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Assessment Scores (assessment + score)
Kinds of Assessment Scores Selected AbstractsParticipation of children with cerebral palsy is influenced by where they liveDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2004Donna Hammal MSc The study aimed to determine whether degree of participation of children with cerebral palsy (CP) is influenced by where they live, as predicted by the social model of disability. Ninety-two per cent children with CP resident in Northern England and born 1991-1996 were entered into the study. Participation was measured by the Lifestyle Assessment Score and its six component domain scores. Regression analysis was used to investigate variations in participation. There were 443 children (265 male, 178 female; mean age 4 years 8 months [SD1 year 1 month] at time of assessment) in the study. In the regression analysis the following factors remained significant with regard to level of participation: type of CP (167 with hemiplegia, and of those remaining 240 with bilateral spasticity); intellectual impairment (105 with IQ<50,113 with IQ 50 to 70, and 225 with IQ>70); presence of seizures (115 with active epilepsy); walking disability (114 unable to walk, 81 restricted and needing aids, 186 restricted but unaided, 62 unrestricted); communication problems (61 no formal communication, 51 use alternative formal methods, 126 some delay or difficulty, 205 no communication problems). After adjustment for these factors, there were significant variations with regard to level of participation in the Lifestyle Assessment Score by district of residence. The magnitude of these variations in Lifestyle Assessment Score between districts is similar to that accounted for by severe intellectual impairment. Similar models were obtained for four of the six domain scores. For one of these four, restriction of social interaction, the significant variation between districts was minimally influenced by the underlying type of CP, walking ability, or presence of seizures. Higher levels of participation among children with CP are associated with residence in certain districts. This is not attributable to variations in case-mix or functional capacity of the children. Participation of children with disability is partly a product of their environment. [source] Temporal Changes in Brain Volume and Cognition in a Randomized Treatment Trial of Vascular DementiaJOURNAL OF NEUROIMAGING, Issue 1 2001Joseph P. Broderick MD ABSTRACT Objective. To measure changes in brain and ischemic volume over time by magnetic resonance imaging (MRI) as part of a randomized treatment trial of vascular dementia. Methods. Participants who met criteria for vascular dementia underwent comprehensive neurological and neuropsychological testing on entrance, during, and at completion of the 1-year study. For those centers who had easily available MRI, MRI of the brain was to be performed on entry and completion of the study. Image analysis was performed on all balanced and T2-weighted MR films to determine ventricular, sulcal, ischemic, and hemispheric brain volumes. Results. Of the 105 patients who met the criteria for vascular dementia, 40 had a baseline MRI study that met protocol requirements and was of excellent image quality. The baseline ventricular volume in these 40 patients with high-quality MR correlated with most measures of cognitive and behavioral function, including the total Alzheimer's Disease Assessment Score (ADAS) (r= 0.51, P= .0024), as well as activities of daily living (r= 0.61, P= .0002). The baseline ischemic brain volume correlated well only with the gait and postural stability scale (r= 0.74, P= .009). Of the 40 participants, 25 had MRI studies at baseline and at completion of the study that were comparable and of excellent image quality. For these 25 patients, the mean ventricular volumes increased by 9% over the study year (P= .001) and the mean ischemic brain volume increased by 18% (P= .01). Temporal changes in the sulcal and nonischemic brain volume did not reach significance. None of the 14 clinical score measures changed significantly between baseline and completion of the study in these 25 patients. Conclusion. In summary, ventricular volume correlated well with cognitive measures in patients with vascular dementia and was a more sensitive marker for change during the study year than the clinical scales used in this study. This study also points out the practical limitations of brain imaging as a surrogate measure of clinical outcome in multicenter randomized treatment trials of brain disease. [source] Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patientsBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2002J. Hanifin Summary Background One of the most troublesome features of atopic dermatitis (AD) is its chronic relapsing nature, and there is a lack of published evidence on the best treatment strategy for long-term management of the disease. Objectives To compare an intermittent dosing regimen of fluticasone propionate (FP) cream 0·05% (twice per week) with its vehicle base in reducing the risk of relapse when added to regular daily emollient in adult and paediatric subjects with stabilized AD. Methods Subjects (aged 3 months to 65 years) with moderate or severe AD were enrolled into an open-label Stabilization Phase of up to 4 weeks on daily emollients plus FP twice daily. Those subjects who achieved ,treatment success' (Global Assessment Score ,,2, erythema, pruritus, and papulation/induration/oedema scores ,,1) entered the double-blind Maintenance Phase. They continued with regular emollients and were randomized at a 2 : 1 ratio to either intermittent FP or vehicle, once daily 4 days per week for 4 weeks followed by once daily 2 days per week for 16 weeks. Subjects who relapsed on intermittent FP were discontinued from the study. Those who did not relapse continued for an additional 24 weeks on intermittent dosing for safety monitoring. Results A total of 372 (247 paediatric, 125 adult) subjects were enrolled into the Stabilization Phase. Of these, 348 (231 children, 117 adults) were randomized into the Maintenance Phase. Analysis of the primary efficacy parameter showed that subjects receiving intermittent FP cream (twice per week), in addition to regular daily emollients in the Maintenance Phase, were 7·7 times less likely to have an AD relapse than subjects receiving intermittent vehicle cream/emollients [Mantel,Haenszel (MH) estimate of the odds ratio, 95% confidence interval (CI) 4·6, 12·8; P < 0·001]. Paediatric subjects were 8·1 times less likely to have an AD relapse (95% CI 4·3, 15·2; P < 0·001) and adult subjects were 7·0 times less likely to