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Research Settings (research + setting)
Selected AbstractsEthical Considerations for Administering Alcohol or Alcohol Cues to Treatment-Seeking Alcoholics in a Research Setting: Can the Benefits to Society Outweigh the Risks to the Individual?ALCOHOLISM, Issue 9 2009A commentary in the context of the National Advisory Council on Alcohol Abuse, Alcoholism, Recommended Council Guidelines on Ethyl Alcohol Administration in Human Experimentation (2005) First page of article [source] Cannabis Withdrawal among Adolescent Cannabis Users in an Outpatient Research SettingTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 6 2006Michael A. Dawes MD No abstract is available for this article. [source] A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of CareACADEMIC EMERGENCY MEDICINE, Issue 11 2009Edward Bernstein MD Abstract This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients. This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources. Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation. Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services. [source] Evaluation of Insulin Sensitivity in Clinical Practice and in Research SettingsNUTRITION REVIEWS, Issue 12 2003Lais U. Monzillo MD Insulin resistance is the core metabolic abnormality in type 2 diabetes. Its high prevalence and its association with dyslipidemia, hypertension, hyperinsulinemia, and high coronary and cerebrovascular mortality put it in the forefront as the plausible target for aggressive intervention. Measurements of insulin sensitivity provide clinicians and clinical researchers with invaluable instruments to objectively evaluate the efficiency of both current and potentially useful interventional tools. Although several methods had been developed and validated to evaluate insulin sensitivity, none of these methods can be universally used in all patients. Nonetheless, a method suitable for use in clinical or basic research may not necessarily be a practical method for use in clinical practice or for epidemiologic research. We reviewed the currently used methods for assessment of insulin sensitivity. For each method, we summarized its procedure, normal value, cut-off value for defining insulin resistance, advantages and limitations, validity, accuracy for each patient population, and suitability for use in clinical practice and in research settings. The methods reviewed include fasting plasma insulin, homeostatic model assessment, quantitative insulin sensitivity check index, glucose-to-insulin ratio, continuous infusion of glucose with model assessment, indices based on oral glucose tolerance test, insulin tolerance test, and the so called "gold standard" methods, the hyperinsulinemic euglycemic clamp and the frequently sampled-intravenous glucose tolerance test. [source] Do rural hospitals lag behind urban hospitals in addressing community health needs?AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009An analysis of recent trends in US community hospitals Abstract Objective:,This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs. Design:,This study used a multivariate, longitudinal research design. Research setting:,A cross-sectional survey was the setting for this study. Participants:,The participants were rural or urban hospitals in the United States. Main outcome measures:,The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location. Results:,Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information. Conclusions:,This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations. [source] Adenosine receptors: promising targets for the development of novel therapeutics and diagnostics for asthmaFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 1 2006Cristina Russo Abstract Interest in the role of adenosine in asthma has escalated considerably since the early observation of its powerful bronchoconstrictor effects in asthmatic but not normal airways. A growing body of evidence has emerged in support of a proinflammatory and immunomodulatory role for the purine nucleoside adenosine in the pathogenic mechanisms of chronic inflammatory disorders of the airways such as asthma. The fact that adenosine enhances mast cell allergen-dependent activation, that elevated levels of adenosine are present in chronically inflamed airways, and that adenosine given by inhalation cause dose-dependent bronchoconstriction in subjects with asthma emphasizes the importance of adenosine in the initiation, persistence and progression of these common inflammatory disorders of the airways. These distinctive features of adenosine have been recently exploited in the clinical and research setting to identify innovative diagnostic applications for asthma. In addition, because adenosine exerts its multiple biological activities by interacting with four adenosine receptor subtypes, selective activation or blockade of these receptors may lead to the development of novel therapies for