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Clinical Performance (clinical + performance)
Selected AbstractsCLINICAL PERFORMANCE OF LOW FUSING FRAMEWORK VENEERING CERAMIC MATERIALSJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 6 2008David Avery CDT Guest Expert [source] Developing a valid and reliable self-efficacy in clinical performance scaleINTERNATIONAL NURSING REVIEW, Issue 2 2009F. Cheraghi phd Aim:, This paper describes the development and testing of the Self-Efficacy in Clinical Performance (SECP) instrument for nursing students. Background:, Accurate measurement of self-efficacy can be used to predict nursing students' clinical performance. The literature review indicated there is no existing self-efficacy in clinical performance instrument for Iranian nursing students. Methods:, To clarify the concept of self-efficacy in clinical performance, 28 semi-structured interviews and three focus groups were conducted. A self-efficacy framework with well-developed theoretical constructs was formed. A review of literature and content analysis of the interview transcripts identified subscales and items to be included in the instrument. Then, a methodological design was used. The SECP was developed into 69 Likert-format items, which were evaluated by 20 nursing experts in the form of content validity index. The scale's validity and reliability were tested in a randomized sample of 207 final year nursing students. Findings:, The final scale consists of four dimensions with 37 items. The overall scale internal reliability had , = 0.96; the dimensions Cronbach's , ranged from 0.90 to 0.92. Test,retest reliability with a 2-week time interval was: r = 0.94. In addition, concurrent validity was obtained (r = 0.73, P = 0.01). Conclusions:, The SECP has demonstrated evidence of content validity, construct validity, concurrent validity, internal consistency reliability and stability. Statistical analysis provided an objective tool for assessing nursing students' self-efficacy in clinical performance. It may have been fruitful to further test the instrument with students from other years of their education. [source] Automatic Mode Switching of Implantable Pacemakers: II.PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2002Clinical Performance of Current Algorithms, Their Programming LAU, C.-P., et al.: Automatic Mode Switching of Implantable Pacemakers: II. Clinical Performance of Current Algorithms and Their Programming. While the hemodynamic and clinical significance of automatic mode switching (AMS) in patients with pacemakers has been demonstrated, the clinical behavior of AMS algorithms differ widely according to the manufacturers and pacemaker models. In general, a "rate-cutoff" detection method of atrial tachyarrhythmias provides a rapid AMS onset and resynchronization to sinus rhythm at the termination of atrial tachyarrhythmias, but may cause intermittent oscillations between the atrial tracking and AMS mode. This can be minimized with a "counter" of total number of high rate events before the AMS occurs. The use of a "running average" algorithm results in more stable rate control during AMS by reducing the incidence of oscillations, but at the expense of delayed AMS onset and resynchronization to sinus rhythm. Algorithms may be combined to fine tune the AMS response and to avoid rapid fluctuation in pacing rate. Appropriate programming of atrial sensitivity, and the avoidance of ventriculoatrial cross-talk are essential for optimal AMS performance. [source] Clinical performance of electronic, head-mounted, low-vision devicesOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2004Louise E. Culham Abstract This study compared four electronic head-mounted devices (HMDs) (Jordy, Flipperport, Maxport and NuVision) with conventional optical low-vision aids (LVAs). The aim was to determine any performance differences for laboratory-based clinical measurements and practical visual tasks for patients with macular disease. Possible factors influencing success were explored. Ten patients with early onset macular disease (EOMD) and 10 with age-related macular disease (AMD) used the four HMDs, habitual spectacles and previously prescribed optical LVAs to complete a range of clinical measurements and everyday visual tasks. The clinical measurements were distance, intermediate and near acuities, and contrast sensitivity. The visual tasks were to read text of three sizes, to write a cheque and to identify grocery items on a shelf. Following the initial evaluation, each subject took home two randomly selected HMD devices for 2 weeks, after which performance measures were repeated. No single HMD stood out as being superior overall. Flipperport and Jordy provided significantly better distance and intermediate acuity than the previously prescribed optical LVAs but near acuity and contrast sensitivity were not consistently better with any of the HMDs. Practice at home provided some improvement in performance with HMDs, nevertheless, optical aids remained the best devices for optimum functioning for the majority of tasks. Younger patients and those with better distance acuity were more likely to benefit from HMDs, particularly when reading small print. In low vision clinics, practitioners should continue to show patients conventional optical aids and demonstrate these electronic HMDs only when appropriate for the individual patient. [source] The Assessment of Emergency Physicians by a Regulatory AuthorityACADEMIC EMERGENCY MEDICINE, Issue 12 2006Jocelyn M. Lockyer PhD Abstract Objectives To determine whether it is possible to develop a feasible, valid, and reliable multisource feedback program (360° evaluation) for emergency physicians. Methods Surveys with 16, 20, 30, and 31 items were developed to assess emergency physicians by 25 patients, eight coworkers, eight medical colleagues, and self, respectively, using five-point scales along with an "unable to assess" category. Items addressed key competencies related to communication skills, professionalism, collegiality, and self-management. Results Data from 187 physicians who identified themselves as emergency physicians were available. The mean number of respondents per physician was 21.6 (SD ± 3.87) (93%) for patients, 7.6 (SD ± 0.89) (96%) for coworkers, and 7.7 (SD ± 0.61) (95%) for medical colleagues, suggesting it was a feasible tool. Only the patient survey had four items with "unable to assess" percentages ,15%. The factor analysis indicated there were two factors on the patient questionnaire (communication/professionalism and patient education), two on the coworker survey (communication/collegiality and professionalism), and four on the medical colleague questionnaire (clinical performance, professionalism, self-management, and record management) that accounted for 80.0%, 62.5%, and 71.9% of the variance on the surveys, respectively. The factors were consistent with the intent of the instruments, providing empirical evidence of validity for the instruments. Reliability was established for the instruments (Cronbach's , > 0.94) and for each physician (generalizability coefficients were 0.68 for patients, 0.85 for coworkers, and 0.84 for medical colleagues). Conclusions The psychometric examination of the data suggests that the instruments developed to assess emergency physicians were feasible and provide evidence for validity and reliability. [source] Tumescent Liposuction Report Performance Measurement Initiative: National Survey ResultsDERMATOLOGIC SURGERY, Issue 7 2004William Hanke MD Background. This study was created by the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement to measure clinical performance and improvement opportunities for physicians and ambulatory health-care organizations. Data were collected prospectively between February 2001 and August 2002. Thirty-nine study centers participated, and 688 patients who had tumescent liposuction were surveyed and followed for 6 months. Objective. The objective was to determine patient satisfaction with tumescent liposuction and examine current liposuction practice and the safety of tumescent liposuction in a representative cohort of patients. Methods. The Accreditation Association for Ambulatory Health Care Institute for Quality Improvement collected prospective data from February 2001 to August 2002 from 68 organizations registered for this study. Ultimately 39 organizations submitted 688 useable cases performed totally with local anesthesia, "tumescent technique." Results. The overall clinical complication rate found in the Accreditation Association for Ambulatory Health Care Institute for Quality Improvement study was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1,5) and 84% had high levels (4 or 5 on a scale of 1,5) of overall satisfaction with the procedure. Conclusions. Our findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction. [source] The effect of nightshift on emergency registrars' clinical skillsEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2010Leonie Marcus Abstract Objective: The effect of nightshift on ED staff performance is of clinical and risk-management significance. Previous studies have demonstrated deterioration in psychomotor skills but the present study specifically assessed the impact of nightshift on clinical performance. Methods: The ED registrars in a tertiary hospital were enrolled in a prospective observational study and served as their own controls. During nightshift, subjects were presented simulated scenarios and tested with eight clinical questions developed to Fellowship examination standard. Matched scenarios and questions for the same subjects during dayshift served as controls. Two investigators, blinded to subject identity and the setting in which questions were attempted, independently collated answers. Results: Of 22 eligible subjects, all were recruited; four were excluded owing to incomplete data. A correlation of 0.99 was observed between the independent scoring investigators. Of a possible score of 17, the median result for nightshift was 9.5 (interquartile range: 8,11); corresponding value for dayshift was 12 (interquartile range: 10,13); P= 0.047. Conclusion: Nightshift effect on clinical performance is anecdotally well known. The present study quantifies such effects, specifically for the ED setting, and paves the way for focused research. The implications for clinical governance strategies are significant, as the fraternity embraces the mandate to maintain quality emergency care 24 h per day. [source] Predictors of Chain Acquisition among Independent Dialysis FacilitiesHEALTH SERVICES RESEARCH, Issue 2 2010Alyssa S. Pozniak Objective. To determine the predictors of chain acquisition among independent dialysis providers. Data Sources. Retrospective facility-level data combined from CMS Cost Reports, Medical Evidence Forms, Annual Facility Surveys, and claims for 1996,2003. Study Design. Independent dialysis facilities' probability of acquisition by a dialysis chain (overall and by chain size) was estimated using a discrete time hazard rate model, controlling for financial and clinical performance, practice patterns, market factors, and other facility characteristics. Data Collection. The sample includes all U.S. freestanding dialysis facilities that report not being chain affiliated for at least 1 year between 1997 and 2003. Principal Findings. Above-average costs and better quality outcomes are significant determinants of dialysis chain acquisition. Facilities in larger markets were more likely to be acquired by a chain. Furthermore, small dialysis chains have different acquisition strategies than large chains. Conclusions. Dialysis chains appear to employ a mix of turn-around and cream-skimming strategies. Poor financial health is a predictor of chain acquisition as in other health care sectors, but the increased likelihood of chain acquisition among higher quality facilities is unique to the dialysis industry. Significant differences among predictors of acquisition by small and large chains reinforce the importance of using a richer classification for chain status. [source] Correlation between clinical success and apical dye penetrationINTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2001C. M. Oliver Abstract Aim This study was undertaken to examine whether a correlation exists between apical dye penetration and the clinical performance of root fillings. Methodology Apical dye penetration into 116 roots of human teeth that had been root-filled at least 6 months prior to extraction was tested in vitro using a vacuum technique and by measuring the length of dye penetration. Endodontic treatment was classified as clinically successful or unsuccessful and results for these groups were compared using analysis of variance and the Student's t -test. Positive and negative controls were used to test the experimental system. Results All controls performed as expected. Dye penetrated significantly further in unsuccessful cases although the raw data suggested little difference. Overall, dye penetrated 99.5% of the specimens, indicating that the presence of dye in the canal is a poor indicator of whether the technique or material will succeed. However, the extent of dye penetration may be related to the clinical outcome. Conclusions Clinically placed root canal fillings do not provide an apical seal that prevents fluid penetration. The outcome of treatment cannot be predicted from the results of apical dye leakage studies. [source] Principles of evidence-based management using stage I,II melanoma as a modelINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2002Tsu-Yi Chuang MD Evidence-Based Medicine (EBM) is the practice of integrating best research evidence with clinical expertise and patent values. 1 The term, Evidence-Based Medicine, was named in 1992 by a group led by Gordon Guyatt at McMaster University in Canada. The practice of EBM arose from the awareness of: 1the daily need for valid information pertinent to clinical practice; 2the inadequacy of traditional sources, like textbooks, for such information; 3the disparity between clinical enhancing skills and declining up-to-date knowledge and eventually, clinical performance; and 4the inability to spend more time in finding and assimilating evidence pertinent to clinical practice. EBM simply emphasizes three As: Access, Appraisal and Application. Access requires refining a clinical question into a searchable term and an answerable question and using search engines to track down the information. Appraisal is using epidemiological principles and methods to critically review evidence for its validity and applicability. Application is integrating the critically appraised evidence with clinical expertise and each patient's unique situation. The outcomes following such practices are then assayed. The last step involves evaluating the effectiveness and efficiency in executing the first two As and seeking ways for improvement. In this article, we describe the concept and steps of practising EBM and utilize melanoma as an example to illustrate how we integrate the best evidence to outline the management plan for stage I-II melanoma. [source] Stainless steel crown versus modified open-sandwich restorations for primary molars: a 2-year randomized clinical trialINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 