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Summary Report (summary + report)
Selected AbstractsNonadherence Consensus Conference Summary ReportAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009R. N. Fine This report is a summary of a ,Consensus Conference' on nonadherence (NA) to immunosuppressants. Its aims were: (1) to discuss the state-of-the-art on the definition, prevalence and measurement of NA, its risk factors and impact on clinical and economical outcomes and interventions and (2) to provide recommendations for future studies. A two-day meeting was held in Florida in January 2008, inviting 66 medical and allied health adherence transplant and nontransplant experts. A scientific committee prepared the meeting. Consensus was reached using plenary and interactive presentations and discussions in small break-out groups. Plenary presenters prepared a summary beforehand. Break-out group leaders initiated discussion between the group members prior to the meeting using conference calls and e-mail and provided a summary afterward. Conclusions were that NA: (a) is more prevalent than we assume; (b) is hard to measure accurately; (c) tends to confer worse outcomes; (d) happens for a number of reasons, and system-related factors including the patient's culture, the healthcare provider and the setting and (e) it is not currently known how to improve adherence. This consensus report provided some roadmaps for future studies on this complicated, multifaceted problem. [source] Summary report on the 19th International Congress of Zoology, Beijing, August 2004INTEGRATIVE ZOOLOGY (ELECTRONIC), Issue 1 2006Yan XIE [source] Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD eraLIVER TRANSPLANTATION, Issue S10 2004Kim M. Olthoff A national conference was held to review and assess data gathered since implementation of MELD and PELD and determine future directions. The objectives of the conference were to review the current system of liver allocation with a critical analysis of its strengths and weaknesses. Conference participants used an evidence-based approach to consider whether predicted outcome after transplantation should influence allocation, to discuss the concept of minimal listing score, to revisit current and potential expansion of exception criteria, and to determine whether specific scores should be used for automatic removal of patients on the waiting list. After review of data from the first 18 months since implementation, association and society leaders, and surgeons and hepatologists with wide regional representation were invited to participate in small group discussions focusing on each of the main objectives. At the completion of the meeting, there was agreement that MELD has had a successful initial implementation, meeting the goal of providing a system of allocation that emphasizes the urgency of the candidate while diminishing the reliance on waiting time, and that it has proven to be a powerful tool for auditing the liver allocation system. It was also agreed that the data regarding the accuracy of PELD as a predictor of pretransplant mortality were less conclusive and that PELD should be considered in isolation. Recommendations for the transplant community, based on the analysis of the MELD data, were discussed and are presented in the summary document. (Liver Transpl 2004;10:A6,A22.) [source] Design principles for virtual patients: a focus group study among studentsMEDICAL EDUCATION, Issue 6 2009Sören Huwendiek Objectives, This study aimed to examine what students perceive as the ideal features of virtual patient (VP) design in order to foster learning with a special focus on clinical reasoning. Methods, A total of 104 Year 5 medical students worked through at least eight VPs representing four different designs during their paediatric clerkship. The VPs were presented in two modes and differed in terms of the authenticity of the user interface (with or without graphics support), predominant question type (long- versus short-menu questions) and freedom of navigation (relatively free versus predetermined). Each mode was presented in a rich and a poor version with regard to the use of different media and questions and explanations explicitly directed at clinical reasoning. Five groups of between four and nine randomly selected students (n = 27) participated in focus group interviews facilitated by a moderator using a questioning route. The interviews were videotaped, transcribed and analysed. Summary reports were approved by the students. Results, Ten principles of VP design emerged from the analysis. A VP should be relevant, of an appropriate level of difficulty, highly interactive, offer specific feedback, make optimal use of media, help students focus on relevant learning points, offer recapitulation of key learning points, provide an authentic web-based interface and student tasks, and contain questions and explanations tailored to the clinical reasoning process. Conclusions, Students perceived the design principles identified as being conducive to their learning. Many of these principles are supported by the results of other published studies. Future studies should address the effects of these principles using quantitative controlled designs. [source] Photodiagnostic techniques for the endoscopic detection of premalignant gastrointestinal