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Rigorous Evaluation (rigorous + evaluation)
Selected AbstractsDemography of the California Condor: Implications for ReestablishmentCONSERVATION BIOLOGY, Issue 4 2000Vicky J. Meretsky The most prominent mortality factor was lead poisoning resulting from ingestion of bullet fragments in carcasses. Successful captive breeding has allowed many birds to be released to the wild since 1992, based originally on an assumption that exposure to lead could be prevented by food subsidy. The mortality of released birds, however, has generally exceeded levels needed for population stability calculated from simple population models. Collision with overhead wires was the most frequent cause of death in releases before 1994. Lead poisoning again surfaced as a problem starting in 1997 as older birds began feeding on carcasses outside the subsidy program. Although poisonings have been treated successfully by chelation therapy in recaptured birds, food subsidy is proving an ineffective solution to lead exposure. The best long-term solution appears to be either the creation of large reserves where hunting is prohibited or the restriction of hunting to nontoxic ammunition in release areas. Until sources of lead contamination are effectively countered, releases cannot be expected to result in viable populations. In addition, problems involving human-oriented behavior have resulted in the permanent removal of many released birds from the wild. The most promising reduction in human-oriented behavior has been achieved in one release of aversively conditioned, parent-reared birds. Rigorous evaluation of the factors reducing attraction to humans and human structures has been hampered by confounding of techniques in releases. Behavioral problems could be more quickly overcome by adoption of a comprehensive experimental approach. Resumen: Las poblaciones silvestres remanentes del cóndor de California (Gymnogyps californianus) de los anõs 80 exhibieron una disminución poblacional rápida debido a altas tasas de mortalidad de individuos adultos e inmaduros. El factor de mortalidad más prominente fue el envenenamiento por plomo ocasionado por la ingestión de fragmentos de municiones en cadáveres. La reproducción exitosa en cautiverio ha permitido muchas liberaciones en ambientes silvestres desde 1992, bajo el argumento de que la exposición al plomo puede ser prevenida mediante el subsidio de alimento. Sin embargo, la mortalidad de aves liberadas ha excedido generalmente los niveles necesarios para alcanzar una estabilidad poblacional calculada a partir de modelos poblacionales simples. Las colisiones con alambres en lo alto fueron la causa más frecuente de las muertes en liberaciones anteriores a 1994. A partir de 1997, el envenenamiento con plomo surgió una vez más como un problema, puesto que las aves de edad avanzada comenzaron a alimentarse de cadáveres fuera del programa de subsidio. A pesar de que el envenenamiento ha sido tratado exitosamente mediante terapia de quelación de las aves recapturadas, el subsidio de alimento ha probado ser una solución ineficaz contra la exposición al plomo. Las mejores soluciones de largo plazo aparentan ser la creación de reservas grandes donde la caza sea prohibida o se restrinja la caza a municiones no tóxicas en las áreas de liberación. Solo una vez que la contaminación por plomo sea contrarrestada efectivamente, no se podrá esperar que las liberaciones resulten en poblaciones viables. Además, los problemas de conductas orientadas hacia humanos ha resultado en la remoción permanente de muchas aves liberadas de zonas silvestres. La reducción más prometedora de conductas orientadas hacia humanos ha sido obtenida en una liberación de aves criadas por sus padres y condicionadas adversamente. La evaluación rigurosa de los factores que reducen la atracción hacia humanos y estructuras de humanos ha sido obstaculizada por la confusión de técnicas en las liberaciones. Los problemas de conducta podrían ser superados más rápidamente mediante la adopción de una estrategia experimental comprensiva. [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] In-vitro release of bupivacaine from injectable lipid formulations investigated by a single drop technique , relation to duration of action in-vivoJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 6 2002Lars Söderberg The aim of this study was to develop an in-vitro release method suitable for injectable slow-release lipid formulations of local anaesthetics (or other drugs). We also aimed that the results of the in-vitro measurements should have a clear relationship to duration of action in-vivo. Six formulations of bupivacaine base in medium-chain triglyceride-glyceryl dilaurate mixtures were developed. A new apparatus was constructed for determination of their in-vitro release profiles. A bulbous glass tube was fixed inside a standard glass bottle, which was then filled with release medium. A stirring magnet was enclosed in the perforated polypropylene cylinder holding the glass tube. The stirring created a continuous, rotating downward flow of medium inside the tube, which kept the lipid phase, introduced by means of a syringe, suspended as a single, free drop. Release profiles were obtained by sampling of the release medium for up to 72 h and analysis by gas-liquid chromatography. The duration of action in-vivo of the respective formulations was tested by the hot-plate method in rats. The release profiles of bupivacaine