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Relevant Questions (relevant + question)
Selected AbstractsA concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance,CANCER, Issue 3 2005Thorsten Kuehn M.D. Abstract The development of standardized and reproducible clinical pathways is an important precondition for quality assurance in medicine, especially if a new method has not yet been ultimately validated. Sentinel lymph node biopsy (SLNB) is a widely accepted new surgical procedure in the treatment of early breast carcinoma. However, numerous steps of the method and details of the technique are not standardized and, thus, hamper quality assurance for SLNB. The German Society of Senology appointed an interdisciplinary consensus committee to work out guidelines for the standardized performance and quality-assured implementation of SLNB on a nationwide, homogeneous standard. The committee consisted of surgeons, gynecologists, radiooncologists, nuclear physicians, oncologists, and pathologists. Relevant questions related to patient selection, lymphatic mapping, surgery, histopathologic work-up, further local and systemic treatment decisions, patient information, training, and follow-up were evaluated with respect to clinical evidence, objectivity, and reproducibility. Clinical pathways were developed on the basis of this analysis. Requirements to the performing institutions and surgeons were defined. Cancer 2005. © 2004 American Cancer Society. [source] Measuring health polarization with self-assessed health dataHEALTH ECONOMICS, Issue 9 2007Benedicte ApoueyArticle first published online: 20 AUG 200 Abstract This paper proposes an axiomatic foundation for new measures of polarization that can be applied to ordinal distributions such as self-assessed health (SAH) data. This is an improvement over the existing measures of polarization that can be used only for cardinal variables. The new measures of polarization avoid one difficulty that the related measures for evaluating health inequalities face. Indeed, inequality measures are mean based, and since only cardinal variables have a mean, SAH has to be cardinalized to compute a mean, which can then be used to calculate an inequality measure. In contrast, the new polarization measures are median based and hence do not require to impose cardinal scaling on the categories. After deriving the properties of these new polarization measures, we provide an empirical illustration using data from the British Household Panel Survey that demonstrates that SAH polarization is also a relevant question on empirical grounds, and that the polarization measures are adequate to evaluate polarization phenomena whereas inequality measures are not adequate in these cases. Copyright © 2007 John Wiley & Sons, Ltd. [source] Project Development in Complex Environments: Assessing Safety in Design and Decision-MakingJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 3 2001Joop F. M. Koppenjan How can we be sure that safety risks are adequately dealt with in the design of complex, innovative projects? In The Netherlands, a number of recent innovative project initiatives have made this a relevant question. These initiatives include projects such as the construction of tunnels using new technologies, the construction of underground facilities that combine several functions, i.e. shopping, parking and transport, and the development of a transport corridor in which rail, road and waterway have been or will be combined. These projects combine several functions and have been, or will be, realised in densely built and populated areas. Although safety regulations for products and systems have been institutionalised through legislation and professional design practices, recent project proposals link systems and their environment in new and complex ways. The risks evolving from these links are unknown and the extent to which they are covered by existing safety approaches is uncertain. In this contribution, we examine how the attention paid to safety can be increased and maintained in the design process of infrastructural projects. First, we discuss the need to reorganise the safety focus in the design process. Then we describe the role of the design process in decision-making for major projects with regard to utility building, town planning and the construction of infrastructures. Third, we elaborate how the focus on safety can be organised within this context, given developments in the field of interactive decision-making and the design and management of interaction processes. We then outline a safety risk management method that can be used to achieve this and, finally, address the conditions that influence the use of this method. [source] ORIGINAL ARTICLE: How Should Data on Murine Spontaneous Abortion Rates be Expressed and Analyzed?AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2008David A. Clark Problem, Spontaneous abortions in the CBA × DBA/2 model are normally reported as number of resorptions/total number of implantations (R/T), pooling data from individual mice. The significance of differences between groups has been determined using non-parametric statistics (e.g. chi-square or Fisher's Exact test) based on a priori predictions. Recently, it has been argued that medians with box plots should replace the accepted standard, but this deprives readers of data needed to verify P -values, and leads to inferences incompatible with biological and statistical reality. Method of study, Raw data on 173 individual CBA × DBA/2 matings were analyzed by median and mean, along with R/T data from 18 independent experiments containing 5,10 mice per group. Raw data from 19 CBA × BALB/c matings were similarly analyzed. Results, Individual CBA × DBA/2 mouse resorption rates showed a non-Gaussian distribution, but the mean and median differed by <0.5%. Resorption data from 6 and 12 independent pools of mice were normally distributed. Only the mean enabled a between-group P -value calculation. CBA × BALB/c matings gave a median of 0 and mean of 5.1%; the data were not normally distributed, but that was because of a bimodal distribution. One group of mice had 0 abortions, and the second a mean of 13.9% abortions, and the data from the latter group were normally distributed. Conclusion, Although it is possible to compare individual mice, and even individual implantation sites, in resorption (abortion) studies, as the relevant question is the significance of differences between treatment groups of mice, and reproducibility, the established classical method of reporting R/T should continue to be provided. In CBA × BALB/c matings, where abortion rates are low, using the median is misleading and may obscure the existence of two distinct populations. [source] Concerning the instantaneous mass and the extent of an expanding universeASTRONOMISCHE NACHRICHTEN, Issue 7 2006H. J. Fahr Abstract In this article we want to answer the cosmologically relevant question what, with some good semantic and physical reason, could be called the massMu of an infinitely extended, homogeneously matter-filled and expanding universe. To answer this question we produce a space-like sum of instantaneous cosmic energy depositions surrounding equally each spacepoint in the homogeneous universe. We calculate the added-up instantaneous cosmic energy per volume around an arbitrary space point in the expanding universe. To carry out this sum we use as basic metrics an analogy to the inner Schwarzschild metric applied to stars, but this time applied to the spacepoint-related universe. It is then shown that this leads to the added-up proper energy within a sphere of a finite outer critical radius defining the point-related infinity. As a surprise this radius turns out to be reciprocal to the square root of the prevailing average cosmic energy density. The equivalent mass of the universe can then also be calculated and, by the expression which is obtained here, shows a scaling with this critical radius of this universe, a virtue of the universe which was already often called for in earlier works by E. Mach, H. Thirring and F. Hoyle and others. This radius on the other hand can be shown to be nearly equal to the Schwarzschild radius of the so-defined mass Mu of the universe. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Electrical stimulation in cerebral palsy: are we asking clinically relevant questions?DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2006Gad Alon No abstract is available for this article. [source] Defining the clinically relevant questions that lead to the best evidence: what is evidence-based medicine?EQUINE VETERINARY JOURNAL, Issue 4 2003C. M. MARR First page of article [source] Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skillsEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2004M. Schittek Janda Simulations are important educational tools in the development of health care competence. This study describes a virtual learning environment (VLE) for diagnosis and treatment planning in oral health care. The VLE is a web-based, database application where the learner uses free text communication on the screen to interact with patient data. The VLE contains forms for history taking, clinical images, clinical data and X-rays. After reviewing the patient information, the student proposes therapy and makes prognostic evaluations of the case in free text. A usability test of the application was performed with seven dental students. The usability test showed that the software responded with correct answers to the majority of the free text questions. The application is generic in its basic functions and can be adapted to other dental or medical subject areas. A randomised controlled trial was carried out with 39 students who attended instruction in history taking with problem-based learning cases, lectures and seminars. In addition, 16 of the 39 students were randomly chosen to practise history taking using the virtual patient prior to their first patient encounter. The performance of each student was recorded on video during the patient sessions. The type and order of the questions asked by the student and the degree of empathy displayed towards the patient were analysed systematically on the videos. The data indicate that students who also undertook history taking with a virtual patient asked more relevant questions, spent more time on patient issues, and performed a more complete history interview compared with students who had only undergone standard teaching. The students who had worked with the virtual patient also seemed to have more empathy for the patients than the students who had not. The practising of history taking with a virtual patient appears to improve the capability of dental students to take a relevant oral health history. [source] Bayeswatch: an overview of Bayesian statisticsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2002Peter C. Austin PhD Abstract Increasingly, clinical research is evaluated on the quality of its statistical