asthma. [source] The Role of International Financial Reporting Standards in Accounting Quality: Evidence from the European UnionJOURNAL OF INTERNATIONAL FINANCIAL MANAGEMENT & ACCOUNTING, Issue 3 2010Huifa Chen Previous studies on the effect of International Financial Reporting Standards (IFRS) on accounting quality often have difficulties to control for confounding factors on accounting quality. As a result, the observed changes in accounting quality could not be attributed mainly to IFRS. We use a unique research setting to address this issue by comparing the accounting quality of publicly listed companies in 15 member states of the European Union (EU) before and after the full adoption of IFRS in 2005. We use five indicators as proxies for accounting quality. We find that the majority of accounting quality indicators improved after IFRS adoption in the EU. That is, there is less of managing earnings toward a target, a lower magnitude of absolute discretionary accruals, and higher accruals quality. But our results also show that firms engage in more earnings smoothing and recognize large losses in a less timely manner in post-IFRS periods. In addition, we examine the effects of institutional variables on financial reporting quality. Our contribution to the literature is that we show the improved accounting quality is attributable to IFRS, rather than changes in managerial incentives, institutional features of capital markets, and general business environment, etc. [source] Comparison of Serum-Free Thyroxine Concentrations Determined by Standard Equilibrium Dialysis, Modified Equilibrium Dialysis, and 5 Radioimmunoassays in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2004Sara Schachter Measurement of serum-free thyroxine (fT4) concentration provides a more accurate assessment of thyroid gland function than serum thyroxine (T4) or 3,5,3'-triiodothyronine (T3). Techniques for measuring serum fT4 concentration include standard equilibrium dialysis (SED), radioimmunoassay (RIA), and a combination of both (modified equilibrium dialysis [MED]). This study compared results of serum fT4 measurements by means of SED, MED, and 5 RIAs in 30 healthy dogs, 10 dogs with hypothyroidism, and 31 euthyroid dogs with concurrent illness for which hypothyroidism was a diagnostic consideration. Serum fT4 concentrations were comparable when determined by the SED and MED techniques, and mean serum fT4 concentrations were significantly (P<.01) lower in dogs with hypothyroidism than in healthy dogs and euthyroid dogs with concurrent illness. Significant (P < .05) differences in fT4 concentrations were identified among the 5 RIAs and among the RIAs and MED and SED. Serum fT4 concentrations were consistently lower when fT4 was determined by the RIAs, compared with either equilibrium dialysis technique. Serum fT4 concentrations were significantly lower (P < .01) in dogs with hypothyroidism than in healthy dogs for all RIAs; were significantly lower (P < .05) in dogs with hypothyroidism than in euthyroid dogs with concurrent illness for 4 RIAs; and were significantly lower (P < .01) in euthyroid dogs with concurrent illness than in healthy dogs for 4 RIAs. RIAs had the highest number of low serum fT4 concentrations in euthyroid dogs with concurrent illness. This study documented differences in test results among fT4 assays, emphasizing the importance of maintaining consistency in the assay used to measure serum fT4 concentrations in the clinical or research setting. [source] An evaluation of invasive and non-invasive tests for the diagnosis of Helicobacter pylori infection in ChineseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2001B. C. Y. Wong Background: Different tests are available for diagnosing Helicobacter pylori infection. Aim: To compare the most commonly used tests either alone or in combination in Chinese patients with respect to routine clinical use or research purpose. Methods: A total of 294 consecutive dyspeptic patients without previous H. pylori treatment were recruited. During upper endoscopy, biopsies were taken from the antrum and corpus, for a commercially available CLO-test, an in-house rapid urease test, culture, polymerase chain reaction and histological examination. Patients then received a 13C-urea breath test. The H. pylori status of each patient was determined by a concordance of test results. Results: For routine clinical use, histology (antral plus corpus biopsies) had an accuracy of 100%, whilst the rapid urease test had an accuracy of 99.7%. The 13C-urea breath test was equally reliable, with an accuracy of 94.5%. Combinations of two tests did not confer additional advantage over the most accurate single test. For research purposes, the accuracy of using the criteria of two positives out of three diagnostic tests was 100% and equivocal results were not found. Conclusion: Histology with or without a rapid urease test was highly accurate for routine clinical use. Alternatively, the 13C-urea breath