lesionsDIGESTIVE ENDOSCOPY, Issue 3 2003Ralph S. DaCosta Considerable attention is given to the clinical diagnosis of gastrointestinal (GI) malignancies as they remain the second leading cause of cancer-associated deaths in developed countries. Detection and intervention at an early stage of preneoplastic development significantly improve patient survival. High-risk assessment of asymptomatic patients is currently performed by strict endoscopic surveillance biopsy protocols aimed at early detection of dysplasia and malignancy. However, poor sensitivity associated with frequent surveillance programs incorporating conventional screening tools, such as white light endoscopy and multiple random biopsy, is a significant limitation. Recent advances in biomedical optics are illuminating new ways to detect premalignant lesions of the GI tract with endoscopy. The present review presents a summary report on the newest developments in modern GI endoscopy, which are based on novel optical endoscopic techniques: fluorescence endoscopic imaging and spectroscopy, Raman spectroscopy, light scattering spectroscopy, optical coherence tomography, chromoendoscopy, confocal fluorescence endoscopy and immunofluorescence endoscopy. Relying on the interaction of light with tissue, these ,state-of-the-art' techniques potentially offer an improved strategy for diagnosis of early mucosal lesions by facilitating targeted excisional biopsies. Furthermore, the prospects of real-time ,optical biopsy' and improved staging of lesions may significantly enhance the endoscopist's ability to detect subtle preneoplastic mucosal changes and lead to curative endoscopic ablation of these lesions. Such advancements within this specialty will be rewarded in the long term with improved patient survival and quality of life. [source] Conference report: Bio-International 2005JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 4 2007Kamal K. Midha Abstract This is a summary report of the International Pharmaceutical Federation/Board of Pharmaceutical Sciences (FIP/BPS) international conference, Bio-International 2005, which was held October 24,26, 2005 at the Royal Pharmaceutical Society, in London, UK. Bioequivalence (BE) issues related to multisource locally delivered topical dosage forms, oral inhalation drug products, highly variable drug products (HVDP), and endogenously occurring drugs were discussed. The conference also focused on alternate approaches to assess BE for some of these drug products. Pharmacokinetic (PK) approaches like, dermatopharmacokinetics (DPK) for dermatological topical dosage forms, scaled average BE (s-ABE) where within-subject variability is considered for estimation of 90% confidence intervals to document BE for highly variable drugs (HVD) were recommended. In addition, issues and difficulties related to the BE assessment of oral inhalation products, role, and appropriateness of metabolites in BE assessment, importance of base line correction in BE assessment of endogenously occurring drugs, and waiver of BE study requirements for certain drugs based on a Biopharmaceutics Classification System (BCS), were also discussed. © 2006 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 96: 747,754, 2007 [source] Joint projections of temperature and precipitation change from multiple climate models: a hierarchical Bayesian approachJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2009Claudia Tebaldi Summary., Posterior distributions for the joint projections of future temperature and precipitation trends and changes are derived by applying a Bayesian hierachical model to a rich data set of simulated climate from general circulation models. The simulations that are analysed here constitute the future projections on which the Intergovernmental Panel on Climate Change based its recent summary report on the future of our planet's climate, albeit without any sophisticated statistical handling of the data. Here we quantify the uncertainty that is represented by the variable results of the various models and their limited ability to represent the observed climate both at global and at regional scales. We do so in a Bayesian framework, by estimating posterior distributions of the climate change signals in terms of trends or differences between future and current periods, and we fully characterize the uncertain nature of a suite of other parameters, like biases, correlation terms and model-specific precisions. Besides presenting our results in terms of posterior distributions of the climate signals, we offer as an alternative representation of the uncertainties in climate change projections the use of the posterior predictive distribution of a new model's projections. The results from our analysis can find straightforward applications in impact studies, which necessitate not only best guesses but also a full representation of the uncertainty in climate change projections. For water resource and crop models, for example, it is vital to use joint projections of temperature and precipitation to represent the characteristics of future climate best, and our statistical analysis delivers just that. [source] Teaching and evaluating point of care learning with an Internet-based clinical-question portfolioTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2009MSc Associate Professor of Medicine, Michael