analysis. Traditionally, statistical analyses in clinical research have been carried out from a ,frequentist' perspective. The presence of an alternative paradigm , the Bayesian paradigm , has been relatively unknown in clinical research until recently. There is currently a growing interest in the use of Bayesian statistics in health care research. This is due both to a growing realization of the limitations of frequentist methods and to the ability of Bayesian methods explicitly to incorporate prior expert knowledge and belief into the analyses. This is in contrast to frequentist methods, where prior experience and beliefs tend to be incorporated into the analyses in an ad hoc fashion. This paper outlines the frequentist and Bayesian paradigms. Acute myocardial infarction mortality data are then analysed from both a Bayesian and a frequentist perspective. In some analyses, the two methods are seen to produce comparable results; in others, they produce different results. It is noted that in this example, there are clinically relevant questions that are more easily addressed from a Bayesian perspective. Finally, areas in clinical research where Bayesian ideas are increasingly common are highlighted. [source] Achievements in high-pressure science at the high-brilliance energy-dispersive X-ray absorption spectrometer of ESRF, ID24JOURNAL OF SYNCHROTRON RADIATION, Issue 6 2009Giuliana Aquilanti Although the idea of an X-ray absorption spectrometer in dispersive geometry was initially conceived for the study of transient phenomena, the instrument at the European Synchrotron Radiation facility has been increasingly exploited for studies at extreme conditions of pressure using diamond anvil cells. The main results of investigations at high pressure obtained at beamline ID24 are reviewed. These concern not only fundamental topics, such as the local and the electronic structure as well as the magnetic properties of matter, but also geological relevant questions such as the behaviour of Fe in the main components of the Earth's interior. [source] How to study postoperative nausea and vomitingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2002C. C. Apfel Anesthesiological journals are flooded by innumerable studies of postoperative nausea and vomiting (PONV). Nevertheless, PONV remains a continuing problem with an average incidence of 20,30%. This paper should provide essential information for the design, conduct, and presentation of these studies. It should also increase comparability among future studies and help clinicians in assessing and reading the literature on PONV. First, future studies should address new and relevant questions instead of repeatedly investigating prophylactically given antiemetics whose main results are predictable (e.g. already proven by meta-analysis). Second, group comparability should be based on well-proven risk factors and a simplified risk score for predicting PONV. Endless listings of doubtful risk factors should be avoided. Third, a realistic sample size estimation should be performed, i.e. in most cases at least 100 patients per group are necessary. Fourth, nausea, vomiting and rescue medication should be recorded and reported separately with the corresponding incidences (and number of patients with these separate symptoms), and the main end-point should be PONV. The entire observation period should cover 24 h. Additional reporting of the early (0,2 h) and delayed (2,24 h) postoperative period is desirable and should consider single and cumulative incidences. Lastly, interpretation of results should take into account the study hypothesis, sources of potential bias or imprecision, and the difficulties associated with multiplicity of analysis and outcomes. [source] Introduction: Comparative Perspectives on the Indigenous Rights Movement in Africa and the AmericasAMERICAN ANTHROPOLOGIST, Issue 4 2002Dorothy L. Hodgson Using ethnographic case studies, these "In Focus" articles explore the indigenous rights movements in two regions, Africa and the Americas, where the histories, agendas, and dynamics of the movements are at once similar and different. They consider a range of relevant questions about the politics of representation, recognition, resources, and rights as these movements engage shifting political and economic landscapes; transnational discourses, alliances, and organizations; and the complicated cultural politics of inclusion and exclusion invoked by the term indigenous. As such, they offer a critical, comparative perspective on the issues of culture, power, representation, and difference inherent in the complicated alliances, articulations, and tensions that have produced and transformed the transnational indigenous rights movement. This introduction provides a brief history of the movement, highlights some major themes in previous anthropological work, reviews the insights of the section articles, and explores some of the ways in which anthropologists have engaged with the movement. [Keywords: indigenous peoples, social movements, cultural politics, ethnography] [source] Ethical issues faced by field primatologists: asking the relevant questionsAMERICAN JOURNAL OF PRIMATOLOGY, Issue 9 2010Linda Marie Fedigan Abstract Field primatologists face unusual ethical issues. We study animals rather than people and receive research approval from animal care rather than ethics committees. However, animal care evaluation forms are developed from concerns about laboratory animal research and are based on the "Three R's" for humane treatment of captive experimental subjects (replacement, reduction and refinement), which are only debatably relevant to field research. Scientists who study wild, free-ranging primates in host countries experience many ethical dilemmas seldom dealt with in animal care forms. This paper reviews the ethical issues many field primatologists say they face and how these might be better addressed by animal care forms. The ethical issues arising for field researchers are divided into three categories: "Presence, Protocols and People" and for each the most frequent issues are described. The most commonly mentioned ethical concern arising from our presence in the field is the possibility of disease transmission. Although most primate field studies employ only observational protocols, the practice of habituating our study animals to close human presence is an ethical concern for many since it can lessen the animals' fear of all humans, thereby facilitating undesirable behaviors (e.g., crop-raiding) and rendering them vulnerable to harm. Field primatologists who work in host countries must observe national laws and local traditions. As conservationists, primatologists must often negotiate between the resource needs and cultural practices of local people and the interests of the nonhuman primates. Many say they face more ethical dilemmas arising from human interactions than from research on the animals per se. This review concludes with suggestions for relevant questions to ask on animal care forms, and actions that field primatologists can take to better inform animal care committees about the common ethical issues we experience as well as how to develop guidelines for addressing them. Am. J. Primatol. 72:754,771, 2010. © 2010 Wiley-Liss, Inc. [source] REVIEW ARTICLE: The Immune System in Pregnancy: A Unique ComplexityAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 6 2010Gil Mor Citation Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol 2010 Abstract Placental immune response and its tropism for specific viruses and pathogens affect the outcome of the pregnant woman's susceptibility to and severity of certain infectious diseases. The generalization of pregnancy as a condition of immune suppression or increased risk is misleading and prevents the determination of adequate guidelines for treating pregnant women during pandemics. There is a need to evaluate the interaction of each specific pathogen with the fetal/placental unit and its responses to design the adequate prophylaxis or therapy. The complexity of the immunology of pregnancy and the focus, for many years, on the concept of immunology of pregnancy as an organ transplantation have complicated the field and delayed the development of new guidelines with clinical implications that could help to answer these and other relevant questions. Our challenge as scientists and clinicians interested in the field of reproductive immunology is to evaluate many of the ,classical concepts' to define new approaches for a better understanding of the immunology of pregnancy that will benefit mothers and fetuses in different clinical scenarios. [source] How Can Research Organizations More Effectively Transfer Research Knowledge to Decision Makers?THE MILBANK QUARTERLY, Issue 2 2003JOHN N. LAVIS Applied research organizations invest a great deal of time, and research funders invest a great deal of money generating and (one hopes) transferring research knowledge that could inform decisions about health and health care. Basing these knowledge-transfer activities on our evolving understanding of the most effective approaches to knowledge transfer will help us achieve value for money in our individual and collective investments in health services and health policy research. Research organizations and research funders can probably be excused for not basing their activities on research evidence until now, however, because the variety of relevant questions, target audiences, and disciplinary perspectives and methodological approaches used in empirical studies has made the identification of take-home messages from this field of research a very difficult task. We provide an organizing framework for a knowledge-transfer strategy and an overview of our understanding of the current knowledge for each of the five elements of the framework. The framework provides an overall approach to knowledge transfer that can be evaluated as a whole over long periods of time, as well as specific elements that can be evaluated and fine-tuned over shorter periods of time. [source] Research Psychotherapy: Aspirin or Music?CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2009John F. Curry Beutler's call for an expanded psychotherapy agenda is appropriate but does not require downgrading the role of randomized clinical trials (RCTs). Large-scale RCTs are necessary to address questions of general public health importance. Within RCTs, psychotherapy can be conducted in a flexible, creative manner, similar to the practice of good clinicians. The aspirin analogy drawn from Klerman is not illustrative of how psychotherapy is actually conducted in contemporary clinical trials. A better analogy is that of music, which not only involves known ingredients and trainable, replicable skills, but also permits tailoring and improvisation. By conducting large RCTs, secondary analyses of these studies, and smaller controlled trials, psychotherapy researchers can address many clinically relevant questions. [source] | ||||||||||