have an AD relapse (95% CI 3·0, 16·7; P < 0·001). For subjects receiving intermittent FP cream/emollient, the median time to relapse could not be estimated as the majority remained controlled at 20 weeks. For those receiving intermittent vehicle/emollient, the median time to relapse was 4·7 weeks. For paediatric and adult groups, this was 5·1 and 4·1 weeks, respectively. Median exposure to FP for all subjects was 337 days. There was only one study drug-related adverse event (acne) and there were no reports of skin thinning or atrophy associated with the use of FP cream in paediatric or adult subjects. Conclusions In paediatric and adult subjects, once stabilized with regular FP treatment, the risk of relapse of AD can be significantly reduced by extended intermittent dosing with FP cream in addition to regular emollient therapy. [source] Effect of extended MMX mesalamine therapy for acute, mild-to-moderate Ulcerative ColitisINFLAMMATORY BOWEL DISEASES, Issue 1 2009Michael A. Kamm MD Abstract Background: Many patients with ulcerative colitis (UC) respond to mesalamine therapy within 8 weeks. Those not achieving remission after 8 weeks are often treated with steroids or other immunosuppressive therapies. This study aimed to determine the effect of 8 weeks' high-dose MMX mesalamine extension therapy in patients with active, mild-to-moderate UC who had previously failed to achieve complete remission in 2 phase III, double-blind, placebo-controlled studies of MMX mesalamine (SPD476-301 and -302). Methods: Patients with active, mild-to-moderate UC who did not achieve clinical and endoscopic remission after ,8 weeks' treatment with MMX mesalamine (2.4 or 4.8 g/day), ASACOL® (mesalamine) delayed-release tablets 2.4 g/day, or placebo in the phase III studies received MMX mesalamine 4.8 g/day for 8 weeks. The aim was to assess remission at week 8, defined as a total modified UC Disease Activity Index score of ,1, calculated as: scores of 0 for rectal bleeding and stool frequency, a combined Physician's Global Assessment score and sigmoidoscopy score of ,1, no mucosal friability, and a ,1 point reduction from baseline in sigmoidoscopy score. Results: Overall, 304 patients who entered this acute extension study were evaluated; 59.5% achieved remission at week 8. Remission rates were similar irrespective of prior treatment in the initial acute phase III studies. Conclusions: Most patients with mild-to-moderate UC who fail to achieve remission with up to 8 weeks' initial mesalamine therapy can achieve clinical and endoscopic remission following a further 8 weeks' treatment with high-dose MMX mesalamine therapy, thereby avoiding step-up therapy. (Inflamm Bowel Dis 2008) [source] Glutamine administration in patients undergoing cardiac surgery and the influence on blood glutathione levelsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009J. M. ENGEL Background: Cardiac surgery with an extracorporeal circulation cardiopulmonary bypass (CPB) is characterized by an oxidative stress response. Glutathione (GSH) belongs to the major antioxidative defense. In metabolic stress, glutamine (GLN) may be the rate-limiting factor of GSH synthesis. Decreased GLN plasma levels were observed after various critical states. We evaluated, in patients undergoing open heart surgery with CPB, the effects of a peri-operative GLN supplementation on GSH in whole blood and assessed their influence on the Sequential Organ Failure Assessment score and the intensive care unit length of stay. Methods: In this prospective, randomized, double-blinded study, we included 60 patients (age older than 70 years, ejection fraction <40% or mitral valve replacement) undergoing an elective cardiac surgery with CPB. We randomly assigned each subject to receive an infusion with either GLN (0.5 g/kg/day, group 1) or an isonitrogeneous, isocaloric, isovolemic amino acids solution (group 2) or saline (group 3). Results: From the first post-operative day GLN plasma levels in group 1 were significantly increased compared with the other groups. With saline GSH the levels decreased significantly post-operatively compared with GLN. We observed a significant correlation between GLN delivery and GSH levels. Conclusions: A peri-operative high-dose GLN infusion increased plasma GLN concentrations and maintained the GSH levels after cardiac surgery with CPB. [source] Assessment of professional behaviour in undergraduate medical education: peer assessment enhances performanceMEDICAL EDUCATION, Issue 9 2007Johanna Schönrock-Adema Objectives, To examine whether peer assessment can enhance scores on professional behaviour, with the expectation that students who assess peers score more highly on professional behaviour than students who do not assess peers. Methods, Undergraduate medical students in their first and second trimesters were randomly assigned to conditions with or without peer assessment. Of the total group of 336 students, 278 students participated in the first trimester, distributed over 31 tutorial groups, 17 of which assessed peers. The second trimester involved 272 students distributed over 32 groups, 15 of which assessed peers. Professional behaviour was rated by tutors on 3 dimensions: Task Performance; Aspects of Communication, and Personal Performance. The rating scale ranged from 1 (poor) to 10 (excellent). Data were analysed using multivariate repeated measures multilevel analysis. Results, Assessment scores were found to have generally increased in the second trimester, especially the personal performance scores of students who assessed peers. In addition, female students were found to have significantly higher scores than male students. Conclusions, In undergraduate medical education, peer assessment has a positive influence on professional behaviour. However, the results imply that peer assessment is only effective after students have become adjusted to the complex learning environment. [source] Habitat indices for rivers: derivation and applicationsAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue S1 2010Ian P. Vaughan Abstract 1.River Habitat Survey (RHS) is the standard riverine hydromorphology survey in the UK and modified versions have been adopted in several other European Countries. It aims to broadly characterize physical features over 500,m reaches, but in so doing records more than 100 variables, often making interpretation and data analysis challenging. In such instances, synoptic treatment of the data, creating simple indices such as Habitat Modification and Habitat Quality Assessment scores, can prove beneficial. 2.The derivation of seven new indices is described, summarizing nearly half of the variables used by RHS and providing a quantitative overall summary of river reaches. 