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PubMed2006

Digital tools for collecting data from cervigrams for research and training in colposcopy.

Colposcopy is a critical part of gynecologic practice but has documented deficiencies, including lack of correlation between the colposcopic appearance and the severity of underlying neoplasia, limited reproducibility, and difficulty in the optimal placement of colposcopically directed biopsies. In a collaborative effort to improve colposcopy, we are analyzing digitized cervigram images from National Cancer Institute-funded studies. Specifically, the National Cancer Institute has collected close to 100,000 cervigrams, digitized to create a database of images of the uterine cervix for research, training, and education. In addition to the cervigram images, this database contains clinical, cytologic, and molecular information at multiple examinations of 15,000 women, with password and ID labeling strategies to protect patient privacy. The National Library of Medicine has designed two web-accessible software tools. The Boundary Marking Tool allows experts on colposcopy to perform an evaluation of the pictures and to mark boundary regions of normal and abnormal regions of the uterine cervix; these evaluations are collected and saved in the database. The Multimedia Database Tool enables retrieval of test and image biomedical data according to specific queries, for example, all women with cervical intraepithelial neoplasia 3 whose cytologic results are atypical squamous cells of undetermined significance. The resource soon will be available as an open resource, via a teaching tool coordinated by a database manager, which will permit a variety of applications for teaching and research. In this article, we describe the perceived need for the resource and its components.

Biomedical Research↗

PubMed2005

Evaluation of the advance off-stylet insertion technique and the cochlear insertion tool in temporal bones.

OBJECTIVE: The concept and design of new cochlear implant electrodes is a challenging process. To evaluate new electrode designs, we present a study that uses a microgrinding procedure to evaluate damage to the microstructures of the cochlea resulting from the insertion procedure. In this study, we compared different insertion techniques with the Contour electrode with Softip for placement inside the cochlea and any resulting damage. METHODS: Twenty-five fresh frozen human temporal bones were used to compare electrode insertion characteristics with three insertion techniques (i.e., conventional insertion, Advance Off-Stylet performed manually, and Advance Off-Stylet performed with insertion tool) and two prototype variants of the Contour electrode with Softip (referred as Softip I and Softip II in this article). Five temporal bones were used for each arm of the study: Softip I electrode and conventional insertion; Softip I electrode and manual Advance Off-Stylet insertion; Softip I electrode and Advance Off-Stylet insertion with an early experimental insertion tool; Softip II prototype electrode and manual Advance Off-Stylet insertion; and Softip II prototype and Advance Off-Stylet insertion with a prototype insertion tool. The temporal bones were dehydrated and embedded in epoxy and used for the microgrinding procedure. Resulting images were documented and compared with conventional radiographic images. RESULTS: Our results showed that, especially when using the conventional insertion technique with Softip I electrode arrays, basilar membrane perforations were observable. Using the prototype insertion tool, good placement of the electrode array but also two basilar membrane perforations (one with each type of electrode) were observed. In contrast, the Advance Off-Stylet insertion technique did not show basilar membrane perforation with Softip I and II electrodes and resulted in reliable perimodiolar placement of the arrays. CONCLUSION: Using microgrinding of temporal bones, the Advance Off-Stylet insertion technique was proven to enable more atraumatic insertions of Contour electrodes with Softip and to provide very reliable perimodiolar placements.

Basilar Membrane↗

PubMed2005

Stroboscopy as a research instrument: development of a perceptual evaluation tool.

Laryngeal stroboscopy is arguably the most important clinical tool for the evaluation and treatment of patients with voice disorders. Unfortunately, at present, laryngeal stroboscopy is strictly a clinical tool and has no definitive use in the area of voice research. The limitation with laryngeal stroboscopy is the subjective nature of the interpretation of the video examination. A video stroboscopy research tool was developed using 10 stroboscopic parameters selected from the literature and clinical practice. The stroboscopy research tool was validated with the results of 18 reviewers using the instrument to rate 21 unique "cases" and 6 repeated "cases." The results of this video perceptual analysis study identified which parameters were the most robust and reliable across a wide range of reviewers and validated power analysis curves for future similar research. Furthermore, findings from this study revealed that a greater than 80% intra-rater reliability is the preferred method for the selection of a valid and reliable reviewer. Future research using this instrument will most likely increase the reliability and utility of the instrument with the use of prestudy reviewer training and/or the use of video examples to serve as anchors or external references.

Humans↗

PubMed2006

Recent advances in the development of screening tools for mental health in young offenders.

PURPOSE OF REVIEW: To describe recent advances in the development of mental health needs screening tools for use with young offenders and implications for this vulnerable group. RECENT FINDINGS: The literature shows that young offenders in North America and Europe have high levels of diverse needs that often go unmet because of lack of methods for recognizing and assessing them. Effective screening could play an important role in improving recognition of these needs. Substantial developments have been occurring in the United States, England and Wales and the Netherlands in developing screening tools for this purpose and for this population. Now, the literature is beginning to provide a broad understanding of the optimal psychometric properties, utility and limitations of the screening tools that are required. SUMMARY: Several centres are engaged in work to construct mental health screening and assessment tools for use with young offenders. Psychometric measures are being used to determine their validity and reliability. The work has highlighted deficiencies in the healthcare of young persons involved in criminal justice systems but should assist policymakers, healthcare strategists, planners and commissioners to come to better informed decisions about how to utilize most appropriately the limited mental health expertise that is available and how to enhance awareness of nonhealth professionals of basic mental health risks, problems and disorders.

Adolescent↗

PubMed2004

Lateralization of tool use in New Caledonian crows (Corvus moneduloides).

We studied laterality of tool use in 10 captive New Caledonian (NC) crows (Corvus moneduloides). All subjects showed near-exclusive individual laterality, but there was no overall bias in either direction (five were left-lateralized and five were right-lateralized). This is consistent with results in non-human primates, which show strong individual lateralization for tool use (but not for other activities), and also with observations of four wild NC crows by Rutledge & Hunt. Jointly, these results contrast with observations that the crows have a population-level bias for manufacturing tools from the left edges of Pandanus sp. leaves, and suggest that the manufacture and use of tools in this species may have different neural underpinnings.

Animals↗

PubMed2004

Analysis of multiple genomic sequence alignments: a web resource, online tools, and lessons learned from analysis of mammalian SCL loci.

Comparative analysis of genomic sequences is becoming a standard technique for studying gene regulation. However, only a limited number of tools are currently available for the analysis of multiple genomic sequences. An extensive data set for the testing and training of such tools is provided by the SCL gene locus. Here we have expanded the data set to eight vertebrate species by sequencing the dog SCL locus and by annotating the dog and rat SCL loci. To provide a resource for the bioinformatics community, all SCL sequences and functional annotations, comprising a collation of the extensive experimental evidence pertaining to SCL regulation, have been made available via a Web server. A Web interface to new tools specifically designed for the display and analysis of multiple sequence alignments was also implemented. The unique SCL data set and new sequence comparison tools allowed us to perform a rigorous examination of the true benefits of multiple sequence comparisons. We demonstrate that multiple sequence alignments are, overall, superior to pairwise alignments for identification of mammalian regulatory regions. In the search for individual transcription factor binding sites, multiple alignments markedly increase the signal-to-noise ratio compared to pairwise alignments.

Animals↗

PubMed2004

eShadow: a tool for comparing closely related sequences.

Primate sequence comparisons are difficult to interpret due to the high degree of sequence similarity shared between such closely related species. Recently, a novel method, phylogenetic shadowing, has been pioneered for predicting functional elements in the human genome through the analysis of multiple primate sequence alignments. We have expanded this theoretical approach to create a computational tool, eShadow, for the identification of elements under selective pressure in multiple sequence alignments of closely related genomes, such as in comparisons of human-to-primate or mouse-to-rat DNA. This tool integrates two different statistical methods and allows for the dynamic visualization of the resulting conservation profile. eShadow also includes a versatile optimization module capable of training the underlying Hidden Markov Model to differentially predict functional sequences. This module grants the tool high flexibility in the analysis of multiple sequence alignments and in comparing sequences with different divergence rates. Here, we describe the eShadow comparative tool and its potential uses for analyzing both multiple nucleotide and protein alignments to predict putative functional elements.