in-vitro were mono-exponential for four formulations and bi-exponential for the other two. There was a positive correlation between the proportion of glyceryl dilaurate in the formulation and the slow half-life of release of bupivacaine. All formulations showed prolonged duration of action in-vivo, median values within the range 4.5,12 h, as compared with a 2-h effect of bupivacaine hydrochloride solution. A comparison of in-vitro release curves and durations of action in-vivo suggested that to maintain nerve blockade in-vivo the formulations must release bupivacaine at a rate of approximately 350 ,g h,1 under the in-vitro conditions. To conclude, we designed and tested a novel apparatus for measuring release of a local anaesthetic (or other drug) from a fluid or semi-solid formulation in-vitro. Release rates obtained in-vitro by means of this technique may be used to guide the development of formulations with suitable durations of action in-vivo. The apparatus is, however, as yet a prototype. Rigorous evaluation of performance should be carried out on devices built to specific standards according to their intended application. [source] "I Am Not Alone": The Feasibility and Acceptability of Interactive Voice Response-Facilitated Telephone Peer Support Among Older Adults With Heart FailureCONGESTIVE HEART FAILURE, Issue 3 2007Michele Heisler MD Patient self-management is a critical determinant of heart failure (HF) outcomes, yet patients with HF are often frail and socially isolated, factors that may limit their ability to manage self-care and access clinic-based services. Mobilizing peer support among HF patients is a promising strategy to improve self-management support. In this pilot, the authors evaluated the feasibility and acceptability of an interactive voice response (IVR)-based platform to facilitate telephone peer support among older adults with HF. Participants completed a baseline survey, were offered a 3-hour training session in peer communication skills, and were paired with another patient who had HF. Participants were asked to contact their partner weekly using a toll-free IVR phone system that protected their anonymity and provided automated reminders if contacts were not made. Times and duration of participants' telephone contacts were monitored and recorded. After the 7-week intervention, participants completed surveys and brief face-to-face interviews. The authors found high levels of use and satisfaction and improvements in depressive symptoms among the 20 pilot study participants. An IVR peer-support intervention is feasible, is acceptable to patients, and may have positive effects on patients' HF social support and health outcomes, in conjunction with structured health system support, that warrant more rigorous evaluation in a randomized trial. [source] Warnings on alcohol containers and advertisements: International experience and evidence on effectsDRUG AND ALCOHOL REVIEW, Issue 4 2009CLAIRE WILKINSON Abstract Issues. In light of possible introduction of alcohol warning labels in Australia and New Zealand, this paper discusses the international experience with and evidence of effects of alcohol warning labels. Approach. The report describes international experience with providing information and warnings concerning the promotion or sale of alcoholic beverages, and considers the evidence on the effects of such information and warnings. The experience with and evaluations of the effects of tobacco warning labels are also considered. Key Findings. The most methodologically sound evaluations of alcohol warning labels are based on the US experience. Although these evaluations find little evidence that the introduction of the warning label in the USA had an impact on drinking behaviour, there is evidence that they led to an increase in awareness of the message they contained. In contrast, evaluations of tobacco warning labels find clear evidence of effects on behaviour. Implications. There is a need and opportunity for a rigorous evaluation of the impacts of introducing alcohol warning labels to add to the published work on their effectiveness. The experience with tobacco labels might guide the way for more effective alcohol warning labels. Conclusion. Alcohol warning labels are an increasingly popular alcohol policy initiative. It is clear that warning labels can be ineffective, but the tobacco experience suggests that effective warning labels are possible. Any introduction of alcohol warning labels should be evaluated in terms of effects on attitudes and behaviour.[Wilkinson C, Room R. Warnings on alcohol containers and advertisements: International experience and evidence on effects. Drug Alcohol Rev 2009;28:426,435] [source] The work of health visitors and school nurses with children with psychological and behavioural problemsJOURNAL OF ADVANCED NURSING, Issue 4 2008Philip Wilson Abstract Title., The work of health visitors and school nurses with children with psychological and behavioural problems Aim., This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work. Background., There is little published information on the work performed by non-specialist community nurses with children and young people who have psychological, emotional and behavioural problems. Method., We analysed data from a survey conducted in 2002 , 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free-text describing the cases seen by respondents. Responses from a sub-sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text. Findings., Although