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Assessment Protocol (assessment + protocol)
Selected AbstractsRETHINKING THE RESIDENT ASSESSMENT PROTOCOLSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007Brant E. Fries PhD No abstract is available for this article. [source] The Diabetes UK Mozambique Twinning Programme.DIABETIC MEDICINE, Issue 8 2010Results of improvements in diabetes care in Mozambique: a reassessment 6 years later using the Rapid Assessment Protocol for Insulin Access Diabet. Med. 27, 855,861 (2010) Abstract Objective, To assess improvements in diabetes care in Mozambique between 2003 and 2009 following the implementation of the Diabetes UK Twinning Programme. Methods, As in 2003, a Rapid Assessment Protocol was implemented from August to September 2009 in order to assess the improvements in diabetes care and impact of the Diabetes UK Twinning Programme. One hundred and eighty-four interviews were carried out at different levels of the health system in different areas of Mozambique. Results, The Diabetes UK Twinning Programme in Mozambique allowed the development of the first comprehensive non-communicable disease plan in sub-Saharan Africa. The other main improvements include a strengthening of the diabetes association with an 8-fold increase in membership, 265 health workers trained in diabetes care in all provinces, the development of patient education materials inspired by some Diabetes UK tools and the expansion of public awareness, particularly from events associated with World Diabetes Day. Conclusions, Much progress has been made in Mozambique with regard to diabetes and non-communicable diseases. Besides the direct impact of specific activities supported by Diabetes UK, this project allowed for ,collateral' benefits in the overall provision of diabetes care. As diabetes and non-communicable diseases have a low profile on the global health agenda, twinning partnerships based on rigorous needs assessment have the capacity to make significant improvements in diabetes care at a relatively low level of investment. Moreover, this study suggests that the tool used might be of value in assessing progress in health system strengthening as well as in conducting the initial needs assessment. [source] Testing the Biobehavioral Family Model in Pediatric Asthma: Pathways of EffectFAMILY PROCESS, Issue 1 2008BEATRICE L. WOOD PH.D. This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n=199; aged 7,17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (,2[1]=.11, p=.74, NFI=.99, RMSEA=.00). Observed NFEC predicted child depression (,=.19, p<.01), which predicted asthma disease severity (,=.23, p<.01). Relational security inversely predicted depressive symptoms (,=,.40, p<.001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms. RESUMEN Prueba del Biobehavioral Family Model (Modelo familiar de biocomportamiento) en asma pediátrica: Factores desencadenantes Objetivo: Este estudio utiliza un método de laboratorio con varios informantes y distintos enfoques para probar la hipótesis de que un ambiente familiar negativo agrava la enfermedad del asma a través de síntomas de depresión infantil, y que la inseguridad en la relación entre padres e hijos influye en su efecto. Sujetos y métodos: Una serie de niños que padecen asma (n=199; edades entre 7 y 17; 55% varones) informaron sobre conflictos de pareja de sus padres, la seguridad en la relación con sus padres y síntomas de depresión. Los padres, por su parte, aportaron datos demográficos, antecedentes de asma e información acerca de los síntomas. El diagnóstico de asma fue confirmado por examen clínico y pruebas de pulmón, y un experto en asma determinó la gravedad de la enfermedad de acuerdo con las pautas del NHLBI (National Heart, Lung, and Blood Institute). La interacción en familia fue simulada mediante el método Family Process Assessment Protocol (protocolo de evaluación de dinámicas familiares) y estimada mediante el Iowa Family Interaction Rating Scales (escala Iowa de interacciones familiares). Resultados: El análisis de camino demostró que los datos encajaron bien con el modelo de la hipótesis (,2[1]=.11, p=.74, NFI=.99, RMSEA=.00). En las familias en las que se observó un ambiente emocional negativo se predijo la depresión del niño o de la niña (,=.19, p<.01), lo que, a su vez, predijo un agravamiento del asma (,=.23, p<.01). Por otra parte, las relaciones positivas predijeron síntomas de depresión de manera inversa (,=.40, p<.001), y no resultaron ser un mediador, como se había predicho, sino un contribuidor independiente. Conclusión: Las averiguaciones coinciden con el Biobehavioral Family Model (modelo familiar de biocomportamiento), que sugiere la existencia de una influencia psicobiológica de procesos de relaciones familiares específicos en la gravedad de la enfermedad del asma a través de síntomas de depresión infantil. [source] Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data SetJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007David Dosa MD OBJECTIVES: To develop a Nursing Home Confusion Assessment Method (NH-CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items. DESIGN: Retrospective cohort study using MDS and Medicare claims