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At least 253 records · Page 14Linked to original sources

PubMed1997

Diagnostic tools and measurements--impact on appropriate care.

The diagnosis of primary coronal caries should be seen as a complex process, comprising both detection and measurement phases, which enables clinicians, researchers and epidemiologists to make informed decisions about the management and prognosis of the disease process. The different diagnostic thresholds employed for measurements of caries experience can be viewed as an iceberg, a metaphor which demonstrates the ambiguity of the term "caries free" and which can also represent the differing management options appropriate for the care of different types of active and inactive lesions: NAC (No Active Care). PCA (Preventive Care Advised) and OCA (Operative Care Advised). There are considerable methodological difficulties in drawing valid comparisons between studies using incompatible criteria and simulations. However, it is apparent that no caries diagnostic tool in current clinical use fulfils all of the ideal criteria for measurements needed to plan and monitor appropriate care. Systems providing reliable serial measurements with which to assess future caries risk and present caries activity are urgently required as diagnostic tasks are becoming both more difficult and more important from the standpoint of long-term oral health. Existing diagnostic tools frequently rely on subjective judgements and provide only semi-quantitative measures insensitive to smaller lesions. In the future tools are needed which are objective, quantitative and which can provide acceptable compromises between sensitivity and specificity for a wide range of applications for individual patient care as well as for research and survey use. Key problem areas with existing tools include confusion in terminology and between caries assessments made by clinicians and epidemiologists as well as the lack of valid measurements relating to the activity of primary root caries and secondary caries. Deficiencies with current tools impact on the care of individuals by allowing false negative diagnoses of hidden occlusal dentine lesions and approximal cavities on the one hand, whilst generating some false positive diagnoses on sound surfaces leading to inappropriate decisions to restore on the other. At the population level, current conventional tools significantly underestimate overall caries experience. In future the adoption of more accurate and reliable methods would facilitate more effective preventive care and promote more appropriate restorative treatment decisions. Research in this area should focus for the next five years on diagnostic technologies which: 1) inform valid prospective caries risk assessments for different age groups, 2) can help to determine present caries activity and monitor lesion behaviour over time and 3) help identify methods which can implement existing and new research knowledge about diagnostic tools into clinical and research practice.

Age Factors↗

PubMed1999

Role of somatosensory feedback from tools in realizing movements by patients with ideomotor apraxia.

In order to investigate the underlying mechanism of ideomotor apraxia, we studied 9 patients who could not mime using tools despite the ability to manipulate actual tools normally. In all the mime tasks, visually presented tools or model gestures by examiners were fundamentally ineffectual in improving the patients' performances. Even the remarkable improvement demonstrated when using actual tools disappeared immediately after the subjects took their hands off them. In a further experiment, 4 of the 9 patients were required to pretend to use tools while holding a stick, resulting in significant improvements or normal miming. These findings suggest that the somatosensory feedback continuously supplied from a handheld tool is a crucial component in enabling patients with ideomotor apraxia to actually use tools.

Acoustic Stimulation↗

PubMed2005

Mirror neurons responding to observation of actions made with tools in monkey ventral premotor cortex.

In the present study, we describe a new type of visuomotor neurons, named tool-responding mirror neurons, which are found in the lateral sector of monkey ventral premotor area F5. Tool-responding mirror neurons discharge when the monkey observes actions performed by an experimenter with a tool (a stick or a pair of pliers). This response is stronger than that obtained when the monkey observes a similar action made with a biological effector (the hand or the mouth). These neurons respond also when the monkey executes actions with both the hand and the mouth. The visual and the motor responses of each neuron are congruent in that they share the same general goal, that is, taking possession of an object and modifying its state. It is hypothesized that after a relatively long visual exposure to tool actions, a visual association between the hand and the tool is created, so that the tool becomes as a kind of prolongation of the hand. We propose that tool-responding mirror neurons enable the observing monkey to extend action-understanding capacity to actions that do not strictly correspond to its motor representations. Our findings support the notion that the motor cortex plays a crucial role in understanding action goals.

Action Potentials↗

PubMed1996

The effects of text-based and graphics-based software tools on planning and organizing of stories.