community-based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self-harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training. Conclusion., The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people. [source] A review of the impact and effectiveness of nurse-led care in dermatologyJOURNAL OF CLINICAL NURSING, Issue 1 2007Cert Ed, Molly Courtenay BSc Aims and objectives., To identify systematically, summarize and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in dermatology. Background., A diverse range of nurse-led models of care exist in dermatology. Primary studies have been conducted evaluating these models, but review and synthesis of the findings from these studies have not been undertaken. Method., Systematic searches of CINAHL, MEDLINE, British Nursing Index (BNI) and the RCN Library Catalogue from 1990 until March 2005. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. Results., Fourteen relevant publications were identified and included findings from both primary and secondary care. The evidence indicates that nurses are treating a number of dermatological conditions, primarily using treatment protocols, across a broad range of clinical settings. However, some nurses working in primary care, lack confidence to treat some of these conditions and the educational needs of these nurses are frequently unmet. A reduction in the severity of the condition and more effective use of topical therapies are benefits of nurse interventions on service delivery. Faster access to treatment, a reduction in referrals to the general practitioner or dermatologist and an increase in knowledge of their condition are benefits reported by patients. Conclusions., Findings of the review are generally positive. However, there are methodological weaknesses and under researched issues, e.g. cost effectiveness of nurse-led care and the prescription of medicines by nurses for patients with dermatological conditions that point to the need for further rigorous evaluation. Relevance to clinical practice., Nurse-led care is an integral element of the dermatology service offered to patients. This review highlights the impact of this care and the issues that require consideration by those responsible for the development of nurse-led models of care in dermatology. [source] A systematic review of controlled trials evaluating interventions in adult literacy and numeracyJOURNAL OF RESEARCH IN READING, Issue 2 2005Carole Torgerson This paper reports a systematic review of the quasi-experimental literature in the field of adult literacy and numeracy, published between 1980 and 2002. We included 27 controlled trials (CTs) that evaluated strategies and pedagogies designed to increase adult literacy and numeracy: 18 CTs with no effect sizes (incomplete data) and 9 CTs with full data. These nine trials are examined in detail for this paper. Of these nine trials, six evaluated interventions in literacy and three evaluated interventions in literacy and numeracy. Three of the nine trials showed a positive effect for the interventions, five trials showed no difference and one trial showed a positive effect for the control treatment. The quality of the trials was variable, but many of them had some methodological problems. There was no evidence of publication bias in the review. There have been few attempts to expose common adult literacy or numeracy programmes to rigorous evaluation and therefore in terms of policy and practice it is difficult to make any recommendations as to the type of adult education that should be supported. In contrast, however, the review does provide a strong steer for the direction to be taken by educational researchers: because of the present inadequate evidence base rigorously designed randomised controlled trials and quasi-experiments are required as a matter of urgency. [source] Measuring knowledge of natural selection: A comparison of the CINS, an open-response instrument, and an oral interviewJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 10 2008Ross H. Nehm Abstract Growing recognition of the central importance of fostering an in-depth understanding of natural selection has, surprisingly, failed to stimulate work on the development and rigorous evaluation of instruments that measure knowledge of it. We used three different methodological tools, the Conceptual Inventory of Natural Selection (CINS), a modified version of Bishop and Anderson's (Bishop and Anderson [1990] Journal of Research in Science Teaching 27: 415,427) open-response test that we call the Open Response Instrument (ORI), and an oral interview derived from both instruments, to measure biology majors' understanding of and alternative conceptions about natural selection. We explored how these instruments differentially inform science educators about the knowledge and alternative conceptions their students harbor. Overall, both the CINS and ORI provided excellent replacements for the time-consuming process of oral interviews and produced comparable measures of key concept diversity and, to a lesser extent, key concept frequency. In contrast, the ORI and CINS produced significantly different measures of both alternative conception diversity and frequency, with the ORI results completely concordant with oral interview results. Our study indicated that revisions of both the CINS and ORI are necessary because of numerous instrument items characterized by low discriminability, high and/or overlapping difficulty, and mismatches with