastatin treatment and lens nuclear back scattering

    PubMed Central

    Qian, W.; Soderberg, P.; Chen, E.; Magnius, K.; Philipson, B.

    2000-01-01

    AIM—To determine if 3 year treatment of hypercholesterolaemia with simvastatin causes an increase of lens nuclear back scattering.
METHODS—160 patients with hypercholesterolaemia in the Scandinavian Simvastatin Survival Study (4S) were followed for 3 years. Half (80) of the patients took simvastatin and half (80) received placebo. The lens was photographed with a Topcon SL-45 slit lamp camera at the beginning and at 1 year intervals. A common lens nuclear area was used for measuring lens nuclear back scattering.
RESULTS—Nuclear back scattering increased with age and there was more pronounced scattering in women than in men. Lens nuclear back scattering did not differ significantly between the simvastatin and placebo groups, but the power was low (0.2). Lens nuclear back scattering increased during the study period independently of baseline back scattering, age, and sex for both groups.
CONCLUSION—Although no significant difference was found between the simvastatin and placebo groups, the currently available data are insufficient for exclusion of the possibility that taking simvastatin during a 3 year period increases nuclear back scattering. However, a possible minor increase of nuclear back scattering is clinically irrelevant considering known beneficial effects of simvastatin on coronary heart disease.

 PMID:10781516

  13. Two-year clinical evaluation of resin composite in posterior teeth: A randomized controlled study

    PubMed Central

    Gianordoli-Neto, Ranulfo; Padovani, Gislaine Cristina; Mondelli, José; de Lima Navarro, Maria Fidela; Mendonça, Juliano Sartori; Santiago, Sérgio Lima

    2016-01-01

    Background: Clinical evaluations as fundamental method to prove the efficiency of restorative materials. Aim: This study evaluated the clinical performance of restorative systems during 2 years of clinical service. Materials and Methods: This study assessed the clinical performance of restorative systems (Filtek Z250 and P60), during 2 years of clinical service, using the US Public Health Service system. The randomized and double-blind study comprising thirty volunteers. The restorations were evaluated at baseline, 6, 12, and 24 months. It was used the following criteria: marginal discoloration (MD), marginal integrity (MI), superficial texture (ST), wear (W), postoperative sensitivity (PS) and recurrent caries (RC). Results: Statistic analysis was performed using Fisher's and McNemar's exact tests and Pearsons's Chi-square in a significance level of 5%. The results at baseline and 24 months for Group I were: MD – 100, 100%; MI – 100, 88.6%; ST – 100, 94.3%; W – 100, 94.3%; PS – 100, 100%; RC – 100, 100%, of alpha scores; Group II: MD – 100, 97.1%; MI – 100, 91.4%; ST – 100, 94.3%; W – 100, 91.4%; PS – 100, 100%; RC – 100, 100%, of alpha scores. It was observed no statistical difference in the evaluated criteria and period. Conclusions: After 24 months of evaluation, both restorative systems exhibited acceptable clinical performance. PMID:27563176

  14. Evaluation of the Esthetic Properties of Developmental Defects of Enamel: A Spectrophotometric Clinical Study

    PubMed Central

    Guerra, Fabrizio; Mazur, Marta; Corridore, Denise; Pasqualotto, Debora; Nardi, Gianna Maria; Ottolenghi, Livia

    2015-01-01

    Objectives. Detailed clinical quantification of optical properties of developmental defect of enamel is possible with spectrophotometric evaluation. Developmental defects of enamel (DDE) are daily encountered in clinical practice. DDE are an alteration in quality and quantity of the enamel, caused by disruption and/or damage to the enamel organ during amelogenesis. Methods. Several clinical indices have been developed to categorize enamel defects based on their nature, appearance, microscopic features, or cause. A sample of 39 permanent teeth presenting DDE on labial surface was examined using the DDE Modified Index and SpectroShade evaluation. The spectrophotometric approach quantifies L* (luminosity), a* (quantity of green-red), and b* (quantity of blue-yellow) of different DDE. Conclusions. SpectroShade evaluation of the optical properties of the enamel defect enhances clinical understanding of severity and extent of the defect and characterizes the enamel alteration in terms of color discrepancy and surface characterization. PMID:25874260

  15. Results of a 3-Year, Nutrition and Physical Activity Intervention for Children in Rural, Low-Socioeconomic Status Elementary Schools

    ERIC Educational Resources Information Center

    King, Kristi McClary; Ling, Jiying

    2015-01-01

    Improving children's nutrition and physical activity have become priorities in the United States. This quasi-experimental study evaluated the longitudinal effects of a 3-year, school-based, health promotion intervention (i.e. nutrition and physical education, classroom physical activity, professional development and health promotion for teachers…

  16. Impacts of a Violence Prevention Program for Middle Schools: Findings after 3 Years of Implementation. NCEE 2011-4017

    ERIC Educational Resources Information Center

    Silvia, Suyapa; Blitstein, Jonathan; Williams, Jason; Ringwalt, Chris; Dusenbury, Linda; Hansen, William

    2011-01-01

    This is the second and final report summarizing findings from an impact evaluation of a violence prevention intervention for middle schools. This report provides findings from the second and third years of the 3-year intervention. The U.S. Department of Education (ED) contracted with RTI International and its subcontractors, Pacific Institute for…

  17. Evaluation of Medical Students During a Clinical Clerkship in Internal Medicine

    ERIC Educational Resources Information Center

    O'Donohue, W. J., Jr.; Wergin, Jon F.

    1978-01-01

    During a three-month clinical clerkship in medicine 175 medical students were evaluated. A proficiency assessment process was developed that included preceptor evaluation of on-the-job performance as well as oral and written examinations. Data analysis showed small correlations among the three measurements of competence. (Author/LBH)

  18. A Tool To Evaluate How to Learn from Experience in Clinical Settings.

    ERIC Educational Resources Information Center

    Dumas, Louise; Villeneuve, Jean; Chevrier, Jacques

    2000-01-01

    An evaluation tool for the process of learning from experience in a clinical practicum at baccalaureate nursing level was developed and validated. This reflective type of process evaluation helps students link theory to practice and think critically. (Contains 50 references.) (JOW)

  19. Evaluation of Nontraditional Age Learners' Experiences in Internet-Based Clinical Social Work Courses

    ERIC Educational Resources Information Center

    Swanke, Jayme; Zeman, Laura Dreuth

    2015-01-01

    This study involves an evaluation of online learners' experiences with two Internet-based clinical social work courses. The evaluation sought to discover whether there were differences in learning between traditional (under 25 years old) and nontraditional age learners (25 years and over) who completed the asynchronous online course. The study…

  20. [Clinical evaluation of congenital cholesteatoma of the middle ear].

    PubMed

    Kikuchi, Masahiro; Yamamoto, Etsuo; Shinohara, Shogo; Shiomi, Yousaku; Fujiwara, Keizo; Shiomi, Yoshiko; Watanabe, Futoshi; Tanabe, Makito

    2003-08-01

    We conducted a retrospective study to identify the clinical features and surgical observations of congenital cholesteatoma. Sixty patients were diagnosed and underwent surgery for congenital cholesteatoma between April 1987 and May 2002. All diagnoses were made on the basis of two operative findings: 1. the tympanic membrane manifested neither retraction, perforation, nor granulation. 2. the tympanic membrane was not continuous with the cholesteatoma. In this series, congenital cholesteatoma accounted for 7% of all cholesteatomas (853 ears). The patient age ranged from 2 to 48 years. The male to female ratio was 4:1. Seventeen patients had multiple cholesteatoma. Fifty-three patients exhibited closed-type cholesteatomas, while the remaining 7 patients had open-type cholesteatomas that had formed as a flat surface of the epidermis. Patients with open-type cholesteatomas presented with a much more pronounced conductive hearing loss and ossicular erosion or malformation. Twenty-two patients with relatively small cholesteatomas were analyzed to estimate the origin of their cholesteatomas. Of the 22 patients, 13 had anterior superior quadrant (ASQ-type) and 9 had posterior superior quadrant (PSQ-type) cholesteatomas. The mean age at the time of detection was older in the PSQ-type group than in the ASQ-type group and the frequency of ossicular erosion or malformation was more prominent in the PSQ-type group than in the ASQ-type group. The primary site of origin was thought to be the portion between the tympanic ostium of the auditory canal and the semicanal for tensor tympani in the ASQ-type group and near the incudostapedial joint in the PSQ-type group. A planned staged procedure was performed in 29 patients, 15 patients (52%) had residual lesions situated mostly on the oval window, the round window, an exposed facial nerve or an exposed lateral semicircular canal. The frequency of residual lesions in patients who presented with extended, multiple cholesteatoma and

  1. Evaluating clinical ethics support in mental healthcare: a systematic literature review.

    PubMed

    Hem, Marit Helene; Pedersen, Reidar; Norvoll, Reidun; Molewijk, Bert

    2015-06-01

    A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded 'grey zone articles', in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients' and caregivers' views on ethical challenges, is presented.

  2. Case studies on clinical evaluation of biosimilar monoclonal antibody: scientific considerations for regulatory approval.

    PubMed

    Kudrin, Alex; Knezevic, Ivana; Joung, Jeewon; Kang, Hye-Na

    2015-01-01

    The objective of this paper is to provide considerations based on comprehensive case studies important for regulatory evaluation of monoclonal antibodies as similar biotherapeutic products (SBPs) with a special emphasis on clinical aspects. Scientific principles from WHO Guidelines on SBPs were used as a basis for the exercise. Working groups consisted of regulators, manufacturers and academia. The following topics were discussed by the working groups: clinical criteria for biosimilarity, extrapolation approach and the overall regulatory decision making process. In order to determine typical pitfalls in the design of a SBP clinical programme and evaluate the gap of knowledge, amongst different industry and regulatory stakeholders on the appraisal of the data arising from SBP clinical studies, we have presented two fictional but realistic clinical case studies. The first case consists of the fictional development programme for an infliximab SBP candidate. The second case describes clinical studies proposed for a fictional rituximab SBP candidate. In the first scenario a highly similar quality profile has been taken forward into clinical studies whereas there was an important residual difference in functional attributes for the rituximab SBP candidate. These case studies were presented at the WHO implementation workshop for the WHO guidelines on evaluation of similar biotherapeutic products held in Seoul, Republic of Korea, in May 2014. The goal was to illustrate the interpretation of the clinical data arising from studies with SBP candidates and elicit knowledge gaps in clinical assessment. This paper reflects the outcome of the exercise and discussions held in Seoul and offers an analysis of the case studies as a learning opportunity on clinical development and evaluation of SBPs.

  3. [Clinical evaluation of gingival tissue restored with stainless steel crown].

    PubMed

    Chao, D D; Tsai, T P; Chen, T C

    1992-12-01

    The use of stainless steel crown for the restoration of primary molars is widely accepted in pediatric dentistry. There has been a concern regarding their effect on the health of the gingival tissue. It is a possibility that the preformed crown may be a contributing cause of gingivitis. This study evaluated one hundred and thirty-seven crowns in forty-five patients who had received pedodontic treatment at Chang Gung Memorial Hospital. The results indicated that the majority of stainless steel crowns had one or more defects, with crown crimping being the most common error. According to what the paired t-test showed, non-ideal crowns indicated that the gingival index was significantly higher than the entire mouth and control teeth. However the supragingival plaque accumulation of these teeth was significant lower than the entire mouth and control teeth. There was only a moderate positive correlation between supragingival plaque and gingivitis. The operator is necessary to adapt the stainless steel crown margin as closely as possible to the tooth and to avoid the mechanical defect of a crown. It minimizes the irritation of gingival tissue and diminishes the bacterial adherence of subgingival plaque, therefore preserving the health of gingival tissue.

  4. Evaluation of the clinical efficacy of embryo cryopreservation.

    PubMed

    Schnorr, J A; Muasher, S J; Jones, H W

    2000-11-27

    To fully evaluate the advantages of a cryopreservation program a method needs to be established to express the additional patients pregnant from cryopreservation. The patient specific method considers cryopreservation as augmentation only among patients without a pregnancy from the fresh transfer, or from previously transferred frozen material from the same harvest. In an analysis of the pregnancy rate at the Jones Institute between January 1996 and December 1998 we found a fresh pregnancy rate of 40.8% in the good responders and 28.8% in poor responders. The patient specific pregnancy rate in the same cycles was 53.4% in good responders and 32.3% in poor responders. Good responders less than 35 years of age with ten or more mature eggs at retrieval had a fresh pregnancy rate of 40.2% and a patient specific pregnancy rate of 57.9%. It is exceedingly important for the physician and patient to understand and comprehend the potential in cryopreserved material.

  5. Tics and Tourette syndrome: clinical evaluation of 44 cases.

    PubMed

    Teive, H A; Germiniani, F M; Della Coletta, M V; Werneck, L C

    2001-09-01

    We evaluated 44 patients with tics and Tourette's syndrome (TS) emphasising the age of onset of symptoms, sex, classification and localization of tics, associated symptoms and signs and comorbidities. Thirty-three patients (75.2%) had TS defined criteria whereas 10 (22.7%) had chronic motor and/or vocal tics. Simple motor tics were found in 43 cases (97.7%), mainly affecting the eyes (43.2%), mouth (43.2%), face (34.1%). Simple vocal tics occurred in 33 (75%). Coprolalia was found in just 6 cases (13.6%) and copropraxia in just 2 (4.5%). Obsessive compulsive disorder and/or symptoms were found in 26 cases (59.1%) and attention deficit in 17 (38.6%). Eighteen patients (40.9%) had other disorders, such as alcoholism, tabagism, drug abuse, affective disorders, anxiety, sleep and learning disorders. The data obtained are similar to those found by other authors. We highlight the low frequency of coprolalia, as well as the associated neuropsychiatric disorders. PMID:11593273

  6. Clinical Evaluation of Bleeding and Bruising in Primary Care.

    PubMed

    Neutze, Dana; Roque, Jodi

    2016-02-15

    Bleeding and bruising are common symptoms in the primary care setting. The patient history can help determine whether the bruising or bleeding is abnormal. The International Society on Thrombosis and Hemostasis has developed a bleeding assessment tool that can be used to indicate possible pathology. A family history of bleeding problems may suggest a hereditary coagulation defect. Such a history is especially important in children who may not have experienced a major bleeding episode. Medication review can identify pharmacologic causes of the bleeding or bruising. Physical examination findings such as mucocutaneous bleeding suggest that the underlying condition is caused by platelet dysfunction, whereas hemarthroses or hematomas are more common in coagulopathy. If the history and physical examination findings suggest a bleeding diathesis, initial laboratory testing includes a complete blood count, peripheral blood smear, prothrombin time (PT), and partial thromboplastin time (PTT). A normal PT and PTT indicate a platelet disorder, the most common of which is von Willebrand disease. A normal PT and prolonged PTT signal a deficit in the intrinsic pathway, and a mixing study should be performed. A vitamin K challenge is indicated in patients with an abnormal PT and normal PTT. A workup for liver failure is warranted in patients with prolonged PT and PTT. If initial testing does not reveal an etiology in a patient with a high suspicion for a bleeding disorder, the patient should be referred to a hematologist for additional evaluation. PMID:26926815

  7. Clinical parameters for evaluating biological response modifier therapy.

    PubMed

    Hamblin, T J

    1989-01-01

    Evaluating response in cancer is a well established practice, depending on the recognition of complete response, partial response, stable disease and progressive disease. For chemotherapeutic drugs, only those patients achieving a complete response experience an increase in survival. Partial response merely indicates that the drug has some activity in that disease. What the patient wants is not active drugs but prolonged survival with good quality of life. It is well recognised that tumours may remain dormant for many years, and that even those patients with complete responses to chemotherapy usually have minimal residual disease. It is assumed that such minimal disease is controlled and held in check by a biological process. The principal aim of biological response modifiers is to enhance this effect so as to control an even larger tumour load. It therefore follows that removal of all tumour is not the only benefit, and that stable disease and even slower progression might translate to longer survival. Survival curves are the acid test and we should expect longer survival even for those patients failing to achieve complete response if we are to establish that life imprisonment is as effective in cancer treatment as capital punishment.

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

    PubMed

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

    2015-10-01

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

  9. Women's Heart Advantage Program: the impact 3 years later.

    PubMed

    Gombeski, William R; Kramer, R Kyle; Freed, Lisa; Foody, JoAnne; Parkosewich, Janet; Wilson, Tammi; Wack, Jeffery T; D'Onofrio, Gail

    2005-01-01

    Yale-New Haven Hospital, in partnership with Voluntary Hospital Association (VHA Inc), launched the Women's Heart Advantage program in March 2001. Major program components implemented include (1) a comprehensive initial and ongoing internal communication program; (2) a health promotion initiative including a 24-hour, 7-days-a-week women's heart line staffed by nurses and an Internet health question-and-answer forum; (3) significant ongoing communication with nurses and physicians; (4) a community outreach effort to educate poor and minority women; and (5) an aggressive effort to secure financial partners to underwrite the cost of the program. Before launching the program, a telephone survey of 300 randomly selected New Haven County women ages 40 to 70 years was initiated in January 2001 and repeated in January 2002, 2003, and 2004. Findings include (1) the percentage of women who recognize heart disease as the number-one killer of women their age increased from 26% in 2001 to 59% in 2004, (2) the percentage of women who would call 9-1-1 or go directly to a hospital emergency department increased from 63% in 2002 to 83% in 2004, and (3) the percentage of women aware of recent Women's Heart Advantage program promotion grew from 33% in 2002 to 50% in 2004. Perhaps most importantly, the number of women with heart problems admitted through the hospital's emergency department increased from 1528 per year in 2001 to 1870 per year in 2004 (7.5% annual increase), whereas the number of men with heart problems admitted through the emergency department during the same time period has been relatively low (0.8% annual increase). By linking clinical, public health, and marketing expertise along with finding ways to partner with other organizations, the Women's Heart Advantage program has contributed to remarkable changes in women's awareness, knowledge, and behaviors, suggesting a model for approaching similar health-related problems. PMID:16521611

  10. [The evaluation of cefmetazole in clinical use. The study group of cefmetazole in clinical use].

    PubMed

    Si, C; Tian, G

    1996-10-01

    To study the clinical effect of cefmetazole (CMZ), we treated with CMZ 1,926 patients with various infections involving the respiratory tract, gastrointestinal tract, liver and biliary tract, skin and soft tissue and others. The marked effect rate was 56.5%, and the effect rate 33.7%. The sensitivity test of CMZ was also performed in vitro. Staphylococcus aureus, streptococcus, staphylococcus epidermis, E. coli, S. typhi, B. salmonella, B. shigella, B. Klebsiella pneumoniae, B. proteus, etc. were sensitive to CMZ. Injecting CMZ can prevent the infection of operation. The study of the adverse reaction of CMZ showed, an adverse reaction rate of 4.2% (the gastrointestinal tract, allergy, kidney and nervous system). These results suggested that CMZ is an antibiotic of broad spectrum, high efficacy and low toxicity. It is effective in treating sensitive bacterial infection, unknown pathogenic infection and mixed bacterial infection, and preventing infection in surgery. PMID:9592326

  11. Unicystic ameloblastoma in 3 year old paediatric patient - A rare entity.

    PubMed

    Arora, Shelly; Kumar, Priya; Urs, Aadithya B; Augustine, Jeyaseelan

    2013-02-01

    Unicystic ameloblastoma (UA) is a benign epithelial odontogenic tumor of the jaws that commonly occurs in 2nd and 3rd decade of life. In fact, this entity is rare in children under 12 years of age. It is characterised as a distinct variant of ameloblastoma, exhibiting a less aggressive behaviour and a lower rate of recurrence than solid conventional ameloblastoma. There are very few reported cases of UA occurring in children below five years of age. The purpose of this case report is to describe a case of UA involving the crown of an unerupted maxillary second premolar in a 3 year old girl. The pathogenesis, clinical appearance, radiographic presentation, histological findings and management of the tumour have also been discussed.

  12. An unlikely cause of severe malnutrition in a 3-year-old girl with previous gastroschisis.

    PubMed

    Ashton, J J; Blackburn, S; Burge, D; Beattie, R M

    2014-01-01

    A 3-year-old girl with previous gastroschisis associated with jejunal and colonic atresia presented with severe oedema, abdominal pain and diarrhoea. Clinically she was malnourished. Serum albumin and concentrations of micronutrients were low. A barium meal examination showed jejunal dilation. A stricture was suspected and the patient was taken to theatre where an 8 cm length of bowel was resected including a jejunal stricture at the point of previous atresia repair. Inside the proximal dilated jejunum was a large trichobezoar (hairball), thought to be acting as a ball valve inside the bowel. This girl made a rapid recovery after surgery. Her nutritional state improved, symptoms resolved and serum biochemistry normalised. She remains well at follow-up with normal blood results, normal albumin and no diarrhoea. PMID:25183805

  13. An unlikely cause of severe malnutrition in a 3-year-old girl with previous gastroschisis

    PubMed Central

    Ashton, J J; Blackburn, S; Burge, D; Beattie, R M

    2014-01-01

    A 3-year-old girl with previous gastroschisis associated with jejunal and colonic atresia presented with severe oedema, abdominal pain and diarrhoea. Clinically she was malnourished. Serum albumin and concentrations of micronutrients were low. A barium meal examination showed jejunal dilation. A stricture was suspected and the patient was taken to theatre where an 8 cm length of bowel was resected including a jejunal stricture at the point of previous atresia repair. Inside the proximal dilated jejunum was a large trichobezoar (hairball), thought to be acting as a ball valve inside the bowel. This girl made a rapid recovery after surgery. Her nutritional state improved, symptoms resolved and serum biochemistry normalised. She remains well at follow-up with normal blood results, normal albumin and no diarrhoea. PMID:25183805

  14. Epidermoid cyst in the floor of the mouth of a 3-year-old.

    PubMed

    Pascual Dabán, Rossana; García Díez, Eloy; González Navarro, Beatriz; López-López, José

    2015-01-01

    Epidermoid cysts are a rare entity in the oral cavity and are even less frequent in the floor of the mouth, representing less than 0.01% of all the cases. We present the case of a 3-year-old girl with a growth in the floor of the mouth with 2 months of evolution and without changes since it was discovered by her parents. The lesion was asymptomatic; it did not cause dysphagia, dyspnea, or any other alteration. A CT scan with contrast was done which revealed the location and exact size of the lesion, allowing an intraoral approach for its excision. The histological examination confirmed the clinical speculation of an epidermoid cyst. PMID:25694831

  15. Clinical evaluation of alloderm for root coverage and colour match

    PubMed Central

    Shanmugam, M.; Sivakumar, V.; Anitha, V.; Sivakumar, B.

    2012-01-01

    Background: Predictable root coverage and good colour match are the major therapeutic end points in the treatment of gingival recession. Alloderm has been used as a substitute to connective tissue graft, but its colour match in populations with a high degree of melanin pigmentation has not been extensively studied. The aim of this study was to evaluate the effectiveness of an Acellular dermal matrix graft for root coverage procedures and to objectively analyze the post-operative esthetics using a Visual Analog Scale (VAS). Materials and Methods: Both male and female patients were selected, aged 20-50 years presenting with aesthetic problems due to the exposure of recession defects when smiling. A total of 14 patients contributed to 15 sites, each site falling into Miller's class I or class II gingival recession. Results: A total of 15 sites were treated and a mean coverage of (85.56±21.70 and 83.33±21.82%) was obtained at the end of 3rd and 12th month respectively. A mean VAS score of 7.93±1.03 and 8.13±0.99 (3rd and 12th month) and 5.73±0.70 and 6.87±0.83 (3rd and 12th month) was obtained when the colour match recorded by the patients and an independent observer, respectively. Conclusion: The study showed that acellular dermal matrix graft (alloderm) may be successfully used to treat gingival recession, as adequate root coverage may be predictably obtained. The grafted areas underwent melanization from the 6th month onwards and complete blending with the adjacent sites was obtained at 1 year. PMID:23055588

  16. Clinical evaluations for transfer of juveniles to criminal court: current practices and future research.

    PubMed

    Kruh, I P; Brodsky, S L

    1997-01-01

    Completing clinical evaluations of juveniles considered for transfer to criminal court requires specialized expertise. However, there is little empirical foundation upon which they can be based. Within each of the three major evaluation domains (amenability to treatment, risk for future violence, and sophistication/maturity), we ask the following questions: a) Can forensic examiners properly assess this area, and if so using what tools?; b) How can social science research clarify the transfer evaluation, particularly as it is impacted by systems issues?; and c) How should the evaluation be structured? In doing so, we review clinical suggestions for completing these evaluations and identify pertinent research directions. A number of general issues specific to these evaluations are also discussed.

  17. Clinical governance: the need for new directions in Canada: [includes principles to guide changes and evaluation].

    PubMed

    Carlow, Donald R

    2010-01-01

    As greater attention is paid to various facets of quality and safety within the Canadian healthcare system, it is important to understand the current state of clinical governance and clinical quality processes in Canada. Significant advances have been made internationally in understanding the important role of clinical governance in achieving quality and safety. It is clear, however, from various reports that major developments in clinical governance are needed if the quality and safety missions of governing boards of health authorities and other provincial and national bodies are to be achieved. In this paper, several key elements of an effective clinical governance system will be reviewed, some issues that characterize clinical governance in Canada will be raised and some principles that might help in evaluation and moving forward will be identified.

