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At least 559 records · Page 31Linked to original sources

PubMed2002

Assessment and measurement of cough: the value of new tools.

On systematic investigation, patients with persistent cough are often diagnosed as having asthma, gastro-oesophageal reflux (GOR) and post-nasal drip; often, there is no associated diagnosis. Cough-variant asthma and eosinophilic bronchitis are conditions presenting with cough, usually associated with airway eosinophilia and responding well to corticosteroids. These conditions including asthma are best grouped as 'eosinophil-associated cough'. Analysis of induced sputum for eosinophils is an important tool in the investigation of chronic persistent cough. Reliable ambulatory counters for cough have been developed and the contribution of cough count and intensity to the severity of cough have been partly evaluated, and used in assessing antitussive therapies. Self-scoring evaluations are still widely used, but the inclusion of quality of life tools specifically adapted to the evaluation of cough appears to be a useful tool that can directly measure the impact of chronic cough. We need a greater assessment and evaluation of all these tools.

Bronchitis↗

PubMed2001

Tools to manage the enterprise-wide picture archiving and communications system environment.

The presentation will focus on the implementation and utilization of a central picture archiving and communications system (PACS) network-monitoring tool that allows for enterprise-wide operations management and support of the image distribution network. The MagicWatch (Siemens, Iselin, NJ) PACS/radiology information system (RIS) monitoring station from Siemens has allowed our organization to create a service support structure that has given us proactive control of our environment and has allowed us to meet the service level performance expectations of the users. The Radiology Help Desk has used the MagicWatch PACS monitoring station as an applications support tool that has allowed the group to monitor network activity and individual systems performance at each node. Fast and timely recognition of the effects of single events within the PACS/RIS environment has allowed the group to proactively recognize possible performance issues and resolve problems. The PACS/operations group performs network management control, image storage management, and software distribution management from a single, central point in the enterprise. The MagicWatch station allows for the complete automation of software distribution, installation, and configuration process across all the nodes in the system. The tool has allowed for the standardization of the workstations and provides a central configuration control for the establishment and maintenance of the system standards. This report will describe the PACS management and operation prior to the implementation of the MagicWatch PACS monitoring station and will highlight the operational benefits of a centralized network and system-monitoring tool.

Humans↗

PubMed2004

Development of a clinical assessment tool in identifying Asian men with low bone mineral density and comparison of its usefulness to quantitative bone ultrasound.

Osteoporosis in men is a largely neglected condition in Asia (and elsewhere), despite the fact that one-third of hip fractures occur in men. Moreover, access to bone mineral density (BMD) measurements is limited in many areas of Asia, and inexpensive methods of targeting high risk patients for BMD measurements would be valuable. We have developed a simple clinical assessment tool to identify high risk Asian men for BMD measurements. Information on risk factors was collected from 420 community-dwelling adult Chinese men aged 50 years and above using a structured questionnaire, and the ability of these risk factors to identify subjects with femoral neck BMD T score < or = -2.5 was assessed. Multiple regression analysis and item reduction yielded a final clinical risk assessment tool based on only age and weight, similar to the Osteoporosis Self-assessment Tool for Asians (OSTA), described previously for Asian women. The OSTA values of < or = -1 had a sensitivity of 81% and specificity of 66%, and the area under the receiver operating characteristics curve was 0.83. The index was validated in another sample of 356 men with a sensitivity of 82% and specificity of 67 %, and an AUC of 0.85. The usefulness of OSTA was further compared to calcaneal quantitative bone ultrasound (QUS) in the validation sample of 356 men. The optimal cutoff T score of -1.2 for QUS yielded sensitivity and specificity values of 75 and 67%, respectively. The AUC for QUS was 0.79. Combining OSTA and QUI gave a sensitivity of 88% and specificity of 66% to identify men with low BMD at the femoral neck, and an AUC of 0.86 which was statistically not different from either OSTA or QUI alone. We conclude that OSTA is a simple and effective clinical risk assessment tool for identifying not only female but also male subjects at increased risk of osteoporosis, and its use could facilitate the appropriate and more cost-effective use of bone densitometry in developing countries.

