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PubMed2003

Using decision analytic methods to assess the utility of family history tools.

Family history may be a useful tool for identifying people at increased risk of disease and for developing targeted interventions for individuals at higher-than-average risk. This article addresses the issue of how to examine the utility of a family history tool for public health and preventive medicine. We propose the use of a decision analytic framework for the assessment of a family history tool and outline the major elements of a decision analytic approach, including analytic perspective, costs, outcome measurements, and data needed to assess the value of a family history tool. We describe the use of sensitivity analysis to address uncertainty in parameter values and imperfect information. To illustrate the use of decision analytic methods to assess the value of family history, we present an example analysis based on using family history of colorectal cancer to improve rates of colorectal cancer screening.

Colorectal Neoplasms↗

PubMed1999

Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.

Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to develop a simple, reliable and valid malnutrition screening tool that could be used at hospital admission to identify adult acute patients at risk of malnutrition. The sample population included 408 patients admitted to an Australian hospital, excluding pediatric, maternity, and psychiatric patients. The ability of various nutrition screening questions to predict subjective global assessment (SGA) were examined in contingency tables. The combination of nutrition screening questions with the highest sensitivity and specificity at predicting SGA was termed the malnutrition screening tool (MST), and consisted of two questions regarding appetite and recent unintentional weight loss. Subjects who were at risk of malnutrition according to the MST had significantly lower mean values for the objective nutrition parameters (except immunologic parameters) and longer length of stays than subjects who were not at risk of malnutrition. Therefore convergent and predictive validity of the MST was established. The interrater reliability of the malnutrition screening tool was high (93-97%). The MST is a simple, quick, valid, and reliable tool which can be used to identify patients at risk of malnutrition.

Adult↗

PubMed2002

Tool-use learning selectively induces expression of brain-derived neurotrophic factor, its receptor trkB, and neurotrophin 3 in the intraparietal multisensorycortex of monkeys.

When humans repeatedly use a tool, our body image alters until the tool finally becomes a part or an extension of the body. This alteration of body image perhaps results from re-integration of somatosensory and visual signals. We trained Japanese monkeys to use a rake-shaped tool to retrieve a distant food pellet, then used a novel tissue-sampling method to suction brain tissue from the anterior bank of their intraparietal sulcus, where somatosensory and visual signals converge. Examination of the messenger RNA expression levels of neurotrophins and their receptors using real-time quantitative polymerase chain reaction revealed learning-selective induction in the expression of brain-derived neurotrophic factor, its receptor trkB, and NT-3 during, but not after, the learning. These results suggest that these factors are involved in the reorganization of the somatosensory and visual signals in the anterior bank of the intraparietal sulcus when monkeys are learning the use of the tool.

Animals↗

PubMed2002

Developing a pain assessment tool for use by nurses in an adult intensive care unit.

Critically ill patients are particularly vulnerable to pain, patient's citing it as their second greatest ICU stressor. Pain has also been identified as a complicating factor in critical illness. Despite this, pain management is often not considered a priority by the ICU team. Effective management can only be achieved with accurate pain assessment. However, this is difficult in the critically ill as patients are often unable to communicate verbally due to the presence of endotracheal/tracheostomy tubes, sedation and paralysing agents. Nurses therefore rely on behavioural and physiological indicators in establishing the presence of pain. However, as these also occur in situations and conditions not associated with pain there is a need for a systematic, objective assessment tool. Such a tool, consisting of a numerical and verbal rating scale to facilitate documentation and audit, was developed as a result of ongoing adjustment and evaluation. The tool scores the patient's pain by incorporating behavioural and physiological indicators and is used in conjunction with the Glasgow Coma Score and the modified Sheffield Sedation Scale to achieve a comprehensive neurological assessment. As movement and intervention may exacerbate pain, assessment is carried out at rest and during procedures such as suctioning and manual handling. As an aid to pain assessment and management a flow chart and a clinical guideline have also been introduced. Although preliminary evaluation established the effectiveness of the tool as a means of estimating and recording pain levels in individual patients, it was evident that there has been no change to the way in which pain is managed. To address this issue, the level of nurses understanding regarding pain management has been ascertained and teaching sessions delivered to increase the profile of pain management in the unit.

Adult↗

PubMed2002

Using a unit assessment tool to optimize patient flow and staffing in a community hospital.

BACKGROUND: Hospital environments are too often characterized by delays for patients receiving diagnostic testing and prolonged waiting times to complete needed therapy. Frequently there is confusion in scheduling, related at least in part to the complex interplay of clinical acuity and highly individualized care. Luther Midelfort recently began to change the process of patient flow to improve access to care, optimize outcomes by enabling timely intervention, and decrease the wasting of resources. UNIT ASSESSMENT TOOL: The hospital developed a unit assessment tool based on the traffic light concept, which consisted of an assessment of current capacity and a graded, color-coded "workload tolerance" for each hospital unit. Each unit can instantly update its own status and query those of other work environments in the hospital. EXPERIENCE WITH THE UNIT ASSESSMENT TOOL: For most of the January-July 2001 period, there was generally a progressive decrease in the percentage of time that the units were coded as red (unit closed to new admissions), with concurrent increases in the percentage of time that the units were coded as green (unit open). Use of the tool appears to have contributed to a dramatic increase in staff satisfaction. SUMMARY AND CONCLUSIONS: The key to regulating patient flow has been to adopt a nursing-initiated capping trust policy whereby nurses are given the authority to limit new admissions. Initiatives are now under way to provide different units with novel models of resource sharing, ranging from flexible housekeeping to "flying nurse squads" to assist units that have become red.

Appointments and Schedules↗

PubMed2002

Developing a quality measurement tool and reporting format for long- term care.

BACKGROUND: Quality measurement in long term care (LTC) presents many challenges: the lack of a uniform definition of quality, the existence of multiple domains for measurement, a multitude of potential perspectives, and regulatory influences that emphasize measurement only of poor quality. Research efforts have yet to solve the issues of measurement; however, operators of long term care facilities must use the current state of the art in quality measurement as the basis for their quality improvement efforts. A project was commissioned by management of a large integrated delivery system with a robust network of LTC facilities who wished to implement a continuous quality improvement process on the basis of a measurement tool that provides a comprehensive resident-centered assessment of quality. The objectives of this project, therefore, were to identify domains of quality, to select and adapt validated instruments for measurement within each domain, to pilot test a data collection process, and to develop an operational quality profiling report format for LTC facilities. DESIGN AND METHODS: Using an expert panel and the LTC research literature, an operational measurement tool was developed, consisting of four domains of quality: organizational, clinical, environmental, and social. DISCUSSION: A pilot study conducted in two nursing facilities demonstrated that the data collection process could be operationalized within tight resource and budgetary constraints. The development of an operational quality assessment tool enables management to take a consistent view of diverse institutions, focusing in detail on quality of care as it is perceived by residents. The tool allows evaluation of trends over time and comparison to external norms.

Advisory Committees↗

PubMed2003

BlochLib: a fast NMR C++ tool kit.

Computational power, speed, and algorithmic complexity are increasing at a continuing rate. As a result, scientific simulations continue to investigate more and more complex systems. Nuclear magnetic resonance (NMR) is no exception. NMR theory and language is extremely well developed, that simulations have become a standard by which experiments are measured. Nowadays, complex computations can be performed on normal workstations and workstation clusters. Basic numerical operations have also become extremely optimized and new computer language paradigms have become implemented. Currently there exists no complete NMR tool kit which uses these newer techniques. This paper describes such a tool kit, BlochLib. BlochLib is designed to be the next generation of NMR simulation packages; however, the basic techniques implemented are applicable to almost any problem. BlochLib enables the user to simulate almost any NMR idea both experimental or theoretical in nature. Both classical and quantum mechanical techniques are included and demonstrated, as well as several powerful user interface tools. The total tool kit and documentation can be found at http://waugh.cchem.berkeley.edu/blochlib/.

Journal Article↗

PubMed2002

BrainSuite: an automated cortical surface identification tool.

We describe a new magnetic resonance (MR) image analysis tool that produces cortical surface representations with spherical topology from MR images of the human brain. The tool provides a sequence of low-level operations in a single package that can produce accurate brain segmentations in clinical time. The tools include skull and scalp removal, image nonuniformity compensation, voxel-based tissue classification, topological correction, rendering, and editing functions. The collection of tools is designed to require minimal user interaction to produce cortical representations. In this paper we describe the theory of each stage of the cortical surface identification process. We then present classification validation results using real and phantom data. We also present a study of interoperator variability.

Algorithms↗

PubMed1998

Development and validation of an evaluation tool for multimedia resources in health education.