test was an equally reliable non-invasive test. The two positives out of three tests approach was highly reliable in predicting H. pylori status of untreated Chinese patients in a research setting. [source] Lung-function tests in neonates and infants with chronic lung disease: Tidal breathing and respiratory controlPEDIATRIC PULMONOLOGY, Issue 5 2006BMedSc, David N. Baldwin MBBS Abstract This paper is the fourth in a series of reviews that will summarize available data and critically discuss the potential role of lung-function testing in infants with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses information derived from tidal breathing measurements within the framework outlined in the introductory paper of this series, with particular reference to how these measurements inform on control of breathing. Infants with acute and chronic respiratory illness demonstrate differences in tidal breathing and its control that are of clinical consequence and can be measured objectively. The increased incidence of significant apnea in preterm infants and infants with chronic lung disease, together with the reportedly increased risk of sudden unexplained death within the latter group, suggests that control of breathing is affected by both maturation and disease. Clinical observations are supported by formal comparison of tidal breathing parameters and control of breathing indices in the research setting. Pediatr Pulmonol. 2006; 41:391,419. © 2006 Wiley-Liss, Inc. [source] Guest Lecture 9.00,9.45 Wednesday 17 September 2003CYTOPATHOLOGY, Issue 2003Peter A. Hall MD PhD FRCPath The past decades have seen an explosion in our knowledge of the molecular events underpinning the pathogenesis of many disease processes. Furthermore, there have been enormous technical advances with the ability to identify, clone and sequence genes and to characterize their protein products now being common place in research settings. However, despite many claims as to the utility of molecular and biochemical methods in pathology only very few laboratories employ such methods in a clinical setting. Indeed the impact of molecular medicine has been more talked about than real. Why is this? The goal of this presentation is to address this question and present some perspectives on the future of Molecular Pathology. I shall overview, for the BSCC, the current state of the technology available for gene analysis and to explore the developments needed before the mirage of molecular pathology becomes a clinical reality. [source] GLOBAL HEALTH ETHICS FOR STUDENTSDEVELOPING WORLD BIOETHICS, Issue 1 2009ANDREW D. PINTO ABSTRACT As a result of increased interest in global health, more and more medical students and trainees from the ,developed world' are working and studying in the ,developing world'. However, while opportunities to do this important work increase, there has been insufficient development of ethical guidelines for students. It is often assumed that ethics training in developed world situations is applicable to health experiences globally. However, fundamental differences in both clinical and research settings necessitate an alternative paradigm of analysis. This article is intended for teachers who are responsible for preparing students prior to such experiences. A review of major ethical issues is presented, how they pertain to students, and a framework is outlined to help guide students in their work. [source] Development and validation of the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetesDIABETIC MEDICINE, Issue 8 2007H. Hearnshaw Abstract Aims To develop and validate an easy-to-use questionnaire to identify obstacles to self management in Type 2 diabetes. Methods The Diabetes Obstacles Questionnaire (DOQ) was developed from earlier research and the literature. It was completed by 180 people with Type 2 diabetes, recruited from 22 general practices in the UK. Responders also completed a quality-of-life questionnaire (ADDQoL) and the Problem Areas in Diabetes (PAID) scale. Results From analysis of the 176 usable questionnaires, 36 items of the original 113 items were deemed redundant. The remaining 77 items were assembled into eight sub-scales covering Medication, Self Monitoring, Knowledge and Beliefs, Diagnosis, Relationships with Health-Care Professionals, Lifestyle Changes, Coping, and Advice and Support. Each sub-scale had a factor structure of no more than three factors, had Cronbach's alpha of more than 0.75, and a Kaiser,Meyer,Olkin of more than 0.75. Each sub-scale correlated significantly with the PAID scale (P < 0.01), demonstrating criterion validity. Construct validity was shown by significant correlation between HbA1c and the sub-scales which relate to managing blood glucose levels: Self Monitoring, Relationship with Health-Care Professionals, Lifestyle Changes and Coping. Construct validity was further shown by significant correlation between QoL scores and Medication, Lifestyle Changes and Coping. Discussion The