data. SETTING: Free-standing NHs in urban markets in the 48 contiguous U.S. states. PARTICIPANTS: Long-stay residents who returned to their NHs after acute hospitalizations between April and September 2000 (N=35,721). MEASUREMENTS: Mortality and rehospitalization rates within 90 days of readmission to the NH from the hospital. RESULTS: Almost one-third (31.8%) of the residents were identified as having delirium according to the RAP; 1.4% had full delirium, 13.2% had Subsyndromal II delirium, and 17.2% had Subsyndromal I delirium. More-severe NH-CAM scores were associated with greater risks of mortality and rehospitalization. NH-CAM levels were strong independent risk factors for survival and rehospitalization in a Cox model (hazard ratios ranging from 1.5 to 1.9 for mortality and 1.1 to 1.3 for rehospitalization) adjusting for cognitive and physical function, diagnoses, inpatient care parameters, care preferences, and sociodemographic factors. CONCLUSION: The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH. [source] Assessment protocol for identifying preferred social consequencesBEHAVIORAL INTERVENTIONS, Issue 4 2007Krista Smaby Children with autism spectrum disorders (ASD) exhibit deficits in social behavior. Because social consequences may be ineffective or evoke undesirable behavior, teaching interventions for this population may rely heavily on edible or activity reinforcers. This report describes a method, appropriate for young children with ASD, for rapidly identifying social reinforcers and assessing relative preferences among social consequences. The free-operant behavior of three such children was analyzed in three Social Consequence conditions that alternated with an Extinction condition. The results identified some social consequences that functioned as reinforcers and others to which the child was relatively indifferent. The implications of this study may be particularly pertinent for teaching behavior, like joint attention skills, that is maintained by social reinforcers in the natural environment. Copyright © 2007 John Wiley & Sons, Ltd. [source] Qualifications Recognition Reform for Skilled Migrants in Australia: Applying Competency-based Assessment to Overseas-qualified NursesINTERNATIONAL MIGRATION, Issue 6 2002Lesleyanne Hawthorne The past two decades have coincided with unprecedented Australian selection of skilled migrants, in particular professionals from non-English speaking background (NESB) source countries. By 1991, the overseas-born constituted 43 to 49 per cent of Australia's engineers, 43 per cent of computer professionals, 40 per cent of doctors, 26 per cent of nurses, and rising proportions in other key professions. Within one to five years of arrival, just 30 per cent of degree-qualified migrants were employed. However, few diploma holders had found work in any profession, and select NESB groups were characterized by acute labour market disadvantage. Throughout the 1980s and 1990s, barriers to credential recognition were identified as a major contributing factor to these inferior employment outcomes. This paper describes the evolution of Australia's qualifications recognition reform agenda for NESB migrants, including progressive growth in support of a shift from paper to competency-based assessment (CBA). Within this context, the paper examines the degree to which improvements were achieved in the 1990s in the field of nursing , the first major Australian profession to embrace CBA, and one promoted by the National Office of Overseas Skills Recognition as an exemplar of the reform process. Assessment protocols and outcomes are analysed within two contrasting contexts: pre-migration at Australian overseas posts, and within Australia following overseas-qualified nurses' (OQNs) arrival. Based on empirical data from a wide range of sources, the paper identifies the development of a major paradox. Substantial improvements in qualifications recognition were indeed achieved for NESB nurses through CBA in Australia, in particular in the dominant immigrant-receiving states of Victoria and New South Wales. At the same time, it is argued, a significant tightening of recognition procedures was occurring at Australian overseas posts where CBA was unavailable. The Immigration Department placed pre-migration assessment more, rather than less, exclusively in the hands of the professional nursing bodies, in a period coinciding with their harsher, rather than more lenient, treatment of NESB migrants' qualifications. Minimal improvement in recognition of overseas qualifications was achieved in other professions. [source] Histopathological alterations in the liver of the sharptooth catfish Clarias gariepinus from polluted aquatic systems in South AfricaENVIRONMENTAL TOXICOLOGY, Issue 2 2009M. J. Marchand Abstract There is a need for sensitive bio-monitoring tools in toxicant impact assessment to indicate the effect of toxicants on fish health in polluted aquatic ecosystems. Histopathological assessment of fish tissue allows for early warning signs of disease and detection of long-term injury in cells, tissues, or organs. The aim of this study was to assess the degree of histopathological alterations in the liver of C. gariepinus from