3.Derived using an objective analysis of the RHS database (cf expert judgement), one index describes bedrock/boulder channels, two indices describe bank and riparian vegetation and a further two describe aspects of sediment transport and deposition. Two distinct types of modification,,,bank reinforcement and channel re-sectioning,,,are also quantified. 4.Rigorous testing indicates that the indices are reliable across the complete range of conditions and countries in the UK. 5.The new indices are readily interpreted and while providing a simple overview of a river reach, they are objective and quantitative, lending themselves to a range of management and research applications. They have already been used successfully in quantifying riverine bird habitats and this, along with other applications, is discussed. Copyright © 2009 John Wiley & Sons, Ltd. [source] Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010A. PERNER Background: Simple diagnostic tests are needed to screen septic patients for low cardiac output because intervention is recommended in these patients. We assessed the diagnostic value of central venous oxygen saturation in the superior vena cava (ScvO2) for detecting low cardiac output in patients with septic shock. Methods: We conducted a prospective observational study in three general intensive care units (ICUs) of adult patients with septic shock, who were to have a catheter inserted for thermodilution measurement of cardiac index (CITD). Paired measurements of CITD and central venous oximetry values were obtained when the clinician first measured CITD. Results: We included 56 patients with septic shock and a mean sequential organ failure assessment score of 12 (range 3,20). Baseline CITD was 3.5 l/min/m2 (1.0,6.2) and ScvO2 of 70% (33,87). The best cut-off of ScvO2 for CITD>2.5 l/min/m2 (n=42) was a value ,64% with positive and negative predictive values of 91% (95% confidence interval 79,98) and 91% (59,100), respectively. The diagnostic values were not improved by using instead central venous O2 tension or the difference between arterial and central venous O2 saturation. Conclusions: This prospective, observational study found that a ScvO2 measurement of ,64% indicated CITD>2.5 l/min/m2 in ICU patients with septic shock. [source] Prospective Evaluation of Laparoscopic Pancreatic Biopsies in 11 Healthy CatsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010K.L. Cosford Background: Definitive diagnosis of feline pancreatic disease is dependent on histologic examination of biopsies. Hypothesis: Laparoscopic punch biopsy of the pancreas does not significantly affect pancreatic health or clinical status of healthy cats, and provides an adequate biopsy sample for histopathology. Animals: Eleven healthy female domestic shorthair cats. Methods: Effects of laparoscopic pancreatic visualization alone in 5 cats compared with laparoscopic pancreatic visualization and punch biopsy in 6 cats were studied. Temperature, pulse, and respiratory rate, physical examination, and daily caloric intake were evaluated for 1 week before and 1 week after the procedure. Pain scores (simple descriptive score and dynamic interactive visual assessment score) were evaluated hourly during the 1st 6 hours postprocedure. Complete blood cell counts, serum biochemical profiles, serum feline pancreatic lipase immunoreactivity, and urine specific gravity were evaluated before the procedure and at 6, 24, and 72 hours postprocedure. One month postprocedure, during sterilization, the pancreas was reassessed visually in all cats, and microscopically in the biopsy group. Results: For all variables evaluated, there were no significant differences between biopsy and control cats. Re-evaluation of the pancreatic biopsy site 1 month later documented a normal tissue response to biopsy. The laparoscopic punch biopsy forceps provided high-quality pancreatic biopsy samples with an average size of 5 mm × 4 mm on 2-dimensional cut section. Conclusions and Clinical Importance: Laparoscopic pancreatic biopsy is a useful and safe technique in healthy cats. [source] Effect of the combination of laser excision and interstitial hyperthermia in palliative therapy of head and neck tumours in the advanced stage of the diseaseLASERS IN SURGERY AND MEDICINE, Issue 1 2004Roman, mucler CSc Abstract Background and Objectives We evaluated the potential of combining laser excision with laser interstitial hyperthermia in order to improve the quality of life of patients with 3rd or 4th stage malignant head and neck tumours. Study Design/Materials and Methods To evaluate the quality of life, we used the 4th version of the University of Washington Quality of Life assessment score modified for head and neck tumours. The study group of 20 patients assessed their condition in a questionnaire, examining 12 aspects of their quality of life before the laser treatment, the second day after, and 6 weeks after the treatment. Results We observed a gain of 16.41 points, which subjectively represents a 70.32% improvement in the quality of life. Conclusions Following this therapy the quality of life significantly improved in patients with primarily low quality of life, whereas the group of patients with less affected quality of life reported a temporary decline in the quality of life after the treatment. To obtain a proper objective indication, we suggest a mathematical modelling of possible gains for the individual patient using the University of Washington Quality of Life classification. Lasers Surg. Med. 34:12,17, 2004. © 2004 Wiley-Liss, Inc. [source] Early identification of ,at-risk' students by the parents of paediatric patientsMEDICAL EDUCATION, Issue 9 2005Maree O'Keefe Introduction, Assessment of medical student clinical skills is best carried out using multiple assessment methods. A programme was developed to obtain parent evaluations of medical student paediatric interview skills for feedback and to identify students at risk of poor performance in summative assessments. Method, A total of 130 parent evaluations were obtained for 67 students (parent participation 72%, student participation 58%). Parents completed a 13-item questionnaire [Interpersonal Skills Rating Scale (IPS) maximum score 91, higher scores = higher student skill level]. Students received their individual parent scores and de-identified class mean scores as feedback, and participants were surveyed regarding the programme. Parent evaluation scores were compared with student performance in formative and summative faculty assessments of clinical interview skills. Results, Parents supported the programme and participating students valued parent feedback. Students with a parent