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Gold Standards (gold + standards)
Selected AbstractsThe Paradox of Gold Standards,ACADEMIC EMERGENCY MEDICINE, Issue 7 2002Peter B. Richman MD No abstract is available for this article. [source] Response to Ingleton C & Froggatt K (2009) Commentary on Hewison A, Badger F, Clifford C & Thomas K (2009) Delivering ,Gold Standards' in end-of-life care in care homes: a question of teamwork?JOURNAL OF CLINICAL NURSING, Issue 22 20091765 in Journal of Clinical Nursing 1, Journal of Clinical Nursing 1 [source] Delivering ,Gold Standards' in end-of-life care in care homes: a question of teamwork?JOURNAL OF CLINICAL NURSING, Issue 12 2009Alistair Hewison Aim., This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England. Background., The Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design., A case study approach was appropriate for this study of a care programme into a ,real life' setting. Method., Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results., It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion., Effective teamwork was necessary for changes in end-of-life care to be achieved in the care homes. If end-of-life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice., Effective teamwork appears to be a pre-requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first. [source] The global initiative for chronic obstructive lung disease: Gold standards and the Asia,Pacific perspectiveRESPIROLOGY, Issue 1 2002Article first published online: 11 MAR 200 No abstract is available for this article. [source] Detection of Helicobacter pylori DNA by a Simple Stool PCR Method in Adult Dyspeptic PatientsHELICOBACTER, Issue 4 2005Nazime ABSTRACT Introduction.,Helicobacter pylori is the major agent causing peptic ulcer, gastric cancer and mucosa-associated lymphoid tissue (MALT) gastric lymphoma. A simple stool polymerase chain reaction (PCR) method was performed and compared with the gold standards for the diagnosis of H. pylori infection. Material and methods., A total of 54 adult patients (mean age, 46.41 ± 13.12 years) with dyspeptic symptoms from Gastroenterology at Dokuz Eylül University Hospital between May and November 2003 were included. Two antrum and corpus biopsies were taken from each patient. Infection by H. pylori was defined as positivity and negativity of the gold standards. DNA extraction of stool specimens was done using QIAamp DNA Stool Mini Kit (QIAGEN) and PCR conditions included amplification and reamplification steps using the H. pylori ureA gene specific primers (HPU1, HPU2) and were visualized on 1% agarose gel stained with ethidium bromide. Results., Forty-six of 54 patients (85.2%) were diagnosed positive and eight (14.8%) were negative for H. pylori infection by the gold standard methods. Thirty-two patients were positive (59.3%) and 22 of them (40.7%) were detected negative by stool PCR method. The stool PCR method and gold standard methods showed a statistical difference for the detection of H. pylori infection (p < .0001). Sensitivity, specificity, likelihood ratio, and positive and negative predictive values were 65.22%, 75%, 2.61%, 93.75%, and 27.7%, respectively. Discussion., The PCR on the stool specimens resulted as being a very specific test. We suggest that a simple stool PCR method that we developed can be used to detect H. pylori, virulence genes, and in drug resistance studies either first line diagnostic methods in the laboratory or in the clinical management of dyspeptic patients. [source] Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviewsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2009David C. Rettew Abstract Standardized diagnostic interviews (SDIs) have become de facto gold standards for clinical research. However, because clinical practitioners seldom use SDIs, it is essential to determine how well SDIs agree with clinical diagnoses. In meta-analyses of 38 articles published from 1995 to 2006 (N = 15,967 probands), mean kappas (z -transformed) between diagnoses from clinical evaluations versus SDIs were 0.27 for a broad category of all disorders, 0.29 for externalizing disorders, and 0.28 for internalizing disorders. Kappas for specific disorders ranged from 0.19 for generalized anxiety disorder to 0.86 for anorexia nervosa (median = 0.48). For diagnostic clusters (e.g. psychotic disorders), kappas ranged from 0.14 for affective disorders (including bipolar) to 0.70 for eating disorders (median = 0.43). Kappas were significantly higher for outpatients than inpatients and for children than adults. However, these effects were not significant in meta-regressions. Conclusions: Diagnostic agreement between SDIs and clinical evaluations varied widely by disorder and was low to moderate for most disorders. Thus, findings from SDIs may not fully apply to diagnoses based on clinical evaluations of the sort used in the published studies. Rather than implying that SDIs or clinical evaluations are inferior, characteristics of both may limit agreement and generalizability from SDI findings to clinical