two dams in an urban nature reserve, (Gauteng, South Africa). Two dams (Dam 1 and Dam 2) were chosen for their suspected levels of toxicants. Water and sediments were sampled for metal and potential endocrine disrupting chemical analysis. A quantitative and qualitative histology-based health assessment protocol was employed to determine the adverse health effects in fish. The analysis of blood constituents, fish necropsy, calculation of condition factors, and hepatosomatic indices were employed to support the findings of the qualitative and quantitative histological assessment of liver tissue. Assessment of the liver tissue revealed marked histopathological alterations including: structural alterations (hepatic cord disarray) affecting 27% of field specimens; plasma alterations (granular degeneration 98% and fatty degeneration 25%) of hepatocytes; an increase in melanomacrophage centers (32%); hepatocyte nuclear alterations (90%); and necrosis of liver tissue (14%). The quantitative histological assessment indicated that livers of fish collected from Dam 1 were more affected than the fish livers collected from Dam 2. © 2008 Wiley Periodicals, Inc. Environ Toxicol, 2009. [source] Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusionINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 6 2005Ann Callaghan RN RM BNurs(Hons) Executive summary Objective, To critically review all literature related to pacifier use for full-term healthy infants and young children. The specific review questions addressed are: What is the evidence of adverse and/or positive outcomes of pacifier use in infancy and childhood in relation to each of the following subtopics: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Inclusion criteria, Specific criteria were used to determine which studies would be included in the review: (i) the types of participants; (ii) the types of research design; and (iii) the types of outcome measures. To be included a study has to meet all criteria. Types of participants,The participants included in the review were healthy term infants and healthy children up to the age of 16 years. Studies that focused on preterm infants, and infants and young children with serious illness or congenital malformations were excluded. However, some total population studies did include these children. Types of research design, It became evident early in the review process that very few randomised controlled trials had been conducted. A decision was made to include observational epidemiological designs, specifically prospective cohort studies and, in the case of sudden infant death syndrome research, case,control studies. Purely descriptive and cross-sectional studies were excluded, as were qualitative studies and all other forms of evidence. A number of criteria have been proposed to establish causation in the scientific and medical literature. These key criteria were applied in the review process and are described as follows: (i) consistency and unbiasedness of findings; (ii) strength of association; (iii) temporal sequence; (iv) dose,response relationship; (v) specificity; (vi) coherence with biological background and previous knowledge; (vii) biological plausibility; and (viii) experimental evidence. Studies that did not meet the requirement of appropriate temporal sequencing of events and studies that did not present an estimate of the strength of association were not included in the final review. Types of outcome measures,Our specific interest was pacifier use related to: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Studies that examined pacifier use related to procedural pain relief were excluded. Studies that examined the relationship between pacifier use and gastro-oesophageal reflux were also excluded as this information has been recently presented as a systematic review. Search strategy, The review comprised published and unpublished research literature. The search was restricted to reports published in English, Spanish and German. The time period covered research published from January 1960 to October 2003. A protocol developed by New Zealand Health Technology Assessment was used to guide the search process. The search comprised bibliographic databases, citation searching, other evidence-based and guidelines sites, government documents, books and reports, professional websites, national associations, hand search, contacting national/international experts and general internet searching. Assessment of quality, All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms, and a full report was retrieved for all studies that met the inclusion criteria. Studies identified from reference list searches were assessed for relevance based on the study title. Keywords included: dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care. Initially, studies were reviewed for inclusion by pairs of principal investigators. Authorship of articles was not concealed from the reviewers. Next, the methodological quality of included articles was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All 20 studies that were accepted met minimum set criteria, but few passed without some methodological concern. Data extraction, To meet the requirements of the Joanna