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Operational Criteria (operational + criterion)
Selected AbstractsOn the Application of Inductive Machine Learning Tools to Geographical AnalysisGEOGRAPHICAL ANALYSIS, Issue 2 2000Mark Gahegan Inductive machine learning tools, such as neural networks and decision trees, offer alternative methods for classification, clustering, and pattern recognition that can, in theory, extend to the complex or "deep" data sets that pervade geography. By contrast, traditional statistical approaches may fail, due to issues of scalability and flexibility. This paper discusses the role of inductive machine learning as it relates to geographical analysis. The discussion presented is not based on comparative results or on mathematical description, but instead focuses on the often subtle ways in which the various inductive learning approaches differ operationally, describing (1) the manner in which the feature space is partitioned or clustered, (2) the search mechanisms employed to identify good solutions, and (3) the different biases that each technique imposes. The consequences arising from these issues, when considering complex geographic feature spaces, are then described in detail. The overall aim is to provide a foundation upon which reliable inductive analysis methods can be constructed, instead of depending on piecemeal or haphazard experimentation with the various operational criteria that inductive learning tools call for. Often, it would appear that these criteria are not well understood by practitioners in the geographic sphere, which can lead to difficulties in configuration and operation, and ultimately to poor performance. [source] Application of the 1988 International Headache Society Diagnostic Criteria in Nine Italian Headache Centers using a Computerized Structured RecordHEADACHE, Issue 10 2002Virgilio Gallai MD Background.,The actual application of the current International Headache Society (IHS) diagnostic criteria in clinical practice has not been investigated thoroughly. Objectives.,To develop a computerized, structured, medical record based exclusively on the IHS classification system. Design and Method.,We tested the computerized structured record by entering and analyzing data reported on the case sheets of 500 consecutive patients attending nine headache centers in Italy. All clinical diagnoses in the study were made according to current IHS criteria. The rate of concordance between the diagnosis provided by the computerized structured record and that reported by clinicians on the case sheets was calculated, and reasons for any discrepancies between the two diagnoses were analyzed. Results.,Concordance between the two diagnoses was found in 345 of 500 cases examined (69%). In the remaining 155 cases, diagnoses reached with the computerized structured record and case sheets were impossible or discordant with respect to the diagnoses made by the clinician. In 144 of these cases (28.8%), this was due to missing information or errors in the diagnosis recorded by the clinicians on the patient case sheet. In particular, the diagnosis could not be reached using the computerized structured record in 105 cases (20.6%) because of a lack of one or more data needed in formulating a correct diagnosis according to the IHS operational criteria for one of the primary headache disorders. In the remaining 41 cases some data were missing, but the data available were sufficient to reach a diagnosis according to the IHS criteria. Moreover, the diagnoses reached using the computerized structured record were not in agreement with those made by the clinicians in another 39 cases (7.9%) due to an incorrect interpretation by the clinicians of the data reported on the patients' case sheets. In only 2.2% of the cases (n = 11) misdiagnoses were due to errors of the program that were promptly corrected. Conclusions.,The present study suggests that incorrect application of IHS criteria for the diagnosis of primary headache may occur in as many as one third of patients attending headache centers and that use of a computerized structured record based exclusively on current IHS criteria may overcome this deficiency. [source] Clinical indicators of ineffective airway clearance in children with congenital heart diseaseJOURNAL OF CLINICAL NURSING, Issue 5 2009Viviane Martins Da Silva Aims and objectives., To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power. Background., The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Design., Longitudinal study. Methods., Participants consisted of 45 children, ,1 year of age, with congenital heart disease, who had not had definitive or palliative surgical correction. Six assessments were made at 2-day intervals. Each clinical indicator was defined based on previously established operational criteria. Sensitivity, specificity and positive and negative predictive values of each indicator were calculated based on a model for the longitudinal data. Results., A nursing diagnosis of ineffective airway clearance was made in 31% of patients on the first assessment, rising to 71% on the last assessment, for a 40% increase. Sensitivity was highest for Changes in Respiratory Rates/Rhythms (0·99), followed by Adventitious Breath Sounds (0·97), Sputum Production (0·85) and Restlessness (0·53). Specificity was higher for Sputum Production (0·92), followed by Restlessness (0·73), Adventitious Breath Sounds (0·70) and Changes in Respiratory Rates/Rhythms (0·17). The best positive predictive values occurred for Sputum Production (0·93) and Adventitious Breath Sounds (0·80). Conclusions., Adventitious Breath Sounds followed by Sputum Production were the indicators that had the best overall sensitivity and specificity as well as the highest positive predictive values. Relevance to clinical practice., The use of simple indicators in nursing diagnoses can improve identification of ineffective airway clearance in children with congenital heart disease, thus leading to early treatment of the problem and better care for these children. [source] Why borderline personality disorder is neither borderline nor a personality disorderPERSONALITY AND MENTAL HEALTH, Issue 2 2009Peter Tyrer Objectives,Borderline personality disorder is the most well-studied personality disorder in psychiatry. Despite its great influence in the study of these conditions, it has not been properly recognized that borderline personality disorder is atypical. Design,A critical analysis of the differences between borderline and other personality disorders is made. Method,A comparison is made between borderline personality disorder and other personality disorders with respect to diagnostic criteria, relationship to normal personality variation and treatment options. Results,Analysis of the operational criteria for borderline and schizotypal personality disorders shows that these are the only personality disorders that are dominated by discrete symptoms rather than traits. Cluster analysis of a data set of personality traits obtained between 1976 and 1978 (before borderline personality disorder became fashionable in the UK) could find no profile that supports the existence of a borderline personality disorder grouping, and the study of