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PubMedDate not supplied

The multiple--choice test: developing the test blueprint.

As more graduate programs emphasize the preparation of expert clinicians, fewer masters-prepared nurses have been offered the opportunity to select a teaching track. As a result, new faculty members in colleges and universities have limited knowledge and skills in basic education concepts. The articles in this series will address some of these basic concepts, providing practical information for new faculty members in the areas of test development, use of audio-visuals, classroom methods, and teaching strategies.

Education, Nursing, Baccalaureate↗
PubMed2000

Follow-up of differentiated thyroid cancer: comparison of multiple diagnostic tests.

The radioablation of thyroid remnants improves the prognosis of differentiated thyroid cancer. In our prospective study an activity of 3.7 GBq 131I failed to completely ablate the remnants in 46 out of 101 patients, but a 3-year follow-up period was uneventful. One other patient had a recurrence early after thyroidectomy. In view of possible stunning effects of 131I it might be advantageous to visualize such remnants by imaging modalities which do not emit beta-particles. Our data have revealed that neither magnetic resonance imaging (MRI), nor ultrasonography (US), nor 99Tcm-sestamibi scintigraphy, nor positron emission tomography could detect or reliably exclude minimal remnants. Such remnants did not produce thyroglobulin (Tg). A 123I and 131I uptake of> 10% after thyroidectomy was associated with about a 90% probability of persistent remnants. On the other hand, MRI was helpful in the patient group (n = 32) with Tg>4ng x ml(-1) at the second whole-body scintigraphy (TSH>30 mU x l(-1)) for planning the management of lymph node metastases (n = 15 patients): 12 patients had subsequent surgery and three patients radioiodine therapy. We recommend that MRI be used early in follow-up care when Tg is elevated. The decision of whether or not to treat persistent thyroid remnants should not be made on the basis of MRI, US or nonspecific scintigraphic methods. Complete ablation did not appear to have any clinical benefit in our study group.

Adolescent↗
PubMed2006

Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients.

OBJECTIVE: To improve the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) method for predicting hospital mortality among critically ill adults and to evaluate changes in the accuracy of earlier APACHE models. DESIGN: : Observational cohort study. SETTING: A total of 104 intensive care units (ICUs) in 45 U.S. hospitals. PATIENTS: A total of 131,618 consecutive ICU admissions during 2002 and 2003, of which 110,558 met inclusion criteria and had complete data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We developed APACHE IV using ICU day 1 information and a multivariate logistic regression procedure to estimate the probability of hospital death for randomly selected patients who comprised 60% of the database. Predictor variables were similar to those in APACHE III, but new variables were added and different statistical modeling used. We assessed the accuracy of APACHE IV predictions by comparing observed and predicted hospital mortality for the excluded patients (validation set). We tested discrimination and used multiple tests of calibration in aggregate and for patient subgroups. APACHE IV had good discrimination (area under the receiver operating characteristic curve = 0.88) and calibration (Hosmer-Lemeshow C statistic = 16.9, p = .08). For 90% of 116 ICU admission diagnoses, the ratio of observed to predicted mortality was not significantly different from 1.0. We also used the validation data set to compare the accuracy of APACHE IV predictions to those using APACHE III versions developed 7 and 14 yrs previously. There was little change in discrimination, but aggregate mortality was systematically overestimated as model age increased. When examined across disease, predictive accuracy was maintained for some diagnoses but for others seemed to reflect changes in practice or therapy. CONCLUSIONS: APACHE IV predictions of hospital mortality have good discrimination and calibration and should be useful for benchmarking performance in U.S. ICUs. The accuracy of predictive models is dynamic and should be periodically retested. When accuracy deteriorates they should be revised and updated.

APACHE↗
PubMed1986

Assessment of cell-mediated immunity in a British population using multiple skin test antigens.

An in vivo method of assessing the competence of the cell-mediated immune system (Multitest CMI) was used in 200 healthy volunteers (age range 17-88 years). The profile of reactivity to seven individual antigens was determined. A positive reaction was obtained in 96.5% of the subjects who reacted positively to at least one antigen with 78% reacting to two or more antigens. The number of positive responses and the degree of reactivity was significantly reduced in elderly subjects and in females aged 17-65 years. The Multitest CMI system provides a rapid and convenient method of assessing cell-mediated immunity (CMI) in vivo and could have a wide range of applications in the investigation of immunological, infective and neoplastic conditions.

Adolescent↗
PubMed1978

Photocontact dermatitis to hydrocortisone.

A patient was found to have a delayed positive patch test to hydrocortisone on multiple testing. This proved to be due to a photoallergy with an action spectrum in the UV-A range. The patient coincidently had a polymorphous light eruption in the UV-B range.

Administration, Topical↗
PubMedDate not supplied

Tracer mass recovery in fractured aquifers estimated from multiple well tests.

Forced-gradient tracer tests in fractured aquifers often report low mass recoveries. In fractured aquifers, fractures intersected by one borehole may not be intersected by another. As a result (1) injected tracer can follow pathways away from the withdrawal well causing low mass recovery and (2) recovered water can follow pathways not connected to the injection well causing significant tracer dilution. These two effects occur along with other forms of apparent mass loss. If the strength of the connection between wells and the amount of dilution can be predicted ahead of time, tracer tests can be designed to optimize mass recovery and dilution. A technique is developed to use hydraulic tests in fractured aquifers to calculate the conductance (strength of connection) between well pairs and to predict mass recovery and amount of dilution during forced gradient tracer tests. Flow is considered to take place through conduits, which connect the wells to each other and to distant sources or sinks. Mass recovery is related to the proportion of flow leaving the injection well and arriving at the withdrawal well, and dilution is related to the proportion of the flow from the withdrawal well that is derived from the injection well. The technique can be used to choose well pairs for tracer tests, what injection and withdrawal rates to use, and which direction to establish the hydraulic gradient to maximize mass recovery and/or minimize dilution. The method is applied to several tracer tests in fractured aquifers in the Clare Valley, South Australia.

Models, Theoretical↗
PubMedDate not supplied

A measure of satisfaction for the assisted-living industry.

A self-administered satisfaction survey instrument for the assisted-living industry was developed and validated. The survey contains 45 Likert-type items that measure residents' and family members' satisfaction with the most central aspects of housing and care. The scale covers six key service dimensions: activities, personnel, dining, apartment, facility, and management. Internal consistency tests indicate high reliability. Multiple tests of validity confirm the scale's effectiveness in measuring residents' and family members' satisfaction with the six dimensions. Overall, residents are less satisfied with assisted-living programs than their family members are, but they may feel inhibited about expressing criticism in the presence of family. A priority index highlights service areas in which performance improvement efforts should be made to obtain the greatest increases in satisfaction while making the most efficient use of limited resources. Managerial implications of the tool are discussed.

Activities of Daily Living↗