  18. A 3-Year Longitudinal Study of Risk for Bipolar Spectrum Psychopathology.

    PubMed

    Walsh, Molly A; DeGeorge, Daniella P; Barrantes-Vidal, Neus; Kwapil, Thomas R

    2015-08-01

    Current clinical and epidemiological research provides support for a continuum of bipolar psychopathology: a bipolar spectrum that ranges from subthreshold characteristics to clinical disorders. The present research examined risk for bipolar spectrum psychopathology at a 3-year follow-up assessment in a nonclinically ascertained sample of 112 young adults identified by the Hypomanic Personality Scale (HPS). Participants completed diagnostic interviews assessing bipolar psychopathology, borderline personality traits, substance use disorders, impulsivity, and psychosocial functioning. At the original assessment, 18 of the 112 participants met criteria for a bipolar spectrum disorder. At the follow-up, an additional 13 had developed bipolar spectrum disorders. A total of 58% of participants scoring in the upper quartile of the HPS qualified for bipolar spectrum disorders at the follow-up, including 27% with DSM–IV–TR disorders. The HPS predicted new cases and total number of cases of bipolar spectrum disorders, as well as total number of DSM–IV–TR bipolar disorders. The HPS also predicted hyperthymic temperament or history of hypomania, grandiose traits, impulsivity, substance use disorders, psychosocial impairment, and borderline traits. The majority of these effects were significant after removing participants with DSM–IV–TR bipolar disorders from the analyses, suggesting that the results were not driven by a subset of participants with clinical disorders. Overall, these results offer further support for the bipolar spectrum construct and the predictive validity of the HPS as a measure of bipolar spectrum psychopathology.

  19. Evaluating Dopamine Reward Pathway in ADHD; clinical implications

    SciTech Connect

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Wang, G.-J.; Kollins, S.H., Wigal, t.L.; Newcorn, J.H.; Telang, F.; Fowler, J.S.; Zhu, W.; Logan, J.; Ma, Y.; Pradhan, K.; Wong, C.T.; Swanson, J.M.

    2009-09-09

    Attention-deficit/hyperactivity disorder (ADHD) - characterized by symptoms of inattention and hyperactivity-impulsivity - is the most prevalent childhood psychiatric disorder that frequently persists into adulthood, and there is increasing evidence of reward-motivation deficits in this disorder. To evaluate biological bases that might underlie a reward/motivation deficit by imaging key components of the brain dopamine reward pathway (mesoaccumbens). We used positron emission tomography to measure dopamine synaptic markers (transporters and D{sub 2}/D{sub 3} receptors) in 53 nonmedicated adults with ADHD and 44 healthy controls between 2001-2009 at Brookhaven National Laboratory. We measured specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) using [{sup 11}C]cocaine and for D{sub 2}/D{sub 3} receptors using [{sup 11}C]raclopride, quantified as binding potential (distribution volume ratio -1). For both ligands, statistical parametric mapping showed that specific binding was lower in ADHD than in controls (threshold for significance set at P < .005) in regions of the dopamine reward pathway in the left side of the brain. Region-of-interest analyses corroborated these findings. The mean (95% confidence interval [CI] of mean difference) for DAT in the nucleus accumbens for controls was 0.71 vs 0.63 for those with ADHD (95% CI, 0.03-0.13, P = .004) and in the midbrain for controls was 0.16 vs 0.09 for those with ADHD (95% CI, 0.03-0.12; P {le} .001); for D{sub 2}/D{sub 3} receptors, the mean accumbens for controls was 2.85 vs 2.68 for those with ADHD (95% CI, 0.06-0.30, P = .004); and in the midbrain, it was for controls 0.28 vs 0.18 for those with ADHD (95% CI, 0.02-0.17, P = .01). The analysis also corroborated differences in the left caudate: the mean DAT for controls was 0.66 vs 0.53 for those with ADHD (95% CI, 0.04-0.22; P = .003) and the mean D{sub 2}/D{sub 3} for controls was 2.80 vs 2.47 for those with ADHD (95% CI, 0

  20. Iranian Effective Clinical Nurse Instructor evaluation tool: Development and psychometric testing

    PubMed Central

    Shahsavari, Hooman; Yekta, Zohreh Parsa; Zare, Zahra; Sigaroodi, Abdolhossain Emami

    2014-01-01

    Background: Clinical education is the heart of the nursing education program. Effective nursing clinical instructors are needed for graduating the future qualified nurses. There is a well-developed body of knowledge about the effectiveness of clinical teaching and the instructors. However, translating this knowledge into a context-based evaluation tool for measuring the effectiveness of Iranian clinical nursing instructors remains a deficiency. The purpose of this study is to describe the development and psychometric testing process of an instrument to evaluate the characteristics of Iranian effective clinical nurse instructor. Materials and Methods: Following a precise review of Iranian literatures and expert consultation, 83 statements about the characteristics that make clinical nurse instructors effective were extracted. In the next phase, the psychometric properties of the instrument were established by looking at the content validity, face validity, and internal consistency. Content validity of the instrument was assessed based on the comments of an expert panel including 10 nursing faculty members. During this phase, 30 items of the instrument were omitted or merged. Face validity of the instrument was assured based on the advices of 10 nursing students and 10 nursing faculty members. Finally, in the pilot test, the data of 168 filled questionnaires were gathered and analyzed by an exploratory factor analysis to reduce the items and identify the factor structure of the instrument. Results: Through subsequent analyses, of the 83 items, 31 items were merged or omitted. At last, 52 retained items were divided into four subscales including student-centric behaviors, clinical performances, planning ability, and personality traits. The Cronbach's alpha level of the inventory was 0.96, with the value for each domain ranging from 0.87 to 0.94. Conclusions: Iranian Effective Clinical Nurse Instructor evaluation tool has acceptable psychometric properties and can be

  1. Evaluation of a cloud-based local-read paradigm for imaging evaluations in oncology clinical trials for lung cancer

    PubMed Central

    Kobayashi, Naomi; Bonnard, Eric; Charbonnier, Colette; Yamamichi, Junta; Mizobe, Hideaki; Kimura, Shinya

    2015-01-01

    Background Although tumor response evaluated with radiological imaging is frequently used as a primary endpoint in clinical trials, it is difficult to obtain precise results because of inter- and intra-observer differences. Purpose To evaluate usefulness of a cloud-based local-read paradigm implementing software solutions that standardize imaging evaluations among international investigator sites for clinical trials of lung cancer. Material and Methods Two studies were performed: KUMO I and KUMO I Extension. KUMO I was a pilot study aiming at demonstrating the feasibility of cloud implementation and identifying issues regarding variability of evaluations among sites. Chest CT scans at three time-points from baseline to progression, from 10 patients with lung cancer who were treated with EGFR tyrosine kinase inhibitors, were evaluated independently by two oncologists (Japan) and one radiologist (France), through a cloud-based software solution. The KUMO I Extension was performed based on the results of KUMO I. Results KUMO I showed discordance rates of 40% for target lesion selection, 70% for overall response at the first time-point, and 60% for overall response at the second time-point. Since the main reason for the discordance was differences in the selection of target lesions, KUMO I Extension added a cloud-based quality control service to achieve a consensus on the selection of target lesions, resulting in an improved rate of agreement of response evaluations. Conclusion The study shows the feasibility of imaging evaluations at investigator sites, based on cloud services for clinical studies involving multiple international sites. This system offers a step forward in standardizing evaluations of images among widely dispersed sites. PMID:26668754

  2. Evaluation of the Mayo Clinic Phenotype-Based Genotype Predictor Score in Patients with Clinically Diagnosed Hypertrophic Cardiomyopathy.

    PubMed

    Murphy, Sinead L; Anderson, Jason H; Kapplinger, Jamie D; Kruisselbrink, Teresa M; Gersh, Bernard J; Ommen, Steve R; Ackerman, Michael J; Bos, J Martijn

    2016-04-01

    Genetic testing for hypertrophic cardiomyopathy (HCM) can provide an important clinical marker for disease outcome and family screening. This study set out to validate our recently developed phenotype-based HCM genotype predictor score. Patients clinically diagnosed with HCM and evaluated by genetic counselors comprised the study cohort. Genotype score was derived based on clinical and echocardiographic variables. Total score was correlated with the yield of genetic testing. Of 564 HCM patients, 198 sought genetic testing (35 %; 55 % male; mean age at diagnosis, 50 ± 20 years). Of these, 101 patients (51 %) were genotype positive for a HCM-associated genetic mutation (55 % male; mean age at diagnosis, 42 ± 18 years). Cochran-Armitage analysis showed similar, statistically significant trends of increased yields for higher genotype scores for both the original and study cohort. Validated by the current study, this scoring system provides an easy-to-use, clinical tool to aid in determining the likelihood of a positive HCM genetic test. PMID:26914223

  3. Evaluation of the Mayo Clinic Phenotype-Based Genotype Predictor Score in Patients with Clinically Diagnosed Hypertrophic Cardiomyopathy

    PubMed Central

    Murphy, Sinead L.; Anderson, Jason H.; Kapplinger, Jamie D.; Kruisselbrink, Teresa M.; Gersh, Bernard J.; Ommen, Steve R.; Ackerman, Michael J.; Bos, J. Martijn

    2016-01-01

    Genetic testing for hypertrophic cardiomyopathy (HCM) can provide an important clinical marker for disease outcome and family screening. This study set out to validate our recently developed phenotype-based HCM genotype predictor score. Patients clinically diagnosed with HCM and evaluated by genetic counselors comprised the study cohort. Genotype score was derived based on clinical and echocardio-graphic variables. Total score was correlated with the yield of genetic testing. Of 564 HCM patients, 198 sought genetic testing (35 %; 55 % male; mean age at diagnosis, 50 ±20 years). Of these, 101 patients (51 %) were genotype positive for a HCM-associated genetic mutation (55 % male; mean age at diagnosis, 42 ± 18 years). Cochran-Armitage analysis showed similar, statistically significant trends of increased yields for higher genotype scores for both the original and study cohort. Validated by the current study, this scoring system provides an easy-to-use, clinical tool to aid in determining the likelihood of a positive HCM genetic test. PMID:26914223

  4. Participation in clinical supervision (PACS): an evaluation of student nurse clinical supervision facilitated by mental health service users.

    PubMed

    Maplethorpe, Fran; Dixon, Julie; Rush, Brenda

    2014-03-01

    This paper discusses an innovative learning approach in which people having experience of mental health services facilitated humanistic clinical supervision with groups of student nurses in the classroom. A four-day course of preparation for the role of supervisor is described and the results of subsequent clinical supervision sessions are analysed. Seven service users who had previous experience of teaching students in the classroom and fifty students on a Diploma/BSc in mental health nursing course participated in the project, which was evaluated through focus groups. The results indicated that the service user supervisors appreciated the skills they had gained on the course and felt that they were more appropriate than lecturers to facilitate clinical supervision sessions. Some students expressed initial uncertainty about the appropriateness of service users as supervisors but as changes to the pedagogical process of supervision were made and the supervisors gained more experience and confidence, students expressed greater satisfaction. The authors conclude that clinical supervision facilitated by service users who have preparation and continual support can add considerable value to the learning experience of student nurses. PMID:23981566

  5. Recognition and Evaluation of Clinical Section Headings in Clinical Documents Using Token-Based Formulation with Conditional Random Fields.

    PubMed

    Dai, Hong-Jie; Syed-Abdul, Shabbir; Chen, Chih-Wei; Wu, Chieh-Chen

    2015-01-01

    Electronic health record (EHR) is a digital data format that collects electronic health information about an individual patient or population. To enhance the meaningful use of EHRs, information extraction techniques have been developed to recognize clinical concepts mentioned in EHRs. Nevertheless, the clinical judgment of an EHR cannot be known solely based on the recognized concepts without considering its contextual information. In order to improve the readability and accessibility of EHRs, this work developed a section heading recognition system for clinical documents. In contrast to formulating the section heading recognition task as a sentence classification problem, this work proposed a token-based formulation with the conditional random field (CRF) model. A standard section heading recognition corpus was compiled by annotators with clinical experience to evaluate the performance and compare it with sentence classification and dictionary-based approaches. The results of the experiments showed that the proposed method achieved a satisfactory F-score of 0.942, which outperformed the sentence-based approach and the best dictionary-based system by 0.087 and 0.096, respectively. One important advantage of our formulation over the sentence-based approach is that it presented an integrated solution without the need to develop additional heuristics rules for isolating the headings from the surrounding section contents. PMID:26380302

  6. Red blood cell distribution width and 3-year outcome in patients undergoing cardiac catheterization.

    PubMed

    Arbel, Yaron; Birati, Edo Y; Finkelstein, Ariel; Halkin, Amir; Berliner, Shlomo; Katz, Ben-Zion; Revivo, Miri; Saranga, Hila; Herz, Itzhak; Keren, Gad; Banai, Shmuel

    2014-05-01

    Red blood cell distribution width (RDW), which is routinely reported in complete blood counts, is a measure of the variability in size of circulating erythrocytes. RDW is a novel, independent predictor of prognosis in patients with cardiovascular diseases. The aim of the present study was to evaluate the significance of this biomarker in a relatively large cohort of patients, and to assess its association with a more severe underlying cardiovascular disease. A cohort of 3,222 consecutive patients undergoing coronary angiography was divided according RDW median. The association between RDW and 3-year outcome in the context of other predictors was assessed using Cox's proportional hazards analysis. Patients with elevated RDWs were older, had higher body mass indices, and had more cardiovascular risk factors and more cardiovascular diseases. The total rate of mortality, MI and stroke (MACE) was 7.7% (120 events) in the lower RDW group, and 18.2% (303 events) in the higher RDW group, p < 0.001. Following adjustment for multiple background risk factors, medications, and laboratory results, the RDW value was independently associated with worse outcome (HR = 1.12, 95% CI 1.07-1.18, p < 0.001, for each 1% increase in RDW). Elevated RDW values are independently associated with adverse 3-year outcome in patients undergoing coronary angiography. PMID:23836454

  7. [Impact on evaluation of clinical efficacy of traditional Chinese medicine for level in soft targets of processing technology].

    PubMed

    Shao, Ming-Yi; Wei, Ming; Yan, Bo-Hua

    2014-04-01

    Traditional Chinese medicine (TCM) is a very practical subject, which has its unique theoretical system and clinical characteristics. In the course of clinical practice, the exact clinical efficacy is the key of existence and development. But the existing evaluation system is difficult to objectively evaluate the clinical efficacy of TCM. Therefore, how to objectively evaluate the clinical efficacy and get definitive evidence is the focus of the evaluation of clinical efficacy of TCM. Relative to modern medicine, TCM is more concerned about the changes of feelings and clinical symptoms of the patient in the course of the evolution of the disease. Soft targets mainly used for the evaluation of the clinical efficacy of symptoms and functional activity of the disease. The level in soft targets of processing technology is often used methods in clinical evaluation. But it has often produced the phenomenon which the results of the evaluation is mutual contradiction, which will ultimately affect the effect of evaluation of clinical efficacy of TCM. In order to better evaluate the clinical efficacy of TCM, in the process of adoption of soft targets, it clearly identify it's role, highlighting the characteristics of interventions on disease, and as much as possibly avoid the level in soft targets of processing technology to real assess clinical efficacy of TCM.

  8. A framework to support preceptors' evaluation and development of new nurses' clinical judgment.

    PubMed

    Nielsen, Ann; Lasater, Kathie; Stock, Mary

    2016-07-01

    In today's complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates' learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses' clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice. PMID:27428698

  9. Evaluating research for clinical significance: using critically appraised topics to enhance evidence-based neuropsychology.

    PubMed

    Bowden, Stephen C; Harrison, Elise J; Loring, David W

    2014-01-01

    Meehl's (1973, Psychodiagnosis: Selected papers. Minneapolis: University of Minnesota Press) distinction between statistical and clinical significance holds special relevance for evidence-based neuropsychological practice. Meehl argued that despite attaining statistical significance, many published findings have limited practical value since they do not inform clinical care. In the context of an ever expanding clinical research literature, accessible methods to evaluate clinical impact are needed. The method of Critically Appraised Topics (Straus, Richardson, Glasziou, & Haynes, 2011, Evidence-based medicine: How to practice and teach EBM (4th ed.). Edinburgh: Elsevier Churchill-Livingstone) was developed to provide clinicians with a "toolkit" to facilitate implementation of evidence-based practice. We illustrate the Critically Appraised Topics method using a dementia screening example. We argue that the skills practiced through critical appraisal provide clinicians with methods to: (1) evaluate the clinical relevance of new or unfamiliar research findings with a focus on patient benefit, (2) help focus of research quality, and (3) incorporate evaluation of clinical impact into educational and professional development activities.

  10. [Evaluation of secondary care in oral health: a study of specialty clinics in Brazil].

    PubMed

    Goes, Paulo Sávio Angeiras de; Figueiredo, Nilcema; Neves, Jerlucia Cavalcanti das; Silveira, Fabiana Moura da Motta; Costa, José Felipe Riani; Pucca Júnior, Gilberto Alfredo; Rosales, Maritza Sosa

    2012-01-01

    This article discusses the evaluation of secondary care in the area of health surveillance. This was a descriptive and normative/evaluative study. Performance analysis drew on secondary data, based on a historical series of dental procedures conducted at the specialized dental clinics implemented in Brazil and recorded by the Outpatient Information System of the Unified National Health System (SIA/SUS) in 2007, as well as primary data from site visits to the clinics, based on questionnaires completed by clinic staff. Performance of the clinics was poor in most regions of the country, and the North of Brazil had the lowest percentage of specialty services implemented. The indicator "Performance of Secondary Care in Oral Health" was 64.4%. The type 3 specialty clinics showed better results in terms of performance and achievement of targets. The study showed the need to review the legal framework for implementing specialized dental clinics by adjusting the criteria and norms, as well as definition of new standards for achievement of goals in the evaluation and monitoring of these services.

  11. STP Best Practices for Evaluating Clinical Pathology in Pharmaceutical Recovery Studies.

    PubMed

    Tomlinson, Lindsay; Ramaiah, Lila; Tripathi, Niraj K; Barlow, Valerie G; Vitsky, Allison; Poitout-Belissent, Florence M; Bounous, Denise I; Ennulat, Daniela

    2016-02-01

    The Society of Toxicologic Pathology formed a working group in collaboration with the American Society for Veterinary Clinical Pathology to provide recommendations for the appropriate inclusion of clinical pathology evaluation in recovery arms of nonclinical toxicity studies but not on when to perform recovery studies. Evaluation of the recovery of clinical pathology findings is not required routinely but provides useful information on risk assessment in nonclinical toxicity studies and is recommended when the ability of the organ to recover is uncertain. The study design generally requires inclusion of concurrent controls to separate procedure-related changes from test article-related changes, but return of clinical pathology values toward baseline may be sufficient in some cases. Evaluation of either a select or full panel of standard hematology, coagulation, and serum and urine chemistry biomarkers can be scientifically justified. It is also acceptable to redesignate dosing phase animals to the recovery phase or vice versa to optimize data interpretation. Assessment of delayed toxicity during the recovery phase is not required but may be appropriate in development programs with unique concerns. Evaluation of the recovery of clinical pathology data for vaccine development is required and, for efficacy markers, is recommended if it furthers pharmacologic understanding.

  12. [Development and Quality Evaluation of Evidence-based Clinical Practice Guidelines of Chinese Medicine].

    PubMed

    Jiang, Yue-rong; Chen, Ke-ji

    2016-01-01

    More attentions have been paid to the development of evidence-based clinical practice guidelines (ECPGs) of Chinese medicine (CM). International guideline evaluation instruments such as Appraisal of Guidelines for Research and Evaluation (AGREE I) has been gradually applied in ECPGs quality evaluation of CM. Nowadays, there are some certain methodological defects in partial ECPGs of Chinese medicine, with relatively low applicability and slowly update. It is suggested to establish technical specifications of CM-ECPGs in accordance with the characteristics of CM and international general specification, strengthen the quality evaluation of CM-ECPGs, attach great importance to the regularly update as well as popularization and application of CM-ECPGs.

  13. Severely dry skin: clinical evaluation of a highly effective therapeutic lotion.

    PubMed

    Kantor, I; Ballinger, W G; Savin, R C

    1982-09-01

    Four clinical studies are presented on a recently introduced therapeutic lotion for severely dry skin. Two monadic single-blind efficacy studies showed that hands of subjects treated with the product (Lotion V) were significantly improved over untreated hands. Following the completion of a regression study, two subsequent double-blind comparative studies showed Lotion V to be significantly more effective than a well-established therapeutic lotion (Lotion K) for certain major signs and symptoms of dry skin. Results were derived from both objective clinical evaluation by investigating dermatologists and subjective evaluation by participating volunteers.

  14. Evaluation of a clinical simulation-based assessment method for EHR-platforms.

    PubMed

    Jensen, Sanne; Rasmussen, Stine Loft; Lyng, Karen Marie

    2014-01-01

    In a procurement process assessment of issues like human factors and interaction between technology and end-users can be challenging. In a large public procurement of an Electronic health record-platform (EHR-platform) in Denmark a clinical simulation-based method for assessing and comparing human factor issues was developed and evaluated. This paper describes the evaluation of the method, its advantages and disadvantages. Our findings showed that clinical simulation is beneficial for assessing user satisfaction, usefulness and patient safety, all though it is resource demanding. The method made it possible to assess qualitative topics during the procurement and it provides an excellent ground for user involvement.

  15. Evaluation of a clinical simulation-based assessment method for EHR-platforms.

    PubMed

    Jensen, Sanne; Rasmussen, Stine Loft; Lyng, Karen Marie

    2014-01-01

    In a procurement process assessment of issues like human factors and interaction between technology and end-users can be challenging. In a large public procurement of an Electronic health record-platform (EHR-platform) in Denmark a clinical simulation-based method for assessing and comparing human factor issues was developed and evaluated. This paper describes the evaluation of the method, its advantages and disadvantages. Our findings showed that clinical simulation is beneficial for assessing user satisfaction, usefulness and patient safety, all though it is resource demanding. The method made it possible to assess qualitative topics during the procurement and it provides an excellent ground for user involvement. PMID:25160323

  16. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

    NASA Astrophysics Data System (ADS)

    Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

    2013-07-01

    The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

  17. Acute Undifferentiated Febrile Illness in Rural Cambodia: A 3-Year Prospective Observational Study

    PubMed Central

    Mueller, Tara C.; Siv, Sovannaroth; Khim, Nimol; Kim, Saorin; Fleischmann, Erna; Ariey, Frédéric; Buchy, Philippe; Guillard, Bertrand; González, Iveth J.; Christophel, Eva-Maria; Abdur, Rashid; von Sonnenburg, Frank; Bell, David; Menard, Didier

    2014-01-01

    In the past decade, malaria control has been successfully implemented in Cambodia, leading to a substantial decrease in reported cases. Wide-spread use of malaria rapid diagnostic tests (RDTs) has revealed a large burden of malaria-negative fever cases, for which no clinical management guidelines exist at peripheral level health facilities. As a first step towards developing such guidelines, a 3-year cross-sectional prospective observational study was designed to investigate the causes of acute malaria-negative febrile illness in Cambodia. From January 2008 to December 2010, 1193 febrile patients and 282 non-febrile individuals were recruited from three health centers in eastern and western Cambodia. Malaria RDTs and routine clinical examination were performed on site by health center staff. Venous samples and nasopharyngeal throat swabs were collected and analysed by molecular diagnostic tests. Blood cultures and blood smears were also taken from all febrile individuals. Molecular testing was applied for malaria parasites, Leptospira, Rickettsia, O. tsutsugamushi, Dengue- and Influenza virus. At least one pathogen was identified in 73.3% (874/1193) of febrile patient samples. Most frequent pathogens detected were P. vivax (33.4%), P. falciparum (26.5%), pathogenic Leptospira (9.4%), Influenza viruses (8.9%), Dengue viruses (6.3%), O. tsutsugamushi (3.9%), Rickettsia (0.2%), and P. knowlesi (0.1%). In the control group, a potential pathogen was identified in 40.4%, most commonly malaria parasites and Leptospira. Clinic-based diagnosis of malaria RDT-negative cases was poorly predictive for pathogen and appropriate treatment. Additional investigations are needed to understand their impact on clinical disease and epidemiology, and the possible role of therapies such as doxycycline, since many of these pathogens were seen in non-febrile subjects. PMID:24755844

  18. Acute undifferentiated febrile illness in rural Cambodia: a 3-year prospective observational study.

    PubMed

    Mueller, Tara C; Siv, Sovannaroth; Khim, Nimol; Kim, Saorin; Fleischmann, Erna; Ariey, Frédéric; Buchy, Philippe; Guillard, Bertrand; González, Iveth J; Christophel, Eva-Maria; Abdur, Rashid; von Sonnenburg, Frank; Bell, David; Menard, Didier

    2014-01-01

    In the past decade, malaria control has been successfully implemented in Cambodia, leading to a substantial decrease in reported cases. Wide-spread use of malaria rapid diagnostic tests (RDTs) has revealed a large burden of malaria-negative fever cases, for which no clinical management guidelines exist at peripheral level health facilities. As a first step towards developing such guidelines, a 3-year cross-sectional prospective observational study was designed to investigate the causes of acute malaria-negative febrile illness in Cambodia. From January 2008 to December 2010, 1193 febrile patients and 282 non-febrile individuals were recruited from three health centers in eastern and western Cambodia. Malaria RDTs and routine clinical examination were performed on site by health center staff. Venous samples and nasopharyngeal throat swabs were collected and analysed by molecular diagnostic tests. Blood cultures and blood smears were also taken from all febrile individuals. Molecular testing was applied for malaria parasites, Leptospira, Rickettsia, O. tsutsugamushi, Dengue- and Influenza virus. At least one pathogen was identified in 73.3% (874/1193) of febrile patient samples. Most frequent pathogens detected were P. vivax (33.4%), P. falciparum (26.5%), pathogenic Leptospira (9.4%), Influenza viruses (8.9%), Dengue viruses (6.3%), O. tsutsugamushi (3.9%), Rickettsia (0.2%), and P. knowlesi (0.1%). In the control group, a potential pathogen was identified in 40.4%, most commonly malaria parasites and Leptospira. Clinic-based diagnosis of malaria RDT-negative cases was poorly predictive for pathogen and appropriate treatment. Additional investigations are needed to understand their impact on clinical disease and epidemiology, and the possible role of therapies such as doxycycline, since many of these pathogens were seen in non-febrile subjects.

  19. Long-term drug treatment of benign prostatic hyperplasia - results of a prospective 3-year multicenter study using Sabal extract IDS 89.

