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PubMed1997

Scientists' statement regarding data on the sodium-hypertension relationship and sodium health claims on food labeling.

Nutrition Reviews has had a continuing interest in the scientific basis of arguments for and against health claims on foods. Such claims were first authorized by the Food and Drug Administration (FDA) in 1993 under the terms of the Nutrition Labelling and Education Act of the U.S. Congress, passed in 1990. Since then there have been petitions that have resulted in a newly authorized claim for oats and other petitions directed toward modification or deletion of the originally approved claims. The Salt Institute, an industry-supported organization, has actively participated in the discussions regarding the sodium and hypertension health claim. The scientists signing this statement are familiar with the evolving understanding of the relationship between sodium and hypertension. The statement reviews more recent studies and critiques the arguments for a sodium health claim. We invite our readers to respond to the discussion in this controversial area of nutrition science and policy.

Diet, Sodium-Restricted↗
PubMed2001

Influence of emotion and focus location on prosody in matched statements and questions.

Preliminary data were collected on how emotional qualities of the voice (sad, happy, angry) influence the acoustic underpinnings of neutral sentences varying in location of intra-sentential focus (initial, final, no) and utterance "modality" (statement, question). Short (six syllable) and long (ten syllable) utterances exhibiting varying combinations of emotion, focus, and modality characteristics were analyzed for eight elderly speakers following administration of a controlled elicitation paradigm (story completion) and a speaker evaluation procedure. Duration and fundamental frequency (f0) parameters of recordings were scrutinized for "keyword" vowels within each token and for whole utterances. Results generally re-affirmed past accounts of how duration and f0 are encoded on key content words to mark linguistic focus in affectively neutral statements and questions for English. Acoustic data on three "global" parameters of the stimuli (speech rate, mean f0, f0 range) were also largely supportive of previous descriptions of how happy, sad, angry, and neutral utterances are differentiated in the speech signal. Important interactions between emotional and linguistic properties of the utterances emerged which were predominantly (although not exclusively) tied to the modulation of f0; speakers were notably constrained in conditions which required them to manipulate f0 parameters to express emotional and nonemotional intentions conjointly. Sentence length also had a meaningful impact on some of the measures gathered.

Affect↗
PubMed2004

BMAS policy statements in some controversial areas of acupuncture practice.

The safe and competent practice of acupuncture requires the practitioner to conform to a number of basic principles. These include minimising the risk of transmission of infection, maintaining sufficient knowledge of anatomy to guide safe needling, and seeking an orthodox medical diagnosis before embarking on treatment. Beyond these basic principles, there are certain circumstances in practice that generate regular debate amongst practitioners. This article details advice on a limited selection of such circumstances. This advice has been drawn from a set of policy statements originally drafted to facilitate clarity and consistency within the teaching of Western medical acupuncture provided by the BMAS. It is not comprehensive, but covers the areas where there were the greatest differences in approach among the teaching staff. The original policy statements were also incorporated into the BMAS Code of Practice. By using the guidance in this article, in addition to applying sound clinical judgement and a knowledge of relevant anatomy, we hope that practitioners will minimise both the theoretical risks and the reported serious adverse events related to acupuncture, yet be able to practise unencumbered by illogical restrictions.

Acupuncture Therapy↗
PubMed2006

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.

Athletic Injuries↗
PubMed1995

Remembrance of conversations past: oral advance statements about medical treatment.

Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive.

Advance Directives↗
PubMed1993

Improving mortality data in South Africa: review of next of kin statements to determine cause of death in police certification.

STUDY OBJECTIVE: The study aimed to improve mortality data by finding ways of reducing the large number of deaths certified as being from "ill-defined" causes (ICD 780-798) in South Africa. This problem is attributable to the absence of cause of death information in many cases where the police issue the death certificate. DESIGN AND SETTING: A total of 600 consecutive death certification records at the Salt River State Mortuary, Cape Town were reviewed. MEASUREMENTS AND MAIN RESULTS: Altogether 347 (58%) deaths were from unnatural causes, 111 (18%) were certified by a doctor, 83 (14%) were certified as being the result of natural causes after a necropsy, and 59 (10%) were certified by the police as being from natural causes. Analysis of sworn statements obtained from the next of kin of all those certified dead by the police rather than a doctor provided a clear cause of death in 72.9%, and a history of recent contact with health services (less than one week previously) in 47.5%. All infants certified dead by the police had a history consistent with diarrhoeal disease. CONCLUSIONS: The method of death certification may be an indicator of access to health care and reviewing sworn statements to determine the cause of death should improve the quality of mortality data in the developing world.