practice. Copyright © 2009 John Wiley & Sons, Ltd. [source] Ineffective Peripheral Tissue Perfusion: Clinical Validation in Patients With Hypertensive CardiomiopathyINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2006Rita de Cassia Gengo de Silva MS PURPOSE.,To validate defining characteristics of ineffective peripheral tissue perfusion using vasomotor function assessment. METHODS.,Twenty-four patients with hypertensive cardiomiopathy were evaluated for 18 defining characteristics of ineffective peripheral tissue perfusion and underwent vasomotor function assessment with induction of reactive hyperemia, intra-arterial infusion of acetylcholine, and pulse wave velocity measurement. The Student's t test and Kruskall,Wallis test were used to assess the significance of relationships between defining characteristics and vasomotor function data. FINDINGS.,Diminished lower extremity pulses were associated with diminished forearm blood flow during acetylcholine infusion; left ventricular overload, intermittent claudication, and diminished skin moisture were associated with elevated pulse wave velocity values. CONCLUSION.,The defining characteristics of ineffective peripheral tissue perfusion were highly associated with vasomotor function data as "gold standards" for that diagnosis. PRACTICE IMPLICATIONS.,Nurses should be able to accurately assess diminished lower extremity pulses, intermittent claudication, and diminished skin moisture as relevant characteristics of ineffective peripheral tissue perfusion in patients with hypertensive cardiomiopathy. Irrigation Tissulaire Périphérique Inefficace: Validation Clinique Chez les Patients Atteints de Cardiomyopathie Hypertensive BUT.,Valider les caractéristiques de Irrigation tissulaire périphérique inefficace en utilisant l'évaluation de la fonction vasomotrice. MÉTHODES.,Vingt-quatre patients souffrant de cardiomyopathie hypertensive furent évalués au regard des 18 caractéristiques du diagnostic Irrigation vasculaire périphérique inefficace et de la fonction vasomotrice par induction d'une hyperémie réactionnelle, la perfusion intra-artérielle d'acétylcholine, et la mesure de la vélocité de l'onde du pouls. Les tests "Student t et Kruskall,Wallis" furent utilisés pour déterminer l'importance des liens entre les caractéristiques et les valeurs de la fonction vasomotrice. RÉSULTATS.,La diminution des pulsations périphériques des membres inférieurs fut associée à une diminution du flot sanguin pendant la perfusion d'acétylcholine; une surcharge ventriculaire gauche, de la claudication intermittente et une diminution de l'hydratation de la peau furent associées à des valeurs élevées de la vélocité de l'onde du pouls. CONCLUSION.,,Les caractéristiques de Irrigation tissulaire périphérique inefficace qui furent associées de manière significative à la fonction vasomotrice peuvent être considérées comme les "étalons or" de ce diagnostic. IMPLICATIONS POUR LA PRATIQUE.,Les infirmières devraient être capables d'évaluer correctement la diminution des pouls périphériques, la claudication intermittente, et la diminution de l'hydratation de la peau, car ce sont des caractéristiques pertinentes de l'irrigation tissulaire périphérique inefficace chez les patients atteints de cardiomyopathie hypertensive. Translation by Cécile Boisvert, MSN, RN Perfusão Tissular Periférica Ineficaz: Validação Clínica em Pacientes com Miocardiopatia Hipertensiva PROPÓSITO.,Validar as caraterísticas definidoras do diagnóstico de perfusão tissular periférica ineficaz usando a avaliação da função vasomotora. MÉTODO.,Vinte e quatro pacientes com miocardiopatia hipertensiva foram avaliados segundo 18 características definidoras de perfusão tissular periférica ineficaz e submetidos a avaliação da função vasomotora por indução de hiperemia reativa, infusão intra-arterial de acetilcolina e por mensuração da velocidade da onda de pulso. Testes T de Student e de Kruskall,Wallis foram aplicados para avaliar a significância das relações entre as características definidoras e os dados da função vasomotora. RESULTADOS.,Diminuição de pulso nas extremidades inferiores foi associada com o menor fluxo de sangue no antebraço durante a infusão de acetilcolina; sobrecarga ventricular esquerda, claudicação intermitente e diminuição da hidratação da pele foram associados com valores elevados de velocidade de onda de pulso. CONCLUSÃO.,Quatro características definidoras de perfusão tissular periférica ineficaz foram altamente associadas com função vasomotora alterada como "padrão ouro" para este diagnóstico. IMPLICAÇÕES PARA A PRÁTICA.,As enfermeiras devem ser capazes de avaliar com precisão a diminuição dos pulsos das extremidades inferiores, claudicação intermitente e diminuição na hidratação da pele como características definidoras relevantes da perfusão tissular periférica ineficaz em pacientes com miocardiopatia hipertensiva. Translation by Alba Leite de Barros, PhD, RN Perfusión Tisular Periférica Inefectiva: Validación Clínica en Pacientes que Presentan Miocardiopatía Hipertensiva PROPÓSITO.,Validar las características