score that was less than 1 standard deviation (SD) below the class mean (low IPS score students) obtained lower faculty summative assessment scores than did other students (mean ± SD, 59% ± 5 versus 64% ± 7; P < 0.05). Obtaining 1 low IPS score was associated with a subsequent faculty summative assessment score below the class mean (sensitivity 0.38, specificity 0.88). Parent evaluations combined with faculty formative assessments identified 50% of students who subsequently performed below the class mean in summative assessments. Conclusions, Parent evaluations provided useful feedback to students and identified 1 group of students at increased risk of weaker performance in summative assessments. They could be combined with other methods of formative assessment to enhance screening procedures for clinically weak students. [source] GS12P MANAGEMENT OF UPPER GASTROINTESTINAL HAEMORRHAGE IN A DISTRICT HOSPITALANZ JOURNAL OF SURGERY, Issue 2007I. Dayoub Background This study was conducted to assess the management of acute upper gastrointestinal bleeding in a district hospital and to compare these results with national guidelines and the published literature. Materials And Methods This prospective and retrospective study included 112 patients, mean age 66 years, who presented with acute upper gastrointestinal bleeding between July 2004 and February 2005. All patients were assigned a Rockall risk assessment score. Results The surgical on-call teams managed all the patients according to an agreed protocol. 49 patients had a Rockall score > or = 4. Endoscopy was performed in all patients, with 60% accomplished within the first 24 hours. The most common cause found was peptic ulcer (30%). Therapeutic endoscopy was undertaken in 10 patients (9%) with a success rate of 70%. Open surgery was performed in 3 patients. One patient died after having surgery and the Rockall score was >5. Of the patients admitted with acute upper gastrointestinal bleeding, 90.2% were discharged without complication. 11 patients died (9.8%) and all of them from the high risk group with Rockall scores >5. Their mean hospital stay was 17.8 days (range, 2,43 days). Conclusion High-standard results in acute upper gastrointestinal bleeding can be achieved in a district hospital. The management, including the use of the operating theatre facilities with operative and anaesthetic support, was safe and efficient. A 24-hour-a-day endoscopy service is important to achieve early diagnosis and to plan management. A protocol and early endoscopy improve clinical outcome and reduce mortality, which occurred mostly among elderly patients with high risk scores. It is advisable to introduce the Rockall scoring system in practice. [source] Pre-emptive ibuprofen arginate in third molar surgery: a double-blind randomized controlled crossover clinical trialAUSTRALIAN DENTAL JOURNAL, Issue 4 2009SL Lau Abstract Background:, This study evaluated the effectiveness of 400 mg ibuprofen arginate either as a pre-emptive (PRE group) or postoperative (POST group) analgesic using a common dental pain model. Methods:, A randomized double-blind crossover clinical trial involving a series of consecutive patients admitted for bilateral third molar surgery. Results were analysed according to the self-reported pain score and the pattern of rescue medication taken. Results:, The mean pain score ranged from 0.73 to 1.60 for the PRE group and 0.47 to 1.41 for the POST group among 30 included subjects. The mean time point when first rescue medication taken was 7.3 hours and 8.3 hours postoperative, respectively. Nine patients (30 per cent) in the PRE group and 12 patients (40 per cent) in the POST group took no rescue medication. There was no statistically significant difference for all parameters between groups, while a majority (53 per cent) found the drug "good" to "excellent" in both groups. Conclusions:, Ibuprofen arginate may be considered effective in reducing surgically induced moderate to severe pain when administered either pre-operatively or postoperatively due to the reported relatively low pain score, less consumption of rescue medication, delayed onset of pain, good number of pain-free patients and a high rating in the global assessment score. [source] Clinical Trial of Dual Treatment with an Ablative Fractional Laser and a Nonablative Laser for the Treatment of Acne Scars in Asian PatientsDERMATOLOGIC SURGERY, Issue 7 2009SANGEUN KIM MD BACKGROUND Many methods have been proposed for the treatment of acne scars, with variable cosmetic results. Nonablative skin resurfacing is one method that has been proposed. Because of a need for more noticeable clinical improvements, the ablative fractional laser was recently introduced. OBJECTIVE To reduce complications and improve the results of ablative fractional laser resurfacing by combining this treatment of acne scars with nonablative lasers. METHODS A series of 20 patients (skin phototypes IV,V) with atrophic facial acne scars were randomly divided into two groups that received three successive monthly treatments with an ablative fractional laser using high (group A) and low (group B) energy on one facial half and an ablative fractional laser with low energy plus a nonablative resurfacing laser on the other facial half. Patients were evaluated using digital photography at each treatment visit and at 3 months postoperatively. Clinical assessment scores were determined at each treatment session and follow-up visit. RESULTS Although the use of the ablative fractional laser with high energy resulted in an improvement in patients' acne scars, the combination of ablative fractional laser resurfacing and nonablative laser resurfacing yielded the best results, as assessed in photographs as well as by the overall appearance of the acne scars. With the combination method, fewer complications were observed. [source] Improvement of Dermatochalasis and Periorbital Rhytides With a High-Energy Pulsed CO2 Laser: A Retrospective StudyDERMATOLOGIC SURGERY, Issue 4 2004Tina S. Alster MD Background. Upper eyelid dermatochalasis is typically treated with excisional blepharoplasty. The role of the CO2 laser previously had been confined to that of a vaporizing, incisional, or hemostatic tool. Over the past several years, however, ablative CO2 laser skin resurfacing has been popularized as an adjunctive treatment to blepharoplasty to minimize periorbital rhytides through its vaporizing as well as skin-tightening action. Objective. To evaluate the safety and efficacy of a high-energy pulsed CO2 laser as a stand-alone treatment for dermatochalasis and periorbital rhytides. Methods. Sixty-seven patients (skin phototypes I,IV) with mild-to-severe upper eyelid dermatochalasis