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Limited Circumstances (limited + circumstance)
Selected AbstractsElectronic Medical Record Review as a Surrogate to Telephone Follow-up to Establish Outcome for Diagnostic Research Studies in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2005Jeffrey A. Kline MD Abstract Background: Follow-up for diagnostic research studies might be facilitated if medical record review (MRR) could be used instead of telephone calls. Objectives: The authors hypothesized that MRR would yield similar accuracy to telephone follow-up. Methods: This was a secondary analysis of 2,178 initially disease-free patients who were followed after enrollment in a diagnostic study of either acute coronary syndrome (45 days) or pulmonary embolism (90 days) conducted in an urban teaching emergency department (ED). Disease status (positive or negative) was defined explicitly. Using structured data forms, trained researchers performed MRR using a comprehensive electronic database, and formulated an opinion about disease status. Trained researchers, blinded to the MRR, then dialed telephone numbers, asked questions from a script, and categorized disease status. The criterion standard was adjudication by consensus of two of three physicians who independently determined disease status based on explicit criteria and access to all follow-up data. Results: Adjudicators found that 13 of 2,178 patients developed disease during follow-up; all 13 true positives occurred among the 2,054 (94.3%) of patients who acknowledged intent to return to the study hospital. Telephone follow-up was successful in 81% of patients, and found all 13 true positives (sensitivity 100%) but with three additional false-positive cases. MRR disclosed 12 of 13 cases of disease (sensitivity 92%) with no false-positive cases. Further review of the one false-negative case from MRR revealed that it occurred after the prescribed time limit for follow-up. Conclusions: Under limited circumstances, accurate clinical follow-up for diagnostic studies conducted in the ED can be obtained by medical record review. [source] Repeatability of hematocrits and body mass of Gray CatbirdsJOURNAL OF FIELD ORNITHOLOGY, Issue 1 2010Margret I. Hatch ABSTRACT Hematocrits may provide information about the physiological condition of birds, but, to be a useful measure, information is needed concerning how hematocrits vary among individuals and over time. We examined the repeatability of hematocrits in a population of Gray Catbirds (Dumetella carolinensis) in Pennsylvania at several time scales and also examined the repeatability of body mass, another measure commonly used as an indicator of condition. Both hematocrit (r= 0.64) and mass (r= 0.65) were repeatable (P < 0.01) for first captures between years and between first and second captures within a year (r= 0.41 and r= 0.50, respectively; P < 0.01), but not repeatable (P > 0.05) between captures in different months within a year (r= 0.11 for both). Repeatability of both measures differed by sex and age. Females exhibited repeatability of hematocrit and body mass only between years, while male hematocrits were repeatable between years and between first and second captures within a season. Male mass was repeatable for all time periods. Hematocrits of younger birds were repeatable between captures within a season and their body mass was repeatable between months and weeks while hematocrits of older birds were not repeatable and their body mass was repeatable only between captures in a season. Our results indicate that hematocrits and body mass had similar repeatability coefficients overall, but that hematocrits of Gray Catbirds were a consistent trait of individuals only across years. Because repeatability between captures and months depended on sex and age, we conclude that the hematocrit is a useful measure of individual performance only in limited circumstances. RESUMEN El hematocrito podría proveer información sobre la condición física de las aves pero para ser una medida útil se necesita información sobre como el hematocrito varia entre individuos y a través del tiempo. Examinamos la repetibilidad del hematocrito en una población de Dumetella carolinensis en Pennsylvania durante diferentes escalas temporales. También examinamos la repetibilidad del peso corporal, otra medida comúnmente usada como indicador de la condición del individuo. El hematocrito (r= 0.64) y el peso corporal (r= 0.65) eran repetibles (P < 0.01) para las primeras capturas entre años y entre la primera y segunda captura dentro del año (r= 0.41 y r= 0.50, respectivamente; P < 0.01), pero no eran repetibles (P > 0.05) entre capturas realizadas en diferentes meses dentro del año (r= 0.11 para los dos). La repetibilidad de las dos medidas difiere por sexo y edad. Las hembras se caracterizaron por tener repetibilidad del hematocrito y del peso corporal solo entre años, mientras que el hematocrito de los machos era repetible entre años y entre la primera y segunda captura dentro de la temporada. El peso corporal de los machos era repetible durante todos los periodos a través del tiempo. El hematocrito de las aves mas jóvenes era repetible entre capturas dentro de la temporada y su peso corporal era repetible entre meses y semanas, mientras que el hematocrito de