Absorptiometry, Photon↗

PubMed2002

The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity.

Advances in the measurement of swallowing physiologic parameters have been clinician-driven, as has the development of intervention techniques to modify swallowing pathophysiology. However, a critical element to determining the success of such efforts will be established by the patients themselves. We conceptualized, developed, and validated the SWAL-QOL, a 93-item quality-of-life and quality-of-care outcomes tool for dysphagia researchers and clinicians. With 93 items, the SWAL-QOL was too long for practical and routine use in clinical research and practice. We used an array of psychometric techniques to reduce the 93-item instrument into two patient-centered outcomes tools: (1) the SWAL-QOL, a 44-item tool that assesses ten quality-of-life concepts, and (2) the SWAL-CARE, a 15-item tool that assesses quality of care and patient satisfaction. All scales exhibit excellent internal-consistency reliability and short-term reproducibility. The scales differentiate normal swallowers from patients with oropharyngeal dysphagia and are sensitive to differences in the severity of dysphagia as clinically defined. It is intended that the standardization and publication of the SWAL-QOL and the SWAL-CARE will facilitate their use in clinical research and clinical practice to better understand treatment effectiveness as a critical step toward improving patients' quality of life and quality of care.

Aged↗

PubMed2003

The premenstrual symptoms screening tool (PSST) for clinicians.

A variety of instruments have been used in an attempt to operationalize DSM-IV criteria for premenstrual dysphoric disorder (PMDD) and to understand clinically significant premenstrual syndrome (PMS). The objectives of this research were to devise a simple user friendly screening tool to identify women who suffer from severe PMS/PMDD and who are likely to benefit from treatment. Five hundred and nineteen women, between the ages of 18 and 55 yrs, who were seen at a primary care facility completed "The Premenstrual Symptoms Screening tool" (PSST). The PSST reflects and 'translates' categorical DSM-IV criteria into a rating scale with degrees of severity. The results are in line with reported prevalence rates from several recent large prospective studies. We believe that the PSST applies a necessary degree of measure of severity and impact of premenstrual symptoms, establishes quickly if women qualify for PMDD, and is less time consuming and more practical than two cycles of prospective charting. This fast simple tool is an effective screening tool and an important starting point for further assessment.

Adolescent↗

PubMed2004

Preliminary observations of tool use in captive hyacinth macaws (Anodorhynchus hyacinthinus).

Many animals use tools (detached objects applied to another object to produce an alteration in shape, position, or structure) in foraging, for instance, to access encapsulated food. Descriptions of tool use by hyacinth macaws (Anodorhynchus hyacinthinus) are scarce and brief. In order to describe one case of such behavior, six captive birds were observed while feeding. Differences in nut manipulation and opening proficiency between adults and juveniles were recorded. The tools may be serving as a wedge, preventing the nut from slipping and/or rotating, reducing the impact of opening, or providing mechanical aid in its positioning and/or use of force. Data suggest that birds of this species have an innate tendency to use objects (tools) as aids during nut manipulation and opening.

Age Factors↗

PubMed2004

Tool-use learning in Tonkean macaques (Macaca tonkeana).

The transmission of tool use is a rare event in monkeys. Such an event arose in a group of semi-free-ranging Tonkean macaques (Macaca tonkeana) in which leaning a pole against the park's fence (branch leaning) appeared and spread to several males. This prompted us to test individual and social learning of this behavior in seven young males. In the first experiment, three males learned individually to obtain a food reward using a wooden pole as a climbing tool. They began using the pole to retrieve the reward only when they could alternatively experience acting on the object and reaching the target. In a second experiment, we first tested whether four other subjects could learn branch leaning after having observed a group-mate performing the task. Despite repeated opportunities to observe the demonstrator, they did not learn to use the pole as a tool. Hence we exposed the latter subjects to individual learning trials and they succeeded in the task. Tool use was not transmitted in the experimental situation, which contrasts with observations in the park. We can conclude that the subjects were not able to recognize the target as such. It is possible that they recognized it and learned the task individually when we alternated the opportunity to act upon the object and to reach the reward. This suggests that these macaques could then have associated the action they exercised upon the pole and the use of the pole as a means to reach the reward.

