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At least 109 records · Page 6Linked to original sources

PubMed1989

The reproducibility of single photon absorptiometry in a clinical setting.

The reproducibility of single photon absorptiometry (SPA) results for detection of changes in bone mineral content (BMC) was evaluated in a clinical setting. During a period of 18 months with 4 different sources, the calibration scans of an aluminium standard had a variation of less than 1% unless the activity of the 125I source was low. The calibration procedure was performed weekly and this was sufficient to correct for drift of the system. The short term reproducibility in patients was assessed with 119 duplicate measurements made in direct succession. The best reproducibility (CV = 1.35%) was found for fat corrected BMC results expressed in g/cm, obtained at the site proximal to the 8 mm space between the radius and ulna. Analysis of all SPA scans made during 1 year (487 scans) showed a failure of the automatic procedure to detect the space of 8 mm between the forearm bones in 19 scans (3.9%). A space adjacent to the ulnar styloid was taken as the site for the first scan in these examinations. This problem may be recognized and corrected relatively easy. A significant correlation was found between BMC of the lower arm and BMC of the lumbar spine assessed with dual photon absorptiometry. However, the error of estimation of proximal BMC (SEE = 20.0%) and distal BMC (SEE = 19.4%) made these measurements of little value to predict BMC at the lumbar spine in individuals. The short term reproducibility in patients combined with the long term stability of the equipment in our clinical setting showed that SPA is a reliable technique to assess changes in bone mass at the lower arm of 4% between 2 measurements with a confidence level of 95%.

Bone and Bones↗

PubMed2006

Concentration of latanoprost ophthalmic solution after 4 to 6 weeks' use in an eye clinic setting.

PURPOSE: To determine the concentration of latanoprost in bottles of latanoprost ophthalmic solution 0.005% after 4 or 6 weeks of use in patients in an eye clinic setting. METHODS: Patients treated with latanoprost for open-angle glaucoma or ocular hypertension were randomly assigned to refill their prescriptions either at the Doheny Eye Institute clinic or a local pharmacy. Patients who used latanoprost binocularly were asked to return bottles to the clinic after 4 weeks of use and nonrefrigerated storage, and those who used latanoprost monocularly were asked to return used bottles after 6 weeks. Patients were then interviewed to determine bottle storage information and doses missed. Latanoprost concentration in residual solution was analyzed in a masked fashion, by reversed-phase high-performance liquid chromatography (HPLC). RESULTS: In all, 110 patients were enrolled and 89 returned their bottles. Sixty-nine bottles had sufficient residual volume to conduct HPLC analysis. All patients reported that bottles were stored at room temperature (average high from 70-95 degrees F during the daytime). The mean +/- SD latanoprost concentration measured in the residual solutions was 48.31 +/- 2.31 microg/mL. Ninety-four percent of the bottles had concentrations within 90% to 110% of the labeled amount. No difference in latanoprost concentrations was found between the bottles used for 4 weeks versus those used for 6 weeks. CONCLUSIONS: In an eye clinic setting, latanoprost ophthalmic solution 0.005% remains stable after 4 or 6 weeks of patient use from the same bottle when stored at room temperature.

Aged↗

PubMed2005

Prevalence of human papillomavirus genotypes in women from three clinical settings.

Prevalence of 27 human papillomavirus (HPV) genotypes was assessed in 1,331 women in three clinical settings: Family planning clinic (low-risk HIV-, n = 202, 21.3% HPV+), colposcopy clinic (high-risk HIV-, n = 854, 34.3% HPV+), and HIV outpatient clinic (HIV+, n = 275, 48.7% HPV+). Compared to women from both family planning and colposcopy clinics, HIV+ women revealed significantly higher prevalence of infection with oncogenic, non-oncogenic, and multiple HPV types. HPV types 52 and 51 were most prevalent in the low-risk HIV- women, whereas in the high-risk HIV- women, HPV types 16, 52, 58, and 35 were most prevalent. Interestingly, in the HIV+ women, less characterized types 83, 53, and 54 were most prevalent. The distinct profiles of genotype prevalence persisted after stratification by Pap smear status. After adjustment for concurrent infections with other types, HPV type 51 in the low-risk HIV- women, and types 16, 35, 39, 45, 52, and 58 in the high-risk HIV- women were significantly associated with cytologic abnormalities (exact P < 0.05). In HIV+ women across CD4 cell count strata, HPV types 42, 16, and 82 revealed significant decreasing trends with increasing CD4 counts (exact P for trend < 0.05). These data suggest distinct genotypic prevalence profiles in women at diverse risk for cervical cancer. The association of several genotypes with cytologic abnormalities underscores the need for vaccines targeting a wide range of HPV types.

AIDS-Related Opportunistic Infections↗

PubMed2003

Evaluation of a cardiac diagnostic program in a typical clinical setting.

CONTEXT: The Heart Disease Program (HDP) is a novel computerized diagnosis program incorporating a computer model of cardiovascular physiology. Physicians can enter standard clinical data and receive a differential diagnosis with explanations. OBJECTIVE: To evaluate the diagnostic performance of the HDP and its usability by physicians in a typical clinical setting. DESIGN: A prospective observational study of the HDP in use by physicians in departments of medicine and cardiology of a teaching hospital. Data came from 114 patients with a broad range of cardiac disorders, entered by six physicians. MEASUREMENTS: Sensitivity, specificity, and positive predictive value (PPV). Comprehensiveness: the proportion of final diagnoses suggested by the HDP or physicians for each case. RELEVANCE: the proportion of HDP or physicians' diagnoses that are correct. Area under the receiver operating characteristic (ROC) curve (AUC) for the HDP and the physicians. Performance was compared with a final diagnosis based on follow-up and further investigations. RESULTS: Compared with the final diagnoses, the HDP had a higher sensitivity (53.0% vs. 34.8%) and significantly higher comprehensiveness (57.2% vs. 39.5%, p < 0.0001) than the physicians. Physicians' PPV and relevance (56.2%, 56.0%) were higher than the HDP (25.4%, 28.1%). Combining the diagnoses of the physicians and the HDPs, sensitivity was 61.3% and comprehensiveness was 65.7%. These findings were significant in the two collection cohorts and for subanalysis of the most serious diagnoses. The AUCs were similar for the HDP and the physicians. CONCLUSIONS: The heart disease program has the potential to improve the differential diagnoses of physicians in a typical clinical setting.

Adult↗

PubMed2001

Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings.

A brief, 10-item version of the Questionnaire of Smoking Urges (QSU; Tiffany & Drobes, British Journal of Addiction 86:1467-1476, 1991) was administered to 221 active cigarette smokers in a laboratory setting (Study 1) and to 112 smokers enrolled in a comprehensive smoking cessation program (Study 2). In the laboratory setting, craving to smoke was evaluated in response to neutral and smoking-related stimuli. In the clinical setting, craving was assessed prior to cessation and again during treatment. Factor analyses revealed that a two-factor solution best described the item structure of the QSU-Brief across conditions. Factor 1 items reflected a strong desire and intention to smoke, with smoking perceived as rewarding for active smokers. Factor 2 items represented an anticipation of relief from negative affect with an urgent desire to smoke. The findings were consistent with the expressions of craving found in the 32-item version of the QSU (Tiffany & Drobes, 1991). Regression analyses demonstrated stronger baseline mood intensity and self-reported tendency to smoke to achieve pleasurable effects and to experience the desire to smoke when cigarettes are unavailable were predictive of general levels of craving report in active smokers in the laboratory and clinical setting. The findings supported a multidimensional conceptualization of craving to smoke and demