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Guidelines for the retention, storage, and use of residual dried blood spot samples after newborn screening analysis: statement of the Council of Regional Networks for Genetic Services.

These guidelines provide scientific information for policy development by state health departments considering appropriate use of newborn screening specimens after screening tests are finished. Information was collected, debated, and formulated into a policy statement by the Newborn Screening Committee of the Council of Regional Networks for Genetic Services (CORN), a federally funded national consortium of representatives from 10 regional genetics networks. Newborn screening programs vary widely in approaches and policies concerning residual dried blood spot samples (DBS) collected for newborn screening. Recognition of the epidemiological utility of DBS samples for HIV seroprevalence surveys and a growing interest in DBSs for DNA analysis has intensified consideration of issues regarding retention, storage, and use of residual DBS samples. Potentially these samples provide a genetic material "bank" for all newborns nationwide. Their values as a resource for other uses has already been recognized by scientists, administrators, and judicial officials. Programs should promulgate rules for retention and use of residual newborn screening DBS samples based on scientifically valid information. Banking of newborn samples as sources of genetic material should be considered in light of potential benefit or harm to society.

Blood Specimen Collection↗

Video reminders in a representational change task: memory for cues but not beliefs or statements.

Two experiments investigated the effect of video reminders on 3-year-olds' performance in a representational change task. In Experiment 1, children in a video support condition viewed videotapes of their initial incorrect statements about a misleading container prior to being asked to report their initial belief. Children in a control condition viewed an irrelevant videotape. Despite reporting what they had said on the videotape, children in the video support condition typically failed the representational change task. Experiment 2 replicated the main findings from Experiment 1 and also revealed that a video reminder failed to increase the likelihood that children would correctly report what they had said about the object. Results are discussed in terms of the processes whereby mnemonic cues might affect performance on tasks assessing theory of mind.

Child Behavior↗

Validity of cause of death statements from relatives.

In countries where death certificates are inaccessible for various reasons, cause of death statements made by relatives may gain greater importance. The validity of the cause of death of a deceased family member as stated by relatives compared to the underlying cause as stated on the death certificate has been examined in 310 cases. The sensitivity and the rate of confirmation are highest for neoplasms (both 89.6%). For cardiovascular diseases, the sensitivity (70%) is lower than the rate of confirmation (90%), indicating a certain amount of underreporting. The sensitivity is found to be lowest (50%) for diseases of the respiratory system. Violent deaths, on the other hand, were detected in 93.7%, although confirmed for only 75%. Closer relatives were able to report the cause of death more accurately. The time elapsed since the death of the family member, however, did not affect the recall of the relative. The concrete additional information from relatives, especially for cancer cases, is recommended in the absence of other data sources.

Death Certificates↗

Yale Conference on Behavioral Medicine: a proposed definition and statement of goals.

The Yale Conference on Behavioral Medicine brought a diverse group of behavioral and biomedical scientists together for the purpose of arriving at an interdisciplinary yet consensual definition, statement of goals, and set of recommendations regarding the emerging field of behavioral medicine. It was proposed that behavioral medicine be defined as "the field concerned with the development of behavioral science knowledge and techniques relevant to the understanding of physical health and illness and the application of this knowledge and techniques to prevention, diagnosis, treatment, and rehabilitation. psychosis, neurosis, and substance abuse are included only insofar as they contribute to physical disorders as an end point." The rational behind this definition and proposals for future developments in the field are discussed.

Congresses as Topic↗

Effects of immediacy of feedback and level of aspiration statements on learning tasks for delinquent youngsters.

The performance of institutionalized delinquent youngsters on paired associate learning tasks was investigated to determine whether level of aspiration (LOA) statements were associated with improved performance under varying feedback conditions. The effects of the feedback conditions were also examined. Forty-eight male adolescents were randomly assigned to the following six treatment conditions: (1) Delayed Feedback, (2) Delayed Feedback with LOA, (3) Immediate Feedback, (4) Immediate Feedback with LOA, (5) No Feedback, (6) No Feedback with LOA. The LOA conditions produced significantly better performance than did the no-LOA conditions. Implications for curricular intervention are discussed.

Achievement↗

[The pros and cons of honey--are statements about the effects of honey "scientifically verified"?].

The physiological effects attributed to honey are described and discussed. These effects are to a great extent generalizations from experimental and clinical observations. In some cases the effects attributed to honey are based on tests which are no longer acceptable. Most of the statements about physiological effects caused by eating honey cannot be supported by scientific methods. Under German food law these are designated as "misleading". Honey is comparable to sugar in its nutritive value. Other nutrients like protein, minerals and vitamins are present in such small amounts that they have no nutritional importance.

Acetylcholine↗

European Society of Intensive Care Medicine statement: intensive care medicine in Europe--structure, organisation and training guidelines of the Multidisciplinary Joint Committee of Intensive Care Medicine (MJCICM) of the European Union of Medical Specialists (UEMS).