las aves mayores no era repetible y su peso corporal era repetible solo entre capturas dentro de la temporada. Nuestros resultados indican que los hematocritos y el peso corporal en general tuvieron coeficientes de repetibilidad similares, pero que los hematocritos de D. carolinensis eran un rasgo consistente de los individuos solo entre años. Por la razón que la repetibilidad entre capturas y meses dependía del sexo y edad, concluimos que el hematocrito es una medida útil del performance individual solo en circunstancias limitadas. [source] Conscience, discretion and the creation of property rightsLEGAL STUDIES, Issue 4 2006Nicholas Hopkins This paper considers the utility of the concept of conscience or unconscionable conduct as a contemporary rationale for intervention in two principles applied where a person seeks to renege on an informal agreement relating to land: the principle in Rochefoucauld v Boustead; and transfers ,subject to' rights in favour of a claimant. By analysing the concept in light of our current understanding of the nature of judicial discretion and the use of general principles, it responds to arguments that unconscionability is too general a concept on which to base intervention. In doing so, it considers the nature of the discretion that is actually in issue when the court intervenes through conscience in these principles. However, the paper questions the use of constructive trusts as a response to unconscionability. It argues that there is a need, in limited circumstances, to separate the finding of unconscionability from the imposition of a constructive trust. In these limited circumstances, once unconscionability is found, the courts should have a discretion as to the remedy, modelled on that developed in the context of proprietary estoppel. The message underlying this paper is that many of the concerns expressed about unconscionability that have led to suggestions of alternative rationales for intervention can in fact be addressed whilst retaining an unconscionability analysis. Unconscionability remains a preferable rationale for intervention as it provides a common thread that links apparently separate principles and can assist our understanding of their scope. [source] Overview of model-building strategies in population PK/PD analyses: 2002,2004 literature surveyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 5 2007C. Dartois What is already known about this subject ,,The reviews already published on population pharmacokinetic/pharmacodynamic (PK/PD) analyses have focused on theory and have presented some clinical applications, evaluated validation practices in limited circumstances, defined the interest and sometimes the complexity of this approach in drug development or proposed a list of relevant articles. ,,None of them has exhaustively evaluated published analyses and more precisely the model-building steps. ,,In view of the statistical complexity of population PK/PD methodology, more attention is required to how models are built and how they are reported in the literature. What this study adds ,,With a strict methodology and by establishing a standardized tool, this survey provides an exhaustive, objective and up-to-date review of model-building practices. ,,It reveals deficiencies in information reporting in most articles and the genuine need for guidance in publishing. ,,An initial, minimal list of items is suggested, which can be used by authors and reviewers in pharmacology journals. ,,The value of published peer-reviewed papers could be greatly improved if authors were to address the suggested list of items systematically. Aims A descriptive survey of published population pharmacokinetic and/or pharmacodynamic (PK/PD) analyses from 2002 to 2004 was conducted and an evaluation made of how model building was performed and reported. Methods We selected 324 articles in Pubmed using defined keywords. A data abstraction form (DAF) was then built comprising two parts: general characteristics including article identification, context of the analysis, description of clinical studies from which the data arose, and model building, including description of the processes of modelling. The papers were examined by two readers, who extracted the relevant information and transmitted it directly to a MySQL database, from which descriptive statistical analysis was performed. Results Most published papers concerned patients with severe pathology and therapeutic classes suffering from narrow therapeutic index and/or high PK/PD variability. Most of the time, modelling was performed for descriptive purposes, with rich rather than sparse data and using NONMEM software. PK and PD models were rarely complex (one or two compartments for PK; Emax for PD models). Covariate testing was frequently performed and essentially based on the likelihood ratio test. Based on a minimal list of items that should systematically be found in a population PK,PD analysis, it was found that only 39% and 8.5% of the PK and PD analyses, respectively, published from 2002 to 2004 provided sufficient detail to support the model-building methodology. Conclusions This survey allowed an efficient description of recent published population analyses, but also revealed deficiencies in reporting information on model building. [source] | ||||||||||