Briggs Institute, reasons for acceptance and non-acceptance at each phase were clearly documented. An assessment protocol and report form was developed for each of the three phases of review. The first form was created to record investigators' evaluations of studies included in the initial review. Those studies that failed to meet strict inclusion criteria were excluded at this point. A second form was designed to facilitate an in-depth critique of epidemiological study methodology. The checklist was pilot tested and adjustments were made before reviewers were trained in its use. When reviewers could not agree on an assessment, it was passed to additional reviewers and discussed until a consensus was reached. At this stage, studies other than cohort, case,control and randomised controlled trials were excluded. Issues of clarification were also addressed at this point. The final phase was that of integration. This phase, undertaken by the principal investigators, was assisted by the production of data extraction tables. Through a process of trial and error, a framework was formulated that adequately summarised the key elements of the studies. This information was tabulated under the following headings: authors/setting, design, exposure/outcome, confounders controlled, analysis and main findings. Results, With regard to the breast-feeding outcome, 10 studies met the inclusion criteria, comprising two randomised controlled trials and eight cohort studies. The research was conducted between 1995 and 2003 in a wide variety of settings involving research participants from diverse socioeconomic and cultural backgrounds. Information regarding exposure and outcome status, and potential confounding factors was obtained from: antenatal and postnatal records; interviews before discharge from obstetric/midwifery care; post-discharge interviews; and post-discharge postal and telephone surveys. Both the level of contact and the frequency of contact with the informant, the child's mother, differed widely. Pacifier use was defined and measured inconsistently, possibly because few studies were initiated expressly to investigate its relationship with breast-feeding. Completeness of follow-up was addressed, but missing data were not uniformly identified and explained. When comparisons were made between participants and non-participants there was some evidence of differential loss and a bias towards families in higher socioeconomic groups. Multivariate analysis was undertaken in the majority of studies, with some including a large number of sociodemographic, obstetric and infant covariates and others including just maternal age and education. As might be expected given the inconsistency of definition and measurement, the relationship between pacifier use and breast-feeding was expressed in many different ways and a meta-analysis was not appropriate. In summary, only one study did not report a negative association between pacifier use and breast-feeding duration or exclusivity. Results indicate an increase in risk for a reduced overall duration of breast-feeding from 20% to almost threefold. The data suggest that very infrequent use may not have any overall negative impact on breast-feeding outcomes. Six sudden infant death syndrome case,control studies met the criteria for inclusion. The research was conducted with information gathered between 1984 and 1999 in Norway, UK, New Zealand, the Netherlands and USA. Exposure information was obtained from a variety of sources including: hospital and antenatal records, death scene investigation, and interview and questionnaire. Information for cases was sought within 2 days after death, within 2,4 weeks after death and in one study between 3 and 11 years after death. Information for controls was sought from as early as 4 days of a nominated sudden infant death syndrome case, to between 1 and 7 weeks from the case date, and again in one study some 3,11 years later. In the majority of the studies case ascertainment was determined by post-mortem. Pacifier use was again defined and measured somewhat inconsistently. All studies controlled for confounding factors by matching and/or using multivariate analysis. Generally, antenatal and postnatal factors, as well as infant care practices, and maternal, family and socioeconomic issues were considered. All five studies reporting multivariate results found significantly fewer sudden infant death syndrome cases used a pacifier compared with controls. That is, pacifier use was associated with a reduced incidence of sudden infant death syndrome. These results indicate that the risk of sudden infant death syndrome for infants who did not use a pacifier in the last or reference sleep was at least twice, and possibly five times, that of infants who did use a pacifier. Three studies reported a moderately sized positive association between pacifier use and a variety of infections. Conversely, one study found no positive association between pacifier use at 15 months of age and a range of infections experienced between the ages of 6 and 18 months. Given the limited number of studies available and the variability of results, no meaningful conclusions could be drawn. Five cohort studies and one