    PubMed

    Bach, D; Ebeling, L

    1996-09-01

    A 3-year prospective multicenter study on Sabal extract IDS 89 was carried out to evaluate its potential and limitations as phytotherapy in the treatment of benign prostatic hyperplasia (BPH). The results obtained from 435 patients confirm its sustained therapeutic efficacy. A marked symptomatic improvement, that included a 50% reduction in residual urine and a 6.1 ml/sec increase in peak urinary flow rate due to therapy was observed. Both physicians and patients voted its efficacy as good or very good in over 80% of the cases, and the drug was well tolerated by 98% of the patients. The clinical status of BPH and thus the quality of life of 4 out of 5 patients was markedly improved by long-term IDS 89 therapy. Furthermore, the deterioration rate at the end of the 3-year treatment period was significantly lower than in untreated BPH subjects. It is therefore concluded that long-term IDS 89 therapy can also reduce the incidence of surgery.

  20. A Quantitative and Qualitative Evaluation of Sentence Boundary Detection for the Clinical Domain

    PubMed Central

    Griffis, Denis; Shivade, Chaitanya; Fosler-Lussier, Eric; Lai, Albert M.

    2016-01-01

    Sentence boundary detection (SBD) is a critical preprocessing task for many natural language processing (NLP) applications. However, there has been little work on evaluating how well existing methods for SBD perform in the clinical domain. We evaluate five popular off-the-shelf NLP toolkits on the task of SBD in various kinds of text using a diverse set of corpora, including the GENIA corpus of biomedical abstracts, a corpus of clinical notes used in the 2010 i2b2 shared task, and two general-domain corpora (the British National Corpus and Switchboard). We find that, with the exception of the cTAKES system, the toolkits we evaluate perform noticeably worse on clinical text than on general-domain text. We identify and discuss major classes of errors, and suggest directions for future work to improve SBD methods in the clinical domain. We also make the code used for SBD evaluation in this paper available for download at http://github.com/drgriffis/SBD-Evaluation. PMID:27570656

  1. A Quantitative and Qualitative Evaluation of Sentence Boundary Detection for the Clinical Domain.

    PubMed

    Griffis, Denis; Shivade, Chaitanya; Fosler-Lussier, Eric; Lai, Albert M

    2016-01-01

    Sentence boundary detection (SBD) is a critical preprocessing task for many natural language processing (NLP) applications. However, there has been little work on evaluating how well existing methods for SBD perform in the clinical domain. We evaluate five popular off-the-shelf NLP toolkits on the task of SBD in various kinds of text using a diverse set of corpora, including the GENIA corpus of biomedical abstracts, a corpus of clinical notes used in the 2010 i2b2 shared task, and two general-domain corpora (the British National Corpus and Switchboard). We find that, with the exception of the cTAKES system, the toolkits we evaluate perform noticeably worse on clinical text than on general-domain text. We identify and discuss major classes of errors, and suggest directions for future work to improve SBD methods in the clinical domain. We also make the code used for SBD evaluation in this paper available for download at http://github.com/drgriffis/SBD-Evaluation. PMID:27570656

  2. Rates of mutation and host transmission for an Escherichia coli clone over 3 years.

    PubMed

    Reeves, Peter R; Liu, Bin; Zhou, Zhemin; Li, Dan; Guo, Dan; Ren, Yan; Clabots, Connie; Lan, Ruiting; Johnson, James R; Wang, Lei

    2011-01-01

    Although over 50 complete Escherichia coli/Shigella genome sequences are available, it is only for closely related strains, for example the O55:H7 and O157:H7 clones of E. coli, that we can assign differences to individual evolutionary events along specific lineages. Here we sequence the genomes of 14 isolates of a uropathogenic E. coli clone that persisted for 3 years within a household, including a dog, causing a urinary tract infection (UTI) in the dog after 2 years. The 20 mutations observed fit a single tree that allows us to estimate the mutation rate to be about 1.1 per genome per year, with minimal evidence for adaptive change, including in relation to the UTI episode. The host data also imply at least 6 host transfer events over the 3 years, with 2 lineages present over much of that period. To our knowledge, these are the first direct measurements for a clone in a well-defined host community that includes rates of mutation and host transmission. There is a concentration of non-synonymous mutations associated with 2 transfers to the dog, suggesting some selection pressure from the change of host. However, there are no changes to which we can attribute the UTI event in the dog, which suggests that this occurrence after 2 years of the clone being in the household may have been due to chance, or some unknown change in the host or environment. The ability of a UTI strain to persist for 2 years and also to transfer readily within a household has implications for epidemiology, diagnosis, and clinical intervention.

  3. Technology-Assisted Patient Access to Clinical Information: An Evaluation Framework for Blue Button

    PubMed Central

    Nazi, Kim M; Luger, Tana M; Amante, Daniel J; Smith, Bridget M; Barker, Anna; Shimada, Stephanie L; Volkman, Julie E; Garvin, Lynn; Simon, Steven R; Houston, Thomas K

    2014-01-01

    Background Patient access to clinical information represents a means to improve the transparency and delivery of health care as well as interactions between patients and health care providers. We examine the movement toward augmenting patient access to clinical information using technology. Our analysis focuses on “Blue Button,” a tool that many health care organizations are implementing as part of their Web-based patient portals. Objective We present a framework for evaluating the effects that technology-assisted access to clinical information may have on stakeholder experiences, processes of care, and health outcomes. Methods A case study of the United States Department of Veterans Affairs' (VA) efforts to make increasing amounts of clinical information available to patients through Blue Button. Drawing on established collaborative relationships with researchers, clinicians, and operational partners who are engaged in the VA’s ongoing implementation and evaluation efforts related to Blue Button, we assessed existing evidence and organizational practices through key informant interviews, review of documents and other available materials, and an environmental scan of published literature and the websites of other health care organizations. Results Technology-assisted access to clinical information represents a significant advance for VA patients and marks a significant change for the VA as an organization. Evaluations of Blue Button should (1) consider both processes of care and outcomes, (2) clearly define constructs of focus, (3) examine influencing factors related to the patient population and clinical context, and (4) identify potential unintended consequences. Conclusions The proposed framework can serve as a roadmap to guide subsequent research and evaluation of technology-assisted patient access to clinical information. To that end, we offer a series of related recommendations. PMID:24675395

  4. Development of a New O&M Clinical Competency Evaluation Tool and Examination of Validity and Reliability Evidence

    ERIC Educational Resources Information Center

    Renshaw, Rebecca L.

    2010-01-01

    The goal of this study was to create an evaluation tool that would be the new standard for evaluating clinical competencies of interns in the field of orientation and mobility (O&M). Using results from previous research in this area, specific competency skills were identified and the O&M Clinical Competency Evaluation Matrix (CCEM) was developed.…

  5. Integrating economic evaluation methods into clinical and translational science award consortium comparative effectiveness educational goals.

    PubMed

    Iribarne, Alexander; Easterwood, Rachel; Russo, Mark J; Wang, Y Claire

    2011-06-01

    With the ongoing debate over health care reform in the United States, public health and policy makers have paid growing attention to the need for comparative effectiveness research (CER). Recent allocation of federal funds for CER represents a significant move toward increased evidence-based practice and better-informed allocation of constrained health care resources; however, there is also heated debate on how, or whether, CER may contribute to controlling national health care expenditures. Economic evaluation, in the form of cost-effectiveness or cost-benefit analysis, is often an aspect of CER studies, yet there are no recommendations or guidelines for providing clinical investigators with the necessary skills to collect, analyze, and interpret economic data from clinical trials or observational studies. With an emphasis on multidisciplinary research, the Clinical and Translational Science Award (CTSA) consortium and institutional CTSA sites serve as an important resource for training researchers to engage in CER. In this article, the authors discuss the potential role of CTSA sites in integrating economic evaluation methods into their comparative effectiveness education goals, using the Columbia University Medical Center CTSA as an example. By allowing current and future generations of clinical investigators to become fully engaged not only in CER but also in the economic evaluations that result from such analyses, CTSA sites can help develop the necessary foundation for advancing research to guide clinical decision making and efficient use of limited resources.

  6. Clinical evaluation tools: a survey of doctors of chiropractic and students at one chiropractic college

    PubMed Central

    Mansholt, Barbara A.; Vining, Robert D.

    2016-01-01

    Introduction: The reliability and validity of many evaluation tools leading to clinical decision-making for spinal manipulation are varied. We surveyed senior students and DC employees at one chiropractic college regarding 1) which analysis tools should be used and 2) factors that influence their choices. Methods: The survey queried which tools should be used on a routine patient encounter. Clinical evaluation tools included palpation, skin temperature analysis, leg length analysis, and radiographs. Results: Surveys were collected from 58 doctors of chiropractic (DCs) and 74 students. Respondents from both groups reported to most commonly use static palpation, followed by motion palpation and leg length analysis. DC respondents ranked evidence and personal experience high for rationale; student respondents frequently chose patient preference. Conclusion: DC and student respondents reported use of clinical evaluation tools consistently. However, some variations in rationale were noted. It is important for educators to provide a balanced presentation of the strengths and limitations of clinical analysis procedures to support the development of well-justified evidence-based clinical decision-making skills. PMID:27069264

  7. The Alpha Stem Cell Clinic: A Model for Evaluating and Delivering Stem Cell-Based Therapies

    PubMed Central

    DeWitt, Natalie D.; Feigal, Ellen G.

    2012-01-01

    Summary Cellular therapies require the careful preparation, expansion, characterization, and delivery of cells in a clinical environment. There are major challenges associated with the delivery of cell therapies and high costs that will limit the companies available to fully evaluate their merit in clinical trials, and will handicap their application at the present financial environment. Cells will be manufactured in good manufacturing practice or near-equivalent facilities with prerequisite safety practices in place, and cell delivery systems will be specialized and require well-trained medical and nursing staff, technicians or nurses trained to handle cells once delivered, patient counselors, as well as statisticians and database managers who will oversee the monitoring of patients in relatively long-term follow-up studies. The model proposed for Alpha Stem Cell Clinics will initially use the capacities and infrastructure that exist in the most advanced tertiary medical clinics for delivery of established bone marrow stem cell therapies. As the research evolves, they will incorporate improved procedures and cell preparations. This model enables commercialization of medical devices, reagents, and other products required for cell therapies. A carefully constructed cell therapy clinical infrastructure with the requisite scientific, technical, and medical expertise and operational efficiencies will have the capabilities to address three fundamental and critical functions: 1) fostering clinical trials; 2) evaluating and establishing safe and effective therapies, and 3) developing and maintaining the delivery of therapies approved by the Food and Drug Administration, or other regulatory agencies. PMID:23197634

  8. A CIS (Clinical Information System) Quality Evaluation Tool for Nursing Care Services

    ERIC Educational Resources Information Center

    Lee, Seon Ah

    2010-01-01

    The purpose of this study was to develop a tool to evaluate the quality of a clinical information system (CIS) conceived by nurses and conduct a pilot test with the developed tool as an initial assessment. CIS quality is required for successful implementation in information technology (IT) environments. The study started with the realization that…

  9. The McCarron-Dial System--An Approach to Clinical, Vocational, and Educational Evaluation.

    ERIC Educational Resources Information Center

    Dial, Jack G.; And Others

    The McCarron-Dial System is useful for both vocational and clinical evaluation of neuropsychologically disabled adults. Five factors (verbal-cognitive, sensory, motor, emotional, and integration coping) are used to predict vocational competency, which is measured by work samples and behavior scales, during the first twelve months of a client's…

  10. 75 FR 81611 - Submission for OMB Review; Comment Request; National Evaluation of the Clinical and Translational...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-28

    ... Translational Science Awards (CTSA) Initiative SUMMARY: Under the provisions of Section 3507(a)(1)(D) of the... National Evaluation of the Clinical and Translational Science Awards (CTSA) Initiative. Type of Information... science or laboratory discoveries to become treatments for patients, and for those treatments in turn...

  11. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Active monitoring of conduct and evaluation of clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... to Treat Life-threatening and Severely-debilitating Illnesses § 312.87 Active monitoring of...

  12. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Active monitoring of conduct and evaluation of clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... to Treat Life-threatening and Severely-debilitating Illnesses § 312.87 Active monitoring of...

  13. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Active monitoring of conduct and evaluation of clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... to Treat Life-threatening and Severely-debilitating Illnesses § 312.87 Active monitoring of...

  14. 21 CFR 312.87 - Active monitoring of conduct and evaluation of clinical trials.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Active monitoring of conduct and evaluation of clinical trials. 312.87 Section 312.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH... to Treat Life-threatening and Severely-debilitating Illnesses § 312.87 Active monitoring of...

  15. [Establish research model of post-marketing clinical safety evaluation for Chinese patent medicine].

    PubMed

    Zheng, Wen-ke; Liu, Zhi; Lei, Xiang; Tian, Ran; Zheng, Rui; Li, Nan; Ren, Jing-tian; Du, Xiao-xi; Shang, Hong-cai

    2015-09-01

    The safety of Chinese patent medicine has become a focus of social. It is necessary to carry out work on post-marketing clinical safety evaluation for Chinese patent medicine. However, there have no criterions to guide the related research, it is urgent to set up a model and method to guide the practice for related research. According to a series of clinical research, we put forward some views, which contained clear and definite the objective and content of clinical safety evaluation, the work flow should be determined, make a list of items for safety evaluation project, and put forward the three level classification of risk control. We set up a model of post-marketing clinical safety evaluation for Chinese patent medicine. Based this model, the list of items can be used for ranking medicine risks, and then take steps for different risks, aims to lower the app:ds:risksrisk level. At last, the medicine can be managed by five steps in sequence. The five steps are, collect risk signal, risk recognition, risk assessment, risk management, and aftereffect assessment. We hope to provide new ideas for the future research. PMID:26983223

  16. An Antipodean Evaluation of Problem-Based Learning by Clinical Educators.

    ERIC Educational Resources Information Center

    Williams, Allison F.

    1999-01-01

    The use of problem-based learning in an Australian nursing education program was evaluated through interviews with 14 clinical teachers. They saw improvement in students' self-direction and holistic views of patients, but felt students lacked psychomotor skills and fundamental knowledge of anatomy and physiology. (SK)

  17. Clinical evaluation of a type III secretion system real-time PCR assay for diagnosing melioidosis.

    PubMed

    Meumann, Ella M; Novak, Ryan T; Gal, Daniel; Kaestli, Mirjam E; Mayo, Mark; Hanson, Joshua P; Spencer, Emma; Glass, Mindy B; Gee, Jay E; Wilkins, Patricia P; Currie, Bart J

    2006-08-01

    A Burkholderia pseudomallei type III secretion system real-time PCR assay was evaluated on clinical specimens in a region where melioidosis is endemic. The PCR was positive in 30/33 (91%) patients with culture-confirmed melioidosis. All six patients with melioidosis septic shock were blood PCR positive, suggesting potential for rapid diagnosis and commencement of appropriate therapy.

  18. Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice

    PubMed Central

    Mosca, M.; Tani, C.; Aringer, M.; Bombardieri, S.; Boumpas, D.; Cervera, R.; Doria, A.; Jayne, D.; Khamashta, M. A.; Kuhn, A.; Gordon, C.; Petri, M.; Schneider, M.; Shoenfeld, Y.; Smolen, J. S.; Talarico, R.; Tincani, A.; Ward, M. M.; Werth, V. P.; Carmona, L.

    2014-01-01

    The assessment of systemic lupus erythematosus (SLE) patients in routine clinical practice is mainly based on the experience of the treating physician. This carries the risk of unwanted variability. Variability may have an impact on the quality of care offered to SLE patients, thereby affecting outcomes. Recommendations represent systematically developed statements to help practitioners in reducing variability. However, major difficulties arise in the application of recommendations into clinical practice. In this respect, the use of quality indicators may raise the awareness among rheumatologists regarding potential deficiencies in services and improve the quality of health care. The aim of this study was to develop a set of quality indicators (QI) for SLE by translating into QIs the recently developed EULAR Recommendations for monitoring SLE patients in routine clinical practice and observational studies. Eleven QIs have been developed referring to the use of validated activity and damage indices in routine clinical practice, general evaluation of drug toxicity, evaluation of comorbidities, eye evaluation, laboratory assessment, evaluation of the presence of chronic viral infections, documentation of vaccination and of antibody testing at baseline. A disease specific set of quality assessment tools should help physicians deliver high quality of care across populations. Routine updates will be needed. PMID:21224016

  19. Clinical evaluation of a single crystal sapphire tooth implant in human beings.

    PubMed

    Sclaroff, A; el-Mofty, S; Guyer, S E

    1990-08-01

    Single crystal sapphire implants are commercially prepared ceramics of aluminum oxide. These endosseous implants have been placed in patients at Washington University since 1978. The course of patients has been followed closely with periodic clinical and radiographic evaluations. Sapphire is well tolerated by hard and soft tissue and provides excellent abutments for fixed partial dentures.

  20. The Clinical Teacher for Special Education. Final Report: Volume II; Evaluating the Model.

    ERIC Educational Resources Information Center

    Schwartz, Louis; Oseroff, Andrew

    Effectiveness of the clinical teaching model (CTM) developed at Florida State University is documented in Volume II of the project's final report. Reviewed is literature related to teacher effectiveness and conceptual changes, conceptual models and instructional systems, and evaluation research in education. Research design and procedures are…

  1. [The evaluation of costs: standards of medical care and clinical statistic groups].

    PubMed

    Semenov, V Iu; Samorodskaia, I V

    2014-01-01

    The article presents the comparative analysis of techniques of evaluation of costs of hospital treatment using medical economic standards of medical care and clinical statistical groups. The technique of evaluation of costs on the basis of clinical statistical groups was developed almost fifty years ago and is largely applied in a number of countries. Nowadays, in Russia the payment for completed case of treatment on the basis of medical economic standards is the main mode of payment for medical care in hospital. It is very conditionally a Russian analogue of world-wide prevalent system of diagnostic related groups. The tariffs for these cases of treatment as opposed to clinical statistical groups are counted on basis of standards of provision of medical care approved by Minzdrav of Russia. The information derived from generalization of cases of treatment of real patients is not applied.

  2. A multi agent system model for evaluating quality service of Clinical Engineering Department.

    PubMed

    Gaetano, Laura; Balestra, Gabriella

    2011-01-01

    Biomedical technology is strategically important to the operational effectiveness of healthcare facilities. As a consequence, clinical engineers have become an essential figure in hospital environment: their role in maintenance, support, evaluation, integration, assessment of new, advanced and complex technologies in point of view of patient safety and cost reduction is become inalienable. For this reason, nations have begun to establish Clinical Engineering Department, but, unfortunately, in a very diversified and fragmented way. So, a tool able to evaluate and improve the quality of current services is needed. Hence, this work builds a model that acts as a reference tool in order to assess the quality of an existing Clinical Engineering Department, underlining its defaulting aspects and suggesting improvements.

  3. Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study.

    PubMed

    Stange, Jonathan P; Hamilton, Jessica L; Burke, Taylor A; Kleiman, Evan M; O'Garro-Moore, Jared K; Seligman, Nicole D; Abramson, Lyn Y; Alloy, Lauren B

    2015-03-30

    Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.

  4. Evaluation of undergraduate nursing students' clinical confidence following a mental health recovery camp.

    PubMed

    Cowley, Thomas; Sumskis, Sue; Moxham, Lorna; Taylor, Ellie; Brighton, Renee; Patterson, Chris; Halcomb, Elizabeth

    2016-02-01

    In the present study, we evaluate the impact of participation in a mental health recovery camp on the clinical confidence of undergraduate nursing students in dealing with individuals with mental illness. Twenty undergraduate nursing students who participated in the recovery camp completed the Mental Health Nursing Clinical Confidence Scale both before and directly after attending the camp. Data were analysed using descriptive and inferential statistics. Participation in the recovery camp was associated with a statistically-significant increase in students' level of overall confidence between the pretest and post-test data (P < 0.005). The results also demonstrated that students over the age of 25 years and who do not have a family history of mental illness are more likely to self-report a higher level of confidence in both the pre- and post-results. The clinical confidence of undergraduate nursing students improved through participation in an immersive clinical experience within the recovery camp.

  5. Evaluation of clinical pathology data: correlating changes with other study data.

    PubMed

    Everds, Nancy E

    2015-01-01

    During the conduct of in vivo toxicology studies, in-life, clinical pathology, and anatomic pathology parameters are collected and interpreted. These sets of parameters are evaluated in an integrative manner to determine the overall toxicity of a test article. For clinical pathology parameters, the inherent variability and physiologic factors affecting each analyte must be understood prior to interpretation. Changes in clinical pathology parameters that are considered to be test article-related are then assessed with respect to changes in the concurrent data sets such as clinical signs and anatomic pathology to determine the underlying pathophysiology. In this article, examples of hemolysis and hepatotoxicity are used to demonstrate the relationships among the various parameters and data sets. Whereas there was tight correlation of all data sets in the example of hemolysis in rats, the examples of altered enzymes and other biomarkers indicating liver injury and dysfunction were more often discordant with other data sets.

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

    PubMed

    San Miguel, Caroline; Rogan, Fran

    2015-06-01

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

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

    PubMed

    San Miguel, Caroline; Rogan, Fran

    2015-06-01

    The increase in nursing students for whom English is an additional language requires clinical facilitators to assess students' performance regarding clinical skills, nursing communication and English language. However, assessing language proficiency is a complex process that is often conflated with cultural norms and clinical skills, and facilitators may lack confidence in assessing English language. This paper discusses an evaluation of a set of guidelines developed in a large metropolitan Australian university to help clinical facilitators make decisions about students' English language proficiency. The study found that the guidelines were useful in helping facilitators assess English language. However, strategies to address identified language problems needed to be incorporated to enable the guidelines to also be used as a teaching tool. The study concludes that to be effective, such guidelines need embedding within a systematic approach that identifies and responds to students who may be underperforming due to a low level of English language proficiency. PMID:25784501

  8. Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome

    PubMed Central

    Seyahi, Emire; Cakmak, Osman Serdal; Tutar, Burcin; Arslan, Caner; Dikici, Atilla Suleyman; Sut, Necdet; Kantarci, Fatih; Tuzun, Hasan; Melikoglu, Melike; Yazici, Hasan

    2015-01-01

    Abstract Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes. All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed. Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS. Lower-extremity vein

  9. Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

    PubMed Central

    Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

    2015-01-01

    Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

  10. Developing a Framework for Evaluating Ethical Outcomes of Good Participatory Practices in TB Clinical Drug Trials.

    PubMed

    MacQueen, Kathleen M; Eley, Natalie T; Frick, Mike; Mingote, Laia Ruiz; Chou, Alicia; Seidel, Stephanie S; Hannah, Stacey; Hamilton, Carol

    2016-07-01

    Good Participatory Practice Guidelines for TB Drug Trials (GPP-TB) were issued in 2012, based on similar guidelines for HIV prevention and reflecting growing acceptance of the importance of community engagement and participatory strategies in clinical research. Though the need for such strategies is clear, evaluation of the benefits and burdens are needed. Working with a diverse group of global TB stakeholders including advocates, scientists, and ethicists, we used a Theory of Change approach to develop an evaluation framework for GPP-TB that includes a clearly defined ethical goal, a set of powerful strategies derived from GPP-TB practices for achieving the goal, and outcomes connecting strategies to goal. The framework is a first step in systematically evaluating participatory research in clinical trials. PMID:27368311

  11. Developing a Framework for Evaluating Ethical Outcomes of Good Participatory Practices in TB Clinical Drug Trials.

    PubMed

    MacQueen, Kathleen M; Eley, Natalie T; Frick, Mike; Mingote, Laia Ruiz; Chou, Alicia; Seidel, Stephanie S; Hannah, Stacey; Hamilton, Carol

    2016-07-01

    Good Participatory Practice Guidelines for TB Drug Trials (GPP-TB) were issued in 2012, based on similar guidelines for HIV prevention and reflecting growing acceptance of the importance of community engagement and participatory strategies in clinical research. Though the need for such strategies is clear, evaluation of the benefits and burdens are needed. Working with a diverse group of global TB stakeholders including advocates, scientists, and ethicists, we used a Theory of Change approach to develop an evaluation framework for GPP-TB that includes a clearly defined ethical goal, a set of powerful strategies derived from GPP-TB practices for achieving the goal, and outcomes connecting strategies to goal. The framework is a first step in systematically evaluating participatory research in clinical trials.

  12. Portfolio as a tool to evaluate clinical competences of traumatology in medical students

    PubMed Central

    Santonja-Medina, Fernando; García-Sanz, M Paz; Martínez-Martínez, Francisco; Bó, David; García-Estañ, Joaquín

    2016-01-01

    This article investigates whether a reflexive portfolio is instrumental in determining the level of acquisition of clinical competences in traumatology, a subject in the 5th year of the degree of medicine. A total of 131 students used the portfolio during their clinical rotation of traumatology. The students’ portfolios were blind evaluated by four professors who annotated the existence (yes/no) of 23 learning outcomes. The reliability of the portfolio was moderate, according to the kappa index (0.48), but the evaluation scores between evaluators were very similar. Considering the mean percentage, 59.8% of the students obtained all the competences established and only 13 of the 23 learning outcomes (56.5%) were fulfilled by >50% of the students. Our study suggests that the portfolio may be an important tool to quantitatively analyze the acquisition of traumatology competences of medical students, thus allowing the implementation of methods to improve its teaching. PMID:26929675

  13. Tobacco use and health risks in two dental clinic populations: Implementation and evaluation of a brief targeted intervention.

    PubMed

    Romito, Laura; Budyn, Cynthia; Oklak, Mark A; Gotlib, Josh; Eckert, George J

    2012-01-01

    The present study compared emergency dental clinic and hygiene clinic patients in terms of tobacco use and health risks, and began and evaluated an Ask/Advise/Refer intervention in the emergency clinic. Randomly selected records (N = 820) of patients from both clinics were reviewed and demographics, tobacco, and health data were recorded and analyzed. After a brief training period, student dentists delivered a five-week emergency clinic tobacco intervention and completed a post-intervention evaluation survey. Tobacco use was higher in the emergency clinic and was correlated with systemic and oral disease. Of the 327 emergency clinic patients seen during the pilot study, 50% were smokers, 46% of whom expressed an interested in quitting and 35% of whom obtained cessation referral. Thirty students (86%) completed the evaluation; perceptions of the intervention were neutral to favorable. The emergency clinic Ask/Advise/Refer intervention was well-received by patients and clinicians.