This article describes a research study comparing the effects of two computer-based writing tools on the story-writing skills of fourth-through eighth-grade students with language-related learning disabilities. The first tool, the prompted writing feature of FrEdWriter (Rogers, 1985), allowed students to answer story grammar questions, then type stories using those responses as the plan; the second tool, Once Upon a Time (Urban, Rushing, & Star, 1990), allowed students to create graphic scenes, then type stories about those scenes. Nine students attended a series of after-school writing labs twice weekly for 11 weeks, using each tool for half of the writing sessions. Group results did not clearly favor either tool; however, individual differences suggested that use of planning features should be linked to student needs. Students who had less internal organizational ability benefited from the computer-presented story grammar prompts and wrote less mature stories when using the graphics-based tool. Students with relatively strong organizational skills wrote more mature stories with the graphics-based tool.

Achievement↗

PubMed2006

Cortical networks related to human use of tools.

Greater manual dexterity and greater conceptual knowledge of tool use represent two main features that distinguish humans from other primates. Studies of human brain lesions suggest that the left hemisphere (at least in right-handed people) includes a system for processing manual skills that is specialized for tool use that interacts with another system involved more with conceptualizing, planning, and accessing knowledge associated with tool use. Growing evidence from recent neuroimaging studies supports this organization, and studies have begun to highlight specific brain regions and pathways that may be necessary for tool use. This review compares and summarizes results from 64 paradigms published over the past decade that have examined cortical regions associated with tool use skills and tool knowledge. A meta-analysis revealed cortical networks in both hemispheres, though with a clear left hemisphere bias, which may be organized to optimally represent action knowledge. Portions of this network appear to represent part of a system that is tightly linked with language systems, which is discussed together with the effects that handedness may have on the cortical organization for tool use.

Cerebral Cortex↗

PubMed2006

The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands.

BACKGROUND: Demented nursing home patients are at high risk for falls. Falls and associated injuries can have a considerable influence on the autonomy and quality of life of patients. The prevention of falls among demented patients is therefore an important issue. In order to intervene in an efficient way in this group of patients, it is important to systematically evaluate the fall risk profile of each individual patient so that for each patient tailor-made preventive measures can be taken. Therefore, the objective of the present study is to develop a feasible and evidence based multidisciplinary fall risk evaluation tool to be used for tailoring preventive interventions to the needs of individual demented patients. METHODS: To develop this multidisciplinary fall risk evaluation tool we have chosen to combine scientific evidence on the one hand and experts' opinions on the other hand. Firstly, relevant risk factors for falling in elderly persons were gathered from the literature. Secondly, a group of Dutch experts in the field of falls and fall prevention in the elderly were consulted to judge the suitability of these risk factors for use in a multidisciplinary fall risk evaluation tool for demented nursing home patients. Thirdly, in order to generate a compact list of the most relevant risk factors for falling in demented elderly, all risk factors had to fulfill a set of criteria indicating their relevance for this specific target population. Lastly the final list of risk factors resulting from the above mentioned procedure was presented to the expert group. The members were also asked to give their opinion about the practical use of the tool. RESULTS: The multidisciplinary fall risk evaluation tool we developed includes the following items: previous falls, use of medication, locomotor functions, and (correct) choice and use of assistive and protective devices. The tool is developed for the multidisciplinary teams of the nursing homes. CONCLUSION: This evidence and practice based multidisciplinary fall risk evaluation tool targets the preventive interventions aimed to prevent falls and their negative consequences in demented nursing home patients.

Accidental Falls↗

PubMed2006

Parameter selection for and implementation of a web-based decision-support tool to predict extubation outcome in premature infants.

BACKGROUND: Approximately 30% of intubated preterm infants with respiratory distress syndrome (RDS) will fail attempted extubation, requiring reintubation and mechanical ventilation. Although ventilator technology and monitoring of premature infants have improved over time, optimal extubation remains challenging. Furthermore, extubation decisions for premature infants require complex informational processing, techniques implicitly learned through clinical practice. Computer-aided decision-support tools would benefit inexperienced clinicians, especially during peak neonatal intensive care unit (NICU) census. METHODS: A five-step procedure was developed to identify predictive variables. Clinical expert (CE) thought processes comprised one model. Variables from that model were used to develop two mathematical models for the decision-support tool: an artificial neural network (ANN) and a multivariate logistic regression model (MLR). The ranking of the variables in the three models was compared using the Wilcoxon Signed Rank Test. The best performing model was used in a web-based decision-support tool with a user interface implemented in Hypertext Markup Language (HTML) and the mathematical model employing the ANN. RESULTS: CEs identified 51 potentially predictive variables for extubation decisions for an infant on mechanical ventilation. Comparisons of the three models showed a significant difference between the ANN and the CE (p = 0.0006). Of the original 51 potentially predictive variables, the 13 most predictive variables were used to develop an ANN as a web-based decision-tool. The ANN processes user-provided data and returns the prediction 0-1 score and a novelty index. The user then selects the most appropriate threshold for categorizing the prediction as a success or failure. Furthermore, the novelty index, indicating the similarity of the test case to the training case, allows the user to assess the confidence level of the prediction with regard to how much the new data differ from the data originally used for the development of the prediction tool. CONCLUSION: State-of-the-art, machine-learning methods can be employed for the development of sophisticated tools to aid clinicians' decisions. We identified numerous variables considered relevant for extubation decisions for mechanically ventilated premature infants with RDS. We then developed a web-based decision-support tool for clinicians which can be made widely available and potentially improve patient care world wide.