DOQ, comprising eight sub-scales, is a usable, valid instrument for both clinical and research settings. It helps to identify in detail the obstacles which an individual finds in living with Type 2 diabetes. [source] Diagnostic accuracy of digital photography and image analysis for the measurement of foot conformation in the horseEQUINE VETERINARY JOURNAL, Issue 7 2008J. M. WHITE Summary Reasons for performing study: Rigorous evaluation of practicable methods for the objective assessment of foot conformation has not been performed. Objectives: To assess the practicability, precision and accuracy of the process of obtaining measurements of horses' feet using photography and image processing software. Methods: Precision study: Lateral photographs of horses' feet were obtained twice by 2 veterinary surgeons (image acquisition - IAc). Photographs were analysed by 2 masked veterinary surgeons on 2 occasions (image analysis - IAn). Measurements were compared within and between operators for self and non-self acquired photographs. Agreement indices (AIs) and 95% limits of agreement (LOA) were calculated for the IAn process alone and for the combined IAc + IAn processes. Accuracy study: Measurements obtained from lateral photographs were compared with those obtained from lateromedial radiographs. AIs and 95% LOA were calculated for each measurement. Results: Precision study: Mean intra- and interoperator AIs for the IAn process alone were ,0.90 while those for the combined IAc + IAn processes were ,0.89 for all measurements. Similar mean AIs and 95% LOA were calculated regardless of image origin. The 95% LOA for hoof angle, heel height/toe height% and coronary band angle for all comparisons were within target values. Accuracy study: Mean AIs were ,0.89 for all measurements. The 95% LOA for heel height/toe height% and coronary band angle were within target values. Conclusions: Excellent precision was identified within and between operators regardless of image origin. High levels of accuracy were also identified, especially for heel height/toe height% and coronary band angle, indicating that photography and radiography may be used interchangeably. Potential relevance: Acquisition and analysis of photographic images is an appropriate method for the objective measurement of foot conformation, both in clinical and research settings. [source] Conducting Focus Groups with Latino Populations: Lessons from the Field,FAMILY RELATIONS, Issue 3 2004Adriana J. Umaña-Taylor We explore the use of focus groups with Latino families. Based on our work with Colombian, Guatemalan, Mexican, and Puerto Rican mothers, we review the factors that make this methodology particularly useful for working with these families. In addition, we provide a number of strategies for making the use of focus groups with Latino populations successful. These strategies can be broadly applied to practical aspects of working with Latino populations, as well as in research settings. [source] Performance-Based Measures of Physical Function for High-Function PopulationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006J. David Curb MD OBJECTIVES: To improve and broaden the applicability of performance-based measures of function for use in clinical and research settings. DESIGN: Cross-sectional repeated-measures study. SETTING: Research clinic. PARTICIPANTS: Population-based sample of Japanese Americans without significant functional impairments aged 35 to 55 and 56 to 71 (N=203). MEASUREMENTS: Performance-based measures of physical function, including range of standard tests, newer automated measures of balance and strength and data on cognitive function, lifestyle, medical history, and physical activity. RESULTS: Of the nonplatform balance measures, only the one-leg stand was reliable (reliability coefficient (rc) =0.69) and able to discriminate between functional levels. Combining the Fourth National Health and Nutrition Examination Survey protocol of folded arm position while standing on a foam pad with the more-sophisticated balance platform test had the highest reliability and discrimination. With the strength chair, high rcs (0.88,0.96) were found for upper and lower extremity tests. Timed chair stands, a test of lower extremity and central strength were reliable. The 6-minute walk had a high rc (0.90). CONCLUSION: Many performance tests used today are not reliable. Only a few discriminate between the most highly functioning individuals and individuals with good function. Thus, a new recommended battery includes unassisted single-leg stand, balance platform "foam pad, eyes closed," elbow flexion and knee extension strength (strength chair), grip strength, timed chair stands, and the 6-minute walk. These simple performance-based tests have good reliability and discrimination across the range of function and can be used in most clinical and research settings to quickly assess global functional level. [source] Estimating Cardiorespiratory Fitness in Well-Functioning