  14. Integrating utilization-focused evaluation with business process modeling for clinical research improvement.

    PubMed

    Kagan, Jonathan M; Rosas, Scott; Trochim, William M K

    2010-10-01

    New discoveries in basic science are creating extraordinary opportunities to design novel biomedical preventions and therapeutics for human disease. But the clinical evaluation of these new interventions is, in many instances, being hindered by a variety of legal, regulatory, policy and operational factors, few of which enhance research quality, the safety of study participants or research ethics. With the goal of helping increase the efficiency and effectiveness of clinical research, we have examined how the integration of utilization-focused evaluation with elements of business process modeling can reveal opportunities for systematic improvements in clinical research. Using data from the NIH global HIV/AIDS clinical trials networks, we analyzed the absolute and relative times required to traverse defined phases associated with specific activities within the clinical protocol lifecycle. Using simple median duration and Kaplan-Meyer survival analysis, we show how such time-based analyses can provide a rationale for the prioritization of research process analysis and re-engineering, as well as a means for statistically assessing the impact of policy modifications, resource utilization, re-engineered processes and best practices. Successfully applied, this approach can help researchers be more efficient in capitalizing on new science to speed the development of improved interventions for human disease.

  15. Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation – Outcome Measure

    PubMed Central

    Trujillo, Adriana; Feixas, Guillem; Bados, Arturo; García-Grau, Eugeni; Salla, Marta; Medina, Joan Carles; Montesano, Adrián; Soriano, José; Medeiros-Ferreira, Leticia; Cañete, Josep; Corbella, Sergi; Grau, Antoni; Lana, Fernando; Evans, Chris

    2016-01-01

    Objective The objective of this paper is to assess the reliability and validity of the Spanish translation of the Clinical Outcomes in Routine Evaluation – Outcome Measure, a 34-item self-report questionnaire that measures the client’s status in the domains of Subjective well-being, Problems/Symptoms, Life functioning, and Risk. Method Six hundred and forty-four adult participants were included in two samples: the clinical sample (n=192) from different mental health and primary care centers; and the nonclinical sample (n=452), which included a student and a community sample. Results The questionnaire showed good acceptability and internal consistency, appropriate test–retest reliability, and acceptable convergent validity. Strong differentiation between clinical and nonclinical samples was found. As expected, the Risk domain had different characteristics than other domains, but all findings were comparable with the UK referential data. Cutoff scores were calculated for clinical significant change assessment. Conclusion The Spanish version of the Clinical Outcomes in Routine Evaluation – Outcome Measure showed acceptable psychometric properties, providing support for using the questionnaire for monitoring the progress of Spanish-speaking psychotherapy clients. PMID:27382288

  16. Improving information availability in vascular surgical clinics. A service evaluation and improvement project.

    PubMed

    Hurst, Katherine; Kreckler, Simon; Handa, Ashok; Handa, Ashok

    2016-01-01

    This prospective service evaluation was designed to assess the availability of critical information required in vascular surgical clinics. All the data was collected via a repeated questionnaire, and the outcomes from each cycle were used to highlight where intervention was required to improve the surgical clinic experience. The first audit identified outpatient clinic deficiencies and allowed for problem analysis. Two Plan-Do-Check-Act (PDCA) cycles then were undertaken. Interventions following each cycle included consultant access to online duplex scans and secretarial access to referral letters. Results from the first cycle showed that approximately 20% of clinic appointments were missing information and only 30% of these issues were resolved during the clinic using a work around. Following the first intervention; the numbers of missing patient notes reduced to 4.3% (10.5%), and referral letters to 3.6% (4.6%). Although the numbers of missing duplex scan results increased to 6.5% (3.3%), the new system of online scan results allowed for all scans to be accessed during the clinic. Following results of a second PDCA cycle, vascular surgical secretaries were given access to 'choose and book', a database of GP referral letters. Post intervention, all missing referral letters (2%) could be accessed immediately within the clinic setting. Data driven interventions and repeated PDCA cycles can improve hospital systems for minimal cost. With an annual clinic turnaround of 2500 patients, these interventions can reduce clinic delays and potential harm caused by unavailable records for up to 500 patients a year. PMID:26893887

  17. Accuracy and Robustness Improvements of Echocardiographic Particle Image Velocimetry for Routine Clinical Cardiac Evaluation

    NASA Astrophysics Data System (ADS)

    Meyers, Brett; Vlachos, Pavlos; Charonko, John; Giarra, Matthew; Goergen, Craig

    2015-11-01

    Echo Particle Image Velocimetry (echoPIV) is a recent development in flow visualization that provides improved spatial resolution with high temporal resolution in cardiac flow measurement. Despite increased interest a limited number of published echoPIV studies are clinical, demonstrating that the method is not broadly accepted within the medical community. This is due to the fact that use of contrast agents are typically reserved for subjects whose initial evaluation produced very low quality recordings. Thus high background noise and low contrast levels characterize most scans, which hinders echoPIV from producing accurate measurements. To achieve clinical acceptance it is necessary to develop processing strategies that improve accuracy and robustness. We hypothesize that using a short-time moving window ensemble (MWE) correlation can improve echoPIV flow measurements on low image quality clinical scans. To explore the potential of the short-time MWE correlation, evaluation of artificial ultrasound images was performed. Subsequently, a clinical cohort of patients with diastolic dysfunction was evaluated. Qualitative and quantitative comparisons between echoPIV measurements and Color M-mode scans were carried out to assess the improvements delivered by the proposed methodology.

  18. Mayo clinical Text Analysis and Knowledge Extraction System (cTAKES): architecture, component evaluation and applications.

    PubMed

    Savova, Guergana K; Masanz, James J; Ogren, Philip V; Zheng, Jiaping; Sohn, Sunghwan; Kipper-Schuler, Karin C; Chute, Christopher G

    2010-01-01

    We aim to build and evaluate an open-source natural language processing system for information extraction from electronic medical record clinical free-text. We describe and evaluate our system, the clinical Text Analysis and Knowledge Extraction System (cTAKES), released open-source at http://www.ohnlp.org. The cTAKES builds on existing open-source technologies-the Unstructured Information Management Architecture framework and OpenNLP natural language processing toolkit. Its components, specifically trained for the clinical domain, create rich linguistic and semantic annotations. Performance of individual components: sentence boundary detector accuracy=0.949; tokenizer accuracy=0.949; part-of-speech tagger accuracy=0.936; shallow parser F-score=0.924; named entity recognizer and system-level evaluation F-score=0.715 for exact and 0.824 for overlapping spans, and accuracy for concept mapping, negation, and status attributes for exact and overlapping spans of 0.957, 0.943, 0.859, and 0.580, 0.939, and 0.839, respectively. Overall performance is discussed against five applications. The cTAKES annotations are the foundation for methods and modules for higher-level semantic processing of clinical free-text.

  19. Alumni-based evaluation of a novel veterinary curriculum: are Nottingham graduates prepared for clinical practice?

    PubMed Central

    Cobb, K. A.; Brown, G. A.; Hammond, R. H.; Mossop, L. H.

    2015-01-01

    Introduction Outcomes-based education has been the core of the curriculum strategy of the Nottingham School of Veterinary Medicine and Science (SVMS) since its inception in 2006. As part of the ongoing curriculum evaluation, the first two graduating cohorts were invited to provide an appraisal of their preparation by the SVMS curriculum for their role in clinical practice. This paper provides brief accounts of the SVMS curriculum model, the development of the evaluation instrument and the findings of the alumni survey. Materials and Methods The evaluation instrument contained 25 attributes expected of SVMS graduates. Alumni rated their preparation for practice in relation to each attribute. Results The four highest rated characteristics were compassion for animals and the application of ethics to animal welfare; communication skills; recognising own limitations and seeking help and advice where needed and clinical examination skills. The four lowest rated were clinical case management and therapeutic strategies; dealing with veterinary public health and zoonotic issues; knowledge of current veterinary legislation and dealing with emergency and critical care cases. Free text responses were in line with these quantitative findings. Conclusion The results indicate that this sample of SVMS graduates were satisfied with their undergraduate education and felt well prepared for their role in clinical practice. PMID:26392910

  20. Integration and Evaluation of Clinical Decision Support Systems for Diagnosis Idopathics Pulmonary Fibrosis (IPF)

    PubMed Central

    Chae, Youngmoon; Jeon, Sungwan

    2010-01-01

    Objectives The purpose of this study was to develop clinical decision support systems (CDSS) that are integrated with hospital information systems for the differential diagnosis of idiopathic pulmonary fibrosis (IPF). Methods The integrated CDSS were validated and evaluated by physicians. Knowledge modeling for diagnosing IPF was performed by knowledge working groups, composed of radiologists and respiratory specialists. In order to develop the model for CDSS diagnosis, the clinical cases were collected from 290 cases from Seoul National University Hospital and Sevrance Hospital of Yonsei University. For the evaluation of integrated CDSS, interviews were conducted with respiratory specialists and radiologist 2 weeks after applying CDSSs in clinical settings. The CDSS was integrated with the computer vision system (CVS) and diffuse parenchymal lung diseases (DPLD), CDSS developed in our previous project. Results Eighteen cases diagnosed as IPF were applied to the collection of diagnostic knowledge and the refined knowledge, the former diagnosed 1 case (6%) and the latter diagnosed 14 cases (78%). Therefore, the refined knowledge performed better than collected knowledge. The validation results of integrated CDSSs showed that 81 cases (74.3%) were diagnosed correctly. Conclusions There were 109 cases of IPF diagnosed and initiated on treatment. The significance of this study is in developing integrated CDSS with PACS by acquiring and redefining the knowledge needed for IPF diagnosis. In addition, it is significant for the integration of CDSS to verification and clinical evaluation. PMID:21818445

  1. Clinical and Radiographic Evaluation of Immediate Loaded Dental Implants With Local Application of Melatonin: A Preliminary Randomized Controlled Clinical Trial.

    PubMed

    El-Gammal, Mona Y; Salem, Ahmed S; Anees, Mohamed M; Tawfik, Mohamed A

    2016-04-01

    Immediate loading of dental implants in situations where low bone density exist, such as the posterior maxillary region, became possible recently after the introduction of biomimetic agents. This 1-year preliminary clinical trial was carried out to clinically and radiographically evaluate immediate-loaded 1-piece implants with local application of melatonin in the osteotomy site as a biomimetic material. 14 patients with missing maxillary premolars were randomized to receive 14 implants of 1-piece type that were subjected to immediate loading after 2 weeks of initial placement. Group I included 7 implants with acid-etched surface while group II included 7 implants with acid-etched surface combined with local application of melatonin gel at the osteotomy site. Patients were recalled for follow up at 1, 3, 6, and 12 months after loading. All implants were considered successful after 12 months of follow-up. Significant difference (P < 0.05) was found between both groups at 1 month of implant loading when considering the implant stability. At 1 and 3 months there were significant differences in the marginal bone level between the 2 groups. These results suggest that the local application of melatonin at the osteotomy site is associated with good stability and minimal bone resorption. However, more studies for longer follow-up periods are required to confirm the effect of melatonin hormone on osseointegration of dental implants.

  2. CFD for evaluation and treatment planning of aneurysms: review of proposed clinical uses and their challenges.

    PubMed

    Chung, Bongjae; Cebral, Juan Raul

    2015-01-01

    Computational fluid dynamics (CFD) has been used for several years to identify mechanical risk factors associated with aneurysmal evolution and rupture as well as to understand flow characteristics before and after surgical treatments in order to help the clinical decision making process. We used the keywords, "CFD" and "aneurysms" to search recent publications since about 2000, and categorized them into (i) studies of rupture risk factors and (ii) investigations of pre- and post-evaluations of surgical treatment with devices like coils and flow diverters (FD). This search enables us to examine the current status of CFD as a clinical tool and to determine if CFD can potentially become an important part of the routine clinical practice for the evaluation and treatment of aneurysms in near future. According to previous reports, it has been argued that CFD has become a quite robust non-invasive tool for the evaluation of surgical devices, especially in the early stages of device design and it has also been applied successfully to the study of rupture risk assessment. However, we find that due to the large number of pre-processing inputs further efforts of validation and reproducibility of CFD with larger clinical datasets are still essential to identify standardized mechanical risk factors. As a result, we identify the following needs to have a robust CFD tool for clinical use: (i) more reliability tests through validation studies, (ii) analyses of larger generalized clinical datasets to find converging universal risk parameters, (iii) fluid structure interaction (FSI) analyses to better understand the detailed vascular remodeling processes associated with aneurysm growth, evolution and rupture, and (iv) better coordinated and organized communications and collaborations between engineers and clinicians.

  3. Evaluation of children's dental anxiety levels at a kindergarten and at a dental clinic.

    PubMed

    Kilinç, Gulser; Akay, Aynur; Eden, Ece; Sevinç, Nilgün; Ellidokuz, Hülya

    2016-01-01

    This study evaluated the dental anxiety levels of preschool children at a kindergarten and at a dental clinic. The anxiety levels of ninety 4-6-year-old (4.99 ± 0.81) preschool children were evaluated according to pulse rates, the facial image scale (FIS), the Venham picture test (VPT), and the Frankl behavior rating scale. The children's mothers were asked to complete the state-trait anxiety inventory (STAI) forms 1 and 2 (STAI 2 and STAI 2). The sample t-test, Mann-Whitney U test, and Pearson's correlation test were used. A statistically significant difference was observed between the children's pulse rates when measured at the dental clinic and those when measured at the kindergarten (p < 0.001). Although the results were not statistically significant, more negative facial expressions were observed in the children at the dental clinic than in those at the kindergarten when assessed using FIS and VPT (p = 0.090 and p = 0.108, respectively). There was a statistically significant correlation between the transient anxiety levels (STAI 1) of mothers and the VPT scores of their children evaluated at the dental clinic (r = 0.506, p < 0.001). The continuous anxiety level of the mothers of males was found to be significantly higher (p = 0.033) than that of the mothers of females (STAI 2). Although the children had been informed about dentistry and were introduced to a dentist at the kindergarten, their anxiety levels seemingly increased as they arrived at the dental clinic. The significant increase observed in the children's pulse rates was a physical indicator that their anxiety levels had increased. It can be concluded that the children felt more anxious at the dental clinic that at the kindergarten. PMID:27556551

  4. Evaluation of children's dental anxiety levels at a kindergarten and at a dental clinic.

    PubMed

    Kilinç, Gulser; Akay, Aynur; Eden, Ece; Sevinç, Nilgün; Ellidokuz, Hülya

    2016-08-18

    This study evaluated the dental anxiety levels of preschool children at a kindergarten and at a dental clinic. The anxiety levels of ninety 4-6-year-old (4.99 ± 0.81) preschool children were evaluated according to pulse rates, the facial image scale (FIS), the Venham picture test (VPT), and the Frankl behavior rating scale. The children's mothers were asked to complete the state-trait anxiety inventory (STAI) forms 1 and 2 (STAI 2 and STAI 2). The sample t-test, Mann-Whitney U test, and Pearson's correlation test were used. A statistically significant difference was observed between the children's pulse rates when measured at the dental clinic and those when measured at the kindergarten (p < 0.001). Although the results were not statistically significant, more negative facial expressions were observed in the children at the dental clinic than in those at the kindergarten when assessed using FIS and VPT (p = 0.090 and p = 0.108, respectively). There was a statistically significant correlation between the transient anxiety levels (STAI 1) of mothers and the VPT scores of their children evaluated at the dental clinic (r = 0.506, p < 0.001). The continuous anxiety level of the mothers of males was found to be significantly higher (p = 0.033) than that of the mothers of females (STAI 2). Although the children had been informed about dentistry and were introduced to a dentist at the kindergarten, their anxiety levels seemingly increased as they arrived at the dental clinic. The significant increase observed in the children's pulse rates was a physical indicator that their anxiety levels had increased. It can be concluded that the children felt more anxious at the dental clinic that at the kindergarten.

  5. The Clinical, Radiographic and Histological evaluation of three different concentrations of Formocresol as a pulpotomy agent

    PubMed Central

    Goyal, Swati; Abuwala, Tasnima; Joshi, Keyur; Mehta, Jahnvi; Indushekar, K R; Hallikerimath, Seema

    2014-01-01

    Background: Formocresol, though the center of much controversy is still the most widely used medicament for primary teeth pulpotomy and an intracanal medicament which has undergone a lengthy evolution to shorten the formocresol application time and reduce the concentration of formocresol exposure to the pulp tissue. Hence, the determination of the actual effective dose and concentration of formocresol for clinical application in primary teeth is an important area of research and a thorough clinical, radiographic and histological investigation in human subjects is very much needed. Materials & Methods: The study was conducted on 45 primary molars for the Clinical, Radiographic study and 45 premolars orthodontically indicated for extraction for the Histological study. The samples were randomly and equally divided into 3 groups of 15 each for pulpotomy with full strength formocresol, 1:5 diluted formocresol and 1:25 diluted formocresol respectively. The pulpotomized primary molars were clinically evaluated at 1st, 3rd, 6th and 9th month while the pulpotomized premolars were subjected for histological evaluation after extraction. Results: Obtained by chi-square test revealed that all the pulpotomized primary molars were asymptomatic till the end of the study period; suggesting 100% clinical and radiographic success while histologically, the three concentrations of formocresol showed decreased severity of fixation of the pulp tissue with decreasing concentration of formocresol. Conclusion: It can be inferred that the diluted formulations (1:5 and 1:25) of formocresol are equally efficient when compared to full-strength formocresol and thus, can be recommended for pulpotomy in primary teeth. How to cite the article: Goyal S, Abuwala T, Joshi K, Mehta J, Indushekar KR, Hallikerimath S. The Clinical, Radiographic and Histological evaluation of three different concentrations of Formocresol as a pulpotomy agent. J Int Oral Health 2014;6(2):118-25. PMID:24876712

  6. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    PubMed

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. PMID:26256817

  7. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    PubMed

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders.

  8. An Artificial Neural Network Estimation of Gait Balance Control in the Elderly Using Clinical Evaluations

    PubMed Central

    Lugade, Vipul; Lin, Victor; Farley, Arthur; Chou, Li-Shan

    2014-01-01

    The use of motion analysis to assess balance is essential for determining the underlying mechanisms of falls during dynamic activities. Clinicians evaluate patients using clinical examinations of static balance control, gait performance, cognition, and neuromuscular ability. Mapping these data to measures of dynamic balance control, and the subsequent categorization and identification of community dwelling elderly fallers at risk of falls in a quick and inexpensive manner is needed. The purpose of this study was to demonstrate that given clinical measures, an artificial neural network (ANN) could determine dynamic balance control, as defined by the interaction of the center of mass (CoM) with the base of support (BoS), during gait. Fifty-six elderly adults were included in this study. Using a feed-forward neural network with back propagation, combinations of five functional domains, the number of hidden layers and error goals were evaluated to determine the best parameters to assess dynamic balance control. Functional domain input parameters included subject characteristics, clinical examinations, cognitive performance, muscle strength, and clinical balance performance. The use of these functional domains demonstrated the ability to quickly converge to a solution, with the network learning the mapping within 5 epochs, when using up to 30 hidden nodes and an error goal of 0.001. The ability to correctly identify the interaction of the CoM with BoS demonstrated correlation values up to 0.89 (P<.001). On average, using all clinical measures, the ANN was able to estimate the dynamic CoM to BoS distance to within 1 cm and BoS area to within 75 cm2. Our results demonstrated that an ANN could be trained to map clinical variables to biomechanical measures of gait balance control. A neural network could provide physicians and patients with a cost effective means to identify dynamic balance issues and possible risk of falls from routinely collected clinical examinations

  9. Laboratory evaluation of the Beckman Synchron CX3 clinical chemistry analyzer.

    PubMed

    Peake, M J; Pejakovic, M; White, G H

    1988-02-01

    In this evaluation of the Beckman Synchron CX3, the multi-analyte clinical chemistry analyzer exhibited high precision, good linearity, and no carryover for each of the eight analytes measured. Results obtained correlated well with those produced by our routine instrumentation (Beckman Astra, Varian atomic absorption spectrophotometer). The instrument can process up to 75 samples per hour (600 tests per hour if all tests available are requested) and, after calibration, can provide urgent results for the complete panel of tests within 2 1/2 min. The performance characteristics of this instrument make it ideal as a routine or a "stat" analyzer for commonly requested tests in the clinical chemistry laboratory.

  10. Evaluation of the Dade Behring Dimension RxL clinical chemistry analyzer.

    PubMed

    Cuka, S; Dvornik, S; Drazenović, K; Mihić, J

    2001-01-01

    The performance of the Dade Behring Dimension RxL clinical chemistry analyzer was evaluated according to the guidelines of the European Committee for Clinical Laboratory Standards. The following analytes were tested: glucose, urea, creatinine, albumin, phosphorus, cholesterol, triglyceride, uric acid, magnesium, sodium, potassium, chloride, calcium, iron and total bilirubin. The Dade Behring Dimension RxL was compared with the Hitachi 704, Bayer RA-1000, Ektachem 250 and Chiron 865 depending on available tests on these analyzers. Coefficients of correlation showed high correlation between compared analyzers. Other performances (intra- and inter-assay variation, carry-over and interferences) of the analyzer were satisfactory.

  11. Evaluating Business Value of IT in Healthcare: Three Clinical Practices from Australia and the US.

    PubMed

    Haddad, Peter; Schaffer, Jonathan L; Wickramasinghe, Nilmini

    2015-01-01

    Exponentially increasing costs in healthcare coupled with poor quality and limited access have motivated the healthcare industry to turn to IS/IT solutions to overcome these issues and facilitate superior healthcare delivery. In an environment of rapid development of new clinical informatics solutions claiming to provide better healthcare delivery, there is a paucity of systematic frameworks to robustly measure the actual value of these systems. The promised business value of these solutions has been elusive; hence, this study offers an approach for the evaluation of the business value of health IS/IT solutions based on a conceptual model, which has been validated using three clinical case studies.

  12. Role of the clinical pathology laboratory in the evaluation of endometrial carcinomas for Lynch syndrome.

    PubMed

    Djordjevic, Bojana; Broaddus, Russell R

    2014-05-01

    Molecular diagnostic testing of endometrial carcinomas in the pathology laboratory has recently emerged as a key component of the clinical evaluation of Lynch syndrome in many centers. Testing modalities involve immunohistochemical and PCR-based analyses. This article outlines the routine application of these analyses, provides a practical guide for troubleshooting some of the common technical issues related to their performance, and reviews common pitfalls in their interpretation. Discrepancies between tissue testing and genetic testing results are discussed in the context of the current understanding of endometrial cancer biology. The merits of universal versus targeted tissue testing based on clinical patient history and histological tumor appearance are also addressed.

  13. [Results evaluations 3 years after our first experience with the laparoscopic treatment of Hirschsprung disease].

    PubMed

    Polliotto, S; Heinen, F; Andina, G; Korman, R

    2001-04-01

    The laparoscopic approach has been successfully used during the recent last years in pediatric surgery. We describe the first experience in Argentina using laparoscopic surgery in November 4th in 1996, for the treatment of a Hirschsprung disease case. We used the technique of Soave's modified by Georgenson. Details of the surgical procedure are given. Hospitalization time took 5 days and immediated postoperatory cares were well done. Soave-Georgeson technique seems to be a safe and effective possibility for the Hirschsprung disease treatment, and it is completely achieveable by laparoscopy. The present experience does not show advantages in terms of a lower hospitalization time, however it really shows the benefits of laparoscopic surgery, such as post-operatory comfort and better cosmetic results, both highly superior than those obtained with classical surgery. PMID:11480199

  14. Parent-Reported Distress in Children Under 3-years Old During Preventive Medical and Dental Care

    PubMed Central

    Nelson, Travis M.; Huebner, Colleen E.; Kim, Amy; Scott, JoAnna M.; Pickrell, Jacqueline E.

    2014-01-01

    Purpose This study examined factors related to young children’s distress during preventive oral health visits. Additionally, associations between parent-reported child behavior during the dental visit and during prior medical visits were tested. Methods One hundred twenty two children under 3 years of age enrolled in a government insurance program for low-income children were seen for examination, prophylaxis, and fluoride application at a university-based dental clinic. Child distress was rated by parents on a numerical rating scale. Results The average age of children enrolled was 23.5 ± 7.3 months. The majority (55.7%) were judged to have little or no distress pre-examination. Mild or no distress during the examination was reported for 42.6% of the children and severe distress was reported for 39.4%. Intensity of distress during the examination was not associated with the child’s age, gender, dental health, or prior experience with dental care. Distress was also unrelated to the caregiver’s education level or own dental health. Intensity of distress was associated with the child’s pre-dental examination distress and distress during prior medical examinations and injections. Conclusions Dental professionals can better anticipate child distress by assessing children before examination and inquiring about previous medical experiences. Strategies to prepare parents and alleviate distress may help children cope with the preventive dental visit. PMID:25514877

  15. Caries-inhibiting effects of different modes of Duraphat varnish reapplication: a 3-year radiographic study.

    PubMed

    Petersson, L G; Arthursson, L; Ostberg, C; Jönsson, G; Gleerup, A

    1991-01-01

    One hundred and sixty 11-year-olds were randomly allocated to two experimental groups, one test (group 1) and one control group (group 2), for a 3-year clinical test comparing different modes of fluoride varnish treatment. In the test group, children received Duraphat varnish treatments 3 times a week, once a year. The children in group 2 were treated with Duraphat every 6 months. During the experimental period, children in group 1 received 9 fluoride varnish applications, and in group 2, 6 applications. Four bitewing radiographs were taken in each child each year for the measurements of the incidence and progression of proximal caries. Repeated fluoride varnish treatment with Duraphat, 3 times a week once a year, appears to inhibit proximal caries progression and development since the children in this group showed even a lower caries status, 1.3 +/- 0.3 DS, at the end of the study compared to 1.6 +/- 0.2 DS at the outset. In group 2, the children increased their caries status from 1.7 +/- 0.2 to 2.4 +/- 0.4 DS during the experimental period. The caries difference was statistically significant (p less than 0.05) between the two groups. A health economic comparison of the two modes of application showed 30% lower costs for the children in the test group based on time used for preventive measures and assumed filling therapy.

