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At least 343 records · Page 19Linked to original sources

PubMed1998

Field test of a tool for level-of-care decisions in community mental health systems.

OBJECTIVE: Tools for supporting decisions about placing clients in different levels of mental health care can facilitate several important functions, such as structuring service allocation, providing standards for quality assurance and concurrent review, designing service and benefit packages, and planning for resource needs. This paper describes a level-of-care decision-support tool and tests its reliability and concurrent validity. METHODS: Panels of clinical managers and administrators of mental health centers developed a decision-support tool with eight levels of care and a computerized decision-tree algorithm for level-of-care placement. A random sample of 1,034 adults from one county mental health system were assessed by their case managers using a package that included variables in the eight-level model, but not the algorithm itself. Other variables were included to assess the tool's concurrent validity. RESULTS: Level-of-care placements based on the decision-support tool showed strong interrater reliability. Concurrent validity was demonstrated by significant relationships in the expected direction between level of care and psychiatric hospitalizations, arrests, residential moves, homeless periods, residential independence, lack of work activity, medication noncompliance, and functioning as measured by the Global Assessment of Functioning Scale. CONCLUSIONS: Preliminary empirical evidence indicates that the level-of-care decision-support tool is reliable and valid. It could be further refined by incorporating the impact of social supports, collateral services, current mental health services, and motivation for services.

Adult↗

PubMed1991

Validity and reliability of a pediatric hematology oncology patient acuity tool.

Appropriate use of nursing resources in the pediatric hematology and oncology inpatient settings demands a patient acuity system that is easy to use and accurate, and that objectively measures nursing care needs of a specialized patient population. Structured survey of 13 comprehensive cancer centers and a review of the literature show no valid and reliable acuity tools for this pediatric population. The purpose of this project was to study the validity and reliability of a newly developed pediatric hematology and oncology acuity system designed to quantify patient care needs. A new acuity tool for this pediatric population was developed based on the patient classification tool used at Johns Hopkins Hospital Oncology Center (JHHOC). The levels of care from the JHHOC tool were adopted, with therapeutic indicators modified to reflect nursing diagnoses relevant to the pediatric inpatient. Nursing care hours required for each level of care were also identified. Validity was studied using a content validity index (CVI). Experts from the pediatric unit where the tool would be used were asked whether each therapeutic indicator was assigned to the correct level of care (1 thru 5) based on patient care hours. CVIs for items ranged from .5 to 1.0; the overall CVI for the tool was .93. Interrater reliability was studied using two raters from the unit. Data were collected for 150 patient observations on a 12-bed pediatric hematology and oncology inpatient and short-stay outpatient unit. The resulting Pearson correlation coefficient was r = .97 (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed2004

B.E.A.R. GeneInfo: a tool for identifying gene-related biomedical publications through user modifiable queries.

BACKGROUND: Once specific genes are identified through high throughput genomics technologies there is a need to sort the final gene list to a manageable size for validation studies. The triaging and sorting of genes often relies on the use of supplemental information related to gene structure, metabolic pathways, and chromosomal location. Yet in disease states where the genes may not have identifiable structural elements, poorly defined metabolic pathways, or limited chromosomal data, flexible systems for obtaining additional data are necessary. In these situations having a tool for searching the biomedical literature using the list of identified genes while simultaneously defining additional search terms would be useful. RESULTS: We have built a tool, BEAR GeneInfo, that allows flexible searches based on the investigators knowledge of the biological process, thus allowing for data mining that is specific to the scientist's strengths and interests. This tool allows a user to upload a series of GenBank accession numbers, Unigene Ids, Locuslink Ids, or gene names. BEAR GeneInfo takes these IDs and identifies the associated gene names, and uses the lists of gene names to query PubMed. The investigator can add additional modifying search terms to the query. The subsequent output provides a list of publications, along with the associated reference hyperlinks, for reviewing the identified articles for relevance and interest. An example of the use of this tool in the study of human prostate cancer cells treated with Selenium is presented. CONCLUSIONS: This tool can be used to further define a list of genes that have been identified through genomic or genetic studies. Through the use of targeted searches with additional search terms the investigator can limit the list to genes that match their specific research interests or needs. The tool is freely available on the web at http://prostategenomics.org1, and the authors will provide scripts and database components if requested mdatta@mcw.edu

Databases, Genetic↗

PubMed2006

PET-Tool: a software suite for comprehensive processing and managing of Paired-End diTag (PET) sequence data.