5 2008MOMEN ATIEH Objective., The aim of this study was to investigate the clinical performance and survival of stainless steel crown (SSC) restoration and modified open-sandwich technique using resin-modified glass ionomer cement. Design., Randomized clinical trial. Setting., General dental practice. Materials and methods., A total of 87 children aged 4,7 years at baseline with one or more primary molars that have undergone pulp therapy were randomly assigned to receive either SSC or modified open-sandwich restoration. One hundred and sixty restorations were placed and evaluated after 6, 12, 18, and 24 months using the Ryge criteria. Results., Comparable survival rates were observed for both SSC and modified open-sandwich restoration. With only four SSCs and six modified open-sandwich restorations failing over 24 months, the survival rates were high for both materials (2-year survival rate: 95.0% for SSCs and 92.5% for modified open-sandwich restorations). Significantly better gingival health (P < 0.05) was observed for the modified open-sandwich restorations compared with SSCs, as only one modified open-sandwich restoration was rated Charlie compared to 13 SSCs. No significant differences were observed between the two materials for marginal integrity, proximal contact, occlusion, or recurrent caries. Conclusion., The 2-year results indicated that the modified open-sandwich restoration is an appropriate alternative to SSC in extensive restorations, particularly where aesthetic considerations are important. [source] Conventional versus resin-modified glass-ionomer cement for Class II restorations in primary molars.INTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2003A 3-year clinical study Summary. Objective. To compare the clinical performance of two glass-ionomer cements (GICs)for Class II restorations in primary molars: a conventional cement (Fuji II®) and a resin-modified cement (Vitremer®). Design. Split mouth and random assignment to the two materials were used for the majority of the molars. Sample and methods. Forty consecutive 4,7-year-old children were included. One operator made 115 restorations: 53 with Vitremer and 62 with Fuji II. The restorations were evaluated clinically, radiographically and from colour photographs. Results. The cumulative success rate of the Vitremer restorations was 94% and that of the Fuji II restorations 81%. The difference is statistically significant. The risk of a failed restoration was more than five times higher with Fuji II than with Vitremer as the restorative material. Of the 13 unsuccessful restorations, seven had lost their retention, four had secondary caries, and two were fractured. Conclusions. The resin-modified GIC offered advantages over the conventional GIC for restoring approximal caries in primary molars. [source] Three-year clinical performance of glass ionomer cement in primary molarsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2002J. Rutar No abstract is available for this article. [source] Developing a valid and reliable self-efficacy in clinical performance scaleINTERNATIONAL NURSING REVIEW, Issue 2 2009F. Cheraghi phd Aim:, This paper describes the development and testing of the Self-Efficacy in Clinical Performance (SECP) instrument for nursing students. Background:, Accurate measurement of self-efficacy can be used to predict nursing students' clinical performance. The literature review indicated there is no existing self-efficacy in clinical performance instrument for Iranian nursing students. Methods:, To clarify the concept of self-efficacy in clinical performance, 28 semi-structured interviews and three focus groups were conducted. A self-efficacy framework with well-developed theoretical constructs was formed. A review of literature and content analysis of the interview transcripts identified subscales and items to be included in the instrument. Then, a methodological design was used. The SECP was developed into 69 Likert-format items, which were evaluated by 20 nursing experts in the form of content validity index. The scale's validity and reliability were tested in a randomized sample of 207 final year nursing students. Findings:, The final scale consists of four dimensions with 37 items. The overall scale internal reliability had , = 0.96; the dimensions Cronbach's , ranged from 0.90 to 0.92. Test,retest reliability with a 2-week time interval was: r = 0.94. In addition, concurrent validity was obtained (r = 0.73, P = 0.01). Conclusions:, The SECP has demonstrated evidence of content validity, construct validity, concurrent validity, internal consistency reliability and stability. Statistical analysis provided an objective tool for assessing nursing students' self-efficacy in clinical performance. It may have been fruitful to further test the instrument with students from other years of their education. [source] Effect of long-term natural aging on the thermal, mechanical, and viscoelastic behavior of biomedical grade of ultra high molecular weight polyethyleneJOURNAL OF APPLIED POLYMER SCIENCE, Issue 1 2010H. Fouad Abstract In the total joint prostheses, Ultra