published papers on treatment in personality disorder shows a 3,:,1 ratio for borderline personality disorder compared with all other personality disorders combined, approaching 9,:,1 when unspecified (probably mainly borderline) conditions are taken into account. Conclusions,Borderline personality disorder is incorrectly classified as a personality disorder and does an injustice to those who suffer from it. It is better classified as a condition of recurrent unstable mood and behaviour, or fluxithymia, which is better placed with the mood disorders than in odd isolation as a personality disorder. Copyright © 2009 John Wiley & Sons, Ltd. [source] Is DSM widely accepted by Japanese clinicians?PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2001Toshiyuki Someya MD Abstract The Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), a new standardized diagnostic system with multiaxial diagnosis, operational criteria and renewed definitions of mental disorders, was introduced in 1980 and prompted movements to reform conventions in Japanese psychiatry. This review overviews the initial response of Japanese clinicians to accept DSM-III, and its effects on the development of systematic research of psychiatric diagnosis. These new research activities include those on reliability of psychiatric diagnosis, application of various evaluation tools, discussion on the concept of mental disorders, relation of personality disorders with depressive disorders, and Taijin-kyofusho, or culturally distinctive phobia in Japan. A reference database search to survey the latest trend on psychiatric research indicated that the number of papers published by Japanese workers increased sharply after 1987, and DSM apparently greatly influenced their internationalization. Twenty years after the publication of DSM-III, a questionnaire on the use of DSM-IV was set out in 2000 to survey how widely DSM is utilized in clinical practice in Japan. Two hundred and twelve psychiatrists answered the questionnaire, and the results show that DSM has been accepted positively by the younger generation, while the older generation (over 40s) has still less interest in DSM, and DSM is used mainly for research purposes rather than in daily practice. [source] ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Comparison of Androgens in Women with Hypoactive Sexual Desire Disorder: Those on Combined Oral Contraceptives (COCs) vs.THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2006Those not on COCs ABSTRACT Introduction., Approximately one out of four sexually active women in the United States uses some form of hormonal contraceptive method because they provide the most effective reversible method of birth control available. However, little attention has been paid to possible adverse effects of combined oral contraceptives (COCs) on sexual functioning. Aims., The aim of this study was to examine the potential effects of COCs on women with hypoactive sexual desire disorder (HSDD). It was hypothesized that female patients with generalized, acquired HSDD on COCs have lower androgen levels than those not on COCs. Methods., The patients were healthy premenopausal women with HSDD, aged 22,50 years. Subjects had a history of adequate sexual desire, interest, and functioning. Participants were required to be in a stable, monogamous, heterosexual relationship and were screened for any medication or medical or psychiatric disorders that impact desire. The patients met operational criteria for global, acquired HSDD. The 106 patients were divided into two groups: those on COCs (N = 43) and those not on COCs (N = 63). A two-tailed t -test comparison was made between the two groups comparing free and total testosterone and sex hormone-binding globulin (SHBG). Main Outcome Measures., The main outcome measures are the differences between the two groups comparing free testosterone, total testosterone, and SHBG. Results., These patients with HSDD on COCs had significantly lower free and total testosterone levels compared with those who were not on COCs. The SHBG was significantly higher in the group on COCs compared with those who were not on COCs. Conclusion., The result of this study suggests that COCs in premenopausal women with HSDD are associated with lower androgen levels than those not on COCs. Further research is required to determine if low androgen levels secondary to COCs impact female sexual desire. Warnock JK, Clayton A, Croft H, Segraves R, and Biggs FC. Comparison of androgens in women with hypoactive sexual desire disorder: Those on combined oral contraceptives (COCs) vs. those not on COCs. J Sex Med 2006;3:878,882. [source] Assessment of treatment response in mania: commentary and new findingsBIPOLAR DISORDERS, Issue 2 2003Ross J Baldessarini Background:, Assessment of therapeutic interventions in bipolar disorder is complicated by rapid, complex clinical changes, high placebo-response rates, and varying times to specific levels of clinical recovery that may not be adequately reflected in averaged rating-scale scores particularly in acute mania, calling for improved methods to evaluate treatment responses. Chengappa et al. (1) propose operational criteria for specific outcomes based on rating-scale data from two placebo-controlled trials of olanzapine in mania. Methods:, These trials and other recent research were considered in commenting on the design, conduct, analysis and interpretation of experimental therapeutic trials in mania and to optimize olanzapine versus placebo contrasts by systematically varying end-point criteria for mania (YMRS) and depression (HDRS) ratings. Results:, Olanzapine versus placebo responses were optimally separated at scores of 10 for final paired mania and depression ratings, or 5 for each rating scale considered separately. Conclusions:, Use of empirically determined end-points derived from standard rating scales used in experimental therapeutics research in mood disorders can improve both outcome-assessment and separation of active treatment from placebo responses in acute mania. [source] Redefining Affective Disorders: Relevance for Drug DevelopmentCNS: NEUROSCIENCE AND THERAPEUTICS, Issue 1 2008Steven D Targum The evaluation of new drug entities with specific modes of action may be hampered by rigid diagnostic classification systems and patient selection processes that do not focus on the anticipated symptomatic, behavioral, and functional outcomes to be achieved. Patients enrolled in central nervous system (CNS) clinical trials may present with a heterogeneous group of symptoms representing several syndromes or subtypes, subsumed under the same diagnosis in the DSM-IV classification system. As a result, enrolled patients may not have the valid illness characteristics of interest to the particular study. We propose that clinical drug development needs to focus on the primary nosological entity likely to be affected by a new drug entity's mode of action. Ideally, a valid patient will have the acute primary symptoms that the novel drug is supposed to influence. In this article, we propose operational criteria to delineate a more symptom-specific and ecologically valid approach to the identification of the valid patient for clinical trials. [source] | ||||||||||