Birth Weight↗

PubMed2005

BioAfrica's HIV-1 proteomics resource: combining protein data with bioinformatics tools.

Most Internet online resources for investigating HIV biology contain either bioinformatics tools, protein information or sequence data. The objective of this study was to develop a comprehensive online proteomics resource that integrates bioinformatics with the latest information on HIV-1 protein structure, gene expression, post-transcriptional/post-translational modification, functional activity, and protein-macromolecule interactions. The BioAfrica HIV-1 Proteomics Resource http://bioafrica.mrc.ac.za/proteomics/index.html is a website that contains detailed information about the HIV-1 proteome and protease cleavage sites, as well as data-mining tools that can be used to manipulate and query protein sequence data, a BLAST tool for initiating structural analyses of HIV-1 proteins, and a proteomics tools directory. The Proteome section contains extensive data on each of 19 HIV-1 proteins, including their functional properties, a sample analysis of HIV-1HXB2, structural models and links to other online resources. The HIV-1 Protease Cleavage Sites section provides information on the position, subtype variation and genetic evolution of Gag, Gag-Pol and Nef cleavage sites. The HIV-1 Protein Data-mining Tool includes a set of 27 group M (subtypes A through K) reference sequences that can be used to assess the influence of genetic variation on immunological and functional domains of the protein. The BLAST Structure Tool identifies proteins with similar, experimentally determined topologies, and the Tools Directory provides a categorized list of websites and relevant software programs. This combined database and software repository is designed to facilitate the capture, retrieval and analysis of HIV-1 protein data, and to convert it into clinically useful information relating to the pathogenesis, transmission and therapeutic response of different HIV-1 variants. The HIV-1 Proteomics Resource is readily accessible through the BioAfrica website at: http://bioafrica.mrc.ac.za/proteomics/index.html.

Africa↗

PubMedDate not supplied

Optimum tool handle diameter for a cylinder grip.

The ideal diameter for a tool handle for males and females has been determined using an existing biomechanical model of the hand validated in previous works. The model estimates a 33-mm optimum diameter tool handle for the general population (males and females). When the optimum diameter for a tool handle is selected, the muscles exert the minimum force needed to hold the tool and perform gripping activities. Optimal handle design reduces the force required for gripping a tool, protects the underlying joint structures, and reduces the risk of developing cumulative trauma associated with repetitive task requiring high grip forces and awkward postures. This article provides a design parameter for optimal tool diameter to aid the therapist in the selection of assistive devices, built-up handles, or for the fabrication of a tool handle.

Biomechanical Phenomena↗

PubMed2006

Calculating petal tools by using genetic algorithms.

To pass from a spherical surface to a conic one, it is possible to use a petal tool or a small solid tool that is placed at different time intervals at several radial zones of the glass. Genetic algorithms are applied to calculate the angular sizes of the incomplete annular tools that make up the petal tools. We also present the desired wear results carried out with the petal tool that was designed on the basis of the dwell times of complete annular tools. These dwell times are calculated by using base functions that are generated with annular tools and by applying the genetic algorithms.

Journal Article↗

PubMedDate not supplied

Primary care clinicians' use of standardized tools to assess child psychosocial problems.