and periorbital rhytides received periocular CO2 laser skin treatment. Global assessment scores of dermatochalasis and rhytides were determined by a side-by-side comparison of periocular photographs preoperatively and 1, 3, and 6 months postoperatively. In addition, caliper measurements of upper eyelids before and 1, 3, and 6 months after treatment were obtained. Results. Both dermatochalasis and periorbital rhytides were significantly improved after periocular CO2 laser skin resurfacing. Patients with more severe dermatochalasis and rhytides showed greater improvement after CO2 laser treatment than did those with mild or moderate involvement. Side effects were limited to erythema and transient hyperpigmentation. No scarring, hypopigmentation, or ectropion were observed. Conclusions. Periocular skin resurfacing with a CO2 laser can safely and effectively improve upper eyelid dermatochalasis and periorbital rhytides. [source] Pericranial injection of botulinum toxin type A (Dysport®) for tension-type headache , A multicentre, double-blind, randomized, placebo-controlled studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2008A. Straube Increasingly, botulinum type A toxin is used to influence pathologically increased muscle activity in conditions such as dystonia and spasticity. Studies have also assessed its efficacy in tension-type headache, where muscle tenderness may be increased. We undertook a prospective, multicentre, randomized, double-blind, placebo-controlled trial. Patients received injections of Dysport® (total dose of 420 or 210 units) or saline placebo in 18 sites on the head and neck. Of 125 patients treated, 118 were included in the intention-to-treat dataset. No significant differences between each verum group and placebo were seen for the primary efficacy parameter , change in the number of headache-free days at 4,8 weeks after injection compared with 4 weeks before injection. The groups receiving 420 or 210 units of Dysport experienced 2.60 and 2.87 more headache-free days respectively, compared with 1.93 more headache-free days for the placebo group (P = 0.66 versus 420 units; P = 0.52 versus 210 units). Treatment with 420 units of Dysport was associated with significant improvements compared with placebo for two secondary efficacy parameters: mean change in headache duration from baseline to weeks 8,12 (P < 0.05) and improved global physician and patient assessment scores (P < 0.05). Further studies should address the possible value of multiple injections with extended observation periods, dose optimization, and whether duration of headache history and number of previous treatments are predictors of patient response. [source] Predictors and correlates of edentulism in the healthy old people in Edinburgh (HOPE) studyGERODONTOLOGY, Issue 4 2008John M. Starr Objectives:, To determine the extent to which correlates of edentulism are explained by an association between tooth loss and cognitive ability. Methods:, Participants in the Healthy Old People in Edinburgh (HOPE) study aged 70 or more at baseline were assessed and health, cognitive, socio-economic and socio-environmental data collected on four consecutive occasions. It was noted whether the participant had any retained teeth and if not, the age when the last tooth was lost. Prior determinants of edentulism were investigated with binary logistic regression models. At the 9-year follow-up, associations with edentulism were examined using general linear models with edentulism as an independent factor. Results:, 201 participants were adequately tested, of whom 104 (51.7%) were edentulous. A logistic regression model that considered age, sex, education, social class, deprivation index of residence, objective distance from dentist, participant's estimate of distance from dentist and NART-estimated IQ (NARTIQ) found age (p = 0.032), occupational class (p = 0.019) and NARTIQ (p = 0.027) as significant predictors of edentulism. Cox's proportional hazards modelling found only NARTIQ (p = 0.050) to be correlated. Being edentulous was associated with poorer respiratory function but not hand grip strength (p = 0.23). Edentulous participants had lower self esteem scores (p = 0.020) and poorer dietary assessment scores (p = 0.028). Being edentulous was also associated with significantly lower mean scores on all cognitive testing, although these associations became non-significant after adjustment for NARTIQ and age. Conclusions:, In healthy older people, edentulism is associated with relative impairment of cognitive ability, although this association is explained by the fact that lower original intelligence predisposes to edentulism and poorer performance on cognitive tests in old age. Once original intelligence is adjusted for, tooth loss is not related to cognitive ability. Tooth loss is, however, associated with poorer status across a wide range of health measures: physical health, nutrition, disability and self-esteem. Establishing the degree to which these health outcomes are causally related to edentulism could usefully be factored into cost,benefit analyses of programmes designed to prevent tooth loss. [source] Developing and evaluating an interactive information skills tutorial,HEALTH INFORMATION & LIBRARIES JOURNAL, Issue 2 2006Maria J. Grant Objective:, To develop and evaluate a web-based interactive information skills tutorial integrated into the curriculum. To determine whether the tutorial was acceptable to students and explore the use of a skills assessment tool in identifying whether the tutorial improved skills. Methods:, The development of a tutorial on OVID medline to teach transferable information skills. A small cohort study to evaluate students' views on the tutorial and its effects on information skills. Results:, Thirteen objective assessments were usable. There was a statistically significant improvement in mean final assessment scores, compared with mean pre-training scores, F(2,14) = 11.493, P = 0.001. Eleven (85%) students had improved their overall information skills. The improvement in overall searching skills was enhanced by referral to the tutorial. Conclusions:, The tutorial was successfully developed and integrated into a Masters programme curriculum. In this setting, it appears to reinforce active learning, and was well received by students, who developed core generic searching skills and demonstrated improved information skills in the short and longer term. Students could use the tutorial for revision and study at a time and place of their choosing. Further evaluation is required to assess the impact of using the tutorial with large groups of students, and as a stand-alone teaching medium. [source] Lactate concentrations