the sample. While our results revealed that both instruments are valid and generally reliable measures of knowledge and alternative conceptions about natural selection, a test combining particular components of both instruments,a modified version of the CINS to test for key concepts, and a modified version of the ORI to assess student alternative conceptions,should be used until a more approprite instrument is developed and rigorously evaluated. © 2008 Wiley Periodicals, Inc. J Res Sci Teach 45: 1131,1160, 2008 [source] How effective is antenatal care in preventing maternal mortality and serious morbidity?PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2001An overview of the evidence This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them. [source] A retrospective evaluation of congestive heart failure and myocardial ischemia events in 14,237 patients with type 2 diabetes mellitus enrolled in 42 short-term, double-blind, randomized clinical studies with rosiglitazonePHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2008Alexander Cobitz MD Abstract Purpose Retrospectively investigate potential associations between rosiglitazone and congestive heart failure (CHF) and, separately, events of myocardial ischemia. Methods Data from 14,237 individuals in 42 short-term, double-blind, randomized studies of rosiglitazone versus placebo or active diabetes medications were analyzed across seven treatment comparisons using an exact logistic regression model, adjusted for number of major cardiovascular risk factors and duration of exposure. Results CHF incidence ranged 0,1.27% (SAEs) and 0.12,2.42% (all AEs) with rosiglitazone versus 0.07,0.75% (SAEs) and 0.25,1.36% (all AEs) with control. Higher odds ratios (95%CI) were observed for CHF SAEs with sulfonylurea- and insulin-containing combinations: rosiglitazone monotherapy versus placebo, 0.25 (<0.01,4.75); rosiglitazone monotherapy versus sulfonylurea/metformin monotherapy, 0.23 (<0.01,2.14); sulfonylurea,+,rosiglitazone versus sulfonylurea monotherapy, 0.95 (0.01,75.20); metformin,+,rosiglitazone versus metformin monotherapy, 0.60 (0.00,8.28); metformin,+,rosiglitazone versus metformin,+,sulfonylurea, 1.04 (0.39,2.86); sulfonylurea,+,metformin,+,rosiglitazone versus sulfonylurea,+,metformin, 3.15 (0.35,150.52); insulin,+,rosiglitazone versus insulin monotherapy, 1.63 (0.52,6.01). Myocardial ischemia incidence ranged 0.75,1.40% (SAEs) and 1.49,2.77% (all AEs) with rosiglitazone versus 0.21,2.04% (SAEs) and 0.56,2.38% (all AEs) with control. Each comparison had an OR >1, with wide confidence intervals generally including unity. With data pooling, more events of myocardial ischemia were observed with rosiglitazone (2.00%) versus control (1.53%) (HR 1.30, 95%CI 1.004,1.69). Conclusions CHF incidence may be greater when rosiglitazone is combined with sulfonylureas or insulin. When data were pooled, more events of myocardial ischemia were observed with rosiglitazone versus control. Final results from RECORD will allow a more rigorous evaluation of the cardiovascular safety profile. Copyright © 2008 John Wiley & Sons, Ltd. [source] Design of a Small Centrifugal Blood Pump With Magnetic BearingsARTIFICIAL ORGANS, Issue 9 2009Said Jahanmir Abstract Design of a blood pump with a magnetically levitated rotor requires rigorous evaluation of the magnetic bearing and motor requirements and analysis of rotor dynamics and hydraulic performance with attention to hemolysis and thrombosis potential. Given the desired geometric dimensions, the required operating speed, flow in both the main and wash flow regions, and magnetic bearing performance, one of several design approaches was selected for a new prototype. Based on the estimated operating speed and clearance between the rotor and stator, the motor characteristics and dimensions were estimated. The motor stiffness values were calculated and used along with the hydraulic loading due to the fluid motion to determine the best design for the axial and radial magnetic bearings. Radial and axial stability of the left ventricular assist device prototype was verified using finite element rotor dynamic analysis. The analysis indicated that the rotor could be completely levitated and spun to the desired operating speed with low power loss and no mechanical contact. In vitro experiments with a mock loop test setup were performed to evaluate the performance of the new blood pump prototype. [source] Methods: Measuring physical activity in public open space , an electronic device versus direct observationAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2002Andrew J. Milat Objective: To evaluate the practicality and validity of using infra-red beam counters (IRBCs) to measure walking path use and overall park use. Method: Direct observation was carried out simultaneously with IRBC data collection in five parks on seven non-consecutive days during February-March in 1998 and on matched days in 1999. A second validation study was undertaken in one park in October 1999. Results: The IRBC over-estimated the observed number of people using walking paths by 14% to 78%. When assessed by path volume, the difference between the IRBC and observer ranged from 10% under-estimation to 16% over-estimation. In a more rigorous evaluation of path volume the IRBC under-estimated the observed count by 20%. The extent to which the IRBC equated with the number of observed park users varied from 69% underestimation to no difference. Conclusion: IRBCs are not appropriate