Animals↗

PubMed2003

Tools for managing image flow in the modality to clinical-image-review chain.

Web-based clinical-image viewing is commonplace in large medical centers. As demands for product and performance escalate, physicians, sold on the concept of "any image, anytime, anywhere," fret when image studies cannot be viewed in a time frame to which they are accustomed. Image delivery pathways in large medical centers are oftentimes complicated by multiple networks, multiple picture archiving and communication systems (PACS), and multiple groups responsible for image acquisition and delivery to multiple destinations. When studies are delayed, it may be difficult to rapidly pinpoint bottlenecks. Described here are the tools used to monitor likely failure points in our modality to clinical-image-viewing chain and tools for reporting volume and throughput trends. Though perhaps unique to our environment, we believe that tools of this type are essential for understanding and monitoring image-study flow, re-configuring resources to achieve better throughput, and planning for anticipated growth. Without such tools, quality clinical-image delivery may not be what it should.

Data Display↗

PubMed2004

Multidimensional analysis: a management tool for monitoring HIPAA compliance and departmental performance.

Most RIS and PACS systems include extensive auditing capabilities as part of their security model, but inspecting those audit logs to obtain useful information can be a daunting task. Manual analysis of audit trails, though cumbersome, is often resorted to because of the difficulty to construct queries to extract complex information from the audit logs. The approach proposed by the authors uses standard off-the-shelf multidimensional analysis software tools to assist the PACS/RIS administrator and/or security officer in analyzing those audit logs to identify and scrutinize suspicious events. Large amounts of data can be quickly reviewed and graphical analysis tools help explore system utilization. While additional efforts are required to fully satisfy the demands of the ever-increasing security and confidentiality pressures, multidimensional analysis tools are a practical step toward actually using the information that is already being captured in the systems' audit logs. In addition, once the work is performed to capture and manipulate the audit logs into a viable format for the multidimensional analysis tool, it is relatively easy to extend the system to incorporate other pertinent data, thereby enabling the ongoing analysis of other aspects of the department's workflow.

Computer Security↗

PubMed2007

Development of a content-valid standardized orthopedic assessment tool (SOAT).

INTRODUCTION: Content validation of an instrument that measures student performance in OSCE-type practical examinations is a critical step in a tool's overall validity and reliability [Hopkins (1998), Educational and Psychological Measurement and Evaluation (8th ed.). Toronto: Allyn & Bacon]. PURPOSE: The purpose of the paper is to outline the process employed to create a content-valid Standardized Orthopedic Assessment Tool (SOAT). Orthopedic assessment skills are employed by athletic therapists, physiotherapists and physicians. All follow very similar diagnostic algorithms and that system was used to develop the original SOAT [Cyriax (1982). Textbook of Orthopaedic Medicine, (vol. 1) Bailliere Tindall]. METHODS: To validate the tool, the study followed procedures outlined by Violato, Salami, and Muiznieks (2002), Journal of Manipulative Physiological Therapeutics, 25, 111-115, and Butterwick, Paskevich, Vallevand and Lafave (2006), Journal of Allied Health: a modified Ebel procedure. An expert group of athletic therapists from across Canada were chosen to create the content valid tool. Representation from all accredited athletic therapy programs in Canada was sought. Experts participated in three stages of content validation: Stage one consisted of individuals grading tasks on difficulty (hard, medium, easy) and importance (essential, important, not important) for 8 body regions (cervical spine, lumbar spine, shoulder, elbow, wrist/hand/thumb, hip, knee and lower leg/foot/ankle) and three diagnoses for each body region (24 total). If 80% consensus was not achieved in the first stage, then in stage two, face to face discussion is meant to clarify positions and achieved consensus, if possible. RESULTS: The history component, the observation component, scanning exams, clearing joints above and below the lesion site and active range of motion, passive range of motion and isometric resisted testing all yielded 80% consensus in the first two stages of development. A third stage was added to this process because a new model of measurement was conceptualized during the second stage due to a lack of consensus on two orthopedic assessment categories: special testing and palpation. The new model consisted of a ;;clinical reasoning" metric that tied each section of an orthopedic assessment (history; observation; scanning and clearing; examination, special testing; palpation; conclusion) together and would permit the expert rater to evaluate the student performance based on the student's rationale for tests chosen rather than the traditionally rigid checklists. At least 80% consensus was achieved with the new ;;clinical reasoning" metric and the originally contentious special testing and palpation categories. CONCLUSIONS: The new SOAT that underwent content validation may be a hybrid between the traditional OSCE-type checklists and global scales that provide a more realistic and thus more valid depiction of orthopedic assessment clinical competence. Now that content validation has been established, the next steps include inter-rater reliability testing.