in the rectal lumen in patients in early septic shockACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010M. IBSEN Background: Previously, we observed that rectal luminal lactate was higher in non-survivors compared with survivors of severe sepsis or septic shock persisting >24 h. The present study was initiated to further investigate this tentative association between rectal luminal lactate and mortality in a larger population of patients in early septic shock. Methods: A prospective observational multicentre study of 130 patients with septic shock at six general ICU's of university hospitals. Six to 24 h after the onset of septic shock, the concentration of lactate in the rectal lumen was estimated by a 4-h equilibrium dialysis. Dialysate concentrations of lactate were determined using an auto-analyser. Results: The overall 30-day mortality was 32%, with age and Simplified acute physiology scores II and sequential organ failure assessment scores being significantly higher in non-survivors. In contrast, there were no differences in concentrations of lactate in the rectal lumen [2.2 (1.4,4.1) and 2.8 (1.6,5.1) mmol/l (P=0.34)] (medians and 25th,75th percentiles) or arterial blood [2.1 (1.4,4.2) and 2.0 (1.3,3.2) mmol/l (P=0.15)] between non-survivors and survivors. The rectal,arterial difference of the lactate concentration was higher in survivors. There were no differences in blood pressure, noradrenaline dose or central venous oxygen saturation between the groups. Conclusion: In this prospective, observational study of unselected patients with early septic shock, there was no difference in the concentration of lactate in the rectal lumen between non-survivors and survivors. Trial Registration: Clinicaltrials.gov (no: NCT00197938). [source] Reporting practices of dropouts in psychological research using a wait-list control: current state and suggestions for improvementINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2007Josh M. Cisler M.A. Abstract Reporting practices regarding dropouts in wait-list control studies hold great importance for the ability to replicate, generalize, and draw conclusions from research. This concern is applicable to all psychological research utilizing wait-list controls, regardless of purpose of research (e.g., treatment outcome). The current study assessed the present state of reporting practices in this type of experimental design and discussed the limitations and implications of the insufficient reporting found. 171 articles from psychology journals utilizing wait-list control design were surveyed regarding the reporting of the number of dropouts from the wait-list control and experimental conditions, characteristics and assessment scores of the dropouts, and total dropouts. Variables that are crucial to interpreting research findings are not consistently reported. Additionally, journal impact factor and year of publication were positively correlated with the adequacy of reporting. Consistencies with previous findings were noted, and suggestions for remedying the reporting inadequacies were discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Alpha lipoic acid in burning mouth syndrome , a randomized double-blind placebo-controlled trialJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 3 2009Desirée Rosa Cavalcanti The burning mouth syndrome (BMS) is a chronic condition characterized by oral burning pain in the absence of clinical abnormalities and without established therapy. Objectives:, The purpose of this study was to evaluate the effectiveness of alpha lipoic acid (ALA) in the management of BMS symptoms through a randomized double-blind placebo-controlled trial. Methods:, Thirty-eight patients (34 women and four men, median age 62.9 years, range 36,78) were included and 31 completed the study. The patients were randomized into two cycles of treatment: one with alpha lipoic acid and one with placebo both administered in identical capsules. These cycles were separated by a washout period of 20 days. The oral symptoms and the treatment response were assessed using a 100-mm visual analog scale before and after each cycle and the global perceived effect score, using a 5-point scale after each treatment cycle. Results:, The level of reduction on burning was significant for both treatments (paired t -test: P < 0.05; rp = 0.011; ral < 0.001). Considering the two cycles together, 22 patients reported at least some improvement after ALA use and 23 patients after placebo. Conclusions:, Comparison of the oral assessment scores of the two cycles failed to demonstrate the effectiveness of ALA over placebo (t -test: P > 0.05; r = 0.75). [source] Early identification of ,at-risk' students by the parents of paediatric patientsMEDICAL EDUCATION, Issue 9 2005Maree O'Keefe Introduction, Assessment of medical student clinical skills is best carried out using multiple assessment methods. A programme was developed to obtain parent evaluations of medical student paediatric interview skills for feedback and to identify students at risk of poor performance in summative assessments. Method, A total of 130 parent evaluations were obtained for 67 students (parent participation 72%, student participation 58%). Parents completed a 13-item questionnaire [Interpersonal Skills Rating Scale (IPS) maximum score 91, higher scores = higher student skill level]. Students received their individual parent scores and de-identified class mean scores as feedback, and participants were surveyed regarding the programme. Parent evaluation scores were compared with student performance in formative and summative faculty assessments of clinical interview skills. Results, Parents supported the programme and participating students valued parent feedback. Students with a parent score that was less than 1 standard deviation (SD) below the class mean (low IPS score students) obtained lower faculty summative assessment scores than did other students (mean ± SD, 59% ± 5 versus 64% ± 7; P < 0.05). Obtaining 1 low IPS score was associated with a subsequent faculty summative assessment score below the class mean (sensitivity 0.38, specificity 0.88). Parent evaluations combined with faculty formative assessments identified 50% of students who subsequently performed below the class mean in summative assessments. Conclusions, Parent evaluations provided useful feedback to students and identified 1 group of students at increased risk of weaker performance in summative assessments. They could be combined with other methods of formative assessment to enhance screening procedures for clinically weak students. [source] Reliability: on the reproducibility of assessment dataMEDICAL EDUCATION, Issue 9 2004Steven M Downing Context, All assessment data, like other scientific experimental data, must be reproducible in order to be meaningfully interpreted. Purpose, The purpose of this paper is to discuss applications of reliability to the most common assessment methods in medical education. Typical methods of estimating reliability are discussed intuitively and non-mathematically. Summary, Reliability refers to the consistency of assessment outcomes. The exact type of consistency of greatest interest depends on the type of assessment, its purpose and the consequential use of the data. Written tests of cognitive achievement look to internal test consistency, using estimation methods derived from the test-retest design. Rater-based assessment data, such as ratings of clinical performance on the wards, require interrater consistency or agreement. Objective structured clinical examinations, simulated patient examinations and other performance-type assessments generally require generalisability theory analysis to account for various sources of measurement error in complex designs and to estimate the consistency of the generalisations to a universe or domain of skills. Conclusions, Reliability is a major source of validity evidence for assessments. Low reliability indicates that large variations in scores can be expected upon retesting. Inconsistent assessment scores are difficult or impossible to interpret meaningfully and thus reduce validity evidence. Reliability coefficients allow the quantification and estimation of the random errors of measurement in assessments, such that overall assessment can be improved. [source] Psychopathology in Patients with ICDs over Time: Results of a Prospective StudyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2010SURAJ KAPA M.D. Introduction:The effects of implantable cardioverter defibrillators (ICDs) and ICD shocks on psychological state have previously been studied. However, it is still unclear how health-related quality-of-life changes over time using standardized assessments. We sought to characterize the effects of ICDs and ICD shocks on psychological outcomes. Methods:Three hundred-eight patients receiving ICDs were prospectively identified. Baseline QOL assessments including standardized psychological surveys [Hospital Anxiety and Depression Scale (HADS), Impact of Events Scale-Revised (IES-R), and Short Form 36 Health Survey (SF-36)] were obtained within 2 months of device implantation and at 6 and 12 months, respectively. Outcomes including ICD shocks were followed over the 12-month study period. Results:The number of patients meeting criteria for anxiety or posttraumatic stress disorder (PTSD) at baseline (78/223, 35%) was higher than at 6 (34/223, 15%) or 12 (34/223, 15%) months (P < 0.01). There was a significant improvement over time in HADS (P < 0.001) and IES-R (PTSD) scores (P < 0.001). Amongst the 20 patients who received ICD shocks, no significant differences were observed in IES-R, SF-36, or HADS scores when compared with those who did not receive shocks at any time point. Patients who experienced electrical storms (N = 5) had significantly higher baseline PTSD scores (29.6 ± 11.4 vs 14.6 ± 11.6, P < 0.01). Conclusions:Patients receiving ICDs have significant rates of baseline psychopathology after implantation. However, psychological assessment scores tend to improve with time. ICD shocks do not appear to significantly impact psychological state. These results suggest the importance of close screening and referral for possible psychopathology in patients receiving ICDs, especially in the peri-implant period. (PACE 2010; 33:198,208) [source] Yellow Nail Syndrome in Three Siblings: A Randomized Double-Blind Trial of Topical Vitamin EPEDIATRIC DERMATOLOGY, Issue 4 2006Emily M. Lambert M.D. It has rarely been reported in children and this is the first report of congenital yellow nails in siblings. The purpose of this study was to determine whether topical vitamin E applied to the nail plates and periungual skin would affect the growth rate or appearance of the fingernails in patients with congenital yellow nail syndrome. This study was the first trial of a treatment for this entity in children and the largest randomized double blind trial to date. We found that vitamin E solution had no significant effect (p = 0.84) on fingernail growth or the global appearance score (p = 1.0) when compared with placebo. The average growth rates and global assessment scores improved and onycholysis and onychomadesis decreased from baseline with both vitamin E and placebo treatment, although these were not primary end points of the study. Topical vitamin E did not result in a statistically significant improvement when compared with oil alone for the treatment of the nails in our three patients with yellow nail syndrome. However, it is interesting and perhaps clinically useful that both vitamin E and placebo oil improved the condition of the nails. [source] Approaches to learning on placement: the students' perspectivePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2009Clare Kell Abstract Background and Purpose.,With Continuing Professional Development activity, a requirement of Allied Health Professional registration in the UK and said to be most effectively supported by practitioners who adopt a deep approach to learning, a UK university has been exploring how its pre-registration curriculum influences learner development. This paper investigates the possible influences of the clinical placement component of the curriculum that is structured as four 4-week blocks during both Years 2 and 3 of the 3-year BSc (Hons) programme. A range of placement models are used within this structure including the traditional 1:1 educator,:,student ratio and those that have a higher ratio of student(s),:,educator(s).,Methods.,This phase of the larger project used a case study design framed about students from two academic year groups on one UK undergraduate, pre-registration physiotherapy programme. Three questionnaires comprising a learning approaches inventory, a demographic questionnaire and a placement self-assessment form were posted to Year 2 and 3 students during one clinical placement. The students were invited to complete the questionnaires halfway through their placement, but in advance of the first, formal placement education feedback meeting. The need for students' self-assessment prevented follow-up data collection.,Results.,Analysis of the data from the learning approaches inventory against the demographic variables and placement assessment scores suggest that students' learning strategies depend upon the number of students, educators and assessors involved in their placement. The paper explores the possible links between placement experience, learning strategy and academic outcome. The authors question assumptions about the perceived benefits of some placement education models.,Conclusion.,Increasing the ratio of student,:,educator or educator,:,student may have a detrimental effect on students' learning development when placements are of 4-week duration. If such placement models are adopted, then students and placement educators must be adequately prepared and supported so that students' learning development towards the deep-learning autonomous professionals of tomorrow can continue through placement education. Copyright © 2008 John Wiley & Sons, Ltd. [source] How well can the accuracy of comparative protein structure models be predicted?PROTEIN SCIENCE, Issue 11 2008David Eramian Comparative structure models are available for two orders of magnitude more protein sequences than are experimentally determined structures. These models, however, suffer from two limitations that experimentally determined structures do not: They frequently contain significant errors, and their accuracy cannot be readily assessed. We have addressed the latter limitation by developing a protocol optimized specifically for predicting the C, root-mean-squared deviation (RMSD) and native overlap (NO3.5Å) errors of a model in the absence of its native structure. In contrast to most traditional assessment scores that merely predict one model is more accurate than others, this approach quantifies the error in an absolute sense, thus helping to determine whether or not the model is suitable for intended applications. The assessment relies on a model-specific scoring function constructed by a support vector machine. This regression optimizes the weights of up to nine features, including various sequence similarity measures and statistical potentials, extracted from a tailored training set of models unique to the model being assessed: If possible, we use similarly sized models with the same fold; otherwise, we use similarly sized models with the same secondary structure composition. This protocol predicts the RMSD and NO3.5Å errors for a diverse set of 580,317 comparative models of 6174 sequences with correlation coefficients (r) of 0.84 and 0.86, respectively, to the actual errors. This scoring function achieves the best correlation compared to 13 other tested assessment criteria that achieved correlations ranging from 0.35 to 0.71. [source] Subjective assessments of the quality of life, well-being and self-efficacy in patients with schizophreniaPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2009Bun Chino md Aim:, The present study examined three kinds of subjective assessment scales in the same patient group with schizophrenia to analyze the correlations among scores obtained in relation to the background data. Method:, Thirty-six patients with schizophrenia were examined with the 26-item short form of the World Health Organization Quality of Life (WHO-QOL 26), Subjective Well-being under Neuroleptic drug treatment: Short Japanese version (SWNS) and Self-Efficacy for Community Life scale (SECL) for subjective assessment scales, five kinds of neurocognitive tests, Positive and Negative Syndrome Scale (PANSS) for clinical symptom, Social Functioning Scale (SFS), and Global Assessment of Functioning (GAF) scale for social functioning. Result:, The scores for delusions (components of positive syndrome), anxiety and depression (components of general psychopathology) on the PANSS significantly correlated with QoL and subjective well-being scores. In contrast, the scores for components of negative syndrome were not correlated with the subjective assessment scores. Furthermore, none of the clinical symptom scores were correlated with the score in self-efficacy scale. The SFS and GAF scores were significantly correlated with the subjective assessment scores. There were significant correlations among the scores on the three subjective assessment scales. Conclusion:, Each scale has different features and should be utilized depending upon the expected effect of treatment or the purpose of assessment. The treatments provided to patients must be directed at improving both psychological and social impairments, in order to enhance the social functioning and QoL of patients. [source] Overcoming Abnormal Joint Torque Patterns in Paretic Upper Extremities Using Triceps StimulationARTIFICIAL ORGANS, Issue 3 2005Thierry Keller Abstract:, The goal of this research project was to quantitatively assess whether transcutaneous triceps stimulation can overcome the expression of abnormal torque patterns in the paretic upper limb of subjects with hemiparetic stroke. Abnormal torque patterns consist of strong coupling between shoulder abduction (SAB) and elbow flexion (EF) or between elbow extension (EE) and shoulder adduction (SAD) torques. Both patterns reduce the active range of motion during arm movements. Eight chronic stroke subjects with moderate to severe (Fugl-Meyer assessment scores of 21/66,36/66) upper limb motor impairment participated in this study. Shoulder and elbow joint torques were measured with a 6-degrees-of-freedom load cell under isometric conditions, while the triceps muscle was stimulated to generate EE torques. At the same time the subjects were asked to lift up their arm to generate different SAB torque levels. The obtained isometric results showed that electrical stimulation can overcome abnormal torque patterns in chronic stroke subjects while generating SAB. This is likely to have potential benefits to increase the, reaching, workspace, of, the, paretic, arm. [source] Research: The challenges of clinical trials in the exclusion zone: The case of the frail elderlyAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2008Iman Ridda Frail older people have been systematically excluded from randomised controlled trials (RCT). We aim to recruit older, frail hospitalised patients in an RCT and evaluate the frailty index (FI) as a measure to describe the types of people included in the study. We recruited 315 hospitalised patients aged 65 years; age ranged from 60 to 102 years. Baseline assessment scores ranged as follow: Mini-Mental Status Examination from 7 to 30, Barthel index from 5 to 100 and FI from 2 to 24. Total deaths were 20 (6%). We demonstrated that it is feasible to recruit frail older people into RCTs. The FI does not show any ,floor' or ,ceiling' effects. We can measure frailty in an RCT cohort, and we believe that clinical trials should include more frail older people and that the use of an FI can facilitate such trials and generate reliable data to guide future medical practice in a rapidly ageing society. [source] | |||||||||||||||||||||||||||||||