for measuring the number of people engaging in physical activity in parks. Implications: IRBCs cannot replace direct observation for the collection of valid data on physical activity participation in parks. Further research is needed to determine settings in which electronic devices such as IRBCs may provide valid data on physical activity participation. [source] Evidence-Based Strategies for Reducing Cesarean Section Rates: A Meta-AnalysisBIRTH, Issue 1 2007Nils Chaillet PhD ABSTRACT: Background: Canada's cesarean section rate reached an all-time high of 22.5 percent of in-hospital deliveries in 2002 and was associated with potential maternal and neonatal complications. Clinical practice guidelines represent an appropriate mean for reducing cesarean section rates. The challenge now lies in implementing these guidelines. Objectives of this meta-analysis were to assess the effectiveness of interventions for reducing the cesarean section rate and to assess the impact of this reduction on maternal and perinatal mortality and morbidity. Methods: The Cochrane Library, EMBASE, and MEDLINE were consulted from January 1990 to June 2005. Additional studies were identified by screening reference lists from identified studies and expert suggestions. Studies involving rigorous evaluation of a strategy for reducing overall cesarean section rates were identified. Randomized controlled trials, controlled before-and-after studies, and interrupted time series studies were evaluated according to Effective Practice and Organisation of Care Group criteria. Results: Among the 10 included studies, a significant reduction of cesarean section rate was found by random meta-analysis (pooled RR = 0.81 [0.75, 0.87]). No evidence of publication bias was identified. Audit and feedback (pooled RR = 0.87 [0.81, 0.93]), quality improvement (pooled RR = 0.74 [0.70, 0.77]), and multifaceted strategies (pooled RR=0.73 [0.68, 0.79]) were effective for reducing the cesarean section rate. However, quality improvement based on active management of labor showed mixed effects. Design of studies showed a higher effect for noncontrolled studies than for controlled studies (pooled RR = 0.76 [0.72, 0.81] vs 0.92 [0.88, 0.96]). Studies including an identification of barriers to change were more effective than other interventions for reducing the cesarean section rate (pooled RR = 0.74 [0.71, 0.78] vs 0.88 [0.82, 0.94]). Among included studies, no significant differences were found for perinatal and neonatal mortality and perinatal and maternal morbidity with respect to the mode of delivery. Only 1 study showed a significant reduction of neonatal and perinatal mortality (p < 0.001). Conclusions: The cesarean section rate can be safely reduced by interventions that involve health workers in analyzing and modifying their practice. Our results suggest that multifaceted strategies, based on audit and detailed feedback, are advised to improve clinical practice and effectively reduce cesarean section rates. Moreover, these findings support the assumption that identification of barriers to change is a major key to success. (BIRTH 34:1 March 2007) [source] Do Knowledge and Experience Have Specific Roles in Triage Decision-making?ACADEMIC EMERGENCY MEDICINE, Issue 8 2007EmergCert, GradDipNsg, Julie Considine RN Accuracy of triage decisions is a major influence on patient outcomes. Triage nurses' knowledge and experience have been cited as influential factors in triage decision-making. The aim of this article is to examine the independent roles of factual knowledge and experience in triage decisions. All of the articles cited in this review were research papers that examined the relationship between triage decisions and knowledge and/or experience of triage nurses. Numerous studies have shown that factual knowledge is an important factor in improving triage decisions. Although a number of studies have examined the role of experience as an independent influence on triage decisions, none have found a significant relationship between experience and triage decision-making. Factual knowledge appears to be more important than years of emergency nursing or triage experience in triage decision accuracy. Many triage education programs are underpinned by the assumption that knowledge acquisition will result in improved triage decisions. A better understanding of the relationships between clinical decisions, knowledge, and experience is pivotal for the rigorous evaluation of education programs. [source] Reviewing child deaths,learning from the American experience,CHILD ABUSE REVIEW, Issue 2 2005Lisa Bunting Abstract Current systems for investigating child deaths in England, Wales and Northern Ireland have come under intense scrutiny in recent years and questions have been raised about the accuracy of child death investigations and resulting statistics. Research has highlighted the ways in which multidisciplinary input can contribute to investigative and review processes, a perspective which is further supported by recent UK policy developments. The experience of creating multidisciplinary child death review teams (CDRTs) in America highlights the potential benefits the introduction of a similar system might have. These benefits include improved multi-agency working and communication, more effective identification of suspicious cases, a decrease in inadequate death certification and a broader and more in-depth understanding of the causes of child deaths through the systematic collection and