L. Green MD Abstract Introduction: Diplomates in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program satisfy the self-evaluation of medical knowledge requirement by completing open-book multiple-choice exams. However, this method remains unlikely to affect practice change and often covers content areas not relevant to diplomates' practices. We developed and evaluated an Internet-based point of care (POC) learning portfolio to serve as an alternative. Methods: Participants enter information about their clinical questions, including characteristics, information pursuit, application, and practice change. After documenting 20 questions, they reflect upon a summary report and write commitment-to-change statements about their learning strategies. They can link to help screens and medical information resources. We report on the beta test evaluation of the module, completed by 23 internists and 4 internal medicine residents. Results: Participants found the instructions clear and navigated the module without difficulty. The majority preferred the POC portfolio to multiple-choice examinations, citing greater relevance to their practice, guidance in expanding their palette of information resources, opportunity to reflect on their learning needs, and "credit" for self-directed learning related to their patients. Participants entered a total of 543 clinical questions, of which 250 (46%) resulted in a planned practice change. After completing the module, 14 of 27 (52%) participants committed to at least 1 change in their POC learning strategies. Discussion: Internists found the portfolio valuable, preferred it to multiple-choice examinations, often changed their practice after pursuing clinical questions, and productively reflected on their learning strategies. The ABIM will offer this portfolio as an elective option in MOC. [source] Review of singleton fetal and neonatal deaths associated with cranial trauma and cephalic delivery during a national intrapartum-related confidential enquiryBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2005Fidelma O'Mahony Objective To review delivery details of intrapartum-related fetal and neonatal deaths with singleton cephalic presentation and birthweight of 2500 g or more in which traumatic cranial or cervical spine injury or substantial difficulty at delivery of the head was a dominant feature. Design Review of freestyle summary reports and standard questionnaire responses submitted to the national secretariat for the Confidential Enquiry into Stillbirths and Death in Infancy (CESDI) during the 1994/1995 intrapartum-related mortality enquiry following regional multidisciplinary panel review. Setting United Kingdom. Sample Of the 873 cases of intrapartum-related deaths reported in the 1994,1995 national enquiry, 709 weighed more than 2499 g. Reports from 181 (89 from 1994 and 92 from 1995) with a chance of meeting criteria for cranial or cervical trauma as significant contributors to death were examined in detail. Thirty-seven were judged to meet the criteria stated in the objectives (23 from 1994 and 14 from 1995) and form the basis for this review. Methods Electronic and hand search of CESDI records relating to intrapartum-related deaths. Main outcome measures Intrapartum events and features of care. Results There was evidence of fetal compromise present before birth in 33 of the 37 (89%) study group cases reviewed. One delivery was performed vaginally without instrumentation, and in one there was no attempt at vaginal delivery before caesarean section (CS) in the second stage of labour. Twenty-four cases (65%) were delivered vaginally and 11 (30%) by CS after failure to deliver vaginally with instruments. A single instrument was used in six cases of vaginal delivery (four ventouse and two Kjelland's forceps). At least two separate attempts with different instruments were made in 24 cases. Overall, the ventouse was used in 27 cases and forceps in 29 cases. In six cases, three separate attempts were made with at least two different instruments, all of which included use of ventouse. The grade of operator was recorded in 27 cases. Of these, a consultant obstetrician was present at only one delivery and no consultant was recorded to have made the first attempt to deliver a baby. In six cases, shoulder dystocia was also reported. Conclusions This study suggests a lower incidence of death from difficult cephalic delivery and cranial trauma than previously reported. The CESDI studies were believed to have achieved high levels of ascertainment for all intrapartum-related deaths from which the cases reported here were selected. Strictly applied entry criteria used in this study could have restricted the number of cases considered as could limited in vivo or postmortem investigations and lack of detailed autopsy. When cranial traumatic injury was observed, it was almost always associated with physical difficulty at delivery and the use of instruments. The use of ventouse as the primary or only instrument did not prevent this outcome. Some injuries occurred apparently without evidence of unreasonable force, but poorly judged persistence with attempts at vaginal delivery in the presence of failure to progress or signs of fetal compromise were the main contributory factor regardless of which instruments were used. [source] | ||||||||||