BACKGROUND: We recently developed the Paired End diTag (PET) strategy for efficient characterization of mammalian transcriptomes and genomes. The paired end nature of short PET sequences derived from long DNA fragments raised a new set of bioinformatics challenges, including how to extract PETs from raw sequence reads, and correctly yet efficiently map PETs to reference genome sequences. To accommodate and streamline data analysis of the large volume PET sequences generated from each PET experiment, an automated PET data process pipeline is desirable. RESULTS: We designed an integrated computation program package, PET-Tool, to automatically process PET sequences and map them to the genome sequences. The Tool was implemented as a web-based application composed of four modules: the Extractor module for PET extraction; the Examiner module for analytic evaluation of PET sequence quality; the Mapper module for locating PET sequences in the genome sequences; and the Project Manager module for data organization. The performance of PET-Tool was evaluated through the analyses of 2.7 million PET sequences. It was demonstrated that PET-Tool is accurate and efficient in extracting PET sequences and removing artifacts from large volume dataset. Using optimized mapping criteria, over 70% of quality PET sequences were mapped specifically to the genome sequences. With a 2.4 GHz LINUX machine, it takes approximately six hours to process one million PETs from extraction to mapping. CONCLUSION: The speed, accuracy, and comprehensiveness have proved that PET-Tool is an important and useful component in PET experiments, and can be extended to accommodate other related analyses of paired-end sequences. The Tool also provides user-friendly functions for data quality check and system for multi-layer data management.

Animals↗

PubMed2006

Decision tools in health care: focus on the problem, not the solution.

BACKGROUND: Systematic reviews or randomised-controlled trials usually help to establish the effectiveness of drugs and other health technologies, but are rarely sufficient by themselves to ensure actual clinical use of the technology. The process from innovation to routine clinical use is complex. Numerous computerised decision support systems (DSS) have been developed, but many fail to be taken up into actual use. Some developers construct technologically advanced systems with little relevance to the real world. Others did not determine whether a clinical need exists. With NHS investing 5 billion pounds sterling in computer systems, also occurring in other countries, there is an urgent need to shift from a technology-driven approach to one that identifies and employs the most cost-effective method to manage knowledge, regardless of the technology. The generic term, 'decision tool' (DT), is therefore suggested to demonstrate that these aids, which seem different technically, are conceptually the same from a clinical viewpoint. DISCUSSION: Many computerised DSSs failed for various reasons, for example, they were not based on best available knowledge; there was insufficient emphasis on their need for high quality clinical data; their development was technology-led; or evaluation methods were misapplied. We argue that DSSs and other computer-based, paper-based and even mechanical decision aids are members of a wider family of decision tools. A DT is an active knowledge resource that uses patient data to generate case specific advice, which supports decision making about individual patients by health professionals, the patients themselves or others concerned about them. The identification of DTs as a consistent and important category of health technology should encourage the sharing of lessons between DT developers and users and reduce the frequency of decision tool projects focusing only on technology. The focus of evaluation should become more clinical, with the impact of computer-based DTs being evaluated against other computer, paper- or mechanical tools, to identify the most cost effective tool for each clinical problem. SUMMARY: We suggested the generic term 'decision tool' to demonstrate that decision-making aids, such as computerised DSSs, paper algorithms, and reminders are conceptually the same, so the methods to evaluate them should be the same.

Attitude to Computers↗

PubMed2000

Functional MRI correlates of real and imagined tool-use pantomimes.

OBJECTIVE: To study the pattern of cerebral activation related to the performance of tool-use pantomimes with functional MRI (fMRI) using a task-subtraction design. BACKGROUND: Tool use comprises a particular category of transitive actions. Inability to pantomime the use of tools has been classically associated with retrorolandic dominant hemisphere damage. However, where in the left hemisphere these transitive representations are generated is unclear. METHODS: Echoplanar images were acquired in eight alternating task and control periods. Sixteen right-handed normal adults pantomimed the use of common tools and utensils with each hand. The control condition consisted of a sequence of nonsymbolic complex movements of forearm, hand, and fingers at a self-paced rate. Eight individuals also imagined the execution of the real task and control actions. A repeated measures ANOVA compared activations in five regions of interest in each hemisphere. RESULTS: Regardless of which hand was used, the left hemisphere was more active than the right in both real (p < 0.02) and imagined (p < 0.04) tasks. Activations clustered in the left intraparietal cortex and posterior dorsolateral frontal cortex. CONCLUSIONS: Pantomiming the use of tools is associated with activation of the left intraparietal cortex and dorsolateral frontal cortex. The left intraparietal cortex may store the representations of tool-use formulae, whereas the dorsolateral frontal cortex activation may reflect the switching between innervatory motor programs.

