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Repeated multiphasic screening examinations: evaluating the process.

There are sound clinical and epidemiological reasons to promote and emphasize early detection efforts and disease prevention services. A large body of scientific literature supports the notion that detection and intervention early in the course of many diseases is beneficial both to the afflicted individual and to society at large. Several publications deal with the evaluation of multiphasic screening examinations (MSE) as a tool for simultaneous early detection and prevention of multiple risk factors and various diseases. Usually, this technology is evaluated based on data from a single (cross-sectional) comprehensive screening study. However, frequently MSE are performed periodically, resulting in repeated test results of the same individuals. The health impact of such repeated (longitudinal) MSE has not been studied extensively. Similarly, many of the unique theoretical, technical, and epidemiological features characteristic of consecutive (periodical) comprehensive screening examinations are not well-documented. The purpose of this study was to compare the test results of two MSE, performed 3.5 years apart, in order to demonstrate certain characteristics of multiphasic health testing (MHT) technology related to repeated (longitudinal) multiphasic examination of the same individuals.

Humans

Auditing the clinical learning environment in West Glamorgan: evaluating the process.

The responsibility for auditing clinical learner areas was developed from the Welsh National Board to individual educational establishments in Wales in 1988. The West Glamorgan College of Nursing and Midwifery designed on audit tool, based on the National Board's guidelines, and have used it in clinical areas since 1990. This paper reports on an evaluation survey carried out after the tool had been in use for one year. The results suggest that the ward/area managers involved have been able to identify a range of benefits for their units with the introduction of the tool, and demonstrate an acceptance of the need to maintain standards of practice and education.

Anxiety

[Development and evaluation of self-study material for smoking prevention education].

A booklet for smoking prevention education was developed for junior high school students, which is a role-play activity book for self-study and discusses not only the harmful effects and dependency of smoking but also psychosocial factors affecting smoking behavior among students. The purpose of this material is to provide students with basic information needed to choose a non-smoking lifestyle even without a teacher's direct instruction. Process evaluation and impact evaluation studies were carried out between September 1991 and September 1992. Six hundred sixty-nine students and 9 teachers from three junior high schools in Osaka, Tokyo and Yamagata participated in the process evaluation study. More than 90% of the students were able to complete the material in one school hour and less than 4% students expressed difficulty in learning from the booklet. Nine hundred seventy-seven students from 2 junior high schools in Tokyo participated in an intervention study to evaluate the effectiveness of the material. There were 500 students in the experimental school and 477 students in the control school. All students were given a pretest and posttest, 2 months apart. Knowledge concerning smoking increased and attitudes toward smoking were modified significantly in the experimental school. However, intention to smoke and smoking behavior did not change significantly, due to the small numbers of students with intention to smoke at the time of pretest and because there was not enough time for their intention to change. This study demonstrates the effectiveness of the material in junior high school. However, teacher participation during the instruction is also seen to be necessary for greater effect.

Adolescent

Materials management information systems.