  16. Conservative management of external root resorption after tooth reimplantation: a 3-year follow-up.

    PubMed

    Ionta, Franciny Querobim; de Oliveira, Gabriela Cristina; de Alencar, Catarina Ribeiro Barros; Gonçalves, Priscilla Santana Pinto; Alcalde, Murilo Priori; Minotti, Paloma Gagliardi; Machado, Maria Aparecida de Andrade Moreira; Rios, Daniela

    2016-01-01

    The aim of this case report is to describe the treatment of a 9-year-old patient who suffered external root resorption of the permanent maxillary left lateral incisor following reimplantation of the avulsed left central and lateral incisors. Sixteen days after reimplantation and splinting of the incisors in a hospital emergency department, the patient was brought to the pediatric department of a dental school for further treatment. Root canal access was created in the maxillary left lateral and central incisors, and calcium hydroxide paste was used as intracanal dressing. At the 5-month follow-up, a radiograph revealed extensive external root resorption, a communicating root canal, and a periodontal lesion affecting the left lateral incisor. Management of the root resorption included obturation of the apical third of the canal with gutta percha and the middle third with mineral trioxide aggregate (MTA). At the 3-year recall examination, the patient was asymptomatic, and no mobility or soft tissue alterations were observed clinically. There was no radiographic sign that resorption had progressed. Despite the success of treatment, observation is still required. The use of MTA may be considered an alternative treatment for external root resorption after tooth reimplantation. The technique may allow tooth preservation in children until skeletal growth and development are completed and implant treatment may be considered. PMID:27367632

  17. Effect of Parental Bereavement on Health Risk Behaviors in Youth: A 3-Year Follow-up

    PubMed Central

    Hamdan, Sami; Mazariegos, David; Melhem, Nadine M.; Porta, Giovanna; Payne, Monica Walker; Brent, David A.

    2013-01-01

    Objective To examine the course of health risk behaviors (HRBs) during a 3-year period after a parent’s death in bereaved youth compared with nonbereaved youth (control subjects). Design A longitudinal population-based study. Setting Bereaved families were recruited through coroner records and by advertisement. Control families were recruited using random-digit dialing and by advertisement. Participants Two hundred forty parentally bereaved offspring were compared with 183 nonbereaved control offspring. Main Exposure Sudden parental death due to accident, suicide, or sudden disease-related (natural) death. Main Outcome Measures The sum of the total number of HRBs at a clinically significant frequency threshold assessed 9, 21, and 33 months after the parent’s death. Results The bereaved group showed a higher number of HRBs over time compared with the nonbereaved group (univariate effect sizes, 0.22–0.52; P<.04), even after taking into account correlates of bereavement and of HRBs, such as youth aggression, as well as antisocial and anxiety disorders of the deceased parent. Conclusions Parental bereavement is associated with higher HRBs in youth over time, even after controlling for other covariates associated with bereavement and HRBs. Clinicians should be aware that bereaved youth may be vulnerable to HRBs. Further work is warranted on interventions to attenuate the negative effect of bereavement on HRBs. PMID:22393180

  18. Evaluation of an in-clinic assay for the diagnosis of canine parvovirus.

    PubMed

    Decaro, N; Desario, C; Billi, M; Lorusso, E; Colaianni, M L; Colao, V; Elia, G; Ventrella, G; Kusi, I; Bo, S; Buonavoglia, C

    2013-11-01

    The results of a study designed to evaluate the performance of an in-clinic test for the detection of canine parvovirus (CPV) are reported. A total of 150 faecal samples collected from dogs with acute diarrhoea were tested using the in-clinic test, a haemagglutination assay (HA) and a real-time PCR assay for CPV detection, quantification and characterisation. CPV was detected in 66, 73, and 101 faecal samples by in-clinic, HA and PCR testing, respectively. The relative sensitivity and specificity of the in-clinic test were 86.3% and 96.1%, respectively, when the test was compared to HA, and 65.3% and 100%, respectively, when compared to real-time PCR. The sample distribution according to the virus type was CPV-2a, n=44; CPV-2b, n=11; CPV-2c, n=44, CPV-2, n=2, as determined by minor groove binder probe assays and/or sequence analysis. The percentage of positive in-clinic tests was 70.5% for CPV-2a, 72.7% for CPV-2b and 75.0% for CPV-2c (P>0.05). Using real-time PCR as the reference standard for CPV detection, the in-clinic test was more specific than HA and had comparable sensitivity to HA, demonstrating detection rates similar to those previously observed for other rapid in-clinic tests. The in-clinic test was also able to detect all CPV types at equivalent rates.

  19. Perception and Production of Lexical Tones by 3-Year-Old, Mandarin-Speaking Children

    ERIC Educational Resources Information Center

    Wong, Puisan; Schwartz, Richard G.; Jenkins, James J.

    2005-01-01

    The present study investigated 3-year-old children's perception and production of Mandarin lexical tones in monosyllabic words. Thirteen 3-year-old, Mandarin-speaking children participated in the study. Tone perception was examined by a picture-pointing task, and tone production was investigated by picture naming. To compare children's productions…

  20. Allocation of Resources to Collaborators and Free-Riders in 3-Year-Olds

    ERIC Educational Resources Information Center

    Melis, Alicia P.; Altrichter, Kristin; Tomasello, Michael

    2013-01-01

    Recent studies have shown that in situations where resources have been acquired collaboratively, children at around 3 years of age share mostly equally. We investigated 3-year-olds' sharing behavior with a collaborating partner and a free-riding partner who explicitly expressed her preference not to collaborate. Children shared more equally with…

  1. [Video-based teaching in pathology. Experience gained in the last 3 years at the RWTH Aachen University].

    PubMed

    Perez-Bouza, A; Merk, M; Rieck, I; Knuechel, R

    2011-05-01

    Modern computer technology provides students with easier access to learning materials. Basic knowledge of pathological findings in organs is essential in medical education. We have produced didactic videos for teaching pathology in a clinical context in addition to regular lectures at the university. Didactic material includes macroscopic and histological findings, as well as cartoons explaining pathophysiology and clinical links. Videos can be downloaded in mv4 format as podcasts to a local hard disk or to an iPhone or iPod via iTunes University and are designed to improve classical medical literature. Analysis over 3 years of server traffic and subjective impressions by the students revealed regular use and high acceptance by users. Didactic material in clinical pathology can be successfully integrated in videos to complement lectures and practical training. Modern teaching methods in pathology make the specialty more understandable and therefore more attractive for students.

  2. Agreement between Therapists, Parents, Patients, and Independent Evaluators on Clinical Improvement in Pediatric Obsessive-Compulsive Disorder

    ERIC Educational Resources Information Center

    Lewin, Adam B.; Peris, Tara S.; De Nadai, Alessandro S.; McCracken, James T.; Piacentini, John

    2012-01-01

    Objective: Independent evaluators (IE) are used widely in clinical trials to make unbiased determinations of treatment response. By virtue of being kept blind to treatment condition, however, IEs are also kept unaware of many pertinent clinical details that are relevant for decisions about clinical improvement. In this study, agreement among…

  3. Clinical and histologic evaluation of calcium carbonate in sinus augmentation: a case series.

    PubMed

    Mangano, Carlo; Iaculli, Flavia; Piattelli, Adriano; Mangano, Francesco; Shibli, Jamil Awad; Perrotti, Vittoria; Iezzi, Giovanna

    2014-01-01

    The aim of this case series was a clinical, histologic, and histomorphometric evaluation of calcium carbonate in sinus elevation procedures. Sinus augmentation was performed in the atrophic maxillae of 24 subjects using calcium carbonate. Six months after the regeneration procedures, 68 implants were placed and clinically followed for 1 to 5 years, depending on the placement timing. At the last implant placement procedure, 8 bone cores were harvested and processed for histology. After a 6-month healing period, sinuses grafted with calcium carbonate showed a mean vertical bone gain of 6.93 ± 0.23 mm. The histomorphometric analysis revealed 15% ± 3% residual grafted biomaterial, 28% ± 2% newly formed bone, and 57% ± 2% marrow spaces. The implant survival rate was 98.5%. It can be concluded that calcium carbonate was shown to be clinically suitable for sinus elevation procedures after 1 to 5 years of follow-up and histologically biocompatible and osteoconductive.

  4. Nontraumatic focal lesions of the spleen: Assessment of imaging and clinical evaluation

    SciTech Connect

    Caslowitz, P.L.; Labs, J.D.; Fishman, E.K.; Siegelman, S.S. )

    1990-03-01

    Fifty-nine cases of nontraumatic splenic disease were reviewed to evaluate the roles of clinical findings, computed tomography, ultrasound, and radionuclide scanning in diagnosis and management. Patient groups included lymphoma (30 patients), infarct (11 patients), abscess (9 patients), cyst (5 patients), hemangioma (3 patients), and hamartoma (1 patient). In no case were clinical findings alone sufficient to diagnose a splenic lesion. Clinical and laboratory manifestations were nonspecific in all groups. Moreover, no radiologic study reliably diagnosed splenic lymphoma or leukemia. All other focal splenic lesions were consistently diagnosed noninvasively. Cross-sectional imaging was more useful than radioisotope scanning, and often provided adjunctive diagnosis of extrasplenic pathology. The superior detail, spatial resolution, and sensitivity of computed tomography made it the single most valuable diagnostic modality.

  5. Two preclinical tests to evaluate anticancer activity and to help validate drug candidates for clinical trials

    PubMed Central

    López-Lázaro, Miguel

    2015-01-01

    Current approaches to assessing preclinical anticancer activity do not reliably predict drug efficacy in cancer patients. Most of the compounds that show remarkable anticancer effects in preclinical models actually fail when tested in clinical trials. We blame these failures on the complexity of the disease and on the limitations of the preclinical tools we require for our research. This manuscript argues that this lack of clinical response may also be caused by poor in vitro and in vivo preclinical designs, in which cancer patients' needs are not fully considered. Then, it proposes two patient-oriented tests to assess in vitro and in vivo anticancer activity and to help validate drug candidates for clinical evaluation. PMID:25859551

  6. Evaluation of the William S. Hall Psychiatric Institute Clinical Psychology Internship: a replication and extension.

    PubMed

    Stader, Sandra R; Myers, DeRosset; Forand, Angela Q; Holmes, George R; McNulty, George F; Frey, Linda; Bolton, Staci S

    2010-12-01

    This study extends three earlier investigations involving participants who completed their predoctoral clinical psychology internship at the William S. Hall Psychiatric Institute. Intern graduates (N = 37) evaluated how effectively their internship training prepared them for seven aspects of their current work as practicing psychologists. Participants also rated the relevancy of 24 different internship training experiences to their current work and how much these experiences contributed to their development as clinical psychologists. The present study, in conjunction with the three previous studies, covers most of the 40-year period since the inception of the internship program. Analysis of the current data indicates the internship has improved over time and was deemed an exceptional training experience by its graduates. Findings may be of particular interest to internship directors and faculty interested in improving their training program and those who plan to conduct a self-study to maintain their accreditation for clinical psychology internship.

  7. Dissemination of behavioural activation for depression to mental health nurses: training evaluation and benchmarked clinical outcomes.

    PubMed

    Ekers, D M; Dawson, M S; Bailey, E

    2013-03-01

    Depression causes significant distress, disability and cost within the UK. Behavioural activation (BA) is an effective single-strand psychological approach which may lend itself to brief training programmes for a wide range of clinical staff. No previous research has directly examined outcomes of such dissemination. A 5-day training course for 10 primary care mental health workers aiming to increase knowledge and clinical skills in BA was evaluated using the Training Acceptability Rating Scale. Depression symptom level data collected in a randomized controlled trial using trainees were then compared to results from meta-analysis of studies using experienced therapists. BA training was highly acceptable to trainees (94.4%, SD 6%). The combined effect size of BA was unchanged by the addition of the results of this evaluation to those of studies using specialist therapists. BA offers a promising psychological intervention for depression that appears suitable for delivery by mental health nurses following brief training.

  8. Evaluation of obesity clinic program in public community health centers in South Korea.

    PubMed

    Jo, Heui-Sug; Lee, Bo-Young

    2013-07-01

    The purpose of this study was to evaluate the obesity clinic program in the public community health centers in Korea in 2006-2007. The authors conducted a telephone questionnaire survey for participants to evaluate the outcome of the program. Samples were selected through convenient sampling: 30 persons per one public health center among 2560 participants. The level of improvement in obesity, regular exercise, and the effort for calorie reduction of the participants were analyzed. There were significant differences: The participants who were provided continuously the information of obesity clinic program reduced calories for weight loss (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.34-4.19, P < .01), and showed concern about body weight (OR = 2.17, 95% CI = 1.07-4.41, P < 0.05). This study found that when the program information was provided continually and the participants were motivated, the community obesity program goals could be achieved.

  9. Heterogeneity at Work: Implications of the 2012 Clinical Translational Science Award Evaluators Survey

    PubMed Central

    Kane, Cathleen; Alexander, Angela; Hogle, Janice A.; Parsons, Helen M.; Phelps, Lauren

    2014-01-01

    The Clinical and Translational Science Award (CTSA) program is an ambitious multibillion dollar initiative sponsored by the National Institutes of Health (NIH) organized around the mission of facilitating the improved quality, efficiency, and effectiveness of translational health sciences research across the country. Although the NIH explicitly requires internal evaluation, funded CTSA institutions are given wide latitude to choose the structure and methods for evaluating their local CTSA program. The National Evaluators Survey was developed by a peer-led group of local CTSA evaluators as a voluntary effort to understand emerging differences and commonalities in evaluation teams and techniques across the 61 CTSA institutions funded nationwide. This article presents the results of the 2012 National Evaluators Survey, finding significant heterogeneity in evaluation staffing, organization, and methods across the 58 CTSAs institutions responding. The variety reflected in these findings represents both a liability and strength. A lack of standardization may impair the ability to make use of common metrics, but variation is also a successful evolutionary response to complexity. Additionally, the peer-led approach and simple design demonstrated by the questionnaire itself has value as an example of an evaluation technique with potential for replication in other areas across the CTSA institutions or any large-scale investment where multiple related teams across a wide geographic area are given the latitude to develop specialized approaches to fulfilling a common mission. PMID:24214662

  10. Evaluation and the NIH clinical and translational science awards: a "top ten" list.

    PubMed

    Pincus, Harold Alan; Abedin, Zainab; Blank, Arthur E; Mazmanian, Paul E

    2013-12-01

    Since 2006, a total of 61 Clinical and Translational Science Institutes (CTSAs) have been funded by the National Institutes of Health (NIH), with the aim of reducing translation time from a bench discovery to when it impacts patients. This special issue of Evaluation & the Health Professions focuses on evaluation within and across the large, complex system of the CTSA Program of NIH. Through insights gained by reading the articles in this special edition and the experience of the authors, a "top ten" list of lessons learned and insights gained is presented. The list outlines issues that face those who evaluate the influence of the CTSA Program, as they work to anticipate what will be needed for continuing success. Themes include (1) considering the needs of stakeholders, (2) the perspective of the evaluators, (3) the importance of service improvement, (4) the importance of teams and people, (5) costs and return on investments, (6) methodology considerations to evaluate the CTSA enterprise, (7) innovation in evaluation, (8) defining the transformation of research, (9) evaluating the long-term impact of the CTSAs on public health, and (10) contributing to science policy formulation and implementation. The establishment of the CTSA Program, with its mandated evaluation component, has not only influenced the infrastructure and nature of translational research but will continue to impact policy and management in science. PMID:24214661

  11. Evaluating Creative Thinking of Rn-Bsn Students in the Course of Clinical Case Study and Practicum

    ERIC Educational Resources Information Center

    Ku, Ya-Lie

    2015-01-01

    This case study evaluated creative thinking of RN-BSN students in the course of clinical case study and practicum. Study design used quantitative and qualitative evaluations of creative thinking of RN-BSN students by triangulation method in the course of clinical case study and practicum. Sixty RN-BSN students self-perceived the changing levels of…

  12. Development and evaluation of learning module on clinical decision-making in Prosthodontics

    PubMed Central

    Deshpande, Saee; Lambade, Dipti; Chahande, Jayashree

    2015-01-01

    Purpose: Best practice strategies for helping students learn the reasoning skills of problem solving and critical thinking (CT) remain a source of conjecture, particularly with regard to CT. The dental education literature is fundamentally devoid of research on the cognitive components of clinical decision-making. Aim: This study was aimed to develop and evaluate the impact of blended learning module on clinical decision-making skills of dental graduates for planning prosthodontics rehabilitation. Methodology: An interactive teaching module consisting of didactic lectures on clinical decision-making and a computer-assisted case-based treatment planning software was developed Its impact on cognitive knowledge gain in clinical decision-making was evaluated using an assessment involving problem-based multiple choice questions and paper-based case scenarios. Results: Mean test scores were: Pretest (17 ± 1), posttest 1 (21 ± 2) and posttest 2 (43 ± 3). Comparison of mean scores was done with one-way ANOVA test. There was overall significant difference in between mean scores at all the three points (P < 0.001). A pair-wise comparison of mean scores was done with Bonferroni test. The mean difference is significant at the 0.05 level. The pair-wise comparison shows that posttest 2 score is significantly higher than posttest 1 and posttest 1 is significantly higher than pretest that is, pretest 2 > posttest 1 > pretest. Conclusion: Blended teaching methods employing didactic lectures on the clinical decision-making as well as computer assisted case-based learning can be used to improve quality of clinical decision-making in prosthodontic rehabilitation for dental graduates. PMID:26929504

  13. Considerations in the evaluation and determination of minimal risk in pragmatic clinical trials

    PubMed Central

    Lantos, John D.; Wendler, David; Septimus, Edward; Wahba, Sarita; Madigan, Rosemary; Bliss, Geraldine

    2015-01-01

    The classification system for categorizing the riskiness of a clinical trial is largely defined by the body of federal regulations known as the Common Rule (45 CFR 46, Subpart A) and by regulations governing the US Food and Drug Administration (FDA) codified in 21 CFR 50. This rule is applied according to the interpretation of institutional review boards (IRBs) charged with overseeing the research. If a clinical trial is determined by an IRB to constitute “minimal risk,” there are important practical implications: the IRB may allow waiver or alteration of the informed consent process; the study may be carried out in certain vulnerable populations; or the study may be reviewed by IRBs using an expedited process. However, it is unclear how the risk levels of pragmatic clinical trials (PCTs) should be assessed. Such trials typically compare existing, widely used medical therapies or interventions in the setting of routine clinical practice. Some of the therapies may be considered risky of themselves but the study comparing them may or may not add to that pre-existing level of risk. In this paper, we examine current research regulations and common interpretations of those regulations and suggest that current interpretation and application of regulations governing minimal-risk classification are marked by a high degree of variability and confusion, which in turn may ultimately harm patients by delaying or hindering potentially beneficial research. We advocate for a clear differentiation between the risks associated with a given therapy and the incremental risk incurred during research evaluating those therapies as a basic principle for evaluating the risk of a clinical study. We then examine two studies that incorporate aspects of PCTs and consider how various factors including patient perspectives, clinical equipoise, practice variation, and research methods such as cluster randomization contribute to current and evolving concepts of minimal risk, and how this

  14. Oxygen utilization of the human left ventricle - An indirect method for its evaluation and clinical considerations

    NASA Technical Reports Server (NTRS)

    Ghista, D. N.; Sandler, H.

    1974-01-01

    An analytical method is presented for determining the oxygen consumption rate of the intact heart working (as opposed to empty but beating) human left ventricle. Use is made of experimental recordings obtained for the chamber pressure and the associated dimensions of the LV. LV dimensions are determined by cineangiocardiography, and the chamber pressure is obtained by means of fluid-filled catheters during retrograde or transeptal catheterization. An analytical method incorporating these data is then employed for the evaluation of the LV coronary oxygen consumption in five subjects. Oxygen consumption for these subjects was also obtained by the conventional clinical method in order to evaluate the reliability of the proposed method.

  15. Application Of Cathode-Ray Tube Technology To The Clinical Evaluation Of Visual Functions

    NASA Astrophysics Data System (ADS)

    Vernier, Francoise; Charlier, Jacques; Nguyen, Duc D.

    1988-02-01

    Cathode-ray tubes (CRTs) have many applications in the clinical evaluation of visual functions. They have been used to test visual acuity, contrast sensitivity, visual fields, and early development of vision in preverbal children. Because CRTs provide considerable flexibility for the definition of spatial and temporal components of the stimulus, their use provides an attractive solution to many visual stimulation problems. However, there are some limitations due to the scanning of the picture frame by the electron beam and also to the electron-photon conversion process. The spatial, photometric, spectral, and temporal characteristics of a specifically designed monochromatic television system are evaluated with reference to the physiological requirements of visual tests.

  16. [Basic and clinical evaluation of an immunoradiometric competitive inhibition assay for 2----6 sialyl Lewis a antigen--2. Evaluation of clinical significance].

    PubMed

    Imura, H; Takahashi, T; Matsuda, T; Yoshida, O; Ohkura, H; Seitetsu, Y; Seino, Y; Ishii, M; Kuwabara, M; Ariyoshi, Y

    1989-06-01

    The clinical significance of serum 2----6 sialyl Lewisa antigen was evaluated using "SLA 2----6 Otsuka" kits. Results indicated that the antigen was frequently elevated in sera obtained from patients with various cancers, including pancreas (73%), liver (67%), bilialy tract (66%), uterus (35%), and stomach (33%). Among other tumor markers examined, CA 19-9 (2----3 sialyl Lewisa) had a very similar cancer spectrum as 2----6 sialyl Lewisa. In the sera of patients with malignant disorders of digestive and respiratory organs, including stomach, intestine, pancreas, biliary tract and lung, the serum levels of CA19-9 tended to be higher than those of 2----6 sialyl Lewisa, usually exceeded those of CA19-9. This suggests that the 2----6 sialylation of Lewisa antigen is equally observed in malignant and non-malignant diseases, while the 2----3 sialylation is relatively specific to cancers. As a result, the ratio of the two antigens, CA 19-9: 2----6 sialyl Lewisa antigen ratio, exceeded 2.0 in most of the sera obtained from patients with malignancy, whereas the ratio was below 2.0 in most of patients with corresponding non-malignant diseases of those organs. The determination of the ratio may be clinically useful in the differential diagnosis of the malignant and non-malignant diseases in those organs.

  17. [Introduction of a Clinical Research Experience Program in Hospital Practical Training for Pharmacy Students and Its Evaluation].

    PubMed

    Takahashi, Katsuyuki; Suda, Yasuki; Kawaguchi, Hiroshi; Nakamura, Yasutaka; Kawabata, Shiho; Kawakami, Noriko; Nishikawa, Takeshi; Nagayama, Katsuya

    2015-01-01

    Long-term clinical training based on a model core curriculum was conducted to nurture highly competent pharmacists in the clinical field. Pharmacists' responsibilities are expanding, and a system has been developed to help pharmacists gain accreditation, identify specialties, and improve their training. However, this system requires research competency. Therefore clinical research should be considered a part of clinical training to encourage high competency among pharmacists. Because the model core curriculum does not include a section on clinical research. Osaka City University Hospital introduced a hands-on clinical research experience program and evaluated its usefulness. A significant improvement in the level of knowledge and awareness of clinical research was seen among students who underwent the clinical research experience program. In addition, the level of student satisfaction was higher. These findings suggest that a clinical research experience program may be useful to nurture a greater awareness of clinical research and knowledge acquisition among pharmacists. PMID:26329554

  18. Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement

    PubMed Central

    Trento, Guilherme dos Santos; Bernabé, Felipe Bueno Rosettti; da Costa, Delson João; Rebellato, Nelson Luis Barbosa; Klüppel, Leandro Eduardo; Scariot, Rafaela

    2015-01-01

    Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness. PMID:26691970

  19. Evaluation of nisin-β-lactam antibiotics against clinical strains of Salmonella enterica serovar Typhi.

    PubMed

    Rishi, Praveen; Preet Singh, Aman; Garg, Neha; Rishi, Madhuri

    2014-12-01

    There is an imperative need to discover novel antimicrobials and anti-infective agents and build up innovative strategies to combat multidrug-resistant Salmonella. In this context, we had earlier confirmed that nisin has the potential to act in conjunction with β-lactams against murine salmonellosis using standard strain. However, evaluation of efficacy of these combinations against clinical isolates of Salmonella could be the next key step to confirm the value added potential of this peptide. The present study was therefore planned to validate the synergistic effects of nisin-β-lactams combinations against clinical isolates of Salmonella enterica serovar Typhi. MICs of the selected β-lactams, EDTA and nisin were determined by micro and macro broth dilution assays. In-vitro synergism between the agents was evaluated by fractional inhibitory concentration (FIC) index (checkerboard test) and time-kill assay. All the tested combinations showed synergy against the tested clinical strains except three, as evident by FIC index (checkerboard test) and time-kill assay. Especially, nisin-ceftriaxone and nisin-cefotaxime combinations demonstrated excellent synergistic activity. In view of the encouraging results obtained from the previous and present study, further studies need to be carried out using large number of strains from different regions to take into account the clinical variability of the strains. Though it is a simple study but highlights an important point about the possibility of using the said combination while making strategies to develop newer formulations.

  20. An interdisciplinary methodology for the comparative evaluation of splinting materials (orthotics, thermoplastics, clinical research).