Adolescent↗

PubMedDate not supplied

Malnutrition and pressure ulcers: nutritional assessment tools.

Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. Numerous nutritional assessment tools exist which help to identify a patient's nutritional status. No nationally standardized nutritional assessment tool exists and there is a danger of assessment methods becoming as proliferate as pressure ulcer risk assessment tools. A solution to this problem may be to use a pressure ulcer risk assessment tool with a nutritional risk assessment tool such as the Burton Score. Pressure ulcers and malnutrition have been demonstrated to be strongly correlated with each other. Malnutrition is not just present in hospitals but also in nursing homes. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes.

Humans↗

PubMedDate not supplied

An evaluation of the Waterlow pressure ulcer risk-assessment tool.

The National Institute for Clinical Excellence (NICE, 2001) stated that in order to achieve clinical governance strategies, risk management in the form of pressure ulcer risk assessment will contribute to improved quality of patient care. Risk-assessment tools must display high-predictive values, be highly sensitive and specific, reliable, and easy and convenient to use. Despite their extensively documented poor performance, pressure ulcer risk-assessment scales play a primary role in the prevention and management of pressure ulcers. The tools attempt to determine patients' risk status by quantifying a range of the most commonly recognized risk factors. Although there are over 40 different assessment tools, the Waterlow pressure ulcer risk-assessment tool is the tool that is most widely used in the UK. This article aims to review studies relating to the reliability, content validity, predictive validity, concurrent validity and the construct validity of the Waterlow pressure ulcer risk-assessment tool.

Attitude of Health Personnel↗

PubMed2005

Distinct cortical pathways for processing tool versus animal sounds.

Human listeners can effortlessly categorize a wide range of environmental sounds. Whereas categorizing visual object classes (e.g., faces, tools, houses, etc.) preferentially activates different regions of visually sensitive cortex, it is not known whether the auditory system exhibits a similar organization for different types or categories of complex sounds outside of human speech. Using functional magnetic resonance imaging, we show that hearing and correctly or incorrectly categorizing animal vocalizations (as opposed to hand-manipulated tool sounds) preferentially activated middle portions of the left and right superior temporal gyri (mSTG). On average, the vocalization sounds had much greater harmonic and phase-coupling content (acoustically similar to human speech sounds), which may represent some of the signal attributes that preferentially activate the mSTG regions. In contrast, correctly categorized tool sounds (and even animal sounds that were miscategorized as being tool-related sounds) preferentially activated a widespread, predominantly left hemisphere cortical "mirror network." This network directly overlapped substantial portions of motor-related cortices that were independently activated when participants pantomimed tool manipulations with their right (dominant) hand. These data suggest that the recognition processing for some sounds involves a causal reasoning mechanism (a high-level auditory "how" pathway), automatically evoked when attending to hand-manipulated tool sounds, that effectively associates the dynamic motor actions likely to have produced the sound(s).

Acoustic Stimulation↗

PubMed2006

New tools and emerging technologies for the diagnosis of tuberculosis: part II. Active tuberculosis and drug resistance.

Tuberculosis (TB) is one of the world's most important infectious causes of morbidity and mortality among adults. Between 8 and 9 million develop TB disease, and approximately 2 million die from TB each year. Despite this enormous global burden, case detection rates are low, posing major hurdles for TB control. Conventional TB diagnosis continues to rely on smear microscopy, culture and chest radiography. These tests have known limitations. Conventional tests for detection of drug resistance are slow, tedious and difficult to perform in field conditions. This second half of a two-part review series on new tools for TB diagnosis describes recent advances and emerging technologies in the diagnosis of active disease, and detection of drug resistance. For diagnosis, new tools include newer versions of nucleic acid amplification tests, immune-based assays, skin patch test and rapid culture systems. For drug resistance, new tools include line-probe assays, bacteriophage-based assays, molecular beacons and microscopic observation drug susceptibility assay. Although the ideal test for TB is still not in sight, substantial progress has been made in the past decade. With the resurgence of interest in the development of new tools for TB control, it is likely that the next decade will see greater progress and tangible benefits. However, the challenge will be to ensure that new tools undergo rigorous evaluations in field conditions, and also to make sure that benefits of promising new tools actually reach the populations in developing countries that need them most. Latent TB is discussed in Part I; 413-422 of this issue.

Antigens, Bacterial↗

PubMed2006

The CatchMod toolbox: easy and guided access to ICT tools for Water Framework Directive implementation.