Older Adults: Treadmill Validation of the Long Distance Corridor WalkJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2006Eleanor M. Simonsick PhD Objectives: To determine criterion validity of the 400-m walk component of the Long Distance Corridor Walk (LDCW) and develop equations for estimating peak oxygen consumption (VO2) from 400-m time and factors intrinsic to test performance (e.g., heart rate (HR) and systolic blood pressure (SBP) response) in older adults. Design: Cross-sectional validation study. Setting: Gerontology Research Center, National Institute on Aging, Baltimore, Maryland. Participants: Healthy volunteers (56 men and 46 women) aged 60 to 91 participating in the Baltimore Longitudinal Study of Aging between August 1999 and July 2000. Measurements: The LDCW, consisting of a 2-minute walk followed immediately by a 400-m walk "done as quickly as possible" over a 20-m course was administered the day after maximal treadmill testing. HR and SBP were measured before testing and at the end of the 400-m walk. Weight, height, activity level, perceived effort, and stride length were also acquired. Results: Peak VO2 ranged from 12.2 to 31.1 mL oxygen/kg per minute, and 400-m time ranged from 2 minutes 52 seconds to 6 minutes 18 seconds. Correlation between 400-m time and peak VO2 was ,0.79. The estimating equation from linear regression included 400-m time (partial coefficient of determination (R2)=0.625), long versus short stride (partial R2=0.090), ending SBP (partial R2=0.019), and a correction factor for fast 400-m time (<240 seconds; partial R2=0.020) and explained 75.5% of the variance in peak VO2 (correlation coefficient=0.87). Conclusion: A 400-m walk performed as part of the LDCW provides a valid estimate of peak VO2 in older adults. Incorporating low-cost, safe assessments of fitness in clinical and research settings can identify early evidence of physical decline and individuals who may benefit from therapeutic interventions. [source] Indices for studying urinary incontinence and levator ani function in primiparous womenJOURNAL OF CLINICAL NURSING, Issue 4 2003Cathy L. Antonakos PhD Summary ,,Urinary incontinence (UI) is a complex phenomenon that is prevalent in pregnant and parous women and requires the use of sophisticated measures to adequately reflect functioning of the continence system. ,,The purpose of this study was to develop reliable and valid measures of UI and levator ani function for use in research and clinical settings. ,,A Leakage Index (LI) and a Levator Ani Function Index (LAFI) were developed using data from a longitudinal study of primiparous women. Reliability and validity tests were conducted to: (i) estimate the internal consistency reliability of each index, (ii) determine whether the indices captured change in continence status and pelvic floor function during pregnancy through 1 year postpartum, and (iii) estimate association between the indices as a test of predictive validity. ,,Cronbach's alpha ranged from 0.72 to 0.84 for the LI and from 0.53 to 0.79 for the LAFI across the six data collection time points of the study. Average LI scores increased late in pregnancy and decreased postpartum, though not significantly. Average LAFI scores decreased significantly at 35 weeks gestation (t = 4.84, P = 0.000) and increased significantly at 12 months postpartum (t = ,3.51, P = 0.002) relative to baseline. The LI and LAFI were significantly associated at 20 weeks gestation (Pearson r = ,0.40, P = 0.007) and at 6 weeks postpartum (Pearson r = ,0.33, P = 0.029). ,,The findings suggest the LI and LAFI are reliable and valid measures of UI and levator ani function in primiparous women, which can be used with confidence in clinical and research settings. [source] The Effect of Moderate to Heavy Alcohol Consumption on Neuropsychological Performance as Measured by the Repeatable Battery for the Assessment of Neuropsychological StatusALCOHOLISM, Issue 3 2010Alisa Green Background:, Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the individual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined. The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance. Methods:, Data from a subset of "Using Our Brains" (UoB) donors (n = 28) still actively drinking and meeting criteria for moderate to heavy alcohol use (30 to 80 g of ethanol per day) (Harper, 1988) and 28 matched controls (age, education, and premorbid Intelligence Quotient) were compared. Results:, Participants in the alcohol group performed below the healthy control group on the visuospatial and immediate memory index, and also on the RBANS total score p < 0.001 and showed a greater decline in RBANS scores from estimated cross-sectional premorbid levels. There was a positive association between alcohol ingestion in the preceding 12 months and the language index p < 0.03 and the semantic fluency subtest (p < 0.03). Age was negatively associated with story memory (p < 0.02), coding (p < 0.001), list recognition (p < 