case,control study focused on the relationship between pacifier use and dental malocclusion. Not one of these studies reported a measure of association, such as an estimate of relative risk. It was therefore not possible to include these studies in the final review. Implications for practice, It is intended that this review be used as the basis of a ,best practice guideline', to make health professionals aware of the research evidence concerning these health and developmental consequences of pacifier use, because parents need clear information on which they can base child care decisions. With regard to the association between pacifier use and infection and dental malocclusion it was found that, due to the paucity of epidemiological studies, no meaningful conclusion can be drawn. There is clearly a need for more epidemiological research with regard to these two outcomes. The evidence for a relationship between pacifier use and sudden infant death syndrome is consistent, while the exact mechanism of the effect is not well understood. As to breast-feeding, research evidence shows that pacifier use in infancy is associated with a shorter duration and non-exclusivity. It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven. Because breast-feeding confers an important advantage on all children and the incidence of sudden infant death syndrome is very low, it is recommended that health professionals generally advise parents against pacifier use, while taking into account individual circumstances. [source] Stopping to Rest During a 400-Meter Walk and Incident Mobility Disability in Older Persons with Functional LimitationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009Sonja Vestergaard PhD OBJECTIVES: To examine the association between stopping to rest during a 400-m usual-pace walk test (400-MWT) and incident mobility disability in older persons with functional limitations. DESIGN: Prospective cohort study. SETTING: Community based. PARTICIPANTS: Four hundred twenty-four participants in the Lifestyle Intervention and Independence for Elders Pilot (LIFE-P) Study aged 70 to 89 with functional limitations (summary score ,9 on the Short Physical Performance Battery (SPPB)) but able to complete the 400-MWT within 15 minutes. MEASUREMENTS: Rest stops during the 400-MWT were recorded. The onset of mobility disability, defined as being unable to complete the 400-MWT or taking more than 15 minutes to do so, was recorded at Months 6 and 12. RESULTS: Fifty-four (12.7%) participants rested during the 400-MWT at baseline, of whom 37.7% experienced mobility disability during follow-up, versus 8.6% of those not stopping to rest. Performing any rest stop was strongly associated with incident mobility disability at follow-up (odds ratio (OR)=5.4, 95% confidence interval (CI)=2.7,10.9) after adjustment for age, sex, and clinic site. This association was weaker, but remained statistically significant, after further adjusting for SPPB and time to complete the 400-MWT simultaneously (OR=2.6, 95% CI=1.2,5.9). CONCLUSION: Stopping to rest during the 400-MWT is strongly associated with incident mobility disability in nondisabled older persons with functional limitations. Given the prognostic value, rest stops should be recorded as part of the standard assessment protocol for the 400-MWT. [source] Using ants as bioindicators in land management: simplifying assessment of ant community responsesJOURNAL OF APPLIED ECOLOGY, Issue 1 2002Alan N. Andersen Summary 1The indicator qualities of terrestrial invertebrates are widely recognized in the context of detecting ecological change associated with human land-use. However, the use of terrestrial invertebrates as bioindicators remains more a topic of scientific discourse than a part of land-management practice, largely because their inordinate numbers, taxonomic challenges and general unfamiliarity make invertebrates too intimidating for most land-management agencies. Terrestrial invertebrates will not be widely adopted as bioindicators in land management until simple and efficient protocols have been developed that meet the needs of land managers. 2In Australia, ants are one group of terrestrial insects that has been commonly adopted as bioindicators in land management, and this study examined the reliability of a simplified ant assessment protocol designed to be within the capacity of a wide range of land managers. 3Ants had previously been surveyed intensively as part of a comprehensive assessment of biodiversity responses to SO2 emissions from a large copper and lead smelter at Mt Isa in the Australian semi-arid tropics. This intensive ant survey yielded 174 species from 24 genera, and revealed seven key patterns of ant community structure and composition in relation to habitat and SO2 levels. 4We tested the extent to which a greatly simplified ant assessment was able to reproduce these results. Our simplified assessment was based on ant ,bycatch' from bucket-sized (20-litre) pitfall traps used to sample vertebrates as part of the broader biodiversity survey. We also greatly simplified the sorting of ant morphospecies by considering only large (using a threshold of 4 mm) species, and we reduced sorting time by considering only the presence or absence of species at each site. In this manner, the inclusion of ants in the assessment process required less than 10% of the effort demanded by the intensive ant survey. 