Web-based toolboxes are handy tools to inform experienced users of existing software in their disciplines. However, for the implementation of the Water Framework Directive, a much more diverse public (water managers, consultancy firms, scientists, etc.) will ask for a very wide diversity of Information and Communication Technology (ICT) tools. It is obvious that the users of a web-based ICT-toolbox providing all this will not be experts in all of the disciplines and that a toolbox for ICT tools for Water Framework Directive implementation should thus go beyond just making interesting web-links. To deal with this issue, expert knowledge is brought to the users through the incorporation of visitor-geared guidance (materials) in the Harmoni-CA toolbox. Small workshops of expert teams were organized to deliver documents explaining why the tools are important, when they are required and what activity they support/perform, as well as a categorization of the multitude of available tools. An integration of this information in the web-based toolbox helps the users to browse through a toolbox containing tools, reports, guidance documents and interesting links. The Harmoni-CA toolbox thus provides not only a virtual toolbox, but incorporates a virtual expert as well.

Conservation of Natural Resources↗

PubMed2006

Evaluating microbial safety of slow partial-cooking processes for bacon: use of a predictive tool based on small-scale isothermal meat inoculation studies.

The objective of this study was to develop a predictive tool for evaluating the safety of slow cooking of pork products and identifying associated critical limits. Small-scale (25 g) ground pork isothermal inoculation studies were done to determine Salmonella serovars, Escherichia coli O157:H7, and Staphylococcus aureus estimated critical times (time until growth reached a predefined increase of concern). Estimated critical time values ranged from 720 min at 21 degrees C (S. aureus) to 120 min at 40.6 degrees C (E. coli O157:H7) and were used to develop a multiple-temperature-interval predictive tool for non-isothermal processes. To test predictions, cured-pumped pork bellies were inoculated with Salmonella serovars, E. coli O157:H7, and S. aureus, subjected to slow partial cooking, and quantitatively analyzed for pathogens. Processes lasted 6 to 18 h, with the product interior temperature within the 21 to 46 degrees C range for 263 to 1080 min (high-humidity processes) and 217 to 921 min (low-humidity processes). Growth of Salmonella serovars (>0.3 log), E. coli O157:H7 (>0.3 log), and S. aureus (>1.3 log) in the pork belly interior was predicted for 10, 14, and 5 of 18 trials, respectively. The tool was fail-safe, because pathogen growth, relative to time zero, did not occur anytime regardless of whether it was predicted. For the pork belly surface, the tool performed similarly. Estimated critical time values obtained by fitting the Baranyi equation to isothermal experiment data were also determined and, if used in the predictive tool, would result in even more conservative predictions. Our study substantiates the safety of the tested bacon slow partial-cooking processes and the potential usefulness of our isothermal-based tool in process safety evaluation.

Animals↗

PubMed1993

Program planning: the clinical utility of three activities of daily living assessment tools.

A jury of five occupational therapy experts was used to evaluate the clinical utility of three activities of daily living assessment tools that were originally designed for purposes other than individualized occupational therapy assessment or program planning. The three tools were the Index of Independence in Activities of Daily Living, PULSES Profile, and Physical Self-Maintenance Scale. Using the results from each tool, scored for a simulated patient with a right cerebrovascular accident, as well as medical information about the patient, the jury members were asked to plan a treatment program. The consensus of the jury was that the results from each tool did not provide enough information to help them identify the patient's specific performance problems or the causes of those problems. Therefore, the three tools were considered to have low clinical utility for planning individualized occupational therapy treatment. For use in planning an individualized treatment program, an activities of daily living assessment tool should provide specific information about which component of a task the patient found difficult or was unable to do and the type and level of assistance required.

Activities of Daily Living↗

PubMed2000

Acquisition and development of monkey tool-use: behavioral and kinematic analyses.

Four Japanese macaques were trained in the use of a T-shaped rake. Use the tool and development of the level of the skill of tool-use took place in three distinct stages. During stage 1, two of the monkeys seemed to use insight for initial solution, while fortuitous experiences led the other two monkeys to the solution. All the monkeys used the tool in a stereotyped manner and could retrieve food only when the tool was placed close to the food. At stage 2 the monkeys became able to manipulate the tool in various ways and became able to retrieve the food regardless of its position. By stage 3 they had developed the level of skill required for efficient retrieval. Further experiments revealed that the monkeys attempted to use unfamiliar objects which were similar to the original tool in shape, but not spherical or ring-shaped objects, to rake in the food.

Animals↗

PubMed2001

Cross-tool communication: from protocol authoring to eligibility determination.