The hospital materials management function--ensuring that goods and services get from a source to an end user--encompasses many areas of the hospital and can significantly affect hospital costs. Performing this function in a manner that will keep costs down and ensure adequate cash flow requires effective management of a large amount of information from a variety of sources. To effectively coordinate such information, most hospitals have implemented some form of materials management information system (MMIS). These systems can be used to automate or facilitate functions such as purchasing, accounting, inventory management, and patient supply charges. In this study, we evaluated seven MMISs from seven vendors, focusing on the functional capabilities of each system and the quality of the service and support provided by the vendor. This Evaluation is intended to (1) assist hospitals purchasing an MMIS by educating materials managers about the capabilities, benefits, and limitations of MMISs and (2) educate clinical engineers and information system managers about the scope of materials management within a healthcare facility. Because software products cannot be evaluated in the same manner as most devices typically included in Health Devices Evaluations, our standard Evaluation protocol was not applicable for this technology. Instead, we based our ratings on our observations (e.g., during site visits), interviews we conducted with current users of each system, and information provided by the vendor (e.g., in response to a request for information [RFI]). We divided the Evaluation into the following sections: Section 1. Responsibilities and Information Requirements of Materials Management: Provides an overview of typical materials management functions and describes the capabilities, benefits, and limitations of MMISs. Also includes the supplementary article, "Inventory Cost and Reimbursement Issues" and the glossary, "Materials Management Terminology." Section 2. The MMIS Selection Process: Outlines steps to follow and describes factors to consider when selecting an MMIS. Also includes our Materials Management Process Evaluation and Needs Assessment Worksheet (which is also available online through ECRInet(TM)) and a list of suggested interview questions to be used when gathering user experience information for systems under consideration. Section 3A. MMIS Vendor Profiles: Presents information for the evaluated systems in a standardized, easy-to-compare format. Profiles include an Executive Summary describing our findings, a discussion of user comments, a listing of MMIS specifications, and information on the vendor's business background. Section 3B. Discussion of Vendor Profile Conclusions and Ratings: Presents our ratings and summarizes our rationale for all evaluated systems. Also includes a blank Vendor Profile Template to be used when gathering information on other vendors and systems. We found that, in general, all of the evaluated systems are able to meet most of the functional needs of a materials management department. However, we did uncover significant differences in the quality of service and support provided by each vendor, and our ratings reflect these differences: we rated two of the systems Acceptable--Preferred and four of the systems Acceptable. We have not yet rated the seventh system because our user experience information may not reflect the vendor's new ownership and management. When this vendor provides the references we requested, we will interview users and supply a rating. We caution readers against basing purchasing decisions solely on our ratings. Each hospital must consider the unique needs of its users and its overall strategic plans--a process that can be aided by using our Process Evaluation and Needs Assessment Worksheet. Our conclusions can then be used to narrow down the number of vendors under consideration...

Computer Security

Oral examinations: actual and perceived contributions to surgery clerkship performance.

Controversy persists regarding the validity, utility, and practicality of oral examinations. This study of a recent 3-year experience at the University of Michigan Medical School was undertaken to determine the value of the oral examination in the required junior year surgery clerkship. Multiple regression analysis of the relationship between the oral examination and ward grades, written examination grades, and the final grades for the clerkship years 1980 to 1981 (n = 198), 1981 to 1982 (n = 234), and 1982 to 1983 (n = 215) (classes of 1982, 1983, and 1984) revealed significant correlation between the oral examination and other evaluation parameters. Stepwise regression analysis revealed that the oral examination contributed unique information to final grade determination. Two surveys identified faculty and student opinion regarding the oral examination. The results were consistent during the 3-year period of study. Faculty and student opinion regarding the examination as an evaluation process and motivational device were positive, as was opinion regarding the breadth and depth of knowledge tested and the examination as a learning experience and an accurate reflection of students' performance. Both faculty and students agreed that the examination was worth the time and effort invested by faculty, was an appropriate evaluation process, and was a source of worthwhile faculty and student interaction.

Attitude of Health Personnel

[Quality assurance exemplified by perinatology and surgery].

Quality assurance encompasses all activities which are necessary to obtain a demanded quality of medical care. Typically, a quality assurance process ("monitoring- and evaluation-process") includes the following steps: systematic observation of quality of medical care using quality indicators, assessment of quality by comparison with standards and recognizing problems, analysis of the most important problem, realization of appropriate problem solving strategies and evaluation, if the problem is successfully solved through the corrective action. The quality assurance programs in perinatology and surgery--established in all the states of the Federal Republic of Germany--support the hospitals in the application of this quality assurance process. Uniform documentation and preparation of quality relevant information (lists of complications, profiles, charts, etc.) help the hospitals to perform a self-evaluation, to recognize problems and to verify the elimination of the problems. Hence, comparisons with local results and with results of other hospitals are possible.

Cesarean Section

Human chromosomes: evaluation of processing techniques for scanning electron microscopy.

Methods for scanning electron microscopy (SEM) of chromosomes have been developed in the last two decades. Technical limitations in the study of human chromosomes, however, have hindered the routine use of SEM in clinical and experimental human cytogenetics. We compared different methodologies, including metal impregnation, air drying and specimen coating. SEM preparation of human chromosomes in which osmium impregnation is mediated by tannic acid, yielded more reproducible results when compared with osmium impregnation protocols previously described. The level of osmium impregnation was systematically evaluated by imaging chromosomes in the backscattering mode. Critical point drying and a light gold-palladium coating were essential for appropriate secondary electron imaging of chromosomes. With this method, and in a preliminary quantitative analysis, we show that our SEM technique is more sensitive than light microscopy for the detection of aphidicolin-induced fragile sites. This technical approach is useful for chromosomal studies requiring resolution higher than that obtained by light microscopy. Also, it allows the use of clinical and archival chromosomal samples prepared by routine cytogenetic techniques.

