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Independent Assessment (independent + assessment)
Selected AbstractsRandomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2004R. Ackroyd Background: The aim of this study was to compare laparoscopic and open Nissen fundoplication for gastro-oesophageal reflux disease in a randomized clinical trial. Methods: Ninety-nine patients were randomized to either laparoscopic (52) or open (47) Nissen fundoplication. Patients with oesophageal dysmotility, those requiring a concurrent abdominal procedure and those who had undergone previous antireflux surgery were excluded. Independent assessment of dysphagia, heartburn and patients' satisfaction 1, 3, 6 and 12 months after surgery was performed using multiple standardized clinical grading systems. Objective measurement of oesophageal acid exposure and lower oesophageal sphincter pressure before and after surgery, and endoscopic assessment of postoperative anatomy, were performed. Results: Operating time was longer in the laparoscopic group (median 82 versus 46 min). Postoperative pain, analgesic requirement, time to solid food intake, hospital stay and recovery time were reduced in the laparoscopic group. Perioperative outcomes, postoperative dysphagia, relief of heartburn and overall satisfaction were equally good at all follow-up intervals. Reduction in oesophageal acid exposure, increase in lower oesophageal sphincter tone and improvement in endoscopic appearances were the same for the two groups. Conclusion: The laparoscopic approach to Nissen fundoplication improved early postoperative recovery, with an equally good outcome up to 12 months. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Information derived from sensitization test methods: test sensitivity, false positives and false negativesCONTACT DERMATITIS, Issue 1 2007David A. Basketter Predictive toxicology tests for the prospective identification of skin-sensitizing chemicals are well known and have been used for many years. However, of these, only the local lymph node assay (LLNA) has actually undergone formal independent assessment to determine the accuracy of the predictions, particularly with respect to the likelihood of false positives and false negatives. Often, efforts to increase the sensitivity of a test (reducing false negatives) tend to increase the number of false positives. In this short review, these issues are discussed in particular relation to the 3 predictive tests available in regulatory toxicology, the guinea-pig maximization test, the occluded patch test of Buehler and the LLNA. A key perspective is that no predictive test is without limitations; having a good appreciation of these limitations is necessary for making the best use of the information derived from these methods. [source] Fiscal Policy in the UKECONOMIC OUTLOOK, Issue 3 2001Brian Henry Although the conduct of macroeconomic policy in the UK has been very good by historical standards, Brian Henry argues in this article that there are shortcomings in the framework which mean it is less well suited to adverse shocks than it should be. He recommends that an extension of the present framework be made setting up a committee charged with the independent assessment of fiscal policy. This would help mitigate the lack of balance between monetary and fiscal policy which is evident at present. Fiscal judgements based on cyclical adjustments are too heavily dependant on domestic factors and underestimate the effects of the cycle on revenues. In consequence, fiscal policy, rather than supporting monetary, has been loosened and this indirectly accounts for the continuing strength of the exchange rate. [source] Review Article: A new wrinkle on old skin: the role of elastic fibres in skin ageingINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 5 2010A. K. Langton Synopsis Cutaneous ageing is the result of two distinct, biological processes which may occur concurrently: (i) the passage of time, termed intrinsic ageing and (ii) environmental influences, termed extrinsic ageing. Intrinsic ageing of the skin is a slow process which causes changes in tissue structure and impairs function in the absence of additional biological, chemical and physical factors. The clinical features of intrinsically aged skin are not usually evident until old age when, although smooth and unblemished, the skin surface appears pale and is characterized by fine wrinkles with occasional exaggerated expression lines. Functionally, intrinsically aged skin is dry and less elastic than more youthful skin. In contrast, extrinsically aged skin is exemplified by deep, coarse wrinkles, mottled hyperpigmentation and a marked loss of elasticity and recoil. The two major environmental influences which induce extrinsic ageing are: (i) chronic exposure to solar ultraviolet (UV) irradiation (termed photoageing) and (ii) smoking. This review discusses the changes associated with the ageing process in the skin, with particular emphasis on the role played by the elastic fibre network in maintaining dermal function. The