0.01), story recall (p < 0.03), and figure recall (p < 0.02). Conclusion:, Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures. [source] Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: A survey of traumatic stress professionalsJOURNAL OF TRAUMATIC STRESS, Issue 5 2005Jon D. Elhai We report findings from a Web-based survey of the International Society for Traumatic Stress Studies' members (n = 227) regarding use of trauma exposure and posttraumatic assessment instruments. Across clinical and research settings, the most widely used tests included the Posttraumatic Stress Diagnostic Scale, Trauma Symptom Inventory, Life Events Checklist, Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale, PTSD Checklist, Impact of Event Scale,Revised, and Trauma Symptom Checklist for Children. Highest professional degree, time since degree award, and student status yielded no differences in extent of reported trauma assessment test use. [source] Evaluation of a Quality-of-Life Tool for Cats with Diabetes MellitusJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2010S.J.M. Niessen Background: Success in management of diabetes mellitus (DM) is defined as improvement of blood glucose concentrations and clinical signs. However, the psychological and social impact of DM and its daily treatment regimen on quality of life (QoL) of both animal and owner is uncertain. Hypothesis/Objectives: To design, validate, and apply a diabetic pet and owner-centered, individualized measure of impact of DM (DIAQoL-pet). Animals/Subjects: Two hundred and twenty-one owners of insulin-treated diabetic cats were recruited to complete the DIAQoL-pet. Methods: Discussions and pilot surveys with clinicians and owners of diabetic cats led to the design of 29 specific DM-associated QoL questions. Owners of diabetic cats completed the finalized survey. Each item was scored according to impact frequency and perceived importance. An item-weighted impact score (IWIS) for each item was calculated, as was an average-weighted impact score (AWIS) by averaging all IWISs. Principal component analysis and Cronbach's , calculation assessed the measure's reliability. Two overview questions measured overall QoL and diabetes-dependent QoL. Results: The DIAQoL-pet showed high reliability (Cronbach , 0.83). The AWIS was ,1.76 ± 2.4 (mean ± SD). Areas reported as most negatively impacting QoL included: "boarding difficulties" (IWIS ± SD: ,4.67 ± 5.3), "owner wanting more control" (,4.34 ± 4.7), "difficulties leaving cat with friends or family" (,4.21 ± 4.7), "worry" (,4.10 ± 3.9), "worry hypo" (,3.67 ± 3.5), "social life" (,3.48 ± 3.9), "costs" (,3.04 ± 3.8), and "work life" (,3.03 ± 3.7). Forty-one percent of owners believed their cat's life would be "a little better" without DM. Conclusions and Clinical Importance: The DIAQoL-pet proved robust and identified specific areas most negatively impacting on diabetic cats and their owners' QoL. This tool warrants further investigation for use in clinical or research settings. [source] Assessment of hepatic steatosis: comparison of quantitative and semiquantitative methods in 108 liver biopsiesLIVER INTERNATIONAL, Issue 4 2009Bruno Turlin Abstract Background: There is growing interest in the role of hepatic steatosis in liver injury. The current standard for steatosis assessment is histological grading, although there is variability in the scoring systems used. Aims: The aim of this study was to compare steatosis assessment by image analysis and histological grading. Methods: Three methods were used to measure steatosis: histological grading (from 0 to 4); estimation of the percentage of hepatocytes (to nearest 5%) with steatosis; and computer-assisted image analysis. Image analysis was performed on multiple fields for each biopsy with image pro plus 4.5, with steatotic droplets identified on the basis of shape, colour and size. Computer-selected objects were reviewed to ensure that these were steatotic droplets. The predictive accuracy of the three techniques was assessed using measures of obesity and insulin resistance (homeostasis model assessment) as the outcome variables. Results: There was a strong correlation between the results of image analysis and histological grade (rs=0.89, P<0.01), and estimated per cent steatosis (rs=0.93, P<0.01). The variability in the area of steatosis calculated by image analysis in different fields of a biopsy correlated with the total steatosis area (rs=0.93, P<0.01). Conclusions: Image analysis did not offer any additional predictive value when the association between degree of obesity or insulin resistance was correlated with the different methods of assessing steatosis. Image analysis allows measurement of area of steatosis in liver biopsy material and generates a continuous variable that facilitates statistical analysis. These aspects may prove beneficial in research settings. [source] A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplinesMEDICAL EDUCATION, Issue 9 2006Sara