Animals↗

PubMed2005

Toward supportive data collection tools for plant metabolomics.

Over recent years, a number of initiatives have proposed standard reporting guidelines for functional genomics experiments. Associated with these are data models that may be used as the basis of the design of software tools that store and transmit experiment data in standard formats. Central to the success of such data handling tools is their usability. Successful data handling tools are expected to yield benefits in time saving and in quality assurance. Here, we describe the collection of datasets that conform to the recently proposed data model for plant metabolomics known as ArMet (architecture for metabolomics) and illustrate a number of approaches to robust data collection that have been developed in collaboration between software engineers and biologists. These examples also serve to validate ArMet from the data collection perspective by demonstrating that a range of software tools, supporting data recording and data upload to central databases, can be built using the data model as the basis of their design.

Arabidopsis↗

PubMedDate not supplied

Learning from other people's mistakes: causal understanding in learning to use a tool.

Despite considerable debate about whether nonhuman primates learn to use tools via imitation, this type of learning by children has received surprisingly little attention. The findings of two studies that go some way toward filling this gap are reported here. Study 1 showed that when 2- and 3-year-old children (N = 68) were shown a correct solution to a tool-using task (which they could not solve spontaneously), all the children in both age groups managed at least a partial solution. When children were shown an incorrect solution followed by a correct solution, 2-year-olds again produced only a partial solution. By contrast, most 3-year-olds produced a full solution. Study 2 replicated this age change in a separate sample of children (N = 100) with a different tool-using task. Study 2 also showed that 3-year-olds benefit from observing an incorrect action when it can be contrasted with a correct action: they chose the more effective of the two actions. Taken together, the two studies indicate that by 3 years of age, children do not indiscriminately imitate actions on a tool, but selectively reproduce those actions that have a desired causal effect.

Age Factors↗

PubMed2006

Examining the CDCynergy Event Assessment Tool: an investigation of the anthrax crisis in Boca Raton, Florida.

This paper examines the dependability of the Event Assessment Tool over time. The latter is part of a CD-ROM--Emergency Risk Communication CDCynergy--distributed primarily to public information officers in the United States by the Centers for Disease Control and Prevention. The Event Assessment Tool is designed to aid emergency professionals in identifying the magnitude of a crisis event and to suggest appropriate actions to confront such a situation. Applied twice during the 2001 anthrax bioterrorism crisis in Boca Raton, Florida, the tool functioned in a binary manner by first indicating a moderate crisis level (on 4 October) and then four days later (on 8 October) a highly intense crisis, suggesting that it is time sensitive. This anthrax event provides an opportunity for crisis and disaster managers to understand the dynamic nature of crises. Rapid changes during these types of events suggest that any metric used to predict intensity must account for this variability. Additional limitations and implications of the tool are discussed.

Anthrax↗

PubMed1994

Further validity testing of the Abu-Saad Paediatric Pain Assessment Tool.

This paper reports on the results of two studies conducted to further validate the Abu-Saad Paediatric Pain Assessment Tool, a Dutch-language questionnaire developed to assess pain in school-age children. Children of 5 to 15 years of age reported in the first study their post-operative pain before and after the administration of analgesic medication using word descriptors of pain, the 10-cm scale, the Oucher, and a visual analogue scale (VAS). Lower mean pain scores at 4-hourly intervals post-analgesia supported the construct validity of the tool. Convergent validity was supported in both studies when scores on all concurrently administered measures positively correlated with the pain tool. In the second study, the correlations between pain and fear, a concurrently used measure with the pain instruments, were low, substantiating the discriminant validity of the pain tool. The significance of the results in relation to instrument development and multidimensional pain assessment in children are further discussed and elaborated.