To be effective, informatics tools for clinical trial protocols must inter-operate and share knowledge. We demonstrate a simple XML-based communication of eligibility criteria information between two independently-developed informatics tools. Using a shared DTD model of criteria, an authoring tool (developed within the Protégé environment) can send a list of eligibility criteria to a commercial system for automatic eligibility determination (the "iKnowChart" system by iKnowMed). The criteria model, developed as a Protégé ontology, includes both the terminology and the logic needed to compute eligibility for a given patient. As a demonstration of cross-tool communication, we have encoded criteria from an active clinical trial protocol (E1199), and shown how use of the authoring tool can effectively update the eligibility knowledge and the behavior of the commercial iKnowChart system. As part of the cross-tool knowledge sharing, we use Common Data Elements, an oncology terminology developed by the National Cancer Institute.

Clinical Protocols↗

PubMed2003

Assessing the older person: is the MNA a more appropriate nutritional assessment tool than the SGA?

OBJECTIVES: A study was undertaken to determine which nutritional assessment tool would be better in assessing changes in nutritional status over time in hospitalised older patients. The two tools used were the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA). DESIGN: Single blind, prospective study conducted over a 60-day period. SETTING: Five regional hospitals within Southern New South Wales, Australia. SUBJECTS: There were 43 patients at the commencement of the study, then 28 patients at day 30 and 20 patients at day 60. METHODS: All patients over 65 years of age admitted to the five hospitals during May 2001 were eligible. The only exclusions were those patients admitted to palliative care or with severe dementia. Two dietitians saw each patient. Each dietitian assessed the patient using his or her assigned nutritional assessment tool either the SGA or the MNA. All dietitians were randomly assigned the tool at the commencement of the study. They were familiarised with the use of the tool by participating in a workshop prior to the start of the study. RESULT: The MNA was able to detect greater numbers of malnourished subjects when compared to the SGA. This finding was consistent across Day 0, 30 and 60 and statistically significant (p<0.05) at all time periods. CONCLUSIONS: This study has shown the MNA to be a more appropriate nutrition assessment tool for older patients when compared to the SGA. The MNA is better able to identify severely malnourished patients. This study illustrated the potential use of the MNA as an ongoing monitor of nutritional status and hence a measure of the impact of nutrition intervention.

Aged↗

PubMed2003

Experiences with a generator tool for building clinical application modules.

OBJECTIVES: To elaborate main system characteristics and relevant deployment experiences for the health information system (HIS) Orbis/OpenMed, which is in widespread use in Germany, Austria, and Switzerland. METHODS: In a deployment phase of 3 years in a 1.200 bed university hospital, where the system underwent significant improvements, the system's functionality and its software design have been analyzed in detail. We focus on an integrated CASE tool for generating embedded clinical applications and for incremental system evolution. We present a participatory and iterative software engineering process developed for efficient utilization of such a tool. RESULTS: The system's functionality is comparable to other commercial products' functionality; its components are embedded in a vendor-specific application framework, and standard interfaces are being used for connecting subsystems. The integrated generator tool is a remarkable feature; it became a key factor of our project. Tool generated applications are workflow enabled and embedded into the overall data base schema. Rapid prototyping and iterative refinement are supported, so application modules can be adapted to the users' work practice. CONCLUSIONS: We consider tools supporting an iterative and participatory software engineering process highly relevant for health information system architects. The potential of a system to continuously evolve and to be effectively adapted to changing needs may be more important than sophisticated but hard-coded HIS functionality. More work will focus on HIS software design and on software engineering. Methods and tools are needed for quick and robust adaptation of systems to health care processes and changing requirements.

Computer Systems↗

PubMed2003

[Development and evaluation of a basic documentation tool for guideline-oriented ambulatory care of depressive patients].

Quality assurance in the treatment of mental disorders is becoming increasingly significant. In this context, documentation systems are important in order to control the implementation of guidelines, to analyse shortcomings and to reveal improvement possibilities. Up till now there is no specific documentation tool for the outpatient care of depressive disorders. Within the project "Comprehensive Quality Management in Out-patient Care" a documentation tool for primary care as well as for psychiatric care of depressive patients has been developed, which embraces the principal diagnostic and therapeutic measures. This documentation tool consisting of an instrument for the physician to record the first consultation, a second instrument to record the following consultations as well as a patient questionnaire has been implemented and evaluated in primary care and psychiatric practices. The evaluation results demonstrate that the documentation tool is able to assess guideline-oriented treatment measures. Physicians evaluated the usefulness and practicability of the documentation tool positively. And although the documentation efforts required are quite extensive, this documentation tool provides a suitable basis for external or internal quality assurance as well as patient-oriented case-monitoring.

Ambulatory Care↗