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This Quick Reference Guide for Clinicians contains highlights from Post-Stroke Rehabilitation, Clinical Practice Guideline No. 16, which was developed by a multidisciplinary, private-sector panel comprised of health care professionals and a consumer representative. The Quick Reference Guide for Clinicians is an example of how a clinician might implement the panel's findings and recommendations on the overall management of stroke patients who need post-stroke rehabilitation programs or services before returning to a family or other living environment. Topics include medical management of patients, systematic assessment and evaluation of patients throughout acute care and rehabilitation, referring patients to appropriate rehabilitation programs, managing the rehabilitation process, discharging patients from rehabilitation programs, and reintegrating patients into family and community environments.
Currently, fresh pork color is visually evaluated using either the Japanese Pork Color Standards (JPCS) or the National Pork Producers Council Pork Quality Standards (NPPC) as a reference. Although useful, visual evaluation of meat color can vary with evaluator and may be quite expensive. In this study, three separate studies were used to compare the ability of color machine vision (CMV) and untrained panelists to evaluate pork color. Panels visually evaluated over 200 pork loin chops using either the JPCS or NPPC reference standards. Results from each panel were used to evaluate the ability of the CMV to sort pork loin chops based on the same criteria. Representative samples, typical of each color class, were used to train neural-network-based image processing software. After training, the CMV system was used to evaluate quality classes of pork samples based on color distribution. Classification by CMV was compared with the average panel score, rounded to the nearest integer. Training the CMV system using images of actual meat samples resulted in a stronger correlation to panel scores than training with either set of artificial color standards. Agreement between the CMV system and the panels was as high as 90%. Agreement between individual panelists and the integer panel average (52 to 85%) was less than that observed for CMV classification. Finally, the on-line performance of CMV using a laboratory conveyor system was simulated by repeatedly classifying 37 samples at a speed of 1 sample per second. Collectively, these results demonstrate that CMV is a rapid and repeatable means of evaluating pork color.
SETTING: Quality assurance for the WHO/IUATLD Global Tuberculosis Drug Resistance Surveillance Programme. OBJECTIVE: To implement an ongoing proficiency-testing programme for drug susceptibility testing (DST) of Mycobacterium tuberculosis within the WHO/IUATLD Supranational Reference Laboratories Network (SRLN). DESIGN: Five culture panels, each consisting of 10 duplicate drug-susceptible and drug-resistant clinical isolates (100 strains) of M. tuberculosis were tested for resistance to streptomycin (SM), isoniazid (INH), rifampicin (RMP) and ethambutol (EMB). DST procedures included the proportion, absolute concentration and resistance ratio methods, as well as the radiometric BACTEC 460 method. RESULTS: The efficiency, sensitivity and specificity of M. tuberculosis DST as well as the intra-laboratory reproducibility showed that the laboratories tested susceptibility to RMP and to INH very reliably, with values ranging from 97% to 99%. The testing of SM and EMB was less dependable, with values ranging from 90% to 95%. The sensitivity of testing of EMB increased from 60% in Round 1 to 98% in Round 5, without a concomitant decrease in specificity. CONCLUSIONS: This study has shown that regular proficiency testing can significantly improve the quality of DST, even in the most sophisticated TB laboratories. Mean DST efficiency levels of 92% for both SM and EMB and 97% and 99% for INH and RMP, respectively, are proposed as reasonable performance goals for the SRL network. Efficiency, consistently lower than these values, would require remedial action. Efficiency levels lower than mean -1 standard error, i.e., 80% for SM and EMB, 89% for INH and 95% for RMP, should always be considered as sub-standard performance for DST.