High Molecular Weight Polyethylene (UHMWPE) may undergo an oxidative degradation in the long term. The overall properties of UHMWPE are expected to be altered due to the oxidative degradation. The goal of this study is to investigate the effects of natural aging up to 6 years in air on the thermal, mechanical, and viscoelastic properties of UHMWPE that was used in total joint replacement. The changes in UHMWPE properties due to aging are determined using Differential Scanning Calorimetry (DSC), uniaxial tensile tests, and Dynamic Mechanical Analysis (DMA). The DSC results show that the lamellar thickness and degree of crystallinity of UHMWPE specimens increase by 38% and 12% due to aging. A small shoulder region in the DSC thermograms is remarked for aged specimens, which is an indication of formation of new crystalline forms within their amorphous region. The tensile properties of aged and nonaged UHMWPE specimens show a significant decrease in the elastic modulus, yield, fracture stresses, and strain at break due to aging. The DM testing results indicate that the storage modulus and creep resistance of UHMWPE specimens decrease significantly due to aging. Also, it is remarked that the , relaxation peak for aged UHMWPE specimens occurs at lower temperature compared to nonaged ones. The significant reduction in the strength and creep resistance of UHMWPE specimens due to aging would affect the long-term clinical performance of the total joint replacement and should be taken into consideration during artificial joint design. © 2010 Wiley Periodicals, Inc. J Appl Polym Sci, 2010 [source] Serum TRACP 5b Is a Useful Marker for Monitoring Alendronate Treatment: Comparison With Other Markers of Bone Turnover,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2005Arja Nenonen MSc Abstract We studied clinical performance of serum TRACP 5b and other bone turnover markers, including S-CTX, U-DPD, S-PINP, S-BALP, and S-OC, for monitoring alendronate treatment. TRACP 5b had higher clinical sensitivity, area under the ROC curve, and signal-to-noise ratio than the other markers. Introduction: The purpose of this study was to compare the clinical performance of serum TRACP 5b (S-TRACP5b) with that of other markers of bone turnover in the monitoring of alendronate treatment. Materials and Methods: This double-blinded study included 148 healthy postmenopausal women that were randomly assigned into two groups: one receiving 5 mg alendronate daily (n = 75) and the other receiving placebo (n = 73) for 12 months. All individuals in both groups received calcium and vitamin D daily. The bone resorption markers S-TRACP5b, serum C-terminal cross-linked telopeptides of type I collagen (S-CTX), and total urinary deoxypyridinoline (U-DPD), and the serum markers of bone formation procollagen I N-terminal propeptide (S-PINP), bone-specific alkaline phosphatase (S-BALP), and total osteocalcin (S-OC) were assessed at baseline and at 3, 6, and 12 months after initiation of treatment. Lumbar spine BMD (LBMD) was measured at baseline and 12 months. Results: Compared with the placebo group, LBMD increased, and all bone markers decreased significantly more in the alendronate group (p < 0.001 for each parameter). The decrease of S-TRACP5b after first 3 months of alendronate treatment correlated significantly with the changes of all other markers except S-OC, the best correlation being with S-CTX (r = 0.60, p < 0.0001). The changes of LBMD at 12 months only correlated significantly with the changes of S-TRACP5b (r = ,0.32, p = 0.005) and S-CTX (r = ,0.24, p = 0.037) at 3 months. Based on clinical sensitivity, receiver operating characteristic (ROC) curves, and signal-to-noise ratio, S-TRACP5b, S-CTX, and S-PINP were the best markers for monitoring alendronate treatment. Clinical sensitivity, area under the ROC curve, and signal-to-noise ratio were higher for S-TRACP5b than for the other markers. Conclusion: These results show that S-TRACP5b, S-CTX, and S-PINP are useful markers for monitoring alendronate treatment. [source] Comparison of immunoradiometric assays for determination of thyroglobulin: a validation studyJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 3 2007L.A. Tortajada-Genaro Abstract In this study we compared and validated commercial immunoradiometric assays (IRMA) to determine thyroglobulin (Tg) levels in serum. From a set of 440 samples, 68 were selected to calculate the validation parameters and the clinical performance of the assays. The commercial kits evaluated were the Tg-CTK (DiaSorin), IRMAZenco Tg (ZenTech), and SELco-Tg (Medipan). We found that 21% of the collected samples were in the critical range of concentration. Detection limits were calculated as being below 3,µg/L. Intra- and inter-reproducibility were lower than 3.1% and 9.2%, respectively. Dilution and recovery studies provided quantitative determinations. Correlation regression coefficients from the results of the methods were obtained. The determined concentrations were compared with the clinical evidence of disease. Variation in the 125-iodine-labeled antibody concentration and control charts