review concludes with a discussion of a short-term assay for independent assessment of the efficacy of anti-ageing cosmetic products using the elastic fibre component fibrillin-1 as a biomarker of extracellular matrix repair. Résumé Le vieillissement Cutané est le résultat de deux processus biologiques distincts, qui peuvent se produire concurremment : i) le passage de temps, désigné comme vieillissement intrinsèque et ii) les influences environnementales, désignées comme vieillissement extrinsèque. Le vieillissement intrinsèque de la peau est un processus lent provoquant des changements de la structure et détériorant la fonction tissulaire sans facteurs biologiques, chimiques ou physiques supplémentaires. Les caractéristiques cliniques de la peau intrinsèquement âgée sont peu visibles avant la vieillesse où, bien que lisse et impeccable, la surface de la peau apparaît pâle et marquée par des rides notables et des lignes d'expression exagérées. Au niveau fonctionnel, la peau intrinsèquement âgée est sèche et moins d'élastique que la peau plus jeune. Au contraire, la peau extrinsèquement âgée est caractérisée par des rides profondes, grossières, une hyperpigmentation en taches et une perte marquée d'élasticité. Les deux influences environnementales majeures à l'origine du vieillissement extrinsèque sont : i) l'exposition chronique aux ultra-violets (UV) et ii) l'exposition tabagique. Cette revue envisage les changements associés au processus de vieillissement cutané, avec une attention particulière sur le rôle joué par le réseau élastique dans le maintien de la fonction dermique. Cette analyse se termine par une discussion à propos d'un essai d'évaluation de l'efficacité de produits cosmétiques anti-âges utilisant un composant de fibre élastique la fibrillin-1 comme bio marqueur de la réparation de la matrice extracellulaire. [source] Refinement of an osteoporosis risk-assessment questionnaire for use in community pharmacyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 5 2008Lee Ser Poh pharmacy practice advanced student Objective To explore the influence of bone mineral density (BMD) tests in osteoporosis risk categorisation in community pharmacies, and to develop a simple tool for pharmacists to use as a pre-BMD test screen. Method A secondary data analysis was conducted on the responses of 193 participants to a risk-assessment questionnaire, used in previous osteoporosis research that included a BMD test. To explore the impact of the BMD test on pharmacists' categorisation of risk, the researchers made an independent assessment based on responses of the questionnaire. The influence of risk factors on BMD scores/bone status was explored using multiple and logistic regression respectively. Key findings A total of responses of 193 participants were available for study, with 113 in the BMD group and 80 from the non-BMD group. In the BMD group, both researchers and pharmacists identified a similar proportion of patients in the moderate/high-risk category when BMD results were incorporated in the risk assessments (X2 = 0.78, degrees of freedom (df) = 1, 0.3 < P < 0.5). A statistically significant difference in risk categorisation was found between the pharmacists and researchers in the non-BMD group (X2 = 23.9, df = 1, P < 0.001). Risk factors identified to be significantly affecting BMD and of use for identifying patients at high risk for osteopenia/osteoporosis were age, weight, postmenopause and absence of hormone replacement therapy (HRT). These four factors were used to construct a simple risk index to guide pharmacists' initial risk categorisation. Conclusion The findings of this study suggested that BMD testing may increase the effectiveness of risk assessments and enhance the screening procedures in the community pharmacy. The simple risk index could serve as a pre-BMD test screen, with a BMD test recommended when necessary. A refined risk-assessment questionnaire could serve to guide pharmacists in directing individualised counselling and advice for at-risk patients, through identification of modifiable risk factors and conditions. [source] Levels of quality management of blood transfusion services in EuropeISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2008C. Seidl The European blood legislation has defined several key quality elements to achieve Good Manufacturing Practice (GMP) in the field of blood transfusion. During the recent years, the blood legislation is in the process of implementation throughout its member states. Following the Directive 2002/98/EC, Directive 2005/62/EC has given further requirements for quality-management systems to be fulfilled by blood establishments. In addition, GMP/Good Laboratory Practice (GLP) and ISO standards are used inter alia by blood establishments. In order to support the implementation of the blood legislation, the European Public Health Work Plan (2005/2007) has cofunded two projects, led by the German Red Cross and supported by the European Blood Alliance, delivering a common European Standard Operating Procedure (SOP) methodology (EU-Q-Blood-SOP) and