analysis of data. While a lack of funding, regional coordination and evaluation limit the impact of American CDRTs, the positive aspects of this process make it worthwhile, and timely, to consider how such a model might fit within our own context. Current policy developments such as the Home Office review of coroner services, the Children Bill and related Department for Education and Skills (DfES) work on developing screening groups demonstrate that strides have been made in respect of introducing a multidisciplinary process. Similarly, the development of local protocols for the investigation and[sol ]or review of child deaths in England, Wales and Northern Ireland highlights an increased focus on multidisciplinary processes. However, key issues from the American experience, such as the remit of CDRTs[sol ]screening panels, the need for national coordination and the importance of rigorous evaluation, can inform the development of a similar process in the UK. Copyright © 2005 John Wiley & Sons, Ltd. [source] ANABOLIC AGENTS FOR IMPROVING MUSCLE REGENERATION AND FUNCTION AFTER INJURYCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2008Gordon S Lynch SUMMARY 1In the present review, we describe how muscles can be injured by external factors, internal factors or during the performance of some actions during sports. In addition, we describe the injury to a muscle that occurs when its blood supply is interrupted, an occurrence common in clinical settings. An overview of muscle regeneration is presented, as well as a discussion of some of the potential complications that can compromise successful muscle repair and lead to impaired function and permanent disability. 2Improving muscle regeneration is important for hastening muscle repair and restoring muscle function and the present review describes ways in which this can be achieved. We describe recent advances in tissue engineering that offer considerable promise for treating muscle damage, but highlight the fact that these techniques require rigorous evaluation before they can become mainstream clinical treatments. 3Growth-promoting agents are purported to increase the size of existing and newly regenerating muscle fibres and, therefore, could be used to improve muscle function if administered at appropriate times during the repair process. The present review provides an update on the efficacy of some growth-promoting agents, including anabolic steroids, insulin-like growth factor-I (IGF-I) and b2 -adrenoceptor agonists, to improve muscle function after injury. Although these approaches have clinical merit, a better understanding of the androgenic, IGF-I and b-adrenoceptor signalling pathways in skeletal muscle is important if we are to devise safe and effective therapies to enhance muscle regeneration and function after injury. [source] Standardizing evaluation of on-line continuing medical education: Physician knowledge, attitudes, and reflection on practiceTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2004Associate Director, Dr. Linda Casebeer PhD Associate Professor Abstract Introduction: Physicians increasingly earn continuing medical education (CME) credits through on-line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on-line CME courses. Methods: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on-line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003. Data were collected at baseline, at course completion, and 4 weeks later. Paired t tests were used to compare the means of responses across time. Results: U.S. physicians completed 720 post-tests. Quality of content was the characteristic of most importance to participants; too little interaction was the largest source of dissatis-faction. Overall mean knowledge scores increased from 58.1% to 75.6% at post-test and then decreased to 68.2% at 4 weeks following the course. Effect sizes of increased knowledge immediately following the course were larger for case-based than for text-based courses. Nearly all physicians reported making changes in practice following course completion, although reported changes differed from expected changes. Conclusions: Increases in physician knowledge and knowledge retention were demonstrated following participation in on-line CME courses. The implementation of standardized evaluation tests proved to be feasible and allowed longitudinal evaluation analyses across CME providers and content areas. [source] A systematic approach to biological control agent exploration and prioritisation for prickly acacia (Acacia nilotica ssp. indica)AUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 4 2006K Dhileepan Abstract, Agent selection for prickly acacia has been largely dictated by logistics and host specificity. Given that detailed ecological information is available on this species in Australia, we propose that it is possible to select agents based on agent efficacy and desired impact on prickly acacia demography. We propose to use the ,plant genotype' and ,climatic' similarities as filters to identify areas for future agent exploration; and plant response to herbivory and field host range as ,predictive' filters for agent prioritisation. Adopting such a systematic method that incorporates knowledge from plant population ecology and plant,herbivore interactions makes agent selection decisions explicit and allow more rigorous evaluations of agent performance and better understanding of success and failure of agents in weed biological control. [source] | |||||||||||||||||||||||||