Algorithms↗

PubMed2005

Development of a data management tool for investigating multivariate space and free will experiences in virtual reality.

Virtual reality (VR) has become mature enough to be successfully used in clinical applications such as exposure therapy, pain distraction, and neuropsychological assessment. However, we now need to go beyond the outcome data from this research and conduct the detailed scientific investigations required to better understand what factors influence why VR works (or doesn't) in these types of clinical applications. This knowledge is required to guide the development of VR applications in the key areas of education, training, and rehabilitation and to further evolve existing VR approaches. One of the primary assets obtained with the use of VR is the ability to simulate the complexity of real world environments, within which human performance can be tested and trained. But this asset comes with a price in terms of the capture, quantification and analysis of large, multivariate and concurrent data sources that reflect the naturalistic behavioral interaction that is afforded in a virtual world. As well, while achieving realism has been a main goal in making convincing VR environments, just what constitutes realism and how much is needed is still an open question situated firmly in the research domain. Just as in real "reality," such factors in virtual reality are complex and multivariate, and the understanding of this complexity presents exceptional challenges to the VR researcher. For certain research questions, good behavioral science often requires consistent delivery of stimuli within tightly controlled lab-based experimental conditions. However, for other important research questions we do not want to constrain naturalistic behavior and limit VR's ability to replicate real world conditions, simply because it is easier to study human performance with traditional lab-based methodologies. By doing so we may compromise the very qualities that comprise VR's unique capacity to mimic the experiences and challenges that exist in everyday life. What is really needed to address scientific questions that require natural exploration of a simulated environment are more usable and robust tools to instrument, organize, and visualize the complex data generated by measurements of participant behaviors within a virtual world. This paper briefly describes the rationale and methodology of an initial study in an ongoing research program that aims to investigate human performance within a virtual environment where unconstrained "free will" exploratory behavior is essential to research questions that involve the relationships between physiology, emotion, and memory. After a discussion of the research protocol and the types of data that were collected, we describe a novel tool that was borne from our need to more efficiently capture, manage, and explore the complex data that was generated in this research. An example of a research participant's annotated display from this data management and visualization tool is then presented. It is our view that this tool provides the capacity to better visualize and understand the complex data relationships that may arise in VR research that investigates naturalistic free will behavior and its impact on other human performance variables.

Activities of Daily Living↗

PubMed2005

Values based decision making: a tool for achieving the goals of healthcare.