5Our simplified protocol reproduced virtually all the key findings of the intensive survey. This puts effective ant monitoring within the capacity of a wide range of land managers. [source] Living liver donor death related to complications of myelomaLIVER TRANSPLANTATION, Issue 3 2009Emmanuel Melloul We report a donor death after right hepatectomy for living donor transplantation due to an undiagnosed myeloma. The 47-year-old donor, who was the 147th case performed in our department, was in excellent health without any abnormalities in the preoperative investigations. Despite an uneventful right hepatectomy without transfusion, the patient developed a partial thrombus of the inferior vena cava with a right proximal pulmonary trunk embolism on postoperative day 6. Subsequently, he developed multiorgan dysfunction leading to a coagulopathy, respiratory distress, and renal failure requiring hemodialysis and mechanical ventilation. This clinical scenario led us to suspect a hematological disorder. Immune electrophoresis showed a monoclonal peak of immunoglobulin G (8.7 g/L), a myelogram revealed an abnormally high level of dystrophic plasmocytes (more than 7%), and biopsies of salivary glands confirmed the diagnosis of immunoglobulin G kappa myeloma. The patient progressively deteriorated because of simultaneous hemorrhagic and infectious pulmonary complications resulting in septic shock. Despite an adequate combination of antimicrobial therapy and pleural drainage, the donor died on postoperative day 57 from multiple organ failure. This unusual cause of donor death after right hepatectomy reinforces the need for an extensive preoperative assessment. We advocate the addition of urinary protein loss and electrophoresis to the standard donor assessment protocol. Liver Transpl 15:326,329, 2009. © 2009 AASLD. [source] The Relationship between Eligibility Criteria for Participation in Alcohol Brief Intervention Trials and Other Alcohol and Health-Related VariablesTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2001Stephen A. Maisto Ph.D. In clinical trials of brief interventions for alcohol use, individuals typically are defined as eligible for the research through meeting quantity- frequency (QF) of alcohol consumption criteria, alcohol-related problems criteria, or both. The purpose of this study was to evaluate preintervention and posttreatment differences among three groups of research participants eligible for participation in a brief intervention clinical trial by meeting the AUDIT total score criterion only, the QF criterion only, or both. The participants were 301 men and women 21 years of age or older who presented for medical treatment at one of twelve primary care clinics and were screened for participation in the clinical trial. Participants completed an assessment protocol at preintervention and 1, 3, 6, 9, and 12 months postintervention. The analyses showed statistical differences among the three subgroups on three outcome dimensions of alcohol consumption, related consequences and behaviors, and medical complications; for both consumption and complications, the AUDIT + QF participants showed greater severity than participants in either of the other two groups. For consequences, AU DIT + QF participants scored higher than the QF participants on one variable constituting this dimension. The overall subgroup differences were maintained at six months in the consumption and consequences data. The implications of these findings for sensitivity of brief intervention trial design, the discovery of patient moderators of intervention effectiveness, and clinical practice are discussed. [source] The early pregnancy assessment project: The effect of cooperative care in the emergency department for management of early pregnancy complicationsAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009David O'ROURKE Background: Early pregnancy assessment clinics (EPAC) have been introduced and accepted as the gold standard for management of early pregnancy problems (EPP). However, EPAC are not universally available and management of EPP within the emergency department (ED) can result in prolonged waiting times, inappropriate use of resources and no clear treatment or follow-up plan being implemented. Aim: To assess the effect of an early pregnancy assessment protocol (EPAP) in the ED, designed to create a cultural change among doctors in relation to EPP in order to minimise use of resources, improve treatment times for patients and establish a clear management plan where dedicated EPAC services are not available. Methods: An intervention, the EPAP was introduced to the ED and retrospective and prospective audits of the patients were carried out to assess the effect. Results: Implementation of the EPAP decreased treatment time by 55%, representations by 48%, pathology blood tests by 56% and formal imaging services by 85%. Gynaecological consultation increased by 37% for each patient visit to the ED and by 9% for each EPP. Total direct cost saving was 63% per patient