In order to clarify the role of the amygdala in the working and reference memory of rats in the three-panel runway task, the effects of lesions of subnuclei of the amygdaloid complex on this behavior were studied. Rats that had been trained preoperatively, until they achieved the criterion of learning, were subjected to lesions of the amygdala. In the working memory task, lesions of the basolateral subdivision of the amygdala caused a significant increase in the number of errors (attempts to pass through two incorrect panels of the three panel-gates at four choice points), while lesions of the corticomedial amygdala had no effect on working memory errors. The increase in working errors, observed in basolateral amygdaloid-lesioned rats, declined gradually as retraining sessions were given once each day, reverting to control levels on and after the sixth session. In the reference memory task, the number of errors was not affected by lesions of the basolateral or corticomedial amygdala. The increase in working memory errors, induced by lesions of the basolateral amygdala was significantly reduced by intraperitoneal administration of the inhibitors of cholinesterase, tetrahydroaminoacridine (0.32-1.0 mg/kg) and physostigmine (0.032-0.1 mg/kg), and the muscarinic receptor agonist, oxotremorine (0.1 mg/kg), before the runway test. These findings suggest that the basolateral amygdala is selectively involved in working memory but not in reference memory and that the lowering of central cholinergic function may account for the impairment of working memory, induced by lesions of the basolateral amygdala.
This report summarizes the deliberations of an eight-member panel of scientists convened by Dow AgroSciences in cooperation with the U.S. Environmental Protection Agency (EPA). The panel was charged with evaluating the scientific literature on the health effects potentially associated with exposure to the insecticide chlorpyrifos. Specifically, the panel was asked to (1) evaluate human experience data available and address the adequacy of the available current literature; (2) develop a list of recommendations for epidemiology studies, including appropriate endpoints and study populations, and strengths and weaknesses of each approach; and (3) draft a report to summarize its recommendations. The panel assessed the quality of the existing epidemiologic literature on chlorpyrifos and specific outcomes such as neuropathy (including organophosphate induced delayed neurotoxicity), behavior (cognition and affect), immunologic, and multiple complaints (also referred to as multiple chemical sensitivities). The majority of panel members (five members) agreed that the literature reviewed provided little or no scientific evidence that chlorpyrifos exposure causes harm to human health other than its known cholinergic effects associated with acute poisoning. Those panel members voting in the minority (three members) agreed that the studies reviewed provided inadequate evidence to preclude the possibility of adverse effects to human health from chlorpyrifos exposure at levels associated with its manufacture or professional application. Those voting in the minority suggested further investigation of cohort(s) of workers engaged in either the manufacture or the professional application of chlorpyrifos, or both. Compared to the general population, these groups have relatively high levels of exposure to chlorpyrifos. The primary health outcomes recommended for study were cognitive and affective disorders, with consideration of the assessment of peripheral neuropathy also suggested for at least a subset of the cohort.
A variant strain of rabbit haemorrhagic disease virus, designated "Rainham', originally isolated from a small localized outbreak of the disease in southern England, has been further examined and compared with conventional reference strains. The virus originally failed to haemagglutinate in standard conditions at normal temperature and consistently lacked HA activity after two passages in experimental rabbits. It did haemagglutinate at 4 degrees C. It reacted with hyperimmune sera to normal isolates of RHDV from the UK and Italy, and showed no differential binding activity with a panel of monoclonal antibodies prepared from an Italian reference strain. The Rainham strain appears to be antigenically indistinguishable from other known isolates and this suggests that it may differ by only a few amino acid changes in its capsid protein sequence.
Psychosocial programs designed for cancer patients often facilitate the search for meaning as one of the therapeutic components. This study aimed to develop a self-report instrument, namely Chinese Cancer Coherence Scale (CCCS), which measures the patients' meaning-making process with reference to the concept of coherence. A panel of eight veteran social workers and psychologists generated statements pertaining to the cancer experience. Results from a two-phase study involving 390 breast cancer patients revealed a two-factor structure of the CCCS, namely incoherent-embittered and coherent-enlightened. The use of the CCCS by practitioners and researchers is recommended in order to understand how Chinese cancer patients make sense of their cancer experience.