Adolescent↗

PubMed2005

Ecomapping: an innovative research tool for nurses.

AIM: This paper explores the use of ecomaps as a research tool for capturing data, using the example of the dynamic nature of social networks from which informal carers of people living with motor neurone disease draw their support. BACKGROUND: The need for social support in relation to health maintenance and disease management has been identified in the literature but little has been published about ways to investigate support networks. Existing discussion in the literature about the use of ecomaps as a clinical tool in social work creates a valuable framework for data collection which can be readily adapted by nurse researchers. METHOD: We used ecomaps as part of a repertoire of research tools to gather data about the social networks of carers of people living with motor neurone disease. Primary carers participated in three interviews and collaborated in ecomap construction over a period of 10 months during 2003. Analytical correlations were made between ecomaps and interview data. FINDINGS: Ecomaps provided a visual means of facilitating discussions around the structure and strength of networks. Being able to represent the social networks visually through ecomapping enabled people to identify each member of the network, examine the strength of each relationship and ascertain the sources of nurture and tension over time. Limitations to this type of data collection arise when participants try to quantify relationships that have been visually produced. CONCLUSION: Ecomapping is a valuable research tool because it provides visual representation of supportive care networks, capturing strategic data through symbols expressing relationships that may be inadequately portrayed in words. The ecomap incorporates the use of consistent symbols that standardize recipient responses, enabling data comparisons to be made.

Caregivers↗

PubMed2005

A case study of a preceptorship programme in an acute NHS Trust--using the European Foundation for Quality Management tool to support clinical practice development.

AIMS: To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme. BACKGROUND: Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust. METHOD: The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers. FINDINGS: Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change. CONCLUSIONS: This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.

Clinical Competence↗

PubMed2005

Testing the exportability of a tool for detecting operational problems in VA teaching clinics.

BACKGROUND: Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. OBJECTIVE: This study tests the exportability of a unique CCA tool to identify site-specific operational problems at 5 different VA teaching clinics. DESIGN: We used the CCA tool at 5 teaching clinics to identify group preference differences between the above groups. We averaged the CCA results for all 5 sites. We compared each site with the averages in order to isolate each site's most anomalous responses. Major operational problems were independently identified by workgroups at each site. Cultural consensus analysis performance was then evaluated by comparison with workgroup results. PARTICIPANTS: Twenty patients, 10 residents, 10 faculty, members, and 10 administrators at each site completed the CCA. Workgroups included at minimum: a patient, resident, faculty member, nurse, and receptionist or clinic administrator. APPROACH: Cultural consensus analysis was performed at each site. Problems were identified by multidisciplinary workgroups, prioritized by anonymous multivoting, and confirmed by limited field observations and interviews. Cultural consensus analysis results were compared with workgroup results. RESULTS: The CCA detected systematic, group-specific preference differences at each site. These were moderately to strongly associated with the problems independently identified by the workgroups. The CCA proved to be a useful tool for exploring the problems in depth and for detecting previously unrecognized problems. CONCLUSIONS: This CCA worked in multiple VA sites. It may be adapted to work in other settings or to better detect other clinic problems.

Ambulatory Care Facilities↗

PubMed2003

HandiStroke: a handheld tool for the emergent evaluation of acute stroke patients.