Adolescent↗
PubMed2000

Improving the Quality of Reports of Meta-Analyses of Randomised Controlled Trials: The QUOROM Statement.

BACKGROUND: The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). METHODS: The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. FINDINGS: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with < >, study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. INTERPRETATION: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement. Copyright 2000 S. Karger GmbH, Freiburg

Journal Article↗
PubMed2006

Interpretation of ambiguous idiomatic statements in schizophrenic and depressive patients. Evidence for common and differential cognitive patterns.

BACKGROUND: This study is concerned with the comprehension of ambiguous idiomatic statements in schizophrenic and depressive patients. AIMS: Using a multiple-choice procedure, we simultaneously tested the presence of concrete and literal elements in the understanding of idiomatic statements. METHOD: Fourteen schizophrenic and 10 patients undergoing a major depressive episode as well as 14 control subjects completed a questionnaire with 10 idiomatic expressions with two possible interpretations (figurative and literal) of equivalent prominence. The participants had to choose one word linked with the different interpretations of these idioms (figurative, literal, concrete or inappropriate meaning). RESULTS: The main results show that, in all the subjects, the contextual characteristics of the task induced a bias in favor of figurative interpretations despite the equivalent prominence of the literal interpretations of the idioms. The selection of responses relating to the concrete meaning of a single word in the idiom constituted a response mode common to both the schizophrenic and depressed patients. Despite the contextual constraints of the task, the schizophrenics opted for the literal responses more often than the other participants. The descriptive analysis argues in favor of a cognitive and clinical heterogeneity of schizophrenic patients. CONCLUSION: Results support the idea that literality and concreteness in idiomatic interpretation are possibly due to distinct cognitive impairments, though only some are specific to schizophrenic patients.

Adult↗
PubMed1992

Cognitive processing of contradictory statements: an experimental study of reasoning on proverbs in schizophrenia.

Twenty schizophrenic patients and 20 normal subjects matched for age, sex and verbal level were asked to identify, from a list of alternatives, the statement that was the most contradictory to each of 8 proverbs. Schizophrenics (whether severely disturbed or not) were found to be less accurate in detecting the contradictions [F(1,18) = 29.21; p less than 0.0001]. No significant differences between undifferentiated and disorganized DSM-III subtypes were observed. The greatest tolerance of contradictory statements was interpreted in terms of violation of the 'no contradiction principle' and examined in the light of a deficit in logical abilities.

Adult↗
PubMed1989

Assessing risk associated with carotid endarterectomy. A statement for health professionals by an Ad Hoc Committee on Carotid Surgery Standards of the Stroke Council, American Heart Association.

This position statement provides guidelines for assessing risk associated with carotid endarterectomy and defines the point at which risk is too high to perform surgery for specific indications described below. Morbidity and mortality levels are discussed. This statement does not address indications for surgery or merits of specific medical or surgical treatments. Results of current studies that compare relative risk of various treatments for carotid artery disease are not yet available.

Brain Ischemia↗
PubMed2006

The United States preventive services task force recommendation statement on screening for peripheral arterial disease: more harm than benefit?

Under the auspices of the Agency for Healthcare Research and Quality, the United States Preventive Services Task Force (USPSTF) recently released an update to its 1996 Peripheral Arterial Disease (PAD) Screening Recommendation Statement. The USPSTF recommended against PAD screening, giving the practice a "D" level recommendation. This level suggests that little or no benefit could accrue from PAD screening and that screening-associated harm could occur. The present commentary disputes the Task Force's recommendation. The USPSTF statement omitted important peer-reviewed data on the prevalence, screening efficacy, and short-term adverse prognosis of patients with PAD and failed to consider the beneficial outcomes that probably would result from timely diagnosis and treatment of this important manifestation of atherosclerosis. The Task Force implied that screening may lead to unnecessary tests, including increased risk associated with use of contrast angiographic studies. However, most patients with PAD have neither classic symptoms of leg claudication nor threatened limbs but have an extraordinarily high rate of adverse cardiovascular events, such as myocardial infarction, stroke, and death--events that should serve as a key rationale for screening. Medical therapy, including risk factor modification and antiplatelet medications, is known to reduce cardiovascular morbidity and mortality rates in these patients. The Task Force's recommendation against PAD detection may itself adversely result in inadequate recognition and treatment of PAD, with adverse public health consequences. We encourage the USPSTF to reevaluate the extant data, add vascular specialty expertise to its review group, and reconsider its recommendation.