    PubMed

    Shimeld, A; Campbell, G; Ernest, M

    1982-06-01

    The methodology developed includes both the use of laboratory evaluation and clinical assessment in an area where there are no standard requirements, no specifications, nor any continuity of data available on the various thermoplastic splinting materials now on the market. A series of laboratory tests and clinical trials were devised such that these could be interpreted with regard to clinical considerations, cost analyses and serviceability factors relating to the materials. Laboratory testing covered possible effects on the chemical and mechanical properties of material likely to be caused by various environmental, sterilization and working factors. The complementary clinical evaluation to highlight the behaviour of materials during the fabrication and wearing of splints consisted of specific information generated with the assistance of experienced occupational therapists, occupational therapy students and patients. Biocompatibility studies were also carried out. The data to be published will provide needed information to physicians, occupational therapists, physical therapists, orthotists, prosthetists, and administrators with regard to their making informed decisions on the selection, purchase and use of thermoplastic materials.

  1. Integrating research and clinical neuroimaging for the evaluation of traumatic brain injury recovery

    NASA Astrophysics Data System (ADS)

    Senseney, Justin; Ollinger, John; Graner, John; Lui, Wei; Oakes, Terry; Riedy, Gerard

    2015-03-01

    Advanced MRI research and other imaging modalities may serve as biomarkers for the evaluation of traumatic brain injury (TBI) recovery. However, these advanced modalities typically require off-line processing which creates images that are incompatible with radiologist viewing software sold commercially. AGFA Impax is an example of such a picture archiving and communication system(PACS) that is used by many radiology departments in the United States Military Health System. By taking advantage of Impax's use of the Digital Imaging and Communications in Medicine (DICOM) standard, we developed a system that allows for advanced medical imaging to be incorporated into clinical PACS. Radiology research can now be conducted using existing clinical imaging display platforms resources in combination with image processingtechniques that are only available outside of the clinical scanning environment. We extracted the spatial and identification elements of theDICOM standard that are necessary to allow research images to be incorporatedinto a clinical radiology system, and developed a tool that annotates research images with the proper tags. This allows for the evaluation of imaging representations of biological markers that may be useful in theevaluation of TBI and TBI recovery.

  2. Evaluation of nisin-β-lactam antibiotics against clinical strains of Salmonella enterica serovar Typhi.

    PubMed

    Rishi, Praveen; Preet Singh, Aman; Garg, Neha; Rishi, Madhuri

    2014-12-01

    There is an imperative need to discover novel antimicrobials and anti-infective agents and build up innovative strategies to combat multidrug-resistant Salmonella. In this context, we had earlier confirmed that nisin has the potential to act in conjunction with β-lactams against murine salmonellosis using standard strain. However, evaluation of efficacy of these combinations against clinical isolates of Salmonella could be the next key step to confirm the value added potential of this peptide. The present study was therefore planned to validate the synergistic effects of nisin-β-lactams combinations against clinical isolates of Salmonella enterica serovar Typhi. MICs of the selected β-lactams, EDTA and nisin were determined by micro and macro broth dilution assays. In-vitro synergism between the agents was evaluated by fractional inhibitory concentration (FIC) index (checkerboard test) and time-kill assay. All the tested combinations showed synergy against the tested clinical strains except three, as evident by FIC index (checkerboard test) and time-kill assay. Especially, nisin-ceftriaxone and nisin-cefotaxime combinations demonstrated excellent synergistic activity. In view of the encouraging results obtained from the previous and present study, further studies need to be carried out using large number of strains from different regions to take into account the clinical variability of the strains. Though it is a simple study but highlights an important point about the possibility of using the said combination while making strategies to develop newer formulations. PMID:24961707

  3. [Evaluation of the clinical diagnostic reasoning. Use of dynamic attractors as an alternative].

    PubMed

    Prado-Vega, Rodolfo; Zacatelco-Ramírez, Oliva R; Ortiz-Montalvo, Armando; Ponce de León-Castañeda, Ma Eugenia

    2002-01-01

    The purpose of this study was to apply diagnostic clinical reasoning, based upon cognitive teaching, to help the student develop their own mental structure of an ailment or disease. Such a structure is built as mathematical chaotic deterministic type that can be evaluated through identification of dynamic attractors. To achieve our purpose, clinical diagnostic reasoning skills of two groups of students was compared against those of an expert through revision of 17 clinical cases. Such revision, selection of relevant data, allows for construction of conceptual maps in which several dynamic attractors can be identified, based on the largest number of connections that stem from some concepts. In the majority of cases, statistical analysis showed similarity among types of connections established by the expert; several similar dynamic attractors could be identified, leading us to conclude that cognitive-based teaching of diagnostic clinical reasoning is useful in developing this type of skill, and that it can be evaluated through identification of dynamic attractors. PMID:12404724

  4. Contemporary models of pediatric obsessive-compulsive disorder: An evaluation with a large clinical sample.

    PubMed

    De Nadai, Alessandro; Nagpal, Prianka S; Piacentini, John; Peris, Tara S; Geffken, Gary R; Geller, Daniel A; Murphy, Tanya K; Storch, Eric A; Lewin, Adam B

    2015-09-30

    We evaluated the construct validity of the Child Yale-Brofwn Obsessive-Compulsive Scale (CYBOCS) in a large clinical sample (N=730) using confirmatory factor analysis. Results found inadequate fit for a priori models, though a model accounting for overlapping item content displayed good fit. Parallel obsessions/compulsions items may provide largely redundant information on the CYBOCS. Findings suggest modifying the CYBOCS to reduce burden on researchers, patients, and clinicians, and to more accurately measure pediatric obsessive-compulsive disorder (OCD).

  5. Summary of Medipix Technology's 3-Years in Space and Plans for Future Developments

    NASA Astrophysics Data System (ADS)

    Pinsky, Lawrence

    2016-07-01

    NASA has evaluated 7 Timepix-based radiation imaging detectors from the CERN-based Medipix2 collaboration on the International Space Station (ISS), collecting more than 3-years of data, as well on the December, 2014 EFT-1 mission testing the new Orion Multi-Purpose Crew Vehicle. These data along with data collected at ground-based accelerator facilities including the NASA Space Radiation Lab (NSRL) at Brookhaven in the US, as well as at the HIMAC facility at the National Institute for Radiological Sciences in Japan, have allowed the development of software analysis techniques sufficient to provide a stand-alone accurate assessment of the space radiation environment for dosimetric purposes. Recent comparisons of the performance of the Timepix with both n-on-p and p-on-n Si sensors will be presented. The further evolution of the Timepix technology by the Medipix3 collaboration in the form of the Timepix3 chip, which employs a continuous data-driven readout scheme, is being evaluated for possible use in future space research applications. Initial performance evaluations at accelerators will be reported. The Medipix2 Collaboration is also in the process of designing an updated version of the Timepix chip, called the Timepix2, which will continue the frame-based readout scheme of the current Timepix chip, but add simultaneous charge encoding using the Time-Over-Threshold (TOT) and first-hit Time-of-Arrival (TOA) encoding. Current plans are to replace the Timepix by the Timepix2 with minimal reconfiguration of the supporting electronics. Longer-term plans include participation in the currently forming Medipix4 collaboration. A summary of these prospects will also be included.

  6. A unified procedure for meta-analytic evaluation of surrogate end points in randomized clinical trials.

    PubMed

    Dai, James Y; Hughes, James P

    2012-09-01

    The meta-analytic approach to evaluating surrogate end points assesses the predictiveness of treatment effect on the surrogate toward treatment effect on the clinical end point based on multiple clinical trials. Definition and estimation of the correlation of treatment effects were developed in linear mixed models and later extended to binary or failure time outcomes on a case-by-case basis. In a general regression setting that covers nonnormal outcomes, we discuss in this paper several metrics that are useful in the meta-analytic evaluation of surrogacy. We propose a unified 3-step procedure to assess these metrics in settings with binary end points, time-to-event outcomes, or repeated measures. First, the joint distribution of estimated treatment effects is ascertained by an estimating equation approach; second, the restricted maximum likelihood method is used to estimate the means and the variance components of the random treatment effects; finally, confidence intervals are constructed by a parametric bootstrap procedure. The proposed method is evaluated by simulations and applications to 2 clinical trials.

  7. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome

    PubMed Central

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-01-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment. PMID:27630413

  8. Highly reliable heterologous system for evaluating resistance of clinical herpes simplex virus isolates to nucleoside analogues.

    PubMed

    Bestman-Smith, J; Schmit, I; Papadopoulou, B; Boivin, G

    2001-04-01

    Clinical resistance of herpes simplex virus (HSV) types 1 and 2 to acyclovir (ACV) is usually caused by the presence of point mutations within the coding region of the viral thymidine kinase (TK) gene. The distinction between viral TK mutations involved in ACV resistance or part of viral polymorphism can be difficult to evaluate with current methodologies based on transfection and homologous recombination. We have developed and validated a new heterologous system based on the expression of the viral TK gene by the protozoan parasite Leishmania, normally devoid of TK activity. The viral TK genes from 5 ACV-susceptible and 13 ACV-resistant clinical HSV isolates and from the reference strains MS2 (type 2) and KOS (type 1) were transfected as part of an episomal expression vector in Leishmania. The susceptibility of TK-recombinant parasites to ganciclovir (GCV), a closely related nucleoside analogue, was evaluated by a simple measurement of the absorbance of Leishmania cultures grown in the presence of the drug. Expression of the TK gene from ACV-susceptible clinical isolates resulted in Leishmania susceptibility to GCV, whereas expression of a TK gene with frameshift mutations or nucleotide substitutions from ACV-resistant isolates gave rise to parasites with high levels of GCV resistance. The expression of the HSV TK gene in Leishmania provides an easy, reliable, and sensitive assay for evaluating HSV susceptibility to nucleoside analogues and for assessing the role of specific viral TK mutations.

  9. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome.

    PubMed

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-08-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment. PMID:27630413

  10. The role of 3DCT for the evaluation of chop injuries in clinical forensic medicine.

    PubMed

    Wittschieber, Daniel; Beck, Laura; Vieth, Volker; Hahnemann, Maria L

    2016-09-01

    As hatchet blows to the human head frequently cause fatal injuries, the forensic examination of survivors with cranial chop injuries is a rare phenomenon in forensic casework. Besides evaluation of clinical records, photographs, and medico-legal physical examination, the analysis and 3-dimensional reconstruction of pre-treatment computed tomography data (3DCT) must be considered an important and indispensable tool for the assessment of those cases because the characteristics of chopping trauma often appear masked or changed by clinical treatment. In the present article, the role of 3DCT for the evaluation of chop wounds in clinical forensic medicine is demonstrated by an illustrative case report of a young man who was attacked with a hatchet. 3DCT provides additional possibilities for supplementing missing information, such as number and direction of blows as well as weapon identification. Furthermore, 3DCT facilitates demonstration in court and understanding of medical lay people. We conclude that 3DCT is of particular value for the evaluation of survivors of life-threatening head and face injury. An increasing significance of this technique may be expected.

  11. [Analysis of nursing skills in the clinical diagnosis and evaluation setting].

    PubMed

    Pedarribes, Georges; Lefeuvre, Gwenaël

    2014-01-01

    The research work presented in this article concerns reengineering of the registered nurse diploma, particularly definition of Skills group No. 1: evaluate a clinical situation and establish a nursing diagnosis. It was designed to analyse real nursing practices in a typical clinical evaluation and diagnosis setting on admission of a patient to hospital. This analysis essentially focused on the cognitive processes used to organise nursing practices. The theoretical framework of professional training allowed this analysis to be performed on the basis of concepts of skills, schema and operative model. The research protocol focused on self-assessment interviews allowing explanation of the schemas used by a skilled nurse and a trainee nurse on admission of a patient in the day hospital for colonoscopy. An analysis of these schemas and especially the operative model of the skilled nurse demonstrated the organising concepts of effective nursing practice. The results, apart from their heuristic value to provide a better understanding of nursing professional practices, also provide resources to design training in nursing clinical evaluation. PMID:25490222

  12. WHO consultation on clinical evaluation of vaccines, 17-18 July 2014, WHO Headquarters, Geneva, Switzerland.

    PubMed

    Knezevic, Ivana; Moorthy, Vasee; Sheets, Rebecca

    2015-04-21

    A World Health Organization (WHO) consultation on guidelines for National Regulatory Authorities (NRAs) and vaccine manufacturers on clinical evaluation of vaccines was held from 17 to 18 July 2014, to review key scientific challenges that regulators have been facing since the establishment of the WHO Guidelines on Clinical Evaluation of Vaccines. The guidelines, adopted by the WHO Expert Committee on Biological Standardization (ECBS) in 2001, have served as the basis for setting or updating national requirements for the evaluation and licensing of a broad range of vaccines as well as for WHO vaccine prequalification. Regulators from Australia, Brazil, China, Canada, Germany, India, Republic of Korea, South Africa, United States of America and the United Kingdom were represented. The International Federation for Pharmaceutical Manufacturers' Association (IFPMA) and the Developing Country Vaccine Manufacturers' Network (DCVMN) provided industry representation. The consultation concluded that the guidelines should be revised to address issues that were raised in the context of vaccines that were the subject of clinical development in the past decade. Although the current guidelines have served well over time, it was recognized that an update would further increase their utility and would help regulators, manufacturers, vaccine developers and academia to respond to the challenging questions regarding the safety, immunogenicity, efficacy and effectiveness of vaccines intended for global use. A summary of the main outcomes of the consultation and proposals for the next steps regarding the guidelines and beyond are provided in this report.

  13. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome

    PubMed Central

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-01-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment.

  14. A clinical evaluation of comprehensive dental treatment for children under general anesthesia.

    PubMed

    Su, H L; Chen, P S

    1992-12-01

    The purpose of this study is to evaluate the comprehensive dental treatment for children under general anesthesia. From 1989 to 1991, 57 children with mean age of 3 years 2 months were treated, followed up with a minimal of 1 year. This procedure allows the dentition to be restored in one visit. Further care including preventive options and behavior shaping was provided on a 3-6 months recall schedule. The reasons for general anesthesia are that these children were either unable to accept treatment because of handicaps, extreme fear or young age. Their mean number of decayed tooth was 15 (Standard Deviation, SD = 5) and nearly three quarters of the children were under 6 years old. The most frequent treatment procedures were the extraction of teeth, composite resin restoration and Ni-Cr crown restoration. The Ni-Cr crown (1.7% failure rate) was more successful than the amalgam and composite resin restoration (9.7% failure rate). Pedo-strip crown had the highest failure rate (22%) for anterior teeth restoration. Nineteen children needed retreatment with conventional behavior guide. Six children had new caries and required further treatment. Thirty eight children returned for regular recall during the minimal 1 year follow-up period. PMID:1295652

  15. A clinical evaluation of comprehensive dental treatment for children under general anesthesia.

    PubMed

    Su, H L; Chen, P S

    1992-12-01

    The purpose of this study is to evaluate the comprehensive dental treatment for children under general anesthesia. From 1989 to 1991, 57 children with mean age of 3 years 2 months were treated, followed up with a minimal of 1 year. This procedure allows the dentition to be restored in one visit. Further care including preventive options and behavior shaping was provided on a 3-6 months recall schedule. The reasons for general anesthesia are that these children were either unable to accept treatment because of handicaps, extreme fear or young age. Their mean number of decayed tooth was 15 (Standard Deviation, SD = 5) and nearly three quarters of the children were under 6 years old. The most frequent treatment procedures were the extraction of teeth, composite resin restoration and Ni-Cr crown restoration. The Ni-Cr crown (1.7% failure rate) was more successful than the amalgam and composite resin restoration (9.7% failure rate). Pedo-strip crown had the highest failure rate (22%) for anterior teeth restoration. Nineteen children needed retreatment with conventional behavior guide. Six children had new caries and required further treatment. Thirty eight children returned for regular recall during the minimal 1 year follow-up period.

  16. Multiple trait genetic evaluation of clinical mastitis in three dairy cattle breeds.

    PubMed

    Govignon-Gion, A; Dassonneville, R; Baloche, G; Ducrocq, V

    2016-04-01

    In 2010, a routine genetic evaluation on occurrence of clinical mastitis in three main dairy cattle breeds-- Montbéliarde (MO), Normande (NO) and Holstein (HO)--was implemented in France. Records were clinical mastitis events reported by farmers to milk recording technicians and the analyzed trait was the binary variable describing the occurrence of a mastitis case within the first 150 days of the first three lactations. Genetic parameters of clinical mastitis were estimated for the three breeds. Low heritability estimates were found: between 2% and 4% depending on the breed. Despite its low heritability, the trait exhibits genetic variation so efficient genetic improvement is possible. Genetic correlations with other traits were estimated, showing large correlations (often>0.50, in absolute value) between clinical mastitis and somatic cell score (SCS), longevity and some udder traits. Correlation with milk yield was moderate and unfavorable (ρ=0.26 to 0.30). High milking speed was genetically associated with less mastitis in MO (ρ=-0.14) but with more mastitis in HO (ρ=0.18). A two-step approach was implemented for routine evaluation: first, a univariate evaluation based on a linear animal model with permanent environment effect led to pre-adjusted records (defined as records corrected for all non-genetic effects) and associated weights. These data were then combined with similar pre-adjusted records for others traits in a multiple trait BLUP animal model. The combined breeding values for clinical mastitis obtained are the official (published) ones. Mastitis estimated breeding values (EBV) were then combined with SCSs EBV into an udder health index, which receives a weight of 14.5% to 18.5% in the French total merit index (ISU) of the three breeds. Interbull genetic correlations for mastitis occurrence were very high (ρ=0.94) with Nordic countries, where much stricter recording systems exist reflecting a satisfactory quality of phenotypes as reported by the

  17. [Thinking about vertigo effectiveness evaluation methods in clinical research of Chinese medicine].

    PubMed

    Liu, Hong-mei; Li, Tao

    2014-10-01

    Vertigo is a kind of patients' subjective feelings. The severity of vertigo is closely related to many factors. But we are short of a well accepted quantitative evaluation method capable of accurately and comprehensively evaluating vertigo in clinics. Reducing the onset of vertigo, enhancing the re- covery of equilibrium function, and improving the quality of life of vertigo patients should be taken as the focus of evaluating therapeutic effects. As for establishing a Chinese medical effectiveness evaluation system for vertigo, we believe we should distinguish different "diseases". We could roughly identify it as systemic vertigo and non-systemic vertigo. For systemic vertigo, the efficacy of vertigo could be comprehensively evaluated by UCLA vertigo questionnaire or dizziness handicap inventory combined with equilibrium function testing indices. But for non-systemic vertigo, the efficacy of vertigo could be comprehensively evaluated by taking UCLA vertigo questionnaire or dizziness handicap inventory as main efficacy indices. Secondly, we should analyze different reasons for vertigo, choose symptoms and signs in line with vertigo features as well as with Chinese medical theories, and formulate corresponding syndrome effectiveness standards according to different diseases. We should not simply take syndrome diagnosis standards as efficacy evaluation standards.

  18. One-year clinical evaluation of posterior packable resin composite restorations.

    PubMed

    Loguercio, A D; Reis, A; Rodrigues Filho, L E; Busato, A L

    2001-01-01

    This study evaluated the clinical performance of four packable resin composite restorative materials in posterior teeth (Class I and II) compared with one hybrid composite after one year. Eighty-four restorations were placed in 16 patients. Each patient received at least five restorations. The tested materials were: (1) Solitaire + Solid Bond; (2) ALERT + Bond-1; (3) Surefil + Prime & Bond NT (4) Filtek P60 + Single Bond and; (5) TPH Spectrum + Prime & Bond 2.1. All restorations were made using rubber dam isolation, and the cavity design was restricted to the elimination of carious tissue. Deeper cavities were covered with calcium hydroxide and/or glass ionomer cement. In shallow and medium cavities, no protection was performed except for the respective adhesive system used in each group. Each adhesive system and resin composite was placed according to the manufacturer's instructions. One week later, the restorations were finished/polished and evaluated according to the USPHS modified criteria. All patients attended the one-year recall, and the 84 restorations were evaluated at that time based on the same evaluation criteria. The scores were submitted to statistical analysis (Chi-square test, p<0.05). Solitaire and TPH showed some fractures at marginal ridges. Solitaire, ALERT and TPH showed some concerns related to color match and surface texture. Surefil and Filtek P60 showed an excellent clinical performance after one year.

  19. Development of polarization dental imaging modality and evaluation of its clinical feasibility

    NASA Astrophysics Data System (ADS)

    Kim, Eunji; Son, Taeyoon; Bae, Yunjin; Jung, Byungjo

    2011-03-01

    Recently, it has become more important to objectively analyze teeth color in terms of esthetical point of view. In the evaluation of tooth color, the specular reflection caused by saliva on tooth may cause artifacts in analysis. In this study, a polarization dental imaging modality (PDIM) was developed to address the specular reflection problems. Clinical validity was evaluated by performing three studies such as shade-guide selection for implant, plaque distribution detection, and evaluation of tooth whitening. In the selection of shade-guide, in-vivo human teeth and shade-guide color images were obtained. The minimum color difference between shade-guide and tooth was calculated using Euclidian distance. In the plaque distribution detection, teeth disclosing agent was used to differentiate plaque from teeth and images were taken. In the evaluation of whitening, whiteness indices were calculated using 29 shade-guide images. Results presented that the new imaging modality could provide reproducible images by effectively removing the specular reflection on teeth surface and therefore, minimize artifacts in the quantitatively analysis of shade-guide selection, plaque detection, and tooth whitening. In conclusion, the PDIM potentially proved its clinical efficacy as a new imaging modality.

  20. Objective evaluation of fine motor manipulation-a new clinical tool.

    PubMed

    Andersen Hammond, Elizabeth R; Shay, Barbara L; Szturm, Tony

    2009-01-01

    A new performance-based tool has been developed to accurately and precisely evaluate finger/hand function during manipulation of any object, independent of geometric and surface properties. The objectives of this study were to show test-retest reliability and evaluate criterion validity. Twenty healthy, right-handed participants were recruited. Three objects ranging in weight and size, requiring two or three fingers, were instrumented with a motion sensor that tracked 3D linear/angular motion. A computerized visual-guided tracking task was used to quantify motor performance during object manipulation. Two testing periods, one week apart were performed to evaluate test-retest reliability. Criterion validity was assessed by comparing performance with this tool to performance on commonly used clinical dexterity tests. Global performance, temporal accuracy, and amplitude consistency during manipulation of the objects compared with the reference waveform were highly reliable on the two testing occasions. Low-moderate correlations between the clinical dexterity tests and the task protocol indicate that different aspects of hand function were measured. The task protocol directly measures the ability of the hand to coordinate movement in response to a visual tracking target. Providing effective and objective ways to evaluate manual dexterity and hand function is a critical part of evidence-based practice.

  1. Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan

    PubMed Central

    Nakayama, Takeo; Hatta, Taichi; Takahashi, Naomi; Fujita, Misao

    2016-01-01

    Background Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics’ websites. Meanwhile, the Health Science Council at the Ministry of Health, Labour, and Welfare (MHLW) in Japan has pointed out noncompliance of some local clinics with the provisions concerning medical advertising in the Medical Care Act in the past. However, locally little is known about the current status of those clinics including the quality of their webpage information disseminated. Objective To evaluate the quality of website information of private-practice clinics offering cell therapies in Japan. Methods Twenty-four websites with 77 treatments from the Google search were identified for evaluation. The following three exploratory analyses were performed: first in order to ascertain web-based portrayal of private-practice clinics offering cell therapies, a descriptive analysis was conducted using a coding frame; second we evaluated the quality of the target website information from the viewpoint of the level of consideration taken for patients and their family members, using 10 quality criteria (“the Minimum Standard”) from the e-Health Code of Ethics 2.0; third we counted and coded expressions that matched set categories for “name-dropping” and “personalized medicine” in the information posted on these websites. Results Analysis on the treatments (N=77) revealed 126 indications (multiple response): the top three indications were “cancer,” “skin-rejuvenation/antiaging/anti–skin aging,” and “breast augmentation/buttock augmentation.” As for the portrayal of treatment risks and benefits, 78% (60

  2. Validity and Reliability of the Clinical Competency Evaluation Instrument for Use among Physiotherapy Students

    PubMed Central

    Muhamad, Zailani; Ramli, Ayiesah; Amat, Salleh

    2015-01-01

    Objectives: The aim of this study was to determine the content validity, internal consistency, test-retest reliability and inter-rater reliability of the Clinical Competency Evaluation Instrument (CCEVI) in assessing the clinical performance of physiotherapy students. Methods: This study was carried out between June and September 2013 at University Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia. A panel of 10 experts were identified to establish content validity by evaluating and rating each of the items used in the CCEVI with regards to their relevance in measuring students’ clinical competency. A total of 50 UKM undergraduate physiotherapy students were assessed throughout their clinical placement to determine the construct validity of these items. The instrument’s reliability was determined through a cross-sectional study involving a clinical performance assessment of 14 final-year undergraduate physiotherapy students. Results: The content validity index of the entire CCEVI was 0.91, while the proportion of agreement on the content validity indices ranged from 0.83–1.00. The CCEVI construct validity was established with factor loading of ≥0.6, while internal consistency (Cronbach’s alpha) overall was 0.97. Test-retest reliability of the CCEVI was confirmed with a Pearson’s correlation range of 0.91–0.97 and an intraclass coefficient correlation range of 0.95–0.98. Inter-rater reliability of the CCEVI domains ranged from 0.59 to 0.97 on initial and subsequent assessments. Conclusion: This pilot study confirmed the content validity of the CCEVI. It showed high internal consistency, thereby providing evidence that the CCEVI has moderate to excellent inter-rater reliability. However, additional refinement in the wording of the CCEVI items, particularly in the domains of safety and documentation, is recommended to further improve the validity and reliability of the instrument. PMID:26052461

  3. 10-year clinical evaluation of a self-etching adhesive system.