This article describes the structures and institutions in the European Union by which professional training and qualification in medical specialities will be harmonised. All main medical specialities are represented in the European Union of Medical Specialists (UEMS) by speciality sections. For intensive care medicine, as a multidisciplinary speciality, a new structure of a Multidisciplinary Joint Committee of Intensive Care Medicine (MJCICM) within the UEMS was established in 1999. In this MJCICM the European Society of Intensive Care Medicine and the European Society of Paediatric and Neonatal Intensive Care are represented by delegates without voting capacity in a Standing Advisory Board. Statements and recommendations which the MJCICM has worked out until now are presented: Definitions of intensive care medicine, structural conditions for education and training, continuing medical education, criteria for accreditation of intensive care medicine training centres, common core curriculum for optional specialist training in intensive care medicine, as well as an intensive care units accreditation visiting programme and standards for medical treatment and nursing care.

Accreditation↗

An evaluation of the United Kingdom National Osteoporosis Society position statement on the use of peripheral dual-energy X-ray absorptiometry.

A recent position statement issued by the UK National Osteoporosis Society recommends a triage approach to the use of peripheral dual-energy X-ray absorptiometry (pDXA) devices. Patients with a forearm T-score greater than -1 or less than -2.5 are regarded as normal or osteoporotic, respectively, while those with a T-score between -1 and -2.5 are sent for further assessment with spine and hip DXA. We have evaluated the NOS pDXA algorithm by comparing it with the alternative strategies of relying on forearm BMD alone, or performing spine and hip DXA in every patient. The evaluation was carried out using a mathematical model, and the predictions were compared with in vivo data obtained in patients referred for investigation by their general practitioner. In the model the population distribution of spine, hip, and forearm BMD was described by a trivariant Gaussian function. Relative risks of fracture were taken from a meta-analysis. The three strategies were compared using receiver operating characteristic (ROC) curves in which the percentage of future fracture cases identified was plotted against the percentage of the whole population found to have osteoporosis. ROC curves plotted for the discrimination of hip, vertebral, and Colles fracture risk and the risk of a fracture at any skeletal site were similar for all three strategies, with the curves for the NOS pDXA algorithm nearly identical to those for spine and hip DXA. For the case of hip fracture, vertebral fracture, or a fracture at any site, forearm BMD was slightly inferior to the NOS algorithm, but the reverse was true for Colles fracture. The small difference between the ROC curves suggests that forearm BMD used alone can reproduce clinical decision-making with the NOS pDXA algorithm provided that a T-score threshold of T=-2.1 is used for the diagnosis of osteoporosis, instead of the conventional figure of T=-2.5. Results from the in vivo study were in good agreement with the predictions of the model, although some differences were observed that were explained by inaccuracies in the forearm reference data. We conclude that use of forearm BMD alone with a modified T-score threshold of -2.1 would save the need for spine and hip DXA scans and identify only slightly fewer fracture cases for treatment.

Absorptiometry, Photon↗

The future of cardiovascular imaging and non-invasive diagnosis. A joint statement from the European Association of Echocardiography, the Working Groups on Cardiovascular Magnetic Resonance, Computers in Cardiology, and Nuclear Cardiology, of the European Society of Cardiology, the European Association of Nuclear Medicine and the Association for European Paediatric Cardiology.

Advances in medical imaging now make it possible to investigate any patient with cardiovascular disease using multiple methods which vary widely in their technical requirements, benefits, limitations and costs. The appropriate use of alternative tests requires their integration into joint clinical diagnostic services where experts in all methods collaborate. This statement summarises the principles that should guide developments in cardiovascular diagnostic services.

Cardiovascular Diseases↗

European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography.

Rapid clinical dissemination of CT colonography (CTC) is occurring in parallel with continued research into technique optimisation and diagnostic performance. A need exists therefore for current guidance as to basic prerequisites for effective clinical implementation. A questionnaire detailing CTC technique, analysis, training and clinical implementation was developed by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) CTC committee and circulated to all faculty members of previous ESGAR "hands-on" CTC training courses. Responses were collated and a consensus statement produced. Of 27 invited to participate, 24 responded. Reasonable consensus was reached on bowel preparation, colonic distension, patient positioning, use of IV contrast and optimal scan parameters. Both primary 2D and primary 3D analysis were advocated equally, with some evidence that more experienced readers prefer primary 2D. Training was universally recommended, although there was no consensus regarding minimum requirements. CTC was thought superior to barium enema, although recommended for screening only in the presence of validated local experience. There was consensus that polyps 4 mm or less could be ignored assuming agreement from local gastroenterological colleagues. There is increasing consensus amongst European experts as to the current best practice in CTC.

Advisory Committees↗

[The off-label-prescription of TNF-alpha blocking agents for spondyloarthropathies in the context of recent statement by a German federal court].

With the TNF alpha-blocking agents for the first time a very efficient and probably disease-modifying treatment for the spondyloarthropathies, especially ankylosing spondylitis and psoriatic arthritis, has become available. Because these drugs have not yet been approved for this indication in the European Community they are regarded as off-label-therapy in Germany. It is the purpose of this article to discuss a recently released statement by a German federal court whether the herein formulated conditions for the prescription of off-label therapies is met for TNF-blocker treatment for this indication.