The last decade saw a rapid increase in the use of multimedia in health education. Easy availability, accessibility, low cost of technological resources and the expanding body of research on the role of multimedia in student learning, among others, have all contributed to this increase in usage. Since one of the roles of educators is to assess and select learning resources based on curriculum goals and student needs, the development of standardized methods for multimedia evaluation becomes vital. To the learner, it is important for reviews of the quality of the resource to be readily available. An evaluation too was developed based on the recognition of this need. The validity of the tool was tested using experts in technology and education. Reliability was determined using faculty and students who reviewed the same software, using the tool. In addition, graduate students reviewed two versions of a nursing program, of varying quality. The results indicate that the tool is reliable and valid. It is envisaged that this tool can be utilized by health educators for evaluating multimedia resources and setting up a much needed clearinghouse for health education resources.

CD-ROM↗

PubMedDate not supplied

Extending a teleradiology system by tools for visualization and volumetric analysis through a plug-in mechanism.

This paper describes ongoing research concerning interactive volume visualization coupled with tools for volumetric analysis. To establish an easy to use application, the three-dimensional-visualization has been embedded in a state of the art teleradiology system, where additional functionality is often desired beyond basic image transfer and management. Major clinical requirements for deriving spatial measures are covered by the tools, in order to realize extended diagnosis support and therapy planning. Introducing a general plug-in mechanism, this work exemplarily describes the useful extension of an approved application. Interactive visualization was achieved by a hybrid approach taking advantage of both the precise volume visualization based on the Heidelberg ray-tracing model and the graphics acceleration capabilities of modern workstations. Several tools for volumetric analysis extend the three-dimensional-viewing. They are controlled by adequate input devices to select locations in the data volume, measure anatomical structures or initiate a segmentation process. Moreover, a haptic interface can be connected to provide a more realistic feedback while navigating within the three-dimensional-reconstruction. The work is closely related to research in the field of heart, liver and head surgery. In cooperation with our medical partners the development of tools as presented facilitates the integration of image analysis into the clinical routine.

Humans↗

PubMed2005

Resistance as a tool for discovering and understanding targets in parasite neuromusculature.

The problem of anthelmintic resistance prevents efficient control of parasites of livestock and may soon compromise human parasite control. Research into the mechanisms of resistance and the quest for diagnostic tools to aid control has required research that focuses on field resistance. On the other hand, resistant worms, including those kept in the laboratory, provide useful tools for studying drug action, especially at neuromuscular targets in worms. While the needs and directions of these research aims overlap, this review concentrates on research on drug targets. In this context, resistance is a useful tool for site of action confirmation. For example, correlations between molecular expression studies and resistance assays conducted on whole worms can strengthen claims for sites of anthelmintic action. Model systems such as Caenorhabditis elegans have been very useful in understanding targets but give a limited picture as it is now clear that resistance mechanisms in this worm are different from those in parasites. Accordingly, research on parasites themselves must also be performed. Resistant isolates of the sheep nematode parasite Haemonchus contortus are the most widely used for this purpose as in vivo, in vitro, physiological and molecular studies can be performed with this species. Neuromuscular target sites for the anthelmintics levamisole and ivermectin are the best studied and have benefited most from the use of resistant worm isolates. Resistance to praziquantel and the newer chemical groups should provide new tools to explore targets in the future.

Animals↗

PubMedDate not supplied

Evaluation of the Pediatric Trauma Triage Checklist as a prehospital pediatric trauma triage tool for the state of Florida.

INTRODUCTION: Triage of injured children poses a significant challenge for prehospital care providers because there is not single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not "user friendly" for field personnel. As such, the PTS has been modified to generate the more user-friendly "pediatric trauma triage checklist (PTTC)." METHODS: This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center. RESULTS: The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0% The PTTC demonstrated an overtriage rate of 58.3% and an undertriage rate of 13.8% When compared with a previous study, the PTTC demonstrated a 74% increase in overtriage. However, the 59% reduction in undertriage is more important. CONCLUSIONS: Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.

Algorithms↗

PubMedDate not supplied

"Plasmo2D": an ancillary proteomic tool to aid identification of proteins from Plasmodium falciparum.

Bioinformatics tools to aid gene and protein sequence analysis have become an integral part of biology in the post-genomic era. Release of the Plasmodium falciparum genome sequence has allowed biologists to define the gene and the predicted protein content as well as their sequences in the parasite. Using pI and molecular weight as characteristics unique to each protein, we have developed a bioinformatics tool to aid identification of proteins from Plasmodium falciparum. The tool makes use of a Virtual 2-DE generated by plotting all of the proteins from the Plasmodium database on a pI versus molecular weight scale. Proteins are identified by comparing the position of migration of desired protein spots from an experimental 2-DE and that on a virtual 2-DE. The procedure has been automated in the form of user-friendly software called "Plasmo2D". The tool can be downloaded from http://144.16.89.25/Plasmo2D.zip.

