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Local Experts (local + expert)
Selected AbstractsLiverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasoundBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2008GE Fowler Objective, To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter. Design, A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed. Methods, To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans. Main outcome measures, Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A,E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations. Conclusions, LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms. [source] SCALES: a large-scale assessment model of soil erosion hazard in Basse-Normandie (northern-western France)EARTH SURFACE PROCESSES AND LANDFORMS, Issue 8 2010P. Le Gouée Abstract The cartography of erosion risk is mainly based on the development of models, which evaluate in a qualitative and quantitative manner the physical reproduction of the erosion processes (CORINE, EHU, INRA). These models are mainly semi-quantitative but can be physically based and spatially distributed (the Pan-European Soil Erosion Risk Assessment, PESERA). They are characterized by their simplicity and their applicability potential at large temporal and spatial scales. In developing our model SCALES (Spatialisation d'éChelle fine de l'ALéa Erosion des Sols/large-scale assessment and mapping model of soil erosion hazard), we had in mind several objectives: (1) to map soil erosion at a regional scale with the guarantee of a large accuracy on the local level, (2) to envisage an applicability of the model in European oceanic areas, (3) to focus the erosion hazard estimation on the level of source areas (on-site erosion), which are the agricultural parcels, (4) to take into account the weight of the temporality of agricultural practices (land-use concept). Because of these objectives, the nature of variables, which characterize the erosion factors and because of its structure, SCALES differs from other models. Tested in Basse-Normandie (Calvados 5500,km2) SCALES reveals a strong predisposition of the study area to the soil erosion which should require to be expressed in a wet year. Apart from an internal validation, we tried an intermediate one by comparing our results with those from INRA and PESERA. It appeared that these models under estimate medium erosion levels and differ in the spatial localization of areas with the highest erosion risks. SCALES underlines here the limitations in the use of pedo-transfer functions and the interpolation of input data with a low resolution. One must not forget however that these models are mainly focused on an interregional comparative approach. Therefore the comparison of SCALES data with those of the INRA and PESERA models cannot result on a convincing validation of our model. For the moment the validation is based on the opinion of local experts, who agree with the qualitative indications delivered by our cartography. An external validation of SCALES is foreseen, which will be based on a thorough inventory of erosion signals in areas with different hazard levels. Copyright © 2010 John Wiley & Sons, Ltd. [source] Improving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities?HEALTH SERVICES RESEARCH, Issue 2 2003Controlled Trial, Results of a Randomized Objective. Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. Study Setting. The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. Study Design. Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). Data Extraction Methods. Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. Principal Findings. At baseline, all ethnic groups (Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8,20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. Conclusions. Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities. [source] Standards for the management of cervical and vulval carcinomaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2000Thomas J. D'Arcy Trainee (Gynaecological Oncology) Objective To examine the feasibility of achieving designated target standards for the management of women with cervical and vulval cancer. Design Retrospective casenote review. Setting The Gynaecological Oncology Centre at Hammersmith Hospital, London. Population Sixty-one women with cervical and vulval cancer presenting to the gynaecological oncology clinic at the Hammersmith Hospital during 1996 and 1997. Various aspects of the management of those women were compared with standards suggested by a multidisciplinary panel of local experts. Targets included the referral and treatment process, the accuracy of staging, and measures of surgical performance. Results The target interval of seven days between receipt of the referral and the first visit at the cancer centre was achieved in 93% of women. Surgical treatment was administered to 92% of the women within the target of 20 working days from the first clinic appointment. Tumour close to or involving the margins of the specimen was noted in 13% of cervical and 9% of vulval cancers. The node count fell below the target standards in 13% of pelvic and 10% of groin dissections. Appropriate imaging investigations for staging were not undertaken in 15 of 39 cases (38%) of cervical cancer and in 5 out of 22 (23%) of vulval cancers. Conclusion The suggested targets of process and surgical performance are reasonable and achievable. These standards would be appropriate for national use. The area most clearly identified where these targets were not achieved was the requesting of complementary staging investigations. This could be addressed by the use of a simple investigation protocol to be included in each patient's notes and available at specialist clinics and gynaecology wards. [source] | ||||||||||