showed the robustness of the methods. Analysis time and the simplicity of the methods were also evaluated. Reliable Tg determination is important for monitoring patients with differentiated thyroid cancer (DTC), controlling other thyroid diseases, and assessing the quality of imaging techniques. A strategy for verification and comparison based on analytical parameters and clinical performance is proposed. J. Clin. Lab. Anal. 21:147,153, 2007. © 2007 Wiley-Liss, Inc. [source] Methodology for evaluating physician order entry (POE) implementationsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2003Glen Geiger MD CM MASc BASc FRCPC Abstract The body of physician order entry (POE) implementations literature uses statistical evaluation methods to demonstrate changes in specified variables after POE implementation. To understand and manage the holistic impact of POE on the health care institution, a methodology that utilizes feedback to guide the POE implementation towards the satisfaction of stakeholder objectives is presented. Stakeholders jointly define quantitative and qualitative metrics for their objectives, establish target value vectors for the metrics that represent acceptable implementation outcomes and specify evaluation milestones. These are used to compare pre- and post-POE implementation clinical performance, enabling a socio-technical feedback,improvement cycle. A case study is provided to illustrate how the methodology is being used at Sunnybrook and Women's College Health Science Centre in Toronto, Canada. [source] Comparison of the technical and clinical performance of the Elecsys® HBsAg II assay with the Architect®, AxSym®, and Advia® Centaur HBsAg screening assaysJOURNAL OF MEDICAL VIROLOGY, Issue 5 2010S. Louisirirotchanakul Abstract South East Asia has some of the highest prevalence rates of hepatitis B virus (HBV) infection (,8%) in the world, and the emergence of hepatitis B surface antigen (HBsAg) mutant strains is a growing problem. Assays with the highest levels of sensitivity, including mutant detection, should be used for routine HBsAg screening. In this large multicenter study, the clinical and technical performance of the fully automated Elecsys HBsAg II assay was compared with the Architect, AxSYM, and Advia Centaur HBsAg assays for HBsAg screening. Nine laboratories (three each from Thailand, Korea, and Singapore) compared the Elecsys HBsAg II assay with their routine HBsAg screening assay against a range of stored and routine clinical samples, including recombinant mutants. The Elecsys HBsAg II assay demonstrated equivalent sensitivity and specificity to the Architect HBsAg assay. However, the Elecsys HBsAg II assay recognized a native mutant sample (L94S, L97V, L98V, T123A) that the Architect HBsAg assay failed to detect. The AxSYM and Advia Centaur HBsAg assays appeared less sensitive for the detection of early HBV infection and also failed to detect some of the recombinant mutant strains. There was almost complete agreement between the Elecsys HBsAg II assay and comparator assays with respect to routine serum samples. The results of this study demonstrate that the Elecsys HBsAg II assay is a highly sensitive and specific screening assay for HBsAg and detects reliably the most important and clinically relevant HBV mutants and genotypes. It is suitable for routine HBsAg screening in Asia. J. Med. Virol. 82: 755,762, 2010. © 2010 Wiley-Liss, Inc. [source] Teamwork and patient safety in dynamic domains of healthcare: a review of the literatureACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009T. MANSER Aims/Background: This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Results: Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. Conclusion: In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care. [source] Performance assessment in health care providers: a critical review of evidence and current practiceJOURNAL OF NURSING MANAGEMENT, Issue 8 2007KAREN E. STC. Aim, To evaluate methods of performance assessment through an international literature review and a survey of current practice. Background, Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. Methods, A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Results, Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. Conclusions, No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice. [source] A retrospective study of pre-fabricated carbon fibre root canal postsJOURNAL OF ORAL REHABILITATION, Issue 10 2003S.