BACKGROUND AND OBJECTIVES: Children's psychosocial problems are prevalent but often inaccurately diagnosed. This study investigated primary care clinicians' (PCCs) use of standardized tools for psychosocial problems among children in whom they reported finding a problem. METHODS: The data consisted of 21 065 unique visits by children ages 4 to 15 years in 204 practices. Parents completed questionnaires before seeing the PCCs, who completed a survey after the visit. This analysis included 3934 children who were recognized by PCCs as having one or more psychosocial problems. The primary outcome was the PCCs' usage of a tool to assess child psychosocial problems. RESULTS: PCCs used a tool in 20.2% of visits where a psychosocial problem was recognized, whereas 50% of PCCs never used such tools. Tools were less likely to be used by female PCCs and family practitioners and were less likely to be used with girls and African American children. Tools were more frequently used with children with attention problems, during visits for psychosocial problems, and when the PCC knew about the problem before the visits. CONCLUSIONS: PCCs use standardized tools infrequently to screen for, confirm, or monitor psychosocial problems.

Adolescent↗

PubMed2006

Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs.

OBJECTIVES: Currently there are few practical methods to identify and measure harm to hospitalized children. Patients in NICUs are at high risk and warrant a detailed assessment of harm to guide patient safety efforts. The purpose of this work was to develop a NICU-focused tool for adverse event detection and to describe the incidence of adverse events in NICUs identified by this tool. METHODS: A NICU-focused trigger tool for adverse event detection was developed and tested. Fifty patients from each site with a minimum 2-day NICU stay were randomly selected. All adverse events identified using the trigger tool were evaluated for severity, preventability, ability to mitigate, ability to identify the event earlier, and presence of associated occurrence report. Each trigger, and the entire tool, was evaluated for positive predictive value. Study chart reviewers, in aggregate, identified 88.0% of all potential triggers and 92.4% of all potential adverse events. RESULTS: Review of 749 randomly selected charts from 15 NICUs revealed 2218 triggers or 2.96 per patient, and 554 unique adverse events or 0.74 per patient. The positive predictive value of the trigger tool was 0.38. Adverse event rates were higher for patients <28 weeks' gestation and <1500 g birth weight. Fifty-six percent of all adverse events were deemed preventable; 16% could have been identified earlier, and 6% could have been mitigated more effectively. Only 8% of adverse events were identified in existing hospital-based occurrence reports. The most common adverse events identified were nosocomial infections, catheter infiltrates, and abnormal cranial imaging. CONCLUSIONS: Adverse event rates in the NICU setting are substantially higher than previously described. Many adverse events resulted in permanent harm and the majority were classified as preventable. Only 8% were identified using traditional voluntary reporting methods. Our NICU-focused trigger tool appears efficient and effective at identifying adverse events.

Catheterization↗

PubMed1998

Evaluation of three commercial tick removal tools.

OBJECTIVE: To evaluate three commercially available tick removal tools against medium-tipped nontissue tweezers. METHODS: We evaluated three commercially available tick removal tools against medium-tipped tweezers. Three inexperienced users randomly removed attached American dog ticks (Dermacentor variabilis Say) and lone star ticks (Amblyomma americanum L.) from laboratory rabbits in a university animal facility using all tools during one removal session. RESULTS: Tick damage occurring from removal and quantity of attachment cement were compared. No tool removed nymphs without damage and all tools removed adults of both species successfully. American dog ticks proved easier to remove than lone star ticks, whose mouthparts often remained in the skin. CONCLUSIONS: Nymphal ticks were consistently removed more successfully with commercial tools when compared with tweezers but with more difficulty than adults were removed. The commercial tick removal tools tested are functional for removal of nymphs and adults and should be considered as viable alternatives to medium-tipped tweezers.

Animals↗

PubMed1978

Training generalized improvisation of tools by preschool children.

The development of new, "creative" behaviors was examined in a problem-solving context. One form of problem solving, improvisation, was defined as finding a substitute to replace the specifically designated, but currently unavailable, tool ordinarily used to solve the problem. The study examined whether preschool children spontaneously displayed generalized improvisation skills, and if not, whether they could be trained to do so within different classes of tools. Generalization across different tool classes was monitored but not specifically trained. Five preschool children participated in individual sessions that first probed their skill at improvising tools, and later trained and probed generalized improvisation in one or more of three tool classes (Hammers, Containers, and Shoelaces), using a multiple-baseline design. All five children were trained with Hammers, two were trained in two classes, and two were trained in all three tool classes. Four of the five children improvised little in Baseline. During Training, all five showed increased generalized improvisation within the trained class, but none across classes. Tools fabricated by item combinations were rare in Baseline, but common in Training. Followup probes showed that the training effects were durable.