    PubMed

    Akimoto, Naotake; Takamizu, Masaaki; Momoi, Yasuko

    2007-01-01

    This study evaluated the long-term clinical performance of a self-etching adhesive system, Clearfil Liner Bond 2. Two operators placed a total of 87 restorations among 42 patients. Carious dentin was identified with the help of Caries Detector and was removed using only a low speed round bur. Clearfil Liner Bond 2 was applied following the manufacturer's directions, and the resin composite was then placed. The number of restorations placed by cavity classification were: 8-Class I, 11-Class II, 21-Class III, 2-Class IV and 45-Class V. The restorations were evaluated in 5 categories according to modified USPHS criteria: pulpal response, marginal integrity, marginal discoloration, retention and secondary caries. Assessments were done at baseline, immediately after placement and at 6-months and 1, 5, 7 and 10 years. Recall rates at each assessment period were 83.9% (6-months), 82.8% (1 year), 59.8% (5 years), 77.0% (7 years) and 50.6% (10 years). In terms of assessment categories, there were no recorded sensitivity, retention loss or secondary caries at any of the five recall periods. At the 10-year assessment, 40 out of 44 restorations (90.9%) were rated Bravo for marginal integrity and 39 restorations (88.6%) were rated Bravo for marginal discoloration (Wilcoxon signed-ranks test p < 0.05). This data demonstrates the retention rate and pulpal response of the self-etching adhesive system Clearfil Liner Bond 2 was excellent at 10 years. Most cases showed slight marginal changes during clinical function; however, these changes were not clinically severe by USPHS criteria. These data demonstrate that placement of the Clearfil Liner Bond 2 self-etching adhesive system was demonstrated to be acceptable for the clinical restoration of human teeth following 10 years of clinical function.

  4. Nitrous oxide emissions from Chinese maize-wheat rotation systems: A 3-year field measurement

    NASA Astrophysics Data System (ADS)

    Cai, Yanjiang; Ding, Weixin; Luo, Jiafa

    2013-02-01

    Nitrous oxide (N2O) fluxes were measured over a 3-year period (2004-2007) in a long-term experimental field. The objectives of the study were to evaluate the interannual variation of N2O emissions from a maize-wheat rotation, under different fertilizer regimes and to determine the key controlling factors. The study involved four treatments: compost (OM), half compost N plus half inorganic fertilizer-N (HOM), inorganic fertilizer-N (NPK), and control (CK) where no N application. The mean annual N2O emission over a 3-year period was 0.30 ± 0.11 kg N2O-N ha-1 in the CK treatment, but increased to 1.61 ± 0.10 kg N2O-N ha-1 in the HOM treatment, 2.13 ± 0.15 kg N2O-N ha-1 in the OM treatment, and 2.76 ± 0.19 kg N2O-N ha-1 in the NPK treatment. Differences were significant among treatments. The N2O emission factors of the applied OM, NPK and HOM were 0.61 ± 0.02, 0.82 ± 0.10 and 0.44 ± 0.04%, respectively, at a rate of 300 kg N ha-1 year-1, indicating that the combined application of compost with inorganic fertilizer significantly reduced N2O emission. Over a maize-wheat rotation year, more than 65% of the annual N2O emission occurred during the maize growing season. There was a large interannual variation in N2O emission in all treatments, albeit not significant either during the maize growing season or at an inter-year scale. This interannual variation was mainly attributable to differences in soil moisture after basal fertilizer application, and irrigation and/or heavy rainfall events immediately following basal fertilization could induce more N2O production than pre-irrigation before plowing. The HOM treatment had higher N fertilizer use efficiency and lowest yield-scaled N2O emissions compared with the OM and NPK treatments. We therefore argue that the combined application of half compost N plus half fertilizer-N will mitigate N2O emissions from soils in the North China plain.

  5. Controlled clinical evaluations of chlorine dioxide, chlorite and chlorate in man.

    PubMed Central

    Lubbers, J R; Chauan, S; Bianchine, J R

    1982-01-01

    To assess the relative safety of chronically administered chlorine water disinfectants in man, a controlled study was undertaken. The clinical evaluation was conducted in the three phases common to investigational drug studies. Phase I, a rising dose tolerance investigation, examined the acute effects of progressively increasing single doses of chlorine disinfectants to normal healthy adult male volunteers. Phase II considered the impact on normal subjects of daily ingestion of the disinfectants at a concentration of 5 mg/l. for twelve consecutive weeks. Persons with a low level of glucose-6-phosphate dehydrogenase may be expected to be especially susceptible to oxidative stress; therefore, in Phase III, chlorite at a concentration of 5 mg/l. was administered daily for twelve consecutive weeks to a small group of potentially at-risk glucose-6-phosphate dehydrogenase-deficient subjects. Physiological impact was assessed by evaluation of a battery of qualitative and quantitative tests. The three phases of this controlled double-blind clinical evaluation of chlorine dioxide and its potential metabolites in human male volunteer subjects were completed uneventfully. There were no obvious undesirable clinical sequellae noted by any of the participating subjects or by the observing medical team. In several cases, statistically significant trends in certain biochemical or physiological parameters were associated with treatment; however, none of these trends was judged to have physiological consequence. One cannot rule out the possibility that, over a longer treatment period, these trends might indeed achieve proportions of clinical importance. However, by the absence of detrimental physiological responses within the limits of the study, the relative safety of oral ingestion of chlorine dioxide and its metabolites, chlorite and chlorate, was demonstrated. PMID:6961033

  6. A clinical evaluation of the Cobas Fara clinical chemistry analyzer for some routine serum enzymes and glucose.

    PubMed

    Moses, G C; Lightle, G O; Tuckerman, J F; Henderson, A R

    1987-11-01

    The authors evaluated the Cobas FARA centrifugal analyzer with respect to pipetting precision and accuracy, instrument temperature, spectrophotometric response, and analytic performance for the assay of five serum enzymes and glucose. Spectrophotometric response, temperature response, pipetting precision, and accuracy were satisfactory. However, sufficient time must be allowed for cuvet contents to reach a stable temperature before measurements are made. Total day-to-day imprecision (within plus between run) was less than 5% (coefficient of variation) for aspartate and alanine aminotransferases (AST; Enzyme Commission classification number [EC] EC 2.6.1.1; and ALT; EC 2.6.1.2); alkaline phosphatase (AP; EC 3.1.3.1); gamma-glutamyltransferase (GGT; EC 2.3.1.2); lactate dehydrogenase (LD; EC 1.1.1.17); creatine kinase (CK; EC 2.7.3.1); and glucose assays. Results compare well with those obtained with other current clinical chemistry analyzers; correlation coefficients were greater than 0.993. Sample-to-sample carryover was negligible, and method linearity was satisfactory for all tests.

  7. 3D kinematic analysis and clinical evaluation of neck movements in patients with whiplash injury.

    PubMed

    Antonaci, F; Bulgheroni, M; Ghirmai, S; Lanfranchi, S; Dalla Toffola, E; Sandrini, G; Nappi, G

    2002-09-01

    In recent decades whiplash injuries, being a major reason for compensation claims, have become increasingly important in forensic medicine. In view of this, a reliable diagnostic method of assessing cervical range of motion (ROM) is needed. The aim of the present study was to evaluate neck function with a 3D kinematic method compared with clinical evaluation in whiplash injury. Seventy consecutive patients (M/F = 18/52) with a history of whiplash injury (WH) and 46 healthy volunteers (M/F = 24/22), mean age, respectively 33 +/- 9 and 28 +/- 6 years (mean+/-SD) entered the study. Patients suffered from neck pain and/or unilateral headache. A computerized kinematic analysis of the ROM (Elite system) using passive markers and two infrared TV cameras was used. Clinical evaluation of active ROM was also performed both in patients and in 61 controls (M/F = 23/38; mean age 47 +/- 18 years). Thirty out of 70 patients were tested at the time of their first consultation (T0) and 6 months later (T6), and 12 were also followed up after a year (T12). All neck movements, except extension, were significantly reduced in WH subjects compared with controls, in particular lateral bending. Comparing ROM at T0, T6 and T12, no significant differences were found. A global index of motion (GIM), obtained by calculating the sum of ROM in absolute value for all the movements acquired, was significantly reduced in WH compared with control subjects. The interobserver reliability of the clinical evaluation was globally acceptable. On the basis of the clinical evaluation, a significantly reduced ROM was found in all movements in WH subjects compared with an age-matched population. Computing the number of impaired cervical movements (ICMs), a significantly higher number was observed in WH patients than in controls, showing a decreasing trend at T6 and T12, with a significant improvement at T6 vs. T0. The computerized study of neck ROM may constitute a useful tool in the evaluation of WH at

  8. Assessing an adherent silicone foam dressing: a clinical evaluation across five NHS trusts.

    PubMed

    Stephen-Haynes, Jackie; Callaghan, Rosie; Bethell, Elaine; Linthwaite, Adele; Bullough, Lindsey; Armstrong, Jayne

    2015-12-01

    The wound contact layer of UrgoTul Absorb Border (Urgo Medical) foam dressing contains a Technology Lipido Colloid (TLC) Healing Matrix, which includes hydrocolloid and lipophilic substances designed to stimulate fibroblast proliferation and thus promote granulation tissue formation. A multicentre, noncomparative, clinical evaluation of UrgoTul Absorb Border investigated whether use of the dressing promoted granulation tissue formation and the management of wound exudate. Other parameters evaluated included: pain-free dressing changes, protection and improvement of surrounding tissue, ease of application, conformability, ability to remain in place, wear time, effect on peri-wound skin, durability, ease of removal, and patient comfort. There were 43 patients recruited into the evaluation. Results show that 8 wounds (19%) achieved full epithelialisation and 34 (81%) improved. All participating clinicians rated the dressing's overall performance, including its ability to manage exudate, as excellent, very good, or good. PMID:26639071

  9. Evaluation of a multimodal, distance learning HIV management course for clinical care providers in India.

    PubMed

    Chang, Larry William; Kadam, Dileep B; Sangle, Shashi; Narayanan, Shivakumar; Borse, Rohidas T; McKenzie-White, Jane; Bowen, Craig W; Sisson, Stephen D; Bollinger, Robert C

    2012-01-01

    Distance learning is an important tool for training HIV health workers. However, there is limited evidence on design and evaluation of distance learning HIV curricula and tools. We therefore designed, implemented, and evaluated a distance learning course on HIV management for clinical care providers in India. After course completion, participant scores rose significantly from a pretest (78.4% mean correct) compared with the posttest (87.5%, P < .001). After course completion, participants were more likely to be confident in starting an initial antiretroviral (ARV) regimen, understanding ARV toxicities, encouraging patient adherence, diagnosing immune reconstitution syndrome, and monitoring patients on ARV medications (P ≤ .05). All participants (100%) strongly agreed/agreed that they would recommend this course to others, and most of them (96%) strongly agreed/agreed that they would take a course in this format again. A pragmatic approach to HIV curriculum development and evaluation resulted in reliable learning outcomes, as well as learner satisfaction and improvement in knowledge.

  10. Report on the use of non-clinical studies in the regulatory evaluation of oncology drugs.

    PubMed

    Hayakawa, Yoshihiro; Kawada, Manabu; Nishikawa, Hiroyoshi; Ochiya, Takahiro; Saya, Hideyuki; Seimiya, Hiroyuki; Yao, Ryoji; Hayashi, Masahiro; Kai, Chieko; Matsuda, Akira; Naoe, Tomoki; Ohtsu, Atsushi; Okazaki, Taku; Saji, Hideo; Sata, Masataka; Sugimura, Haruhiko; Sugiyama, Yuichi; Toi, Masakazu; Irimura, Tatsuro

    2016-02-01

    Non-clinical studies are necessary at each stage of the development of oncology drugs. Many experimental cancer models have been developed to investigate carcinogenesis, cancer progression, metastasis, and other aspects in cancer biology and these models turned out to be useful in the efficacy evaluation and the safety prediction of oncology drugs. While the diversity and the degree of engagement in genetic changes in the initiation of cancer cell growth and progression are widely accepted, it has become increasingly clear that the roles of host cells, tissue microenvironment, and the immune system also play important roles in cancer. Therefore, the methods used to develop oncology drugs should continuously be revised based on the advances in our understanding of cancer. In this review, we extensively summarize the effective use of those models, their advantages and disadvantages, ranges to be evaluated and limitations of the models currently used for the development and for the evaluation of oncology drugs.

  11. Predictors of detention among juveniles referred for a court clinic forensic evaluation.

    PubMed

    Tolou-Shams, Marina; Rizzo, Christie J; Conrad, Selby M; Johnson, Sarah; Oliveira, Cassandra; Brown, Larry K

    2014-01-01

    Juvenile offenders have disproportionately high rates of psychiatric and substance use disorders relative to their nonoffending counterparts. Less is known about the impact of psychiatric and substance use disorders on repeat juvenile justice involvement among juveniles specifically referred for forensic mental health evaluations. We describe the demographic, psychiatric, and legal history background of 404 juveniles who underwent a court clinic forensic mental health evaluation, and we examine the association between these factors and detention rates of 20 percent over a 12-month post-evaluation period. After accounting for known predictors of reoffending, such as prior offense history and externalizing disorders, dual diagnosis (i.e., co-occurring psychiatric and substance use disorders) remained a salient predictor of future detention. Consistent with prior literature on juvenile offending, substance use may greatly enhance the likelihood of subsequent detention. PMID:24618520

  12. Evaluation of Leber's hereditary optic neuropathy patients prior to a gene therapy clinical trial

    PubMed Central

    Yang, Shuo; Yang, Hong; Ma, Si-qi; Wang, Shuai-shuai; He, Heng; Zhao, Min-jian; Li, Bin

    2016-01-01

    Abstract Gene therapy may be a promising approach for the treatment of Leber hereditary optic neuropathy. The aim of this study was to evaluate patients with this condition who were recruited into an upcoming gene therapy clinical trial and to assess any changes in the detection parameters to provide support for the clinical trial. Sixteen patients with Leber hereditary optic neuropathy were evaluated using visual function tests 12 months before the initiation of gene therapy. Then, the results of visual acuity (VA), visual field (VF), RNFL (retinal nerve fiber layer) thickness, and Pattern-reversal Visual evoked potential (PR-VEP) were compared and analyzed. A total of 32 eyes of 16 patients were evaluated. Based on the best-corrected visual acuity (BCVA), 24 eyes were relatively stable compared with the baseline evaluation, and 8 eyes had significant changes, including 5 eyes that showed improvement and 3 eyes that showed impairment. In all eyes, the changes in the best-corrected visual acuity were significantly correlated with the changes in the visual field index (VFI), mean defect (MD), and P100 of the visual evoked potential. In the eyes with relatively stable BCVA and those with an obvious improvement in the BCVA, only the visual mean defect showed a significant change; the other indicators were not significantly different. Aside from the patients showing a tendency of spontaneous improvement, the others were in accordance with the requirement. The effects of Leber hereditary optical neuropathy (LHON) gene therapy should be evaluated primarily based on visual acuity. Additionally, visual field, neural fiber thickness, and electrophysiology should be considered in the evaluation. PMID:27749593

  13. PACS in the Utrecht University Hospital: final conclusions of the clinical evaluation

    NASA Astrophysics Data System (ADS)

    Wilmink, J. B.; ter Haar Romeny, Bart M.; Barneveld Binkhuysen, Frits H.; Achterberg, A. J.; Zuiderveld, Karel J.; Calkoen, P.; Kouwenberg, Jef M.

    1990-08-01

    In the past three years, a clinical evaluation of a PACS has been performed in the Utrecht University Hospital as part of the Dutch PACS project. The clinical evaluation focussed on the following aspects: technical evaluation of the prototype PACS equipment coupled to the HIS; diagnostic accuracy studies; studies concerning the impact on the organization of the radiology-department and the referring wards; and cost-savings analysis. Some of the results of these subprojects have already been presented at previous SPIE conferences. In this paper the general condusions are presented about the usefulness of the evaluated PAC-System in the daily routine of radiology department and clinic. By making available the images of radiological examinations fast, complete, reliable and continously on the ward, concrete improvements with regard to the current process could be realized. The possibilities of PACS caused an increasing enthousiasm among the clinicians. By the easier access to all images of their patients during 24 hours/day, they saw more images on the day of the examination and images could be more easily used at consultations of other specialists. The overall conclusion is positive, but a lot of work has to be done to transform PACS from an experimental setup into a routine production system on which a flimless hospital can be based. A complete PACS needs an inteffigent Image Management System, which indudes prefetching algorithms based on data from the Hospital Information System and automated procedures for removing obsolete images from the local buffers in the workstations. As yet PACS is very expensive, and the direct savings in the hospital cannot compensate for the high costs of investment. Possibly PACS can contribute to a shorter stay of patients in the hospital. This will lead to savings for government and health insurance companies and they can be expected to contribute to PAS implementation studies.

  14. CLINICAL AND RADIOLOGICAL EVALUATION ON DEVELOPMENTAL HIP DYSPLASIA AFTER SALTER AND OMBRÉDANNE PROCEDURE

    PubMed Central

    da Rocha, Válney Luiz; Thomé, André Luiz Coelho; da Silva Castro, Daniel Labres; de Oliveira, Leandro Zica; de Moraes, Frederico Barra

    2015-01-01

    Objective: To evaluate the clinical and radiological medium-term results from surgical treatment of developmental hip dysplasia through Salter innominate bone osteotomy and Ombrédanne femoral shortening. Methods: Fourteen patients were evaluated, with surgical treatment on 18 hips (seven right-side hips and eleven left-side hips) using the proposal technique, performed between 1998 and 2008. The Dutoit and Severin criteria were used respectively for clinical and radiographic evaluations. Results: The average preoperative index for the seven right-side hips was 43.3° (40° to 50°), and this was corrected through surgery to an average of 31.57° (24° to 42°). The average preoperative index for the eleven left-side hips was 42.1° (36° to 56°), and this was corrected through surgery to an average of 30.36° (20° to 44°). There was a statistically significant difference between the preoperative and postoperative acetabular indexes, with P > 0.05. The clinical evaluation showed that there were seven excellent hips (38.9%), eight good ones (44.4%), three fair hips (16.7%) and no poor ones (0%). By grouping the hips rated good and excellent as satisfactory and those rated poor and fair as unsatisfactory, 83.3% of the results were seen to be favorable. There were no statistically significant correlations between occurrences of complications and patient age at the time of surgery or between complications and the preoperative acetabular index (p > 0.05). The complications observed consisted of one case each of subluxation, osteonecrosis and osteonecrosis together with subluxation. Conclusion: The combined procedure of Salter and Ombrédanne is a viable option for treating developmental hip dysplasia after patients have started to walk. PMID:27027068

  15. Reading Intervention Outcomes for Adults with Disabilities in a Vocational Rehabilitation Setting: Results of a 3-Year Research and Demonstration Grant

    ERIC Educational Resources Information Center

    Vanderberg, Laura E.; Pierce, Margaret E.; Disney, Laurel J.

    2011-01-01

    This study reports on an examination of the effectiveness of a reading intervention for adults with disabilities in a vocational rehabilitation setting. Participants were 57 adults with disabilities and low reading skills enrolled at the Reading Clinic at the Michigan Career and Technical Institute. As part of a 3-year research and demonstration…

  16. Evaluating clinical supervision in community homes and teams serving adults with learning disabilities.

    PubMed

    Malin, N A

    2000-03-01

    Evaluating clinical supervision in community homes and teams serving adults with learning disabilities This paper provides a discussion of some of the professional and policy outcomes associated with implementing clinical supervision within a community service for adults with learning disabilities. It is based upon a small qualitative study whose aim was to examine how clinical supervision was operating, its strengths, its weaknesses and where improvements might be made. The study followed the introduction of clinical supervision 9 months earlier for nurses and carers employed in three community homes and one community multiprofessional team. The method consisted of direct observation of individual and group supervision and staff completing critical incident questionnaires, followed by semi-structured, audio-taped interviews with seven registered nurses and four community team members, including a social worker, psychologist and physiotherapist. Outcomes were expressed in two ways: in terms of the benefits of clinical supervision or of its ambivalence. The range of matters brought for discussion, or resolution, in supervision reflected some of the difficulties or dilemmas staff faced working in this area, for example promoting empowerment and assisting clients to make choices, and dealing with clients' challenging and inappropriate behaviours. As for the role of supervisor there was some evidence of nurses expressing apprehension or unpreparedness, also a perceived general concern over the relatively low status of clinical supervision, thought to be due to absence of visible management approval or failure to articulate properly the objective of supervision. A limitation of the study was its small subject sample although considerable data were gathered in each of the units through relatively long-term contact.

  17. Evaluation of Drug Treatment of Bronchopneumonia at the Pediatric Clinic in Sarajevo

    PubMed Central

    Zec, Svjetlana Loga; Selmanovic, Kenan; Andrijic, Natasa Loga; Kadic, Azra; Zecevic, Lamija; Zunic, Lejla

    2016-01-01

    Introduction: Bronchopneumonia is the most common clinical manifestation of pneumonia in pediatric population and leading infectious cause of mortality in children under 5 years. Evaluation of treatment involves diagnostic procedures, assessment of disease severity and treatment for disease with an emphasis on vulnerability of the population. Aim: To determine the most commonly used antibiotics at the Pediatric Clinic in Sarajevo and concomitant therapy in the treatment of bronchopneumonia. Patients and Methods: The study was retrospective and included a total of 104 patients, hospitalized in pulmonary department of the Pediatric Clinic in the period from July to December 2014. The treatment of bronchopneumonia at the Pediatric Clinic was empirical and it conformed to the guidelines and recommendations of British Thoracic Society. Results and Discussion: First and third generation of cephalosporins and penicillin antibiotics were the most widely used antimicrobials, with parenteral route of administration and average duration of treatment of 4.3 days. Concomitant therapy included antipyretics, corticosteroids, leukotriene antagonists, agonists of β2 adrenergic receptor. In addition to pharmacotherapy, hospitalized patients were subjected to a diet with controlled intake of sodium, which included probiotic-rich foods and adequate hydration. Recommendations for further antimicrobial treatment include oral administration of first-generation cephalosporins and penicillin antibiotics. Conclusion: Results of the drug treatment of bronchopneumonia at the Pediatric Clinic of the University Clinical Center of Sarajevo are comparable to the guidelines of the British Thoracic Society. It is necessary to establish a system for rational use of antimicrobial agents in order to reduce bacterial resistance. PMID:27594741

  18. A new cognitive evaluation battery for Down syndrome and its relevance for clinical trials

    PubMed Central

    de Sola, Susana; de la Torre, Rafael; Sánchez-Benavides, Gonzalo; Benejam, Bessy; Cuenca-Royo, Aida; del Hoyo, Laura; Rodríguez, Joan; Catuara-Solarz, Silvina; Sanchez-Gutierrez, Judit; Dueñas-Espin, Ivan; Hernandez, Gimena; Peña-Casanova, Jordi; Langohr, Klaus; Videla, Sebastia; Blehaut, Henry; Farre, Magi; Dierssen, Mara; Cuenca-Royo, Aida

    2015-01-01

    The recent prospect of pharmaceutical interventions for cognitive impairment of Down syndrome (DS) has boosted a number of clinical trials in this population. However, running the trials has raised some methodological challenges and questioned the prevailing methodology used to evaluate cognitive functioning of DS individuals. This is usually achieved by comparing DS individuals to matched healthy controls of the same mental age. We propose a new tool, the TESDAD Battery that uses comparison with age-matched typically developed adults. This is an advantageous method for probing the clinical efficacy of DS therapies, allowing the interpretation and prediction of functional outcomes in clinical trials. In our DS population the TESDAD battery permitted a quantitative assessment of cognitive defects, which indicated language dysfunction and deficits in executive function, as the most important contributors to other cognitive and adaptive behavior outcomes as predictors of functional change in DS. Concretely, auditory comprehension and functional academics showed the highest potential as end-point measures of therapeutic intervention for clinical trials: the former as a cognitive key target for therapeutic intervention, and the latter as a primary functional outcome measure of clinical efficacy. Our results also emphasize the need to explore the modulating effects of IQ, gender and age on cognitive enhancing treatments. Noticeably, women performed significantly better than men of the same age and IQ in most cognitive tests, with the most consistent differences occurring in memory and executive functioning and negative trends rarely emerged on quality of life linked to the effect of age after adjusting for IQ and gender. In sum, the TESDAD battery is a useful neurocognitive tool for probing the clinical efficacy of experimental therapies in interventional studies in the DS population suggesting that age-matched controls are advantageous for determining normalization of

  19. A new cognitive evaluation battery for Down syndrome and its relevance for clinical trials.

    PubMed

    de Sola, Susana; de la Torre, Rafael; Sánchez-Benavides, Gonzalo; Benejam, Bessy; Cuenca-Royo, Aida; Del Hoyo, Laura; Rodríguez, Joan; Catuara-Solarz, Silvina; Sanchez-Gutierrez, Judit; Dueñas-Espin, Ivan; Hernandez, Gimena; Peña-Casanova, Jordi; Langohr, Klaus; Videla, Sebastia; Blehaut, Henry; Farre, Magi; Dierssen, Mara

    2015-01-01

    The recent prospect of pharmaceutical interventions for cognitive impairment of Down syndrome (DS) has boosted a number of clinical trials in this population. However, running the trials has raised some methodological challenges and questioned the prevailing methodology used to evaluate cognitive functioning of DS individuals. This is usually achieved by comparing DS individuals to matched healthy controls of the same mental age. We propose a new tool, the TESDAD Battery that uses comparison with age-matched typically developed adults. This is an advantageous method for probing the clinical efficacy of DS therapies, allowing the interpretation and prediction of functional outcomes in clinical trials. In our DS population the TESDAD battery permitted a quantitative assessment of cognitive defects, which indicated language dysfunction and deficits in executive function, as the most important contributors to other cognitive and adaptive behavior outcomes as predictors of functional change in DS. Concretely, auditory comprehension and functional academics showed the highest potential as end-point measures of therapeutic intervention for clinical trials: the former as a cognitive key target for therapeutic intervention, and the latter as a primary functional outcome measure of clinical efficacy. Our results also emphasize the need to explore the modulating effects of IQ, gender and age on cognitive enhancing treatments. Noticeably, women performed significantly better than men of the same age and IQ in most cognitive tests, with the most consistent differences occurring in memory and executive functioning and negative trends rarely emerged on quality of life linked to the effect of age after adjusting for IQ and gender. In sum, the TESDAD battery is a useful neurocognitive tool for probing the clinical efficacy of experimental therapies in interventional studies in the DS population suggesting that age-matched controls are advantageous for determining normalization of

  20. A new cognitive evaluation battery for Down syndrome and its relevance for clinical trials.

    PubMed

    de Sola, Susana; de la Torre, Rafael; Sánchez-Benavides, Gonzalo; Benejam, Bessy; Cuenca-Royo, Aida; Del Hoyo, Laura; Rodríguez, Joan; Catuara-Solarz, Silvina; Sanchez-Gutierrez, Judit; Dueñas-Espin, Ivan; Hernandez, Gimena; Peña-Casanova, Jordi; Langohr, Klaus; Videla, Sebastia; Blehaut, Henry; Farre, Magi; Dierssen, Mara

    2015-01-01

    The recent prospect of pharmaceutical interventions for cognitive impairment of Down syndrome (DS) has boosted a number of clinical trials in this population. However, running the trials has raised some methodological challenges and questioned the prevailing methodology used to evaluate cognitive functioning of DS individuals. This is usually achieved by comparing DS individuals to matched healthy controls of the same mental age. We propose a new tool, the TESDAD Battery that uses comparison with age-matched typically developed adults. This is an advantageous method for probing the clinical efficacy of DS therapies, allowing the interpretation and prediction of functional outcomes in clinical trials. In our DS population the TESDAD battery permitted a quantitative assessment of cognitive defects, which indicated language dysfunction and deficits in executive function, as the most important contributors to other cognitive and adaptive behavior outcomes as predictors of functional change in DS. Concretely, auditory comprehension and functional academics showed the highest potential as end-point measures of therapeutic intervention for clinical trials: the former as a cognitive key target for therapeutic intervention, and the latter as a primary functional outcome measure of clinical efficacy. Our results also emphasize the need to explore the modulating effects of IQ, gender and age on cognitive enhancing treatments. Noticeably, women performed significantly better than men of the same age and IQ in most cognitive tests, with the most consistent differences occurring in memory and executive functioning and negative trends rarely emerged on quality of life linked to the effect of age after adjusting for IQ and gender. In sum, the TESDAD battery is a useful neurocognitive tool for probing the clinical efficacy of experimental therapies in interventional studies in the DS population suggesting that age-matched controls are advantageous for determining normalization of

  1. A Required Course in the Development, Implementation, and Evaluation of Clinical Pharmacy Services

    PubMed Central

    Kamal, Khalid M.; Berdine, Hildegarde J.