-O. Hedlund summary, Although pre-fabricated carbon fibre posts have been used during the past decade clinical evaluations of the technique are still few. Using dental records and radiographs the clinical performance of 65 pre-fabricated carbon fibre posts (Composipost and Endopost) placed in 48 patients who regularly visited a general practice were evaluated in the present study. After an average time of 2.3 ± 0·8 years (median 2·1 years, range 1,4·9 years) of clinical service the failure rate was 3%. Failure occurred in one tooth with a single crown restoration and in one tooth that was part of a cantilever fixed partial denture. Although the failure rate is lower than those mostly reported for metallic posts and cores more clinical studies are necessary to assess the suitability of pre-fabricated carbon fibre posts for routine use as an alternative to individually cast posts. [source] Clinical and SEM evaluations of three compomer systems in Class V carious lesionsJOURNAL OF ORAL REHABILITATION, Issue 8 2002A. I. Abdalla Summary The aim of this study was to evaluate the clinical performance of three compomer systems: Compoglass F, Dyract AP and F2000 in Class V carious lesions. In addition, some restorations were placed in teeth scheduled for extractions in order to evaluate the compomer/dentin interface with the scanning electron microscope (SEM). A total of 175 Class V carious lesions having the gingival margins extending into cementum were restored with the tested materials. Each restoration was clinically evaluated immediately after placement, after 1 year and after 2 years using the USPHS criteria. After 1 year no loss of restoration was recorded. No significant difference between the materials was observed for any evaluation category. After 2 years, one Compoglass and two Dyract restorations were lost. No loss of F2000 was reported. No significant difference was reported between the tested materials and between the 2-year data and baseline ones. A well-defined hybrid layer as well as resin tags was seen at the interface between the tested materials and vital dentin. [source] Investigation of interaction between human hemoglobin A0 and platinum anticancer drugs by capillary isoelectric focusing with whole column imaging detectionJOURNAL OF SEPARATION SCIENCE, JSS, Issue 10 2008Tibebe Lemma Abstract CIEF with whole column imaging detection (WCID) was used to investigate the interaction of platinum-based anticancer drugs, cis -platinum(II) diamine dichloride (cisplatin) and [SP-4-2-{1R-trans)]-(1,2-cyclohexanediamine- N,N,)[ethanedioata(2,)- O,O,]platinum (oxaliplatin), with human hemoglobin A0 (Hb). This technique facilitates the investigation and characterization of the formation of adducts between drugs and proteins. Cisplatin and oxaliplatin were mixed with the target protein at different concentrations (0:1, 1:1, 1:10, 1:50, and 1:100), and the reaction mixtures were incubated for 0, 0.5, 1, 12, 24, 48, and 72 h at 37°C in a water-bath. The focused Hb,drug adduct profiles were imaged by WCID. At higher drug to protein molar ratios (for both oxaliplatin and cisplatin), the results exhibit significant changes in the peak shapes and heights, which may indicate the destabilization of the protein. However, the conformational change was less evident at lower molar ratios. In addition, a major pI shift was observed for the oxaliplatin reaction mixtures (for 1:10, 1:50, and 1:100 ratios). In comparison with previously reported findings obtained by other analytical methods, conclusions were drawn about the validity of CIEF as a simple and convenient method for the investigation of protein,drug interactions. These results may provide useful information for further understanding the activity and toxicity of these chemotherapeutic drugs and improving their clinical performance. [source] Commissioned analysis of surgical performance using routine data: lessons from the Bristol inquiryJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 2 2002David J. Spiegelhalter The public inquiry into paediatric cardiac surgery at the Bristol Royal Infirmary commissioned the authors to design and conduct analyses of routine data sources to compare surgical outcomes between centres. Such analyses are necessarily complex in this context but were further hampered by the inherent inconsistencies and mediocre quality of the various sources of data. Three levels of analysis of increasing sophistication were carried out. The reasonable consistency of the results arising from different sources of data, together with a number of sensitivity analyses, led us to conclude that there had been excess mortality in Bristol in open heart operations on children under 1 year of age. We consider criticisms of our analysis and discuss the role of statisticians in this inquiry and their contribution to the final report of the inquiry. The potential statistical role in future programmes for monitoring clinical performance is highlighted. [source] The new DR-70 immunoassay detects cancer of the gastrointestinal tract: a validation studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2004A. Kerber Summary Background :,Malignant cells characteristically possess high levels of plasminogen activator, which induce local fibrinolysis. The DR-70 immunoassay is a newly developed test, which quantifies fibrin degradation products in serum by a proprietary antibody. Aim :,To evaluate the DR-70 immunoassay as a detection assay for the presence of gastrointestinal cancers. Methods :,We prospectively collected blood sera of 85 patients with histologically proven tumour and 100 healthy blood donors. Ten microlitres of the sera was used for the DR-70 immunoassay. Nineteen patients had a hepatocellular and 10 cholangiocellular carcinoma, 