Journal Article↗

PubMedDate not supplied

A review of features in Internet consumer health decision-support tools.

BACKGROUND: Over the past decade, health care consumers have begun to benefit from new Web-based communications tools to guide decision making on treatments and tests. Using today's online tools, consumers who have Internet connections can: watch and listen to videos of physicians; watch and hear the stories of other consumers who have faced the same decisions; join an online social support network; receive estimates of their own chances of experiencing various outcomes; and do it all at home. OBJECTIVE: To review currently-available Internet consumer health decision-support tools. METHODS: Five Web sites offering consumer health decision-support tools are analyzed for their use of 4 key Web-enabled features: the presentation of outcomes probability data tailored to the individual user; the use of videotaped patient interviews in the final product to convey the experiences of people who have faced similar diagnoses in the past; the ability to interact with others in a social support network; and the accessibility of the tool to any health care consumers with an Internet connection. RESULTS: None of the 5 Web sites delivers all 4 target features to all Web users. The reasons for these variations in the use of key Web functionality--features that make the Web distinctive--are not immediately clear. CONCLUSIONS: Consumers trying to make health care decisions may benefit from current Web-based decision-support tools. But, variations in Web developers' use of 4 key Web-enabled features leaves the online decision-support experience less than what it could be. Key research questions are identified that could help in the development of new hybrid patient decision-support tools.

Decision Support Systems, Clinical↗

PubMed2003

Design and testing of a tool for evaluating the quality of diabetes consumer-information Web sites.

BACKGROUND: Most existing tools for measuring the quality of Internet health information focus almost exclusively on structural criteria or other proxies for quality information rather than evaluating actual accuracy and comprehensiveness. OBJECTIVE: This research sought to develop a new performance-measurement tool for evaluating the quality of Internet health information, test the validity and reliability of the tool, and assess the variability in diabetes Web site quality. METHODS: An objective, systematic tool was developed to evaluate Internet diabetes information based on a quality-of-care measurement framework. The principal investigator developed an abstraction tool and trained an external reviewer on its use. The tool included 7 structural measures and 34 performance measures created by using evidence-based practice guidelines and experts' judgments of accuracy and comprehensiveness. RESULTS: Substantial variation existed in all categories, with overall scores following a normal distribution and ranging from 15% to 95% (mean was 50% and median was 51%). Lin's concordance correlation coefficient to assess agreement between raters produced a rho of 0.761 (Pearson's r of 0.769), suggesting moderate to high agreement. The average agreement between raters for the performance measures was 0.80. CONCLUSIONS: Diabetes Web site quality varies widely. Alpha testing of this new tool suggests that it could become a reliable and valid method for evaluating the quality of Internet health sites. Such an instrument could help lay people distinguish between beneficial and misleading information.

Diabetes Mellitus↗

PubMed2006

Technical note: development of a tool to insert abomasal infusion lines into dairy cows.

A tool was developed to aid in ruminal insertion of abomasal infusion lines into dairy cows. The tool consisted of 2 pieces cut from polyvinyl chloride pipe. The first piece of pipe, the insertion tool, contained a groove that held the flexible plastic flange that is on the end of the infusion line. The insertion tool containing the flange was inserted into the ruminal cannula, through the sulcus omasi, and into the abomasum. The second piece of pipe, the delivery tool, was threaded through the insertion tool, and it was used to dislodge the flange from the insertion tool and into the abomasum.

Abomasum↗

PubMed2005

Classification tool for the systematic histological assessment of hepatocellular carcinoma, macroregenerative nodules, and dysplastic nodules in cirrhotic liver.

AIM: To design a classification tool for the histological assessment of hepatocellular carcinoma (HCC), dysplastic nodules (DN), and macroregenerative nodules (MRN) in cirrhotic liver. METHODS: Two hundred and twelve hepatocellular nodules (106 HCC; 74 MRN; 32 DN) were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis (MCA). RESULTS: MCA distributed HCC, DN, and MRN as defined by traditional histological evaluation as well as the individual histological variables, in a "malignancy scale". Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features (i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss, capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity). The classification tool classified most (83%) of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepancies were present for DN and MRN between the routine histological assignment and the classification tool. Of 25 HCC assigned by routine assessment in the validation set, 8 were assigned to the DN category by the classification tool. CONCLUSION: We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this tool systematically records histological features of diagnostic importance in the evaluation of small HCC.

Carcinoma, Hepatocellular↗