In 1992 the Dutch College of General Practitioners (NHG) started a project, which lasted until May 1994. The project had three major objectives: establishing as exactly as possible what benefits we gain from using an Electronic Medical Dossier (EMD) can we find an influence on the quality of care? Which drawbacks or problems are there, advising on the optimal use of an EMD; What is the best place to record certain data? advising the Working Committee on Informatics (WCIA), of Dutch National Association of General Practitioners (LHV) and NHG on the directions for the new Reference Model 1995. To obtain these goals panel discussions and a questionnaire were used. The project resulted in advice on how to use the EMD in the most efficient way. Also we have learned about the use of GP-information systems and the perception about this usage by the Dutch GPs.
Results from dalbavancin dry-form commercial broth microdilution MIC panels (Sensititre, TREK Diagnostics) were compared with reference frozen-form MIC values to assure the validity and reproducibility of the extended shelf-life product. A collection of 402 organisms from four major organism groups were used in the validation trial and 10 strains for reproducibility replicate tests. A total of 98.6% commercial dalbavancin MIC results were within +/-1 log(2) dilution of reference values (76.2% were identical) and reproducibility trials produced identical MIC results in 88.9-92.2% of dalbavancin MIC comparisons. These dalbavancin MIC results demonstrated the acceptable accuracy of commercially-prepared broth microdilution products for use in subsequent clinical trials.
Under the auspices of the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC), an appropriateness review was conducted for radionuclide cardiovascular imaging (RNI), specifically gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The review assessed the risks and benefits of the imaging test for several indications or clinical scenarios and scored them based on a scale of 1 to 9, where the upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The mid range (4 to 6) implies that the test may be generally acceptable and may be a reasonable approach for the indication. The indications for this review were primarily drawn from existing clinical practice guidelines and modified based on discussion by the ACCF Appropriateness Criteria Working Group and the Technical Panel members who rated the indications. The method for this review was based on the RAND/UCLA approach for evaluating appropriateness, which blends scientific evidence and practice experience. A modified Delphi technique was used to obtain first- and second-round ratings of 52 clinical indications. The ratings were done by a Technical Panel with diverse membership, including nuclear cardiologists, referring physicians (including an echocardiographer), health services researchers, and a payer (chief medical officer). These results are expected to have a significant impact on physician decision making and performance, reimbursement policy, and future research directions. Periodic assessment and updating of criteria will be undertaken as needed.
Dizziness is a common and often disabling disorder. In some people the cause of their dizziness is pathology or dysfunction of upper cervical vertebral segments that can be treated with manual therapy. The aim of the present study was to systematically review the literature on the manual therapy treatment of patients with cervicogenic dizziness, by identifying and evaluating both randomized controlled trials (RCTs) and non-RCTs (controlled clinical trials and non-controlled studies). Seven electronic databases were searched up to July 2003, article reference lists were screened and an expert panel elicited to obtain relevant trials. Nine studies met the inclusion criteria and key data was extracted. Two reviewers assessed the validity of the studies using the Cochrane format and found that all studies had low methodological quality. However, a consistent finding was that all studies had a positive result with significant improvement in symptoms and signs of dizziness after manual therapy treatment. Therefore, Level 3 evidence for manual therapy treatment of cervicogenic dizziness was obtained indicating it should be considered in the management of patients with this disorder provided there is evidence of improvement. This review has identified the need for further RCTs of acceptable methodological quality.
This study is part of an ongoing project at the National Institute of Standards and Technology (NIST) that generates a panel of DNA clones containing the most common mutations found in the human p53 tumor suppressor gene. This panel will be made available as a reference source for evaluation and testing for p53 mutations. Single strand conformation polymorphism (SSCP) analysis has found widespread acceptance as a tool for simply and rapidly screening for mutations, albeit with a detection rate that can be below 100%. We have begun to analyze mutations found in exon 7 of the p53 gene by SSCP using laser induced fluorescence capillary electrophoresis (LIF-CE). PCR fragments, containing single point mutations, were amplified from genomic DNA isolated from cell lines using primers labeled with two different fluorophores. This dual labeling approach allowed better traceability of mobility shifts as a function of the experimental conditions. While analyzing the clones H596, Colo320, Namalwa and wild type (reference samples) at different temperatures, ranging from 25 to 45 degrees C, it was observed that each mutation responded in a unique way to changes in temperature both in magnitude and direction of shifts relative to the wild type sample. In a blinded study, ten p53 exon 7 samples were matched automatically, using ABI PRISM Genotyper software, against the four reference samples. From these 10 samples, six were correctly identified as containing one of the reference mutations, two corresponded to wild type, and two were correctly identified as non-reference mutations. This approach should prove helpful in the rapid screening of target sequences that are known to bear a limited number of mutations.