Adult

Anticonvulsant drugs affect particular steps of verbal memory processing--an evaluation of 13 patients with intractable complex partial seizures of left temporal lobe origin.

Thirteen patients with intractable complex partial seizures of left temporal lobe origin were tested for verbal memory performance under the conditions of full and reduced anticonvulsant medication. As suggested by previous investigations memory performance improved significantly with the reduction of anticonvulsants. However, our observations refute assumptions that the effects of antiepileptic drugs act primarily by non-specific mechanisms affecting attention and/or memory diffusely. Our data rather suggest that very specific and circumscribed steps of verbal memory processing, particularly retrieval abilities after interference, are affected by anticonvulsants. The possible implications of these findings in relation to morphological and electrophysiological aspects in patients with temporal lobe epilepsy are discussed.

Adolescent

Integrating occupational health into the medicine clerkship using problem-based learning.

OBJECTIVE: To improve medical students' ability and willingness to obtain occupational histories from their patients. PARTICIPANTS: General medicine faculty and internal medicine teaching residents, who participated as instructors, and medical students during their required internal medicine clerkships. SETTING: The primary teaching hospitals of two medical schools. DESIGN: During alternate months, students participated in problem-based sessions that included occupational health objectives (intervention) or attended the standard small-group didactic sessions (control). Process evaluations were collected from students and faculty in the intervention group following each session. Outcome evaluation was performed using chart audit and multiple-choice testing to compare the intervention and control groups. INTERVENTION: Intervention students participated in at least one problem-based session incorporating occupational aspects of disease into clinical internal medicine. Instructors received information packets and materials but had no other expertise in occupational medicine. MEASUREMENTS AND MAIN RESULTS: The great majority of ratings on the process evaluations showed that the students were "moderately" to "extremely" interested in the session attended. No student rated any session to be a "waste of time," and over 90% of students would recommend the session being evaluated to a friend. Chart audit showed that students in the intervention group recorded slightly more occupational information than did those in the control group (an average of 2.97 vs. 2.37 pieces of information, p = 0.06). When the most commonly documented data (employment status and job title) were ignored, the difference between group means (1.1 vs. 0.91) was significant (p = 0.03), suggesting that intervention students were more likely to probe further into a patient's occupational history. Both groups of students collected less occupational information from women than from men (t = 3.22, p = 0.0035). Multiple-choice tests revealed no difference between the two groups in overall medical knowledge or occupational medicine knowledge. CONCLUSIONS: Problem-based learning with specific occupational content is well accepted by students and modestly improves their occupational history taking.

Clinical Clerkship

Primary prevention of coronary heart disease versus health promotion--a contradiction?

The German Cardiovascular Prevention Study is a multicentre community-based intervention study with the primary goal of reducing cardiovascular mortality by primary prevention measures. The intervention strategy comprises improving people's life styles as well as health promotion so as to modify cardiovascular risk factors (hypercholesterolemia, cigarette smoking, arterial hypertension, physical inactivity and over-weight). Design elements of the German Cardiovascular Prevention Study, now in its fifth year, were adopted from well known community intervention studies, including monitoring of mortality and morbidity, health examination surveys to assess distribution of cardiovascular risk factors, health attitudes and health behaviour in the community and use of formative and process evaluation to monitor the effects of intervention policies in the community. To identify risk factor profiles a cluster analysis was carried out from survey data. Four clusters were identified: a) people with none or few risk factors; b) those with high prevalence of smoking; c) those with high prevalence of hypercholesterolemia and hypertension; d) high risk factor exposure individuals. The clusters are different along social indicators like age, sex and social status. Process evaluation data show that special strategies like interventive blood pressure screenings reached a relatively high proportion of people from lower socioeconomic status. But they also indicate that there is a long way to go from publicity of intervention programs to lasting changes in behaviour.

Adult

Application of digital image processing to evaluation of eye fundus pictures. Preliminary report.