and no adverse outcomes were recorded. Conclusion: Introduction of the EPAP was successful in creating cultural change and delivering clinical and financial benefits to the hospital, patients and staff. Early gynaecological consultation and bedside ultrasound scanning within the ED were key factors. Similar benefits could be reproduced in other institutions and for other clinical scenarios where a need has been identified. [source] Review article: Indications for thoracolumbar imaging in blunt trauma patients: A review of current literatureEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2009Enda O'Connor Abstract Thoracolumbar spine injury is a common complication of blunt multitrauma and up to one third of fractures are associated with spinal cord dysfunction. Delayed fracture diagnosis increases the risk of neurological complications. While validated screening guidelines exist for traumatic c-spine injury equivalent guidelines for thoracolumbar screening are lacking. We conducted a literature review evaluating studies of thoracolumbar injury in trauma patients to generate indications for thoracolumbar imaging. We performed MEDLINE and Pubmed searches using MeSH terms "Wounds, Nonpenetrating", "Spinal Fractures", "Spinal Injuries" and "Diagnostic Errors", MeSH/subheading terms "Thoracic Vertebrae/injuries" and "Lumbar Vertebrae/injuries" and keyword search terms "thoracolumbar fractures", "thoracolumbar injuries", "thoracolumbar trauma", "missed diagnoses" and "delayed diagnoses". Limits and inclusion criteria were defined prior to searching. We evaluated 16 articles; 5 prospective observational studies (1 cohort study) and 11 retrospective observational studies. Predictors of TL injury in prospective studies , high-risk injury mechanism, distracting injury, impaired cognition, symptoms/signs of vertebral fracture and known cervical fracture , were defined and used to construct a decision algorithm, which in a total of 14189 trauma patients from all eligible studies recommended TL screening in 856(99.1%) of 864 patients with TL fractures and would probably have directed TL imaging in the remaining 8 patients. There is limited low level evidence guiding surveillance TL imaging in adult blunt trauma patients. Despite this, we propose and evaluate an algorithm with a high negative predictive value for TL fractures. This should be incorporated into spinal injury assessment protocols. [source] Competitive binding comparison of endocrine-disrupting compounds to recombinant androgen receptor from fathead minnow, rainbow trout, and humanENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 9 2007Vickie S. Wilson Abstract Typically, in vitro hazard assessments for the identification of endocrine-disrupting compounds (EDCs), including those outlined in the Endocrine Disruptor Screening and Testing Advisory Committee (EDSTAC) Tier 1 Screening protocols, utilize mammalian receptors. Evidence, however, exists that fish sex steroid hormone receptors differ from mammalian receptors both structurally and in their binding affinities for some steroids and environmental chemicals. Most of the binding studies to date have been conducted using cytosolic preparations from various tissues. In the present study, we compare competitive binding of a set of compounds to full-length recombinant rainbow trout androgen receptor , (rtAR), fathead minnow androgen receptor (fhAR), and human androgen receptor (hAR), each expressed in COS cells. Saturation binding and subsequent Scatchard analysis using [3H]R1881, a high-affinity synthetic androgen, revealed an equilibrium dissociation constant (Kd) of 0.11 nM for the rtAR, 1.8 nM for the fhAR, and 0.84 nM for the hAR. Compounds, including endogenous and synthetic steroids, known mammalian antiandrogens, and environmental compounds, were tested for competitive binding to each of the three receptors. Overall, agreement existed across receptors as to binding versus nonbinding for all compounds tested in this study. Minor differences, however, were found in the relative order of binding of the compounds to the individual receptors. Studies such as these will facilitate the identification of EDCs that may differentially affect specific species and aid in the development and support of future risk assessment protocols. [source] Continuous curriculum assessment and improvement: A case studyNEW DIRECTIONS FOR TEACHING & LEARNING, Issue 112 2007Art Hill This chapter describes the simple sustainable assessment protocols followed in food science at the University of Guelph to help ensure a continuously improving curriculum that satisfies the pedagogical prescriptions of the Institute of Food Technology, the learning objectives of the university, and learning outcomes of other stakeholders, including employers, students, and faculty. [source] Benchmarking habitat quality: observations using River Habitat Survey on near-natural streams and rivers in northern and western EuropeAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue S1 2010Paul J. Raven Abstract 1.Some ecological effects of physically modifying rivers are still unclear, partly due to scale factors, but also because the character of high quality habitat is poorly understood. 