definitorias del diagnóstico Perfusión tisular periférica inefectiva utilizando una valoración de la función vasomotora. METODOLOGÍA.,Veinticuatro pacientes diagnosticados de Miocardiopatía Hipertensiva fueron evaluados con respecto a las 18 características definitorias del diagnóstico Perfusión tisular periférica inefectiva y sometidos a una valoración de la función vasomotora con inducción de Hiperemia reactiva, infusión intra-arterial de acetilcolina, y medida de la velocidad de la onda del pulso. Se utilizaron los análisis estadísticos de t-Student y Kruskall,Wallis para valorar el significado de las relaciones entre las características definitorias y los datos obtenidos de la valoración de la función vasomotora. HALLAZGOS.,Durante la infusión de acetilcolina se detectó disminución de los pulsos en la extremidad inferior relacionado con la disminución del volumen de sangre en el antebrazo; la sobrecarga ventricular izquierda, claudicación intermitente y disminución de la hidratación de la piel fueron asociadas con la elevación de los valores de la velocidad de la onda del pulso. CONCLUSIÓN.,Las características definitorias del diagnóstico Perfusión tisular periférica inefectiva estaban fuertemente asociadas a los datos procedentes de la valoración de la función vasomotora identificándose como "estándares fundamentales" para este diagnóstico. IMPLICACIONES PARA LA PRÁCTICA.,Las enfermeras deberían ser capaces de valorar cuidadosamente la presencia de pulsos disminuidos en las extremidades inferiores, y la disminución de la hidratación de la piel ya que son características relevantes del diagnóstico Perfusión tisular periférica inefectiva en pacientes que presentan Miocardiopatía Hipertensiva. Translation by Adolf Guirao, RN [source] Flash-echo contrast sonography in the evaluation of response of small hepatocellular carcinoma to percutaneous ablationJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2006Jing-Houng Wang MD Abstract Purpose. To evaluate the use of flash-echo contrast sonography (FECS) in subtraction mode in assessing small hepatocellular carcinoma (HCC) after percutaneous local ablation therapy. Methods. Between March 2000 and February 2002, we prospectively assessed small HCCs after percutaneous local ablation therapy using FECS in subtraction mode. Thirty-three patients (22 men, 11 women) with 35 tumors ranging in size from 1.1 to 3.0 cm (mean ± SD, 2.0 ± 0.5) were enrolled. Twenty-one tumors received percutaneous ethanol injection only, 13 tumors received percutaneous microwave ablation therapy only, and the remaining tumor received both treatments. CT, hepatic angiography, and follow-up were used as gold standards in analyzing the accuracy of FECS in detecting residual tumors. Results. The agreements between FECS and CT, FECS and hepatic angiography, and all 3 imaging modalities were 80% (28/35), 85.7% (30/35), and 77.1% (27/35), respectively. Twenty-one patients with 23 completely ablated tumors were followed up for 5 to 39 months (mean ± SD, 20.2 ± 11.2). Recurrent disease was detected in 11 (52.4%) patients; local tumor recurrence occurred in 4 (17.4%) patients. The sensitivity, specificity, accuracy, and positive and negative predictive value of FECS in detecting viable tumors were 53.8% (7/13), 90.9% (20/22), 77.1% (27/35), 77.8% (7/9), and 76.9% (20/26), respectively. Conclusions. FECS in subtraction mode shows good agreement with hepatic angiography and CT in the assessment of small HCC after percutaneous local ablation therapy. The sensitivity of FECS in detecting residual tumors is suboptimal. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:161,168, 2006 [source] Latent Class Modeling Approaches for Assessing Diagnostic Error without a Gold Standard: With Applications to p53 Immunohistochemical Assays in Bladder TumorsBIOMETRICS, Issue 2 2001Paul S. Albert Summary. Improved characterization of tumors for purposes of guiding treatment decisions for cancer patients will require that accurate and reproducible assays be developed for a variety of tumor markers. No gold standards exist for most tumor marker assays. Therefore, estimates of assay sensitivity and specificity cannot be obtained unless a latent class model-based approach is used. Our goal in this article is to estimate sensitivity and specificity for p53 immunohistochemical assays of bladder tumors using data from a reproducibility study conducted by the National Cancer Institute Bladder Tumor Marker Network. We review latent class modeling approaches proposed by previous authors, and we find that many of these approaches impose assumptions about specimen heterogeneity that are not consistent with the biology of bladder tumors. We present flexible mixture model alternatives that are biologically plausible for our example, and we use them to estimate sensitivity and specificity for our p53 assay example. These mixture models are shown to offer an improvement over other methods in a variety of settings, but we caution that, in general, care must be taken in applying latent class models. [source] | ||||||||||