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Biomedical subjects

V Barnett

Publications and source records attributed to V Barnett.

7 recordsLinked to original sources
PubMed2000

Methods to improve diagnostic accuracy in a community mental health setting.

OBJECTIVE: This study determined the extent to which adding structured procedures improved diagnostic accuracy for outpatients with severe mental illness in a community mental health setting. METHOD: The Structured Clinical Interview for DSM-III-R (SCID) was used to interview 200 psychiatric outpatients. A research nurse reviewed medical records and amended the SCID diagnoses accordingly. A research psychiatrist or psychologist reviewed the diagnostic data and interviewed each patient to verify or further modify the previous findings. Diagnostic outcomes at each step of the procedure were compared to determine whether adding additional data improved diagnostic accuracy. The additional time required for each element of the diagnostic procedure was also assessed. RESULTS: Kappa comparisons of the different diagnostic levels showed that adding additional data significantly improved accuracy. Diagnoses rendered by combining the SCID and review of the medical record were the most accurate, followed by the SCID alone, and then diagnoses made by psychiatrists during routine care. In addition, the SCID alone identified five times as many current and past secondary diagnoses as were documented routinely in patients' charts. CONCLUSIONS: Combining structured interviewing with a review of the medical record appears to produce more accurate primary diagnoses and to identify more secondary diagnoses than routine clinical methods. The patients' knowledge of their diagnoses was limited, suggesting a need for patient education in this setting. Whether use of structured interviewing in routine practice improves patient outcomes deserves further study.

Adolescent↗
PubMed1997

Predicting wheat yields: the search for valid and precise models.

Interest in predicting wheat yield in terms of physiological, cultural and meteorological variables is more than a century old. Early attempts involved statistical analyses of relationships between yield and observational data on precipitation, temperature, radiation, etc., and scientific study of physiological and cultural influences such as dates of sowing or anthesis, farming procedures and soil treatments. More recently these have been augmented by large-scale mechanistic models of phenological development, such as AFRCWHEAT, CERES and SIRIUS, incorporating some simulation facilities. All approaches implicitly involve fitting models of some sort: statistical, mechanistic or (preferably) a hybrid of these forms. Levels of success on this important matter are highly variable. After reviewing the field, we consider the results of recent efforts to contrast and evaluate the (large-scale) mechanistic approaches, using spatial/temporal methods for interpolating the required climatological input variables. The work employs a substantial database of wheat yields assembled for this purpose. After assessing the validity of the large-scale mechanistic models (with some intriguing conclusions), we then consider some results from a current approach to parsimonious hybrid modelling, based on statistical study of accessible climatological data interpreted in terms of physiological knowledge of key influences on plant development.

Models, Biological↗
PubMed1994

Ethical considerations in the management of individuals with severe neuromuscular disorders.

There have been many recent advances in improving the quality of life and prolonging life for individuals with advanced neuromuscular disease. These include the use of physical medicine techniques to balance extremity muscle strength and improve range of motion and noninvasive techniques to provide inspiratory and expiratory muscle assistance to prolong life without resort to tracheostomy. Such advances help eliminate the "crisis" decision making about "going on a respirator" and sophisticated assistive equipment and robotic aids. Physicians and society in general use quality of life issues inappropriately derived by questioning physically able individuals to justify withholding or implementing life-sustaining therapeutic interventions for these individuals. Informed decisions about ethically and financially complex matters such as long-term ventilator use should be made by examining the life satisfaction of competent individuals who have already chosen these options. The great majority of severely disabled ventilator-assisted individuals with neuromuscular disease are satisfied with their lives despite the inability to achieve many of the "usual" goals associated with quality of life in the physically able population. Their principle life satisfaction derives from social relationships, the reorganization of goals and from their immediate environment. Although the Americans with Disabilities Act is seen as an important step to prevent discrimination against disabled individuals, it does little or nothing for the self-directed disabled individual who is not informed by his/her physicians regarding potentially vital therapeutic options nor does it help those who are warehoused in institutions because of lack of a national personal assistance services policy.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1980

Observer errors in assessing tumour size from liver scans.

Examination of liver scans is a component in the study of hepatic cancer, with changes in the size of perfusion defects attributed progression or regression of the disease. The experiment reported below involved a group of experienced oncologists examining a set of actual liver scans. Estimated probabilities of misclassification of the different types were calculated and were found to be of rather disturbing extent. For example, erroneous attribution of progression (or regression) at the 50 percent level was found to occur at estimated probabilities of 0.23 and 0.37 in the two cases when a single investigator examined a scan on two occasions, or different investigators investigated the scan, respectively. Results from the study will be discussed in some detail and the influence of unjustified round-off of measured values examined as a major factor in producing misclassification.

Diagnostic Errors↗