Animals↗

PubMed2003

The power of collaboration: using internet-based tools to facilitate networking and benchmarking within a consortium of academic health centers.

The University HealthSystem Consortium (UHC) represents a strategic alliance of 169 academic health centers and associated institutions engaged in knowledge sharing and idea-generation. The use of the Internet as a tool in the delivery of UHC's products and services has increased dramatically over the past year and will continue to increase during the foreseeable future. This paper examines the current state of UHC-member institution driven tools and services that utilize the Web as a fundamental component in their delivery. The evolution of knowledge management at UHC, its management information and reporting tools, and expansion of e-commerce provide real world examples of Internet use in health care delivery and management. Health care workers are using these Web-based tools to help manage rising costs and optimize patient outcomes. Policy, technical, and organizational issues must be resolved to facilitate rapid adoption of Internet applications.

Academic Medical Centers↗

PubMed2002

A medication screening tool for cognitive aging researchers.

A Web-based medication screening tool that provides researchers with information about side effects associated with medications commonly used by older participants is described. This tool can be used for research purposes to better separate the effects of normal, healthy aging processes from the deleterious effects often associated with medication usage. Researchers can use this tool, called SMART (Screening Medications: Aging Research Taxonomy), to (a) obtain information pertaining to the cognitive, sensory, and motor side effects associated with specific medications and (b) screen medications in their research for side effect severity. The Web address for the tool is www.psychology.gatech.edu/SMART

Adverse Drug Reaction Reporting Systems↗

PubMed1988

Lion-tailed macaques (Macaca silenus) manufacture and use tools.

Lion-tailed macaques (Macaca silenus) in captive social groups spontaneously manufactured and used tools to extract syrup from an apparatus that was designed to accommodate probing behavior. An attempt to replicate these findings with mandrills (Mandrillus sphinx) was unsuccessful. This report is the first to describe spontaneous manufacture of tools in any group of Old World monkeys and provides evidence of greater continuity among primates for the expression of complex cognitive abilities. These data are consistent with hypotheses that lion-tailed macaques have extensive propensities for advanced sensorimotor skills and that omnivorous, extractive foraging is associated with the manufacture and use of tools. I present a proximate model that integrates sensorimotor and social factors to account for diverse expression of tool-related behavior.

Animals↗

PubMed1991

Hand preference in the use and manufacture of tools by tufted capuchin (Cebus apella) and lion-tailed macaque (Macaca silenus) monkeys.

The purpose of this study was to examine hand preference in the use and manufacture of probing tools by tufted capuchin and lion-tailed macaque monkeys (Cebus apella and Macaca silenus). Hand preference for the tool-using sequence was noted in 4 of 5 capuchins (a left-hand preference was noted in 3 ss) and 3 of 4 macaques (a left-hand preference was noted in 2 ss). The monkeys frequently used bimanual action in the initial and final segments of the 3-component task and typically modified tools through coordinated action of the hands and teeth. These data provide evidence consistent with the hypotheses that (a) hemisphere specialization for manual control evolved in primates prior to intensive use of tools by early hominids and (b) monkeys prefer the left hand for precise, visually guided, manipulative actions.

Animals↗

PubMed2000

Naive chimpanzees' (Pan troglodytes) observation of experienced conspecifics in a tool-using task.

The authors investigated the occurrence of naive chimpanzees' (Pan troglodytes) spontaneous observation of experienced conspecifics during a tool-use task entailing honey fishing. The chimpanzees were presented with 20 kinds of "tools" of which 12 kinds were usable. Six pairs of naive and experienced chimpanzees were brought to this honey-fishing situation. A total of 40 observation episodes occurred between the naive and experienced groups, 34 of which were from naive toward experienced individuals. Naive chimpanzees never observed their partners after their own success but did so after their own failure or before their first attempts. In addition, there were 10 cases in which naive individuals used the left-over tools of the experienced ones. Two factors for the transmission of tool use were clearly evident in this study: (a) spontaneous observation of an appropriate behavioral sequence and (b) enhanced environmental cues made by skilled individuals.

Animals↗