    2008-01-01

    Objective To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Design Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. Assessment One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. Conclusion The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care. PMID:19214263

  2. Gender-specific factors associated with shorter sleep duration at age 3 years.

    PubMed

    Plancoulaine, Sabine; Lioret, Sandrine; Regnault, Nolwenn; Heude, Barbara; Charles, Marie-Aline

    2015-12-01

    Total sleep duration has been decreasing among children in the last decades. Short sleep duration (SSD) has been associated with deleterious health consequences, such as excess weight/obesity. Risk factors for SSD have already been studied among school-aged children and adolescents, but inconsistent results have been reported regarding possible gender differences. Studies reporting such relationships are scarce in preschoolers, despite the importance of this period for adopting healthy behaviour. We aimed to investigate factors associated with SSD in 3-year-old boys (n = 546) and girls (n = 482) in a French Mother-Child Cohort (EDEN Study). Children were born between 2003 and 2006 in two French university hospitals. Clinical examinations and parent self-reported questionnaires allowed us to collect sociodemographic (e.g. income, education, family situation, child-minding system), maternal [e.g. body mass index (BMI), parity, depression, breastfeeding duration] and child's characteristics (e.g. gender, birth weight, term, physical activity and TV viewing duration, food consumption, usual sleep time). Sleep duration/24-h period was calculated and SSD was defined as <12 h. Analyses were performed using logistic regression. The mean sleep duration was 12 h 35 ± 56 min, with 91% of the children napping. Patterns of risk factors associated with SSD differed according to gender. In addition to parental presence when falling asleep, short sleep duration was associated strongly positively with high BMI Z-score and TV viewing duration among boys and with familial home child-minding and lower scores on the 'fruits and vegetables' dietary pattern among girls. These results suggest either a patterning of parental behaviours that differs according to gender, or a gender-specific sleep physiology, or both.

  3. Gender-specific factors associated with shorter sleep duration at age 3 years.

    PubMed

    Plancoulaine, Sabine; Lioret, Sandrine; Regnault, Nolwenn; Heude, Barbara; Charles, Marie-Aline

    2015-12-01

    Total sleep duration has been decreasing among children in the last decades. Short sleep duration (SSD) has been associated with deleterious health consequences, such as excess weight/obesity. Risk factors for SSD have already been studied among school-aged children and adolescents, but inconsistent results have been reported regarding possible gender differences. Studies reporting such relationships are scarce in preschoolers, despite the importance of this period for adopting healthy behaviour. We aimed to investigate factors associated with SSD in 3-year-old boys (n = 546) and girls (n = 482) in a French Mother-Child Cohort (EDEN Study). Children were born between 2003 and 2006 in two French university hospitals. Clinical examinations and parent self-reported questionnaires allowed us to collect sociodemographic (e.g. income, education, family situation, child-minding system), maternal [e.g. body mass index (BMI), parity, depression, breastfeeding duration] and child's characteristics (e.g. gender, birth weight, term, physical activity and TV viewing duration, food consumption, usual sleep time). Sleep duration/24-h period was calculated and SSD was defined as <12 h. Analyses were performed using logistic regression. The mean sleep duration was 12 h 35 ± 56 min, with 91% of the children napping. Patterns of risk factors associated with SSD differed according to gender. In addition to parental presence when falling asleep, short sleep duration was associated strongly positively with high BMI Z-score and TV viewing duration among boys and with familial home child-minding and lower scores on the 'fruits and vegetables' dietary pattern among girls. These results suggest either a patterning of parental behaviours that differs according to gender, or a gender-specific sleep physiology, or both. PMID:26041449

  4. Molecular diagnosis of toxoplasmosis in immunocompromised patients: a 3-year multicenter retrospective study.

    PubMed

    Robert-Gangneux, Florence; Sterkers, Yvon; Yera, Hélène; Accoceberry, Isabelle; Menotti, Jean; Cassaing, Sophie; Brenier-Pinchart, Marie-Pierre; Hennequin, Christophe; Delhaes, Laurence; Bonhomme, Julie; Villena, Isabelle; Scherer, Emeline; Dalle, Frédéric; Touafek, Feriel; Filisetti, Denis; Varlet-Marie, Emmanuelle; Pelloux, Hervé; Bastien, Patrick

    2015-05-01

    Toxoplasmosis is a life-threatening infection in immunocompromised patients (ICPs). The definitive diagnosis relies on parasite DNA detection, but little is known about the incidence and burden of disease in HIV-negative patients. A 3-year retrospective study was conducted in 15 reference laboratories from the network of the French National Reference Center for Toxoplasmosis, in order to record the frequency of Toxoplasma gondii DNA detection in ICPs and to review the molecular methods used for diagnosis and the prevention measures implemented in transplant patients. During the study period, of 31,640 PCRs performed on samples from ICPs, 610 were positive (323 patients). Blood (n = 337 samples), cerebrospinal fluid (n = 101 samples), and aqueous humor (n = 100 samples) were more frequently positive. Chemoprophylaxis schemes in transplant patients differed between centers. PCR follow-up of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients was implemented in 8/15 centers. Data from 180 patients (13 centers) were further analyzed regarding clinical setting and outcome. Only 68/180 (38%) patients were HIV(+); the remaining 62% consisted of 72 HSCT, 14 solid organ transplant, and 26 miscellaneous immunodeficiency patients. Cerebral toxoplasmosis and disseminated toxoplasmosis were most frequently observed in HIV and transplant patients, respectively. Of 72 allo-HSCT patients with a positive PCR result, 23 were asymptomatic; all were diagnosed in centers performing systematic blood PCR follow-up, and they received specific treatment. Overall survival of allo-HSCT patients at 2 months was better in centers with PCR follow-up than in other centers (P < 0.01). This study provides updated data on the frequency of toxoplasmosis in HIV-negative ICPs and suggests that regular PCR follow-up of allo-HSCT patients could guide preemptive treatment and improve outcome.

  5. Er:YAG laser ablation: evaluation after a two-year clinical treatment

    NASA Astrophysics Data System (ADS)

    Dostalova, Tatjana; Jelinkova, Helena; Kucerova, Hana; Krejsa, Otakar; Hamal, Karel; Kubelka, Jiri; Prochazka, Stanislav

    1998-04-01

    The aim of the clinical study is to evaluate Er:YAG laser ablation after two year-long clinical treatment. One hundred fifty cavities were volunteered for checking. Three restorative materials were used following manufacturer's directions. For the experiment, an Er:YAG laser drilling machine was applied. The laser delivered energy from 100 to 450 mJ, repetition rate from 1 to 4 Hz. The length of the generated pulses was 200 microseconds. During our experiments cooling of the teeth was achieved by fine water mist. The number of pulses was from 16 to 489. Caries of enamel and dentin were treated. Old insufficient fillings were also removed (not amalgam or metal alloys). The experiments followed the guidelines of the Declaration of Helsinki (1964), Tokyo (1975), Venice (1983) and Hong-Kong (1989). Clinical evaluation of fillings after 6, 12, 18 and 24 months based on ADA recommendation was used. Eight criteria were applied for the restoration control. Composite resins and glassionomers could be used as filling materials.

  6. Clinical consequences of untreated dental caries evaluated using PUFA index in orphanage children from India

    PubMed Central

    Shanbhog, Raghavendra; Godhi, Brinda S; Nandlal, Bhojraj; Kumar, Shruti S; Raju, Veena; Rashmi, S

    2013-01-01

    Background: To determine the prevalence and severity of oral condition related to untreated dental caries with PUFA index and to relate period of institutional stay, oral hygiene practice and diet of orphan children to caries experience ratio. Materials & Methods: A cross sectional survey conducted among 488 children of 12-14 years living in 5 different orphanages of Mysore district, India. Data regarding oral hygiene practices and oral health status (PUFA, DMFT, OH I-S and GI) were collected through structured questionnaire and by type III clinical oral examinations. The collected data were processed statistically. Results: The PUFA ratio indicates 21% of decayed component had progressed to pulp involvement and abscess formation. The overall prevalence of PUFA was 37.7%. 31.1% children showed one or more pulpally involved tooth in their oral cavity. Correlation between periods for being the child in the institute to DMFT showed negative value indicting decrease in DMFT as the duration of stay in orphanage increases. Conclusion: The result show oral health condition in orphan children was neglected. Children from this disadvantaged background have shown a high prevalence of dental caries with low dental care utilization. PUFA index is an effective index in evaluating clinical consequences of un-treated caries. How to cite this article: Shanbhog R, Godhi BS, Nandlal B, Kumar SS, Raju V, Rashmi S. Clinical consequences of untreated dental caries evaluated using PUFA index in orphanage children from India. J Int Oral Health 2013; 5(5):1-9. PMID:24324297

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

    PubMed

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

    2013-10-01

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

  8. CLINICAL AND RADIOGRAPHIC EVALUATION OF ELBOWS FROM SPINAL CORD INJURIED PATIENTS

    PubMed Central

    Casimiro, Fabiana de Godoy; de Oliveira, Gabriel Faria; Tenório, Pedro Henrique de Magalhães; Gagliardi, Isabella da Costa; Zoppi, Américo; Cliquet, Alberto

    2016-01-01

    Objectives : To evaluate clinically and radiologically the elbows of spinal cord injured patients and compare them to the control group. Methods : Twenty patients (10 paraplegics and 10 tetraplegics) were clinically evaluated through assessment of pain scale, measurement of active and passive range of motion, degree of muscle strength and MEPS score. They were also submitted to bilateral plain radiography of the elbows. Both groups were compared to the control group. Results : Four paraplegic and three tetraplegic patients referred mild to moderate, sporadic and motion related pain. The control group was asymptomatic. No statistic significant difference was found in passive range of motion among the three groups. The tetraplegic group showed a lower active range of motion as well as lower MEPS score as compared to the control group. Equal number of patients in the spinal cord injured patients had radiological abnormalities, but those were more severe in the tetraplegic group. Conclusion : Spinal cord injured patients presented clinical and radiological elbow abnormalities, which were more evident on tetraplegics. Level of Evidence III, Case Control. PMID:26981040

  9. Steps and Time to Process Clinical Trials at the Cancer Therapy Evaluation Program

    PubMed Central

    Dilts, David M.; Sandler, Alan B.; Cheng, Steven K.; Crites, Joshua S.; Ferranti, Lori B.; Wu, Amy Y.; Finnigan, Shanda; Friedman, Steven; Mooney, Margaret; Abrams, Jeffrey

    2009-01-01

    Purpose To examine the processes and document the calendar time required for the National Cancer Institute's Cancer Therapy Evaluation Program (CTEP) and Central Institutional Review Board (CIRB) to evaluate and approve phase III clinical trials. Methods Process steps were documented by (1) interviewing CTEP and CIRB staff regarding the steps required to activate a trial from initial concept submission to trial activation by a cooperative group, (2) reviewing standard operating procedures, and (3) inspecting trial records and documents for selected trials to identify any additional steps. Calendar time was collected from initial concept submission to activation using retrospective data from the CTEP Protocol and Information Office. Results At least 296 distinct processes are required for phase III trial activation: at least 239 working steps, 52 major decision points, 20 processing loops, and 11 stopping points. Of the 195 trials activated during the January 1, 2000, to December 31, 2007, study period, a sample of 167 (85.6%) was used for gathering timing data. Median calendar days from initial formal concept submission to CTEP to trial activation by a cooperative group was 602 days (interquartile range, 454 to 861 days). This time has not significantly changed over the past 8 years. There is a high variation in the time required to activate a clinical trial. Conclusion Because of their complexity, the overall development time for phase III clinical trials is lengthy, process laden, and highly variable. To streamline the process, a solution must be sought that includes all parties involved in developing trials. PMID:19255315

  10. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media.

    PubMed

    Rosman, Yossi; Eisenkraft, Arik; Milk, Nadav; Shiyovich, Arthur; Ophir, Nimrod; Shrot, Shai; Kreiss, Yitshak; Kassirer, Michael

    2014-05-01

    On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events.

  11. Evaluation of Clinical Interest of Anti-Aquaporin-4 Autoantibody Followup in Neuromyelitis Optica

    PubMed Central

    Chanson, Jean-Baptiste; Alame, Melissa; Collongues, Nicolas; Blanc, Frédéric; Fleury, Marie; Rudolf, Gabrielle; de Seze, Jérôme; Vincent, Thierry

    2013-01-01

    Neuromyelitis optica (NMO) is an autoimmune disease in which a specific biomarker named NMO-IgG and directed against aquaporin-4 (AQP4) has been found. A correlation between disease activity and anti-AQP4 antibody (Ab) serum concentration or complement-mediated cytotoxicity has been reported, but the usefulness of longitudinal evaluation of these parameters remains to be evaluated in actual clinical practice. Thirty serum samples from 10 NMO patients positive for NMO-IgG were collected from 2006 to 2011. Anti-AQP4 Ab serum concentration and complement-mediated cytotoxicity were measured by flow cytometry using two quantitative cell-based assays (CBA) and compared with clinical parameters. We found a strong correlation between serum anti-AQP4 Ab concentration and complement-mediated cytotoxicity (P < 0.0001). Nevertheless, neither relapse nor worsening of impairment level was closely associated with a significant increase in serum Ab concentration or cytotoxicity. These results suggest that complement-mediated serum cytotoxicity assessment does not provide extra insight compared to anti-AQP4 Ab serum concentration. Furthermore, none of these parameters appears closely related to disease activity and/or severity. Therefore, in clinical practice, serum anti-AQP4 reactivity seems not helpful as a predictive biomarker in the followup of NMO patients as a means of predicting the onset of a relapse and adapting the treatment accordingly. PMID:23710199

  12. Evaluation of Asperger Syndrome in Youth Presenting to a Gender Dysphoria Clinic

    PubMed Central

    Reisner, Sari L.; Edwards-Leeper, Laura; Tishelman, Amy

    2016-01-01

    Abstract Purpose: There is evolving evidence that children and adolescents with gender dysphoria have higher-than-expected rates of autism spectrum disorder (ASD), yet clinical data on ASD among youth with gender dysphoria remain limited, particularly in North America. This report aims to fill this gap. Methods: We conducted a retrospective review of patient chart data from 39 consecutive youth ages 8 to 20 years (mean age 15.8 years, natal male: n = 22, natal female: n = 17) presenting for evaluation at a multidisciplinary gender clinic in a large U.S. pediatric hospital from 2007 to 2011 to evaluate the prevalence of ASD in this patient population. Results: Overall, 23.1% of patients (9/39) presenting with gender dysphoria had possible, likely, or very likely Asperger syndrome as measured by the Asperger Syndrome Diagnostic Scale (ASDS). Conclusion: These findings are consistent with growing evidence supporting increased prevalence of ASD in gender dysphoric children. To guide provision of optimal clinical care and therapeutic intervention, routine assessment of ASD is recommended in youth presenting for gender dysphoria. PMID:26651183

  13. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media.

    PubMed

    Rosman, Yossi; Eisenkraft, Arik; Milk, Nadav; Shiyovich, Arthur; Ophir, Nimrod; Shrot, Shai; Kreiss, Yitshak; Kassirer, Michael

    2014-05-01

    On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events. PMID:24798526

  14. Enhancing the executive functions of 3-year-olds in the dimensional change card sort task

    PubMed Central

    Perone, Sammy; Molitor, Stephen; Buss, Aaron T.; Spencer, John P.; Samuelson, Larissa K.

    2015-01-01

    Executive functions (EFs) enable flexible thinking, something young children are notoriously bad at. For instance, in the dimensional change card sort (DCCS) task, 3-year-olds can sort cards by one dimension (shape), but continue to sort by this dimension when asked to switch (to color). This study tests a prediction of a Dynamic Neural Field (DNF) model that prior experience with the post-switch dimension can enhance 3-year-old’s performance in the DCCS task. In Experiment 1A, a matching game was used to pre-expose 3-year-olds (n=36) to color. This facilitated switching from sorting by shape to color. In Experiment 1B, 3-year-olds (n=18) were pre-exposed to shape. This did not facilitate switching from sorting by color to shape. The DNF model was used to provide a mechanistic explanation for this asymmetry. PMID:25441395

  15. The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis

    PubMed Central

    Yang, Baohui; Hu, Hongbo; Chen, Jie; He, Xijing

    2016-01-01

    Objective. To evaluate the clinical, laboratory, and radiological presentation of 16 cases of brucellar spondylitis. Methods. The clinical manifestations, laboratory tests, and imaging findings of 16 patients (aged from 24 to 66 years) with brucellar spondylitis treated between September 2012 and September 2014 at the Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively analyzed. Results. Clinical manifestations included high fever, severe pain, sweating, and fatigue. One patient had epididymitis, and two showed clear signs of spinal nerve damage. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein content. Serum brucella agglutination tests were positive, and 11 brucella blood cultures were positive. Imaging manifestations mainly consisted of abnormal signals in the intervertebral space or abnormal signals in the adjacent vertebral bodies (16/16, 100%) in magnetic resonance imaging (MRI), disc space narrowing (14/16, 88%) in X-ray and MRI, or bone destruction and sclerosis around the damaged zone (13/16, 81%) in computed tomography, with rare cases of psoas abscess (2/16, 13%) and sequestrum (1/16, 6%). Conclusion. Since brucellar spondylitis exhibited characteristic clinical and imaging manifestations, it could be diagnosed with specific laboratory tests. Early MRI examination of suspected cases could improve rapid diagnosis. PMID:27672661

  16. An evaluation of wait-times at an interprofessional student-run free clinic.

    PubMed

    Hu, Tina; Leung, Fok-Han

    2016-07-01

    Student-run free clinics (SRFCs) are becoming increasingly popular programmes in schools for promoting interprofessional education and service learning. Despite their prevalence, little research has been done surrounding SRFCs and wait-times. SRFCs may experience long wait-times because patients are often seen on a drop-in basis and time has to be allotted for interprofessional case discussion and teaching. The purpose of this study was to evaluate the wait-times for patients being seen at an interprofessional SRFC and determine potential improvements. Wait-times, total treatment room times, total time per patient, and whether a referral and/or prescription was given were tracked from May 2014 to July 2015 at an SRFC. A total of 268 patients were seen in 52 clinics. On average, five patients were seen per clinic. Patients waited for an average time of 21 minutes before they were seen by the team. Average treatment time per patient was 69 minutes. Patients were generally at the clinic for a total of 91 minutes before being discharged. Several improvements for managing client flow at interprofessional SRFCs are discussed. PMID:27332500

  17. Clinical evaluation of music perception, appraisal and experience in cochlear implant users

    PubMed Central

    Drennan, Ward. R.; Oleson, Jacob J.; Gfeller, Kate; Crosson, Jillian; Driscoll, Virginia D.; Won, Jong Ho; Anderson, Elizabeth S.; Rubinstein, Jay T.

    2014-01-01

    Objectives The objectives were to evaluate the relationships among music perception, appraisal, and experience in cochlear implant users in multiple clinical settings and to examine the viability of two assessments designed for clinical use. Design Background questionnaires (IMBQ) were administered by audiologists in 14 clinics in the United States and Canada. The CAMP included tests of pitch-direction discrimination, and melody and timbre recognition. The IMBQ queried users on prior musical involvement, music listening habits pre and post implant, and music appraisals. Study sample One-hundred forty-five users of Advanced Bionics and Cochlear Ltd cochlear implants. Results Performance on pitch direction discrimination, melody recognition, and timbre recognition tests were consistent with previous studies with smaller cohorts, as well as with more extensive protocols conducted in other centers. Relationships between perceptual accuracy and music enjoyment were weak, suggesting that perception and appraisal are relatively independent for CI users. Conclusions Perceptual abilities as measured by the CAMP had little to no relationship with music appraisals and little relationship with musical experience. The CAMP and IMBQ are feasible for routine clinical use, providing results consistent with previous thorough laboratory-based investigations. PMID:25177899

  18. Active multimodal psychotherapy in children and adolescents with suicidality: description, evaluation and clinical profile.

    PubMed

    Högberg, Goran; Hällström, Tore

    2008-07-01

    The aim of this study was to describe and evaluate the clinical pattern of 14 youths with presenting suicidality, to describe an integrative treatment approach, and to estimate therapy effectiveness. Fourteen patients aged 10 to 18 years from a child and adolescent outpatient clinic in Stockholm were followed in a case series. The patients were treated with active multimodal psychotherapy. This consisted of mood charting by mood-maps, psycho-education, wellbeing practice and trauma resolution. Active techniques were psychodrama and body-mind focused techniques including eye movement desensitization and reprocessing. The patients were assessed before treatment, immediately after treatment and at 22 months post treatment with the Global Assessment of Functioning Scale. The clinical pattern of the group was observed. After treatment there was a significant change towards normality in the Global Assessment of Functioning scale both immediately post-treatment and at 22 months. A clinical pattern, post trauma suicidal reaction, was observed with a combination of suicidality, insomnia, bodily symptoms and disturbed mood regulation. We conclude that in the post trauma reaction suicidality might be a presenting symptom in young people. Despite the shortcomings of a case series the results of this study suggest that a mood-map-based multimodal treatment approach with active techniques might be of value in the treatment of children and youth with suicidality.

  19. The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis

    PubMed Central

    Yang, Baohui; Hu, Hongbo; Chen, Jie; He, Xijing

    2016-01-01

    Objective. To evaluate the clinical, laboratory, and radiological presentation of 16 cases of brucellar spondylitis. Methods. The clinical manifestations, laboratory tests, and imaging findings of 16 patients (aged from 24 to 66 years) with brucellar spondylitis treated between September 2012 and September 2014 at the Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively analyzed. Results. Clinical manifestations included high fever, severe pain, sweating, and fatigue. One patient had epididymitis, and two showed clear signs of spinal nerve damage. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein content. Serum brucella agglutination tests were positive, and 11 brucella blood cultures were positive. Imaging manifestations mainly consisted of abnormal signals in the intervertebral space or abnormal signals in the adjacent vertebral bodies (16/16, 100%) in magnetic resonance imaging (MRI), disc space narrowing (14/16, 88%) in X-ray and MRI, or bone destruction and sclerosis around the damaged zone (13/16, 81%) in computed tomography, with rare cases of psoas abscess (2/16, 13%) and sequestrum (1/16, 6%). Conclusion. Since brucellar spondylitis exhibited characteristic clinical and imaging manifestations, it could be diagnosed with specific laboratory tests. Early MRI examination of suspected cases could improve rapid diagnosis.

  20. To Use or Not? Evaluating ASPECTS of Smartphone Apps and Mobile Technology for Clinical Care in Psychiatry.

    PubMed

    Torous, John B; Chan, Steven R; Yellowlees, Peter M; Boland, Robert

    2016-06-01

    In this commentary, we discuss smartphone apps for psychiatry and the lack of resources to assist clinicians in evaluating the utility, safety, and efficacy of apps. Evaluating an app requires new considerations that are beyond those employed in evaluating a medication or typical clinical intervention. Based on our software engineering, informatics, and clinical knowledge and experiences, we propose an evaluation framework, "ASPECTS," to spark discussion about apps and aid clinicians in determining whether an app is Actionable, Secure, Professional, Evidence-based, Customizable, and TranSparent. Clinicians who use the ASPECTS guide will be more informed and able to make more thorough evaluations of apps. PMID:27136691