criteria and standards for the inspection of blood establishments (EUBIS). The EU-SOP manual will assist blood establishments in preparing for the inspection of their services related to the implementation of quality relevant elements required by the EU Directive 2002/98/EC and its technical annexes. The standards and criteria for inspection of blood establishments will cross-reference existing quality standards to the directive requirements and define requirements for the structure of quality-management systems based on the directive 2002/98/EC and its technical annexes. Based on these requirements, inspection standards and criteria are developed to assist in the independent assessment of quality systems established by individual blood establishments. These assessments are done in relation to the requirements defined by the European Union legislation on blood, in order to safeguard the quality of blood and to achieve continuous improvement of its quality throughout Europe. [source] Experiences of loss and chronic sorrow in persons with severe chronic illnessJOURNAL OF CLINICAL NURSING, Issue 3a 2007Gerd Ahlström PhD Aims and objectives., The aims of the present study were to describe losses narrated by persons afflicted with severe chronic physical illness and to identify the concomitant occurrence of chronic sorrow. Background., Reactions connected with repeated losses are referred to in the literature as chronic sorrow, which has recently been described in conjunction with chronic illness. Design., A qualitative study with an abductive approach of analysis, including both inductive and deductive interpretations. Method., The study is based on 30 persons of working age with average disease duration of 18 years. The average age was 51 years. All of the persons had personal assistance for at least three months because of considerable need for help in daily life due to physical disability. Each person was interviewed twice. There was also an independent assessment of the deductive results concerning chronic sorrow. Results., The inductive findings show that all persons had experienced repeated physical, emotional and social losses. Most common were ,Loss of bodily function', ,Loss of relationship', ,Loss of autonomous life' and ,Loss of the life imagined'. ,Loss of identity' included the loss of human worth, dignity and a changed self-image. In addition, the deductive findings suggest that chronic sorrow exists in the study population. Sixteen of 30 participating subjects were assessed by both assessors to be in a state of chronic sorrow and there was an especially high agreement with respect to one criterion of chronic sorrow ,Loss experience, ongoing or single event' (28 of 30 subjects). Conclusions., This study shows that persons with severe chronic illness often experience recurring losses. These experiences are consistent with the phenomenon of chronic sorrow. Relevance to clinical practice., Knowledge of the existence of chronic sorrow in persons with chronic illness will enable nurses to support these persons in a more sensitive and appropriate way. [source] Kernel texture differences among US soft wheat cultivars,,JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 11 2005Dr Craig F Morris Abstract Kernel texture is a key factor in the quality and utilization of soft wheat (Triticum aestivum L), yet the variation in kernel texture among US soft wheat cultivars is largely unknown. This study evaluated the following hypothesis: soft wheat cultivars differ in kernel texture due to minor genetic factor(s). Once identified, selected contrasting cultivars could serve as candidates for crop improvement and future genetic studies. To test the hypothesis, kernel texture (SKCS, Single Kernel Characterization System), NIR (near-infrared reflectance) and Quadrumat break flour yield were evaluated for 30 cultivars drawn from the four major US soft wheat regions and sub-classes (eastern and western soft white winter, soft red winter and Club). Cultivars were grown in replicated trials over 6 site-years in Washington state. The results clearly indicated that relatively large, consistent genetic differences in kernel texture exist among US soft wheat cultivars. SKCS and NIR were fairly well correlated (r = 0.85) and tended to rank cultivars in the same order. However, individual cultivars deviated from this linear relationship and occasionally rankings changed substantially. Trends were observed among the geographical regions and sub-classes, eg the first 13 hardest-ranked positions (SKCS) were held by western cultivars (13 of the 16 total western cultivars). Quadrumat break flour yield provided an independent assessment of kernel texture and was not correlated with SKCS or NIR hardness. Four distinct cultivar groupings were made based on analysis of variance and two-dimensional graphical assessment. Each group represented contrasting levels of kernel texture (SKCS or NIR) and break flour yield. Identification of the specific underlying gene(s) conferring kernel texture variation among US soft wheats awaits the