The recognition that the success of the healthcare organization depends on its achievement of two interrelated goals is a relatively recent phenomenon. In its mid-history the healthcare organization was largely able to ignore cost issues. In its latter history, many would argue that it ignored its quality goals as it pursued its cost goals (15). Either approach, given declining revenues and a competitive landscape, is incompatible with continued responsible operation. If this is true, then tools that were appropriate when the healthcare organization was focused on the achievement of one or another of these goals are not adequate as the healthcare organization seeks to achieve both goals together. Thus, new perspectives and new tools must be found that help the organization address two intimately related but sometimes conflicting goals. Values based decision-making can be the perspective needed, and organization ethics is one tool that can be of use in supporting it within the institution. But there are caveats. In order for values based decision-making to be effective, leadership must take an active role in promoting its use. It must relinquish a degree of control and it must begin to trust its stakeholders to make decisions within the context of the organization's values and goals. This can be extremely difficult, as control by senior management is often seen as the only effective means of ensuring that correct decisions are made. There are additional difficulties in the healthcare organization. Control rests within two groups and the healthcare organization is operating in an environment in which variance elimination is emphasized as a means of controlling costs. This may be an appealing notion for revenue strapped healthcare organization leaders, but it implies greater control exerted by managers, not less. Relinquishing any degree of control is a frightening prospect, but it has been done successfully. An excellent example of leadership encouraging decisions based on values was presented by a unit administrator frustrated by the hierarchical structure and ponderous rituals of a traditional intensive care unit. Invoking a management tool called "the balanced scorecard" (which recognizes the multiplicity of goals and values in any organization) he identified the goals and values of the unit, and with the help and input of his staff he restructured it into functional multidisciplinary "teams" organized around tasks and goals which were based on values. The transformation of identities of unit members from their job description to their accomplishments improved both the efficiency of the unit and its morale--as well as resulting in cost savings. In this example teams had to learn to work together, collaborate and disregard the fear of doing things differently. Staff had to be motivated and feedback was necessary to ensure goals rather then rules were being meet. The balanced scorecard was implemented with mechanisms to support the communication and collaboration necessary to achieve the goals of the unit. The experiment was successful, but only because leadership recognized that multiple goals and multiple values were involved, that were explicitly articulated with the priority of excellent care. But once leadership was sure that "shared vision" existed leadership was able to trust staff to make appropriate decisions to realize that vision.

Attitude of Health Personnel↗

PubMed2006

Validation of a comprehensive classification tool for treatment-related problems.

OBJECTIVE: Several drug-related problem classification systems can be found in the literature. However, it is generally agreed that a comprehensive, well constructed and validated instrument is currently lacking. The aim of this study is the development and validation of a comprehensive treatment-related problems assessment and classification tool for use in teaching, practicing and researching pharmaceutical care and to improve identification, resolving and preventing of treatment-related problems. METHOD: The development and validation involved five steps starting with literature search to define a treatment related problem and also to form a database of treatment-related problems identified in the literature. In the next step, all problems that were identified in the first step and passed the evaluation of the three authors were pooled together and then divided into groups according to their common or shared construct, in the third step a suitable assessment method was developed according to the construct of the different problems, in the next step the developed instrument was validated for content, internal and external validity. Finally the tool was finalized and tested for reproducibility and inter-rater agreement. RESULTS: The final validated version included six main categories for treatment-related problems (Indication, Effectiveness, Safety, Knowledge, Adherence and Miscellaneous). These categories include a total of nine subcategories and a total of 29 treatment related problems. CONCLUSION: The treatment-related problems assessment and classification tool introduced in this paper was applied to actual patient cases and proved to be valid. This tool also has several features that are new.

Adverse Drug Reaction Reporting Systems↗

PubMed1991

Ergonomics evaluation of a foam rubber grip for tool handles.

An important consideration in tool design is the avoidance of hand discomfort and a reduction of work efficiency by using proper grip designs. To measure grip force distribution on a tool handle, Force Sensing Resistors were calibrated, placed on two different types of grip (wood and foam) and interfaced to a personal computer. The results, using six common garden tools - loppers, hedge shears, shovels, leaf rakes, hoes, garden rakes - indicated a very uneven distribution in grip force, but with the foam grip providing a more uniform distribution. Unfortunately, in most cases, the tool grip force was greater for the foam grip due to the deformation of the foam and a 'loss of control' feeling in the subjects. However, most subjects strongly preferred the foam grips.