Arterial Occlusive Diseases↗
PubMed2006

Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth.

This statement is an updated report of the American Heart Association's previous publications on exercise in children. In this statement, exercise laboratory requirements for environment, equipment, staffing, and procedures are presented. Indications and contraindications to stress testing are discussed, as are types of testing protocols and the use of pharmacological stress protocols. Current stress laboratory practices are reviewed on the basis of a survey of pediatric cardiology training programs.

Clinical Protocols↗
PubMed2006

Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology.

With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.

American Heart Association↗
PubMed2006

Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics.

Although for most children the process of atherosclerosis is subclinical, dramatically accelerated atherosclerosis occurs in some pediatric disease states, with clinical coronary events occurring in childhood and very early adult life. As with most scientific statements about children and the future risk for cardiovascular disease, there are no randomized trials documenting the effects of risk reduction on hard clinical outcomes. A growing body of literature, however, identifies the importance of premature cardiovascular disease in the course of certain pediatric diagnoses and addresses the response to risk factor reduction. For this scientific statement, a panel of experts reviewed what is known about very premature cardiovascular disease in 8 high-risk pediatric diagnoses and, from the science base, developed practical recommendations for management of cardiovascular risk.

Arthritis, Rheumatoid↗
PubMed1987

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986.

Chronic obstructive pulmonary disease (COPD) and asthma are the major causes of pulmonary disability in the United States, with at least 10 million Americans suffering form COPD and up to 5% of the population afflicted with asthma. Over the past 20 years, major strides have been made in our understanding of the pathophysiology of these disorders, although there are still large gaps in our knowledge. While a number of position papers and statements have been promulgated by the American Thoracic Society concerning various aspects of the diagnosis and treatment of COPD and asthma, it was felt that a review of the overall topic was timely. This statement represents the combined efforts of a Task Group appointed by the Scientific Assemble of Clinical Problems of the American Thoracic Society to accomplish this task. Clearly, we could not cover every aspect of this broad topic nor even provide a detailed review of those areas addressed. We elected instead to concentrate on clinically relevant topics and to provide sufficient data to be useful as a guide as well as to include selected, but in no was exhaustive, references. The first two chapters define the entities and set forth recommendations for diagnosis, hospital admission, and discharge. The remaining four chapters critically review the various facets of therapy. We have noted controversial areas and those were conclusive experimental data are not yet available. In these situations, the committee often decided to take a position on one side or the other based upon the best available information.

Asthma↗
PubMedDate not supplied

The effect of numerical statements of risk on trust and comfort with hypothetical physician risk communication.

OBJECTIVE: To contribute to the debate about whether numeric statements of risk ought to be included in risk communications. DESIGN: Subjects (n = 115) completed a questionnaire involving a physician risk communication and 4 scenarios, each of which described a patient with symptoms and signs potentially suggestive of cancer. Each scenario was presented in 3 risk communication versions (a verbal version and 2 numeric versions) in a within-subject 4 x 3 design. Subjects rated their trust in and comfort with the information and their belief that the physician distorted their risk level. RESULTS: Subjects were significantly more trusting of (t =4.0, P < 0.001) and comfortable with (t =3.4, P = 0.001) the risk information, less likely to believe that the physician minimized the risk in the numeric versions than verbal versions (t =4.3, P < 0.0001), and just as likely to believe that the physician exaggerated the risk in the 2 versions (P = 0.588). CONCLUSIONS: Including a numeric statement of risk in a risk communication can increase trust and belief in and comfort with the risk information.

Humans↗
PubMed2001

Empirical tests of the Neuman systems model: relational statement analysis.

To be a valid test of the Neuman systems model, researchers' relational statements must be congruent with Neuman's axioms and must also be congruent at the conceptual, theoretical, and operational levels. Guided by Cooper's five-stage integrative review method, 92 quantitative research studies (dissertations and journal articles) were collected and categorized according to an expanded version of Silva's levels of theory testing. Nine studies, with explicit relational statements, were analyzed at three levels of abstraction, and interpretations of the studies' results were explored. Recommendations are made for the establishment of a program of research.

Data Collection↗