next phase of research. Copyright © 2005 Society of Chemical Industry [source] Total imprecision of exposure biomarkers: implications for calculating exposure limitsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2007Philippe Grandjean MD Abstract Background Assessment of the imprecision of exposure biomarkers usually focuses on laboratory performance only. Unrecognized imprecision leads to underestimation of the true toxicity of the exposure. We have assessed the total imprecision of exposure biomarkers and the implications for calculation of exposure limits. Methods In a birth cohort study, mercury concentrations in cord blood, cord tissue, and maternal hair were used as biomarkers of prenatal methylmercury exposure. We determined their mutual correlations and their associations with the child's neurobehavioral outcome variables at age 7 years. With at least three exposure parameters available, factor analysis and structural equation modeling could be applied to determine the total imprecision of each biomarker. The estimated imprecision was then applied to adjust benchmark dose calculations and the derived exposure limits. Results The exposure biomarkers correlated well with one another, but the cord blood mercury concentration showed the best associations with neurobehavioral deficits. Factor analysis and structural equation models showed a total imprecision of the cord-blood parameter of 25,30%, and almost twice as much for maternal hair. These imprecisions led to inflated benchmark dose levels. Adjusted calculations resulted in an exposure limit 50% below the level recommended by the U.S. National Research Council. Conclusions The biomarker imprecisions of 25,50% much exceeded normal laboratory variability. Such imprecision causes underestimation of dose-related toxicity and therefore must be considered in the data analysis and when deriving exposure limits. Future studies should ideally include at least three exposure parameters to allow independent assessment of total imprecision. Am. J. Ind. Med. 50:712,719, 2007. © 2007 Wiley-Liss, Inc. [source] Scoring Total Inflammation Is Superior to the Current Banff Inflammation Score in Predicting Outcome and the Degree of Molecular Disturbance in Renal AllograftsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009M. Mengel Emerging molecular analysis can be used as an objective and independent assessment of histopathological scoring systems. We compared the existing Banff i-score to the total inflammation (total i-) score for assessing the molecular phenotype in 129 renal allograft biopsies for cause. The total i-score showed stronger correlations with microarray-based gene sets representing major biological processes during allograft rejection. Receiver operating characteristic curves showed that total-i was superior (areas under the curves 0.85 vs. 0.73 for Banff i-score, p = 0.012) at assessing an abnormal cytotoxic T-cell burden, because it identified molecular disturbances in biopsies with advanced scarring. The total-i score was also a better predictor of graft survival than the Banff i-score and essentially all current diagnostic Banff categories. The exception was antibody-mediated rejection which is able to predict graft loss with greater specificity (96%) but at low sensitivity (38%) due to the fact that it only applies to cases with this diagnosis. The total i-score is able to achieve moderate sensitivities (60,80%) with losses in specificity (60,80%) across the whole population. Thus, the total i-score is superior to the current Banff i-score and most diagnostic Banff categories in predicting outcome and assessing the molecular phenotype of renal allografts. [source] Systematic review of the impact of volume of oesophagectomy on patient outcomeANZ JOURNAL OF SURGERY, Issue 5 2010Christopher I. W. Lauder Abstract Purpose:, This systematic review aims to assess whether overall survival, mortality, morbidity, length of stay and cost of performing oesophagectomy are related to surgical volume. Methods:, A systematic search strategy from 1997 until December 2006 was used to retrieve relevant studies. Inclusion of articles was established through application of a predetermined protocol, independent assessment by two reviewers and a final consensus decision. Results:, A total of 55 studies were identified of which 27 studies, representing 68 882 patients, met the inclusion criteria. Twenty-one of these solely examined hospital volume, 5 examined both hospital and surgeon volume, and 1 examined surgeon volume in isolation. All but one of the studies were retrospective in nature, and because of the heterogeneity of the literature, no meta-analysis could be performed. Of the studies exploring the relationship between hospital volume and mortality, 20 reported a statistically significant benefit to large volume centres. Five of six included studies showed significant evidence for a reduced mortality risk with greater surgeon volume. Conclusions:, Based on the evidence from these retrospective studies, oesophagectomy performed in high volume centres