Newcastle disease virus isolated from an outbreak in racing pigeons in India was found to be velogenic, based on the mean time to death in 10-day-old embryonated hen's eggs, the intravenous pathogenicity index in 6-week-old chickens and the pathogenesis in chickens and pigeons. The virus induced disease in chickens without prior adaptation in chickens. The virus was antigenically unusual since it could not be grouped with the available panel of monoclonal antibodies at the World Reference Laboratory for Newcastle disease, UK. However, commercially available lentogenic and mesogenic vaccines provided 100% protection to chickens against this antigenically unusual NDV.
In a two-year study of asthma mortality in New Zealand conducted between August 1981 and July 1983, the certified cause of death and its subsequent statistical coding was compared with the opinion of a panel of respiratory physicians who had made detailed enquiry into the medical history and circumstances surrounding the death of each patient. When the panel's opinion was taken as the reference standard, the national health statistics overestimated asthma mortality for all age groups by 26.0%. For patients aged 15-64 years, the net overestimate was 12.9%, no greater than that found in a similar study in this age group in the United Kingdom. Failure of certifying doctors and coroners to follow appropriate procedures for identification of the primary condition leading to death, or misdiagnosis of other lung disease as asthma, accounted for most inaccuracies in certification. In patients under age 35 years, certification and statistical coding of asthma death was considered accurate in 97.8% of all cases, but accuracy declined with increasing age. The high New Zealand asthma mortality rate, especially in young people, could not be explained by inaccuracies in death certification or statistical coding.
Constructing detailed chromosome maps relies on the ability to place new markers rapidly and accurately. Here we map two new anonymous DNA markers precisely on chromosome 11q and refine the location of established markers using a panel of just six fragmentation hybrids, with reference to four translocation chromosomes. As several of the hybrids retain multiple segments of chromosome 11, it is possible to quickly assign new markers to subintervals using this modest set of hybrid DNAs.
Rare mutant forms of circulating albumin and prealbumin [transthyretin (TTR)] have increased binding affinity for thyroxine (T4). Patients with these variant plasma proteins, as a result of inherited mutations or as a paraneoplastic phenomenon, typically present with increased serum total T4 and, by some assay methodologies, an increased free T4 as well. Although these individuals are, in fact, euthyroid, nonspecific symptoms may lead to inappropriate treatment for hyperthyroidism. We present a 34-year-old woman in whom a mutant form of TTR with increased T4 binding affinity and coexisting Graves disease was present. Subsequent 131I therapy led to development of postablative hypothyroidism, which was obscured by her higher serum free T4 concentration. Circulating thyroid-binding globulin (TBG), albumin, and TTR concentrations were all within their respective reference limits. A T4-binding protein panel confirmed that TTR-bound T4 was significantly increased, whereas TBG- and albumin-bound T4 was normal, indicating that this patient had euthyroid dysprealbuminemic hyperthyroxinemia, which had been masked by the initial presentation of hyperthyroidism. These findings indicate that hypothyroidism can be masked by coexisting euthyroid dysprealbuminemic hyperthyroxinemia.
OBJECTIVES: We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians. RESEARCH DESIGN AND METHODS: We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as >90 cm in men and >80 cm in women, BMI cutoff as >23 kg/m(2), and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] >18 mm). RESULTS: The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure. CONCLUSIONS: The criteria for defining MS in adult Asian Indians need revision. Inclusion of modified cutoffs of waist circumference and BMI and measures of truncal subcutaneous fat in the NCEP ATPIII definition requires further validation.