Antibodies, Monoclonal↗

Information from false statements concerning visual acuity and visual field in cases of psychogenic visual impairment.

BACKGROUND: If visual acuity (VA) and/or visual field (VF) is claimed to be worse than in reality, it can be difficult to estimate the actual VA/VF. This paper describes a method of proving malingering and of estimating the actual VA by statistical evaluation of the subjective responses to discrete visual stimuli. METHODS: VA is measured by using a Landolt or Snellen optotype with four possible directions. There are n (> or = 16) questions at each acuity level. Each direction of the optotype occurs with the same frequency. The sequence is not predictable. In testing the VF, the stimulus is presented in an unpredictable sequence but with the same frequency at each of four distinct locations outside the claimed field at the horizontal and the vertical meridian. The field is divided into four quadrants defined by the 45 degrees-225 degrees and 135 degrees-315 degrees meridians. The candidate is requested to search for the light. The target quadrant of the first eye movement is recorded. At each VA level, the distribution function of the binomial formula allows estimation of the probability Pc of < or = kc and > or = kc correct answers to n questions by mere accident. Regarding the VF, the direction of the first saccade at each stimulus presentation can be processed accordingly. RESULTS: If n = 32 and kc = 0,1,2, the chance P that this pattern is merely accidental is about 0.0001, 0.001, 0.007. Values of P < or = 0.01 strongly suggest that the answers were voluntarily wrong. Preference for the opposite direction can also point to psychogenic influence: If ko = 15,16,17,18, P is about 0.006, 0.002, 0.0006, 0.0002. CONCLUSION: Systematically false statements can yield valuable information about the actual visual functions.

Adult↗

Resuscitation of the newly born infant: an advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours following birth and the techniques for providing advanced life support.

Delivery Rooms↗

[How reliable are statements on extensive noninflammatory pain? Comparison of patients with fibromyalgia, backache, and other local pain].

PURPOSE: The effect yielded by the degree of differentiation of two methods for measuring pain on patient statements regarding the extent of clinical pain was analyzed. At the same time, the reference time frame for the patient reports was varied. METHODS: The influence exerted by differentiated questioning was determined by comparing two pictorial body diagrams. Three reference time frames were specified (current pain, last week, last half year). RESULTS: Patients with wide-spread pain reacted stronger to variations in differentiated questioning the older the pain experienced was and the longer the time frame reported on. Upon differentiated questioning, patients with juxta-articular pain however remembered a lower number of pain sites in the past than on global assessment. Patients with backache reported their current pain to be less widely spread when assessed differentially than on global assessment. CONCLUSION: Patient reports on the extent of pain mainly differ in those patients with extensive pain depending on the degree of differentiation during questioning. In these cases, the probability is high that the symptomatic complaints first became established, at least in part, as a reaction to the situational questioning conditions and therefore cannot be generalized to other questioning conditions.

Art↗

Antiemetic therapy for multiple-day chemotherapy and high-dose chemotherapy with stem cell transplant: review and consensus statement.

The objective of this paper is to evaluate the efficacy of modern antiemetic therapy for chemotherapy-induced nausea and vomiting for patients receiving multiple-day or high-dose chemotherapy. Published phase II and phase III studies as well as their personal experiences were evaluated by the authors to develop this consensus statement. The largest published experience with multiple-day chemotherapy is with 5-day cisplatin combination chemotherapy. The introduction of 5-HT3 antagonists greatly improved emetic control. However, day 4-5 nausea as well as delayed nausea and vomiting remains a clinical problem despite the inclusion of dexamethasone. A 5-HT3 antagonist plus dexamethasone is the preferred current option for patients receiving high-dose chemotherapy with stem cell transplant. However, the results do not appear as successful as for highly emetic standard-dose chemotherapy.

Antiemetics↗

Authorship in a small medical journal: a study of contributorship statements by corresponding authors.

The authorship criteria of the International Committee of Medical Journal Editors (ICMJE) are widely accepted in biomedical journals, but many studies in large and prestigious journals show that a considerable proportion of authors do not fulfill these criteria. We investigated authorship contributions in a small medical journal outside the scientific mainstream, to see if poor adherence to authorship criteria is common in biomedical journals. We analyzed statements on research contribution, as checked by the corresponding author, for individual authors of 114 research articles, representing 475 authors, submitted to the Croatian Medical Journal (CMJ) from 1999 to 2000. Only 40% of authors fulfilled the ICMJE authorship criteria. The authors listed first on the by-line were more likely to fulfill the authorship criteria than all other authors on the by-line. The percentage of authors fulfilling the ICMJE criteria of authorship decreased with the increase in the number of authors listed on the by-line. These results indicate that poor adherence to ICMJE authorship criteria is poor across biomedical journals, regardless of the size of the scientific community. Authorship and contributorship in biomedical journals, as well as editorial ethical responsibilities towards authorship criteria need critical redefinition and education of both editors and authors.

Authorship↗