would appear to be associated with better outcome compared with low volume centres. [source] Radical prostatectomy: a systematic review of the impact of hospital and surgeon volume on patient outcomeANZ JOURNAL OF SURGERY, Issue 1-2 2010Ailsa Wilson Abstract Background:, To assess the impact of hospital and surgeon volume on mortality, morbidity, length of hospital stay and costs of radical prostatectomy (RP). Methods:, This systematic review identified relevant studies published between 1997 and June 2007. Inclusion of papers was established through application of a predetermined protocol, independent assessment by two reviewers, and a final consensus decision. Results:, Compared with low volume hospitals, the included studies showed high volume hospitals demonstrated lower rates of mortality, postoperative complications and readmissions, and lower overall hospital costs. High volume surgeons similarly showed lower rates of postoperative complications and shorter length of stay compared with low volume surgeons, but no difference in mortality. Conclusions:, From the literature obtained, patients undergoing RP performed by high volume providers may have better outcomes compared to low volume providers; however, any move to centralize RP must be further evaluated. [source] Applying the choice/no-choice methodology: the case of children's strategy use in spellingDEVELOPMENTAL SCIENCE, Issue 1 2002Patrick Lemaire The present study illustrates the usefulness of the choice/no-choice method to investigate age-related changes in children's strategies. This method enables independent assessments of strategy use and execution. It is applied in children's spelling strategies. Third- and fifth-grade children were asked to write down words using a dictionary or not (choice condition). Then, they were successively required to spell words using each strategy (no-choice condition). Performance showed that (a) strategy choices and accuracy differed in younger and older children, (b) strategy effectiveness was the strongest predictor of children's strategy use, and (c) having the choice resulted in higher level of spelling accuracy (especially in older children) than having no choice. We discuss the implications of these results on how the choice/no-choice method can be useful for understanding and investigating children's strategy choices in spelling and other cognitive domains. [source] Reducing Suicidal Ideation in Depressed Older Primary Care PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006Jürgen Unützer MD OBJECTIVES: To determine the effect of a primary care,based collaborative care program for depression on suicidal ideation in older adults. DESIGN: Randomized, controlled trial. SETTING: Eighteen diverse primary care clinics. PARTICIPANTS: One thousand eight hundred one adults aged 60 and older with major depression or dysthymia. INTERVENTION: Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual. MEASUREMENTS: Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist. RESULTS: At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available. CONCLUSION: Primary care,based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients. [source] The choice of timing for diuresis renography:the F+0 methodBJU INTERNATIONAL, Issue 1 2001A.A.B. Adeyoju Objective To investigate a method of diuresis renography where the radiopharmaceutical and frusemide (diuretic) are given simultaneously, in contrast to conventional renography which involves an intravenous injection with frusemide 20 min after administering the radiopharmaceutical (F+20) or 15 min before (F,15), with particular interest in the effect of this change on assessing split renal function and interpreting upper tract drainage dynamics. Patients and methods In a prospective study, 29 patients (18 women and 11 men, mean age 47 years, range 21,86) were assessed. Each patient had two renograms taken over a 48-h period, either by the F+20 or F,15, and the F+0 method. Data for split renal function and drainage curves were obtained in the usual way. Two independent assessments of the drainage curves were obtained and the results compared. Results The split function assessments were identical (<5% variation) in all but two patients; 26 of 29 (90%) gave identical conclusions about the drainage curves. The three patients with discrepancies between the studies had either hugely dilated upper tracts or otherwise had multiple complicating factors, e.g. impaired renal function, neuropathic bladder. Conclusions F+0 renography has been used in paediatric urological practice before, but there are no comparative studies and no data on its use in adults. This prospective study confirmed that in investigating dilated upper tracts, the F+0 technique gives similar results to the conventional techniques. The F+0 method has the potential to reduce the time required to undertake standard F+20 renography but it may not be useful in evaluating the grossly dilated upper tract, where the F,15 technique has the best record in terms of reducing equivocal results. [source] | ||||||||||||||||||||||