BACKGROUND: The management of acute stroke is time-sensitive. Clinical decision making requires data not only from laboratory testing and neuroimaging, but also from a detailed history and neurologic examination. The neurologic examination provides baseline information and assists in differentiating acute stroke from its mimickers. There is a need for tools to facilitate the evaluation and decision making in the acute stroke patient to make the correct diagnosis and, when indicated, to properly administer intravenous thrombolytic therapy. OBJECTIVES: The goals of this project were to create a standardized, handheld software program to aid physicians in their evaluation of patients presenting to the emergency department (ED) with acute ischemic stroke, and to create an educational tool with which residents and other health care professionals can gain a level of proficiency in treating these patients. RESULTS: A comprehensive handheld tool was created that incorporates a National Institutes of Health Stroke Scale (NIHSS) calculator, inclusion criteria, absolute contraindications, and relative warnings for thrombolytic use (i.e., recombinant tissue plasminogen activator), and a weight-based dosing calculator that flows in a logical and clinically relevant format. Additionally, the program includes reference materials and guidelines for clinical management to further assist the clinician. CONCLUSIONS: Applications of this program include reformatting for use as a data-gathering tool in future clinical studies investigating the treatment of stroke patients, increasing the use and documentation of the NIHSS within the ED in acute ischemic stroke patients, and improving protocol adherence for rt-PA use.

Emergency Service, Hospital↗

PubMed2002

Pathfinder and other tools for analyzing signal transduction networks.

Many electronic design tools are, at their core, tools for analyzing interacting networks of components in which there is a definite causal sense of direction in each interaction: outputs affect inputs, but not vice versa. Simplifying or restricting a network of protein interactions so that this kind of directedness holds makes the same category of software tools applicable. In signal transduction cascades the direction is usually given by "kinase phosphorylates substrate." This paper examines a few kinds of directed network analysis tools in the context of signal transduction.

Algorithms↗

PubMed2005

The oral health assessment tool--validity and reliability.

BACKGROUND: The Oral Health Assessment Tool (OHAT) was a component of the Best Practice Oral Health Model for Australian Residential Care study. The OHAT provided institutional carers with a simple, eight category screening tool to assess residents' oral health, including those with dementia. This analysis presents OHAT reliability and validity results. METHODS: A convenience sample of 21 residential care facilities (RCFs) in urban and rural Victoria, NSW and South Australia used the OHAT at baseline, three-months and six-months to assess intra- and inter-carer reliability and concurrent validity. RESULTS: Four hundred and fifty five residents completed all study phases. Intra-carer reliability for OHAT categories: percent agreement ranged from 74.4 per cent for oral cleanliness, to 93.9 per cent for dental pain; Kappa statistics were in moderate range (0.51-0.60) for lips, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Inter-carer reliability for OHAT categories: percent agreement ranged from 72.6 per cent for oral cleanliness to 92.6 per cent for dental pain; Kappa statistics were in moderate range (0.48-0.60) for lips, tongue, gums, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Intraclass correlation coefficients for OHAT total scores were 0.78 for intra-carer and 0.74 for inter-carer reliability. Validity analyses of the OHAT categories and examination findings showed complete agreement for the lips category, with the natural teeth, dentures, and tongue categories having high significant correlations and percent agreements. The gums category had significant moderate correlation and percent agreement. Non-significant and low correlations and percent agreements were evident for the saliva, oral cleanliness and dental pain categories. CONCLUSION: The Oral Health Assessment Tool was evaluated as being a reliable and valid screening assessment tool for use in residential care facilities, including those with cognitively impaired residents.

Aged↗

PubMed1998

A quality assurance test tool for high dose-rate remote afterloading brachytherapy units.

A QA test tool is designed to quantitatively measure the HDR source positioning error, and to facilitate quick and dependable HDR timer linearity test and daily output constancy check. The test tool consists of two concentric disks. The lower disk has a cutout for inserting an HDR catheter, and the upper disk accepts a diode or miniature ionization chamber and can rotate relative to the lower disk. Ionization readings from the source (transferred to the center of the disks) are obtained at two rotational positions of the upper disk which houses the detector. The ratio of the readings is used to determine the source-positioning error of the HDR unit relative to the nominal source position by a simple triangulation principle. Experimental measurements confirm that the QA test tool is sensitive to approximately 0.2 mm variance in source positioning errors. In addition, the QA test tool is suitable for other common HDR QA tests such as the source travel step size test, the daily HDR unit output constancy check, and the timer linearity test. Its simple and robust design permits routine clinical use and provides a high confidence level in the accurate operation of HDR units.

Biophysical Phenomena↗