2.Surveys at 278 sites on 141 near-natural streams and rivers in northern and western Europe were carried out between 1994 and 2009 to benchmark the habitat quality assessment system used for River Habitat Survey (RHS). 3.The objectives were to establish if RHS was suitable outside the UK, investigate if 500 m was still valid as the survey length, suggest a benchmarking strategy and recommend improvements to habitat quality assessment protocols. 4.Some modifications to RHS are needed to take account of differences in hydrological conditions, land-use and, most importantly, riparian habitat structure found in mainland Europe. 5.On average, 82,87% of channel attributes and 87,98% of channel and bank features were recorded within the first of consecutive RHS sites, confirming that 500 m is an effective sample length for characterizing small rivers. 6.Stream-flow character appeared to influence the distribution of several in-channel features, with greater diversity and between-site variation associated with rivers of mixed flow-types. To account for local variation and for effective use of survey time, it is recommended that two or more consecutive RHS sites are used for benchmarking purposes. 7.A suite of assessment protocols with agreed criteria and analytical rules, linked to specific objectives (e.g. nature conservation, geomorphic condition), is needed to establish the character and habitat quality of rivers in a consistent fashion. 8.A multi-discipline benchmarking programme using hydro-ecological regions in Europe would build on existing knowledge and help to improve both the inter-calibration and local application of quality assessment protocols. Data-sharing by hydrologists, river ecologists and fluvial geomorphologists would improve the basis for managing rivers in support of the European Water Framework Directive and Habitats Directive. Copyright © 2010 John Wiley & Sons, Ltd. [source] Virtual Reality Triage Training Provides a Viable Solution for Disaster-preparednessACADEMIC EMERGENCY MEDICINE, Issue 8 2010Pamela B. Andreatta EdD ACADEMIC EMERGENCY MEDICINE 2010; 17:870,876 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the triage performances and posttest results of the two groups, and do both methods differentiate between learners of variable experience levels? Methods:, Fifteen Postgraduate Year 1 (PGY1) to PGY4 EM residents were randomly assigned to two groups: VR or SP. In the VR group, the learners were effectively surrounded by a virtual mass disaster environment projected on four walls, ceiling, and floor and performed triage by interacting with virtual patients in avatar form. The second group performed likewise in a live disaster drill using SP victims. Setting and patient presentations were identical between the two modalities. Resident performance of triage during the drills and knowledge of the START triage algorithm pre/post drill completion were assessed. Analyses included descriptive statistics and measures of association (effect size). Results:, The mean pretest scores were similar between the SP and VR groups. There were no significant differences between the triage performances of the VR and SP groups, but the data showed an effect in favor of the SP group performance on the posttest. Conclusions:, Virtual reality can provide a feasible alternative for training EM personnel in mass disaster triage, comparing favorably to SP drills. Virtual reality provides flexible, consistent, on-demand training options, using a stable, repeatable platform essential for the development of assessment protocols and performance standards. [source] Development of an imaginal provocation test to evaluate treatment for anger problems in people with intellectual disabilitiesCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2004John L. Taylor Anger and associated aggressive behaviour are significant clinical issues for many people with intellectual disabilities (IDs) that can lead to serious constraints to their liberty, which, in turn, adversely affects their quality of life. There is some evidence to support cognitive,behavioural anger treatment in this client group; however, anger assessment protocols for people with IDs should be diversified. In this regard, a method for anger assessment using imaginal provocation scenes was extended for use with this client population and the context in which treatment takes place. Two studies of the Imaginal Provocation Test (IPT) were conducted: the first with 48 patients examined its internal reliability and concurrent validity with anger psychometric scales; the second investigated whether it was sensitive to change associated with anger treatment in a small outcome study involving men with IDs and histories of offending. The IPT was found to successfully induce anger, be internally reliable, have strong concurrent validity and detect statistically significant changes in anger following anger treatment (N = 9), compared with a routine care waiting-list control group (N = 8). The IPT also had value in highlighting clinical improvements for anger treatment condition participants compared with the control group.,Copyright © 2004 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||