An application of computerized digital analysis to photographically recorded pictures of the fundus of the eye is described. This approach has been found as a reproducible and objective method for detection and description of different changes in ocular tissues (exudative diabetic maculopathy especially) for the diagnostic or prognostic purposes (progress of the illness, results of the treatment). Possibilities offered by this method in other relevant retrospective studies are also discussed.

Diabetic Retinopathy

[Processing and evaluation of fish silage from accompanying fauna of shrimps].

Fish silage for animal feed was produced from a mixture of several fish species belonging to the shrimp by catch. All of them were ground and mixed with formic and sulfuric acids, 3.5% w/w at 1:2; 1:3 and 1:4, respectively, and stored at room temperature for 15 days, to complete liquefaction. The pH, exuded liquid, consistency, soluble nitrogen, total volatile bases, trimethylamine, lipid oxidation by thiobarbituric acid test and microbial count were measured during the 60 days of the storage period. Fish silage was dried and used for biological tests in chicken fed a diet with 6% of silage as a substitute of fish meal. Results of proximal analysis, amino acid profile and mineral content, as well as of the biological test with the dried product, indicated the feasibility of using fish silage as a substitute of traditional fish meal for the chicks included in the trial. This fact, coupled to its simple processing technology, make fish silage adequate for utilization as animal feed.

Animal Feed

A quality assurance program for a state university student health center.

The New Mexico State University Student Health Center redesigned its quality assurance program to follow the Joint Commission's ten-step process for monitoring and evaluation. This article outlines the scopes of care in the Health Center's different units and provides case-study examples, including important aspects of care and indicators, to illustrate the monitoring and evaluation process as it is used for both retrospective studies and concurrent monitoring.

Data Collection

Digital image processing. I. Evaluation of gray level correction methods in vitro.

The aims of this study were a) to assess in an in vitro model the amount of density changes measured in digitally subtracted images due to electronic noise and image alignment error, and b) to test the accuracy of different gray level correction procedures in the reduction of densitometric image mismatches. A section of a pig mandible in which a hollow cylinder ITI Bonefit implant had been placed was used to obtain pairs of standardized radiographs. Series of radiographs were obtained with different exposure times (0.34, 0.39, 0.44, 0.51, 0.58 s). The radiographs were captured through a video camera, digitized and stored in a personal computer. The same radiographic image was recorded and subtracted from itself 10 times to study the error of the method due to electronic transformations of the images and image alignment. The noise due to the analog-to-digital transformation of the radiographic images was calculated to be +/- 2 gray levels i.e., 2% of the scale of gray levels. This kind of error was reduced up to 40% by capturing the images more than once and averaging the values per pixel. The manual superimposition of the images to be subtracted caused an increase of the error to +/- 3 gray levels (2.7%). Seven methods of gray level correction based either on a linear least squares approximation or on the cumulative density function (CDF) were tested. The group based on the CDF algorithm gave significantly better results than any other method. Pixels yielding differences smaller or equal to +/- 7 gray levels (5.5% of the scale of gray levels) should be excluded from further calculations in order to eliminate (false-positive) errors due to the normalizing algorithms. Furthermore, the CDF method on an arbitrarily chosen area of the image or on the wedge seems to give to subtraction images the ability of revealing real subtle changes in tissue density (fewer false-negative errors). The use of reference structures did not futher improve the ability of the normalization methods to correct gray level mismatches between radiographic pairs.

Absorptiometry, Photon

On the process for evaluating proposed new diagnostic EEG tests.

Assessment of new technology is an important part of the evolving art of medicine. For a variety of reasons, it is appropriate to restrict clinical applications of new technology to those tests which have been shown to be safe and effective. Efficacy of new EEG technology can be assessed through a variety of standard procedures, generally based on controlled, well organized clinical studies. Scientific reports using new EEG technology all too often fail to meet the standards traditionally expected for such clinical trials. Many such studies were never designed to be clinical trials. Misunderstandings occur when reports of scientific studies and informal clinical series become confused with formal clinical trials of efficacy. Based upon examples given during the 1991 ISBET meeting symposium on discriminant analysis, examples are discussed regarding how well individual kinds of presentations can be used to help clarify the generic clinical efficacy of the presented diagnostic tests.

Brain