Journal Article↗

PubMed1992

Design and evaluation of an optical disk handling tool for a cleanroom environment.

In this paper, we present an application of engineering and ergonomics principles in the design of an optical disk handling tool for use in a cleanroom environment. A qualitative model which considers the task, operator, machines and environment (TOME model) was utilized to guide the design process. A 'before-after' evaluation found a significant improvement in the proposed tool over the existing tool with respect to mechanical, biomechanical and subjective measures. Product yield has improved considerably, as measured after the implementation of the proposed tool in December 1989 until the end of the observation period in June 1991.

Journal Article↗

PubMed1987

A research tool for general practitioners.

In this paper a research tool for general practitioners is described, that will be used in a network of community-based primary care practices in order to collect the necessary data for research purpose. The research tool is coupled to a commercial information system for general practitioners. The research tool supports coding strongly. The way in which the research tool is designed is described and examples of the use of windowing techniques are given.

Family Practice↗

PubMedDate not supplied

Chromosomal aberrations and sister-chromatid exchanges in tool and die workers.

Because tool and die workers are exposed to a number of potentially genotoxic agents, including mutagenic metals, polyaromatic hydrocarbons, and nitrosamines, and may be at increased cancer risk, the present study was undertaken to test whether chromosomal damage in peripheral blood cells is associated with work in the tool and die industry. Lymphocyte cultures were established from 27 tool and die fabrication workers from one manufacturing plant who had worked in the trade for more than 15 years. 15 of these workers also had some form of malignancy at the time of the study, but had not been treated with radiation or chemotherapies that could themselves induce chromosomal damage. The frequencies of chromosomal aberrations and sister-chromatid exchanges (SCEs) were measured in workers and the data compared with those of a control group consisting of 7 non-fabrication workers from the same plant and 8 age-matched community controls. In addition, the relative rates of lymphocyte proliferation were estimated for each group by analyzing the percentages of first-, second- and third-division mitotic cells after 72 h of culture. The results of the chromosomal studies show that tool and die workers have significantly increased frequencies of aberrations whether engaged in fabrication work or not, compared to control subjects. The frequency of SCEs and the frequencies of 1st, 2nd and 3rd division figures are not different among the study groups. Among workers who are engaged in fabrication, including those who are cancer patients, the frequency of more complex aberrations (i.e., interstitial deletions and small acentric fragments) is increased. In a five-year follow-up of these workers, 2 of the 13 workers with these aberrations developed some form of colon cancer. Whether the presence of interstitial deletions and small acentric fragments is related to the occupation of these workers, or is tangentially related to the development of cancer, is presently under consideration.

Cell Division↗

PubMed1991

An empirical analysis of a clinical assessment tool.

A tool to measure clinical performance was required by a college-based programme for undergraduate nursing students. Multiple tools currently exist, but after extensive literature review the researchers decided that no tool exactly fitted the requirements of this nursing course. The tool developed by Bondy (1983) was most aligned to our purposes and was used as the basis for the ongoing development of the Clinical Performance Assessment instrument. The CPA measures four dimensions of clinical performance against a 5-point rating scale. Each Likert point has specific criteria for the level relating to the dimensions. The clinical facilitator compares student behaviours against the performance levels of the dimensions for a variety of nursing procedures which are determined by the stage of the program the student has reached. Scores are given for the four dimensions and immediate student feedback is available. Measures were taken on six separate clinical occasions across 2 years on over 100 students in an attempt to determine validity and reliability indices. Relations between variables that appeared to have logical/theoretical connections with the clinical scores were assessed. The findings indicated that scores lacked reliability across the six occasions of measurement and hence validity could not be established. The need to improve the specificity of critical dimensions in clinical performance for the purposes of providing reliable measurement and accurate student feedback was acknowledged by academic staff and the researchers.

Adult↗