Kim Context, Case-based teaching is regarded as a superior instructional method compared with lectures in promoting a learner's critical thinking skills. While much is known about the role a discussion facilitator plays in case-based teaching, the debate on the influence of the format and structure of cases on learning is controversial. Objectives, We sought to identify strategies for constructing cases based on studies from multiple disciplines, which report the development and use of cases in teaching and learning. The purpose was to offer the medical and other educational communities a conceptual framework that can be examined in future research. Results, Based on a review of 100 studies, we synthesised 17 strategies around 5 core attributes of cases: relevant (level of learner, goals and objectives, setting of case narrative); realistic (authenticity, distractors, gradual disclosure of content); engaging (rich content, multiple perspectives, branching of content); challenging (difficulty, unusual cases, case structure, multiple cases), and instructional (build upon prior knowledge, assessment, feedback, and teaching aids). Discussion, Despite the wide use of cases in disparate disciplines, there has been no overarching study that synthesises strategies of case development or tests these strategies in research settings. The framework we developed can serve as a menu of case development options that educators and researchers can pilot and evaluate in their local settings. [source] Evaluation of Insulin Sensitivity in Clinical Practice and in Research SettingsNUTRITION REVIEWS, Issue 12 2003Lais U. Monzillo MD Insulin resistance is the core metabolic abnormality in type 2 diabetes. Its high prevalence and its association with dyslipidemia, hypertension, hyperinsulinemia, and high coronary and cerebrovascular mortality put it in the forefront as the plausible target for aggressive intervention. Measurements of insulin sensitivity provide clinicians and clinical researchers with invaluable instruments to objectively evaluate the efficiency of both current and potentially useful interventional tools. Although several methods had been developed and validated to evaluate insulin sensitivity, none of these methods can be universally used in all patients. Nonetheless, a method suitable for use in clinical or basic research may not necessarily be a practical method for use in clinical practice or for epidemiologic research. We reviewed the currently used methods for assessment of insulin sensitivity. For each method, we summarized its procedure, normal value, cut-off value for defining insulin resistance, advantages and limitations, validity, accuracy for each patient population, and suitability for use in clinical practice and in research settings. The methods reviewed include fasting plasma insulin, homeostatic model assessment, quantitative insulin sensitivity check index, glucose-to-insulin ratio, continuous infusion of glucose with model assessment, indices based on oral glucose tolerance test, insulin tolerance test, and the so called "gold standard" methods, the hyperinsulinemic euglycemic clamp and the frequently sampled-intravenous glucose tolerance test. [source] Practitioner Review: Bridging the gap between research and clinical practice in pediatric obesityTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2007Elissa Jelalian Background:, Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current review highlights findings from the empirical pediatric obesity treatment literature, with particular attention to diet, physical activity, and behavior interventions. Evaluation and treatment considerations relevant to working with overweight children and adolescents with psychiatric comorbidities are reviewed. Methods:, Review of the relevant treatment literature, with a focus on randomized clinical trials, was conducted. Recommendations regarding treatment of children and adolescents with psychiatric comorbidities are based on relevant prospective studies of the relationship between weight status and psychological variables and studies with adult populations. Results:, Well-established pediatric weight control interventions have been conducted in research settings. These studies provide a starting point, but are limited by homogeneous samples that may exclude participants with psychiatric comorbidities. Practitioners treating obese children and adolescents with psychiatric disorders are encouraged to assess individual, familial, and contextual variables specific to weight (e.g., motivation and existing support to change current eating and physical activity patterns, extent of weight-related conflict within family, impact of weight on current functioning) in order to prioritize treatment objectives. Conclusions:, The review concludes with a discussion of current empirical and practical challenges, including explicitly targeting obese children and adolescents with psychiatric concerns and determining appropriateness