13 cancer of the pancreas, 30 colorectal cancer, 10 stomach cancer and three cancer of the oesophagus. Results :,Receiver,operator curve analysis revealed <0.7 ,g/mL as the best cut-off value to distinguish between patients with cancer and healthy controls. Using this cut-off value, the DR-70 immunoassay showed a good clinical performance with a sensitivity of 91% and a specificity of 93%. Patients with advanced tumour spread showed significantly higher DR-70 values than those with early-stage tumours (P < 0.0003). Conclusion :,The DR-70 immunoassay reliably differs between cancer patients and healthy controls. Therefore, it promises to become a useful test for the detection of cancer in clinical practice. [source] The impact of case specificity and generalisable skills on clinical performance: a correlated traits,correlated methods approachMEDICAL EDUCATION, Issue 6 2008Paul F Wimmers Context, The finding of case or content specificity in medical problem solving moved the focus of research away from generalisable skills towards the importance of content knowledge. However, controversy about the content dependency of clinical performance and the generalisability of skills remains. Objectives, This study aimed to explore the relative impact of both perspectives (case specificity and generalisable skills) on different components (history taking, physical examination, communication) of clinical performance within and across cases. Methods, Data from a clinical performance examination (CPX) taken by 350 Year 3 students were used in a correlated traits,correlated methods (CTCM) approach using confirmatory factor analysis, whereby ,traits' refers to generalisable skills and ,methods' to individual cases. The baseline CTCM model was analysed and compared with four nested models using structural equation modelling techniques. The CPX consisted of three skills components and five cases. Results, Comparison of the four different models with the least-restricted baseline CTCM model revealed that a model with uncorrelated generalisable skills factors and correlated case-specific knowledge factors represented the data best. The generalisable processes found in history taking, physical examination and communication were responsible for half the explained variance, in comparison with the variance related to case specificity. Conclusions, Pure knowledge-based and pure skill-based perspectives on clinical performance both seem too one-dimensional and new evidence supports the idea that a substantial amount of variance contributes to both aspects of performance. It could be concluded that generalisable skills and specialised knowledge go hand in hand: both are essential aspects of clinical performance. [source] The reliability and validity of a matrix to assess the completed reflective personal development plans of general practitionersMEDICAL EDUCATION, Issue 4 2006Chris Roberts Introduction, We wished to determine whether assessors could make reliable and valid judgements about the quality of completed reflective personal development plans (PDPs) for the purpose of accrediting UK general practitioners (GPs) for a postgraduate education allowance using a marking matrix, and secondly, to plan a feasible model of PDP assessment in the context of forthcoming GP appraisal/revalidation that would overcome the main sources of error identified from this study. Methods, Within generalisability theory, a variance components analysis on PDP scores estimated reliability and the effect on them of varying, for example, the number of assessors. We investigated the construct validity of the matrix through its internal consistency and detection of differences in the quality of PDPs. Results, For a single PDP and one assessor, 37.6% of the variance in scores was due to true differences in the quality of the PDP. Between 5 and 7 PDP assessors are needed to achieve summative reliability of greater than 0.8. While increasing the number of judges is important, reliability could also be improved by addressing assessor subjectivity. Construct validity was demonstrated, as the matrix distinguished between good, satisfactory and poor PDPs, and it had good internal consistency. Conclusion, PDP assessment has reasonable summative characteristics for the purpose of assessing GPs' reflective continuing professional development. If doctors could include their PDPs within their revalidation folders as evidence of their reflections on pursuing better clinical performance, we have described a reliable, valid and feasible method of external assessment. [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] The quality of a simulation examination using a high-fidelity child manikinMEDICAL EDUCATION, Issue 2003T-C Tsai Purpose, Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented. Method, Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, ,working' as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire. Results, The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score. Conclusions, With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations. [source] | |||||||||||||||||||||||||||||||