of pursuing weight control interventions in this population. [source] Specificity and characteristics of learning disabilitiesTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 10 2005Natasha Eisenmajer Background:, The specificity of impairments in specific reading disabilities (SRD) and specific language impairments (SLI) has recently been questioned, with many children recruited for studies of SRD and SLI demonstrating impairments in both reading and oral language development. This has implications for the results of SRD and SLI studies where both reading and oral language skills are not assessed. Thus there is a need to compare the profiles of children with both oral language and reading impairments to groups of children with SRD and SLI. Methods:, The reading, oral language, short-term auditory memory, phonological processing, spelling, and maths abilities of 151 children (aged between 7 and 12 years) drawn from a Learning Disabilities Clinic were assessed. Results:, Five groups were identified, including children who demonstrated either a specific reading disability or a specific language impairment and children who showed evidence of both reading and oral language impairments. Differences were found between the groups on maths, phonological processing, short-term auditory memory, and spelling measures, with the children displaying both language and reading deficits generally performing at a lower level than the children with specific reading or language deficits. Conclusions:, It was concluded that more careful screening needs to be conducted in both clinical and research settings to accurately identify the nature of deficits in children with reading and oral language difficulties. Furthermore, a third and separate category of children with a mixed pattern of impairments needs to be considered. [source] Incidental Findings in Pediatric ResearchTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 2 2008Benjamin S. Wilfond The approach to incidental research fndings in children emerges by considering the child-parent relationship and balancing divergent interests and preferences. Incidental fndings with clear and proximate clinical importance should be disclosed to both. We recommend that particularly sensitive or private information (e.g., pregnancy or drug use) should be disclosed to the adolescent frst, while particularly serious information (e.g., cancer) should frst be disclosed to the parent. These approaches allow the researcher to form an alliance with one party prior to engaging the other. However, unlike clinical settings, where there may be presumptive expectations of confdentiality about sharing information within the family, in most research settings it is reasonable to plan to disclose such information to both parties. It is important to communicate this plan during the informed consent process separately to adolescents to avoid enrolling adolescents when sensitive incidental fndings such as pregnancy and drug use may be detected. The approach to incidental fndings without clear and proximate beneft is challenging. Researchers should plan more limited disclosure of such incidental fndings for pediatric participants than for adult participants. [source] A Partially Linear Tree-based Regression Model for Multivariate OutcomesBIOMETRICS, Issue 1 2010Kai Yu Summary In the genetic study of complex traits, especially behavior related ones, such as smoking and alcoholism, usually several phenotypic measurements are obtained for the description of the complex trait, but no single measurement can quantify fully the complicated characteristics of the symptom because of our lack of understanding of the underlying etiology. If those phenotypes share a common genetic mechanism, rather than studying each individual phenotype separately, it is more advantageous to analyze them jointly as a multivariate trait to enhance the power to identify associated genes. We propose a multilocus association test for the study of multivariate traits. The test is derived from a partially linear tree-based regression model for multiple outcomes. This novel tree-based model provides a formal statistical testing framework for the evaluation of the association between a multivariate outcome and a set of candidate predictors, such as markers within a gene or pathway, while accommodating adjustment for other covariates. Through simulation studies we show that the proposed method has an acceptable type I error rate and improved power over the univariate outcome analysis, which studies each component of the complex trait separately with multiple-comparison adjustment. A candidate gene association study of multiple smoking-related phenotypes is used to demonstrate the application and advantages of this new method. The proposed method is general enough to be used for the assessment of the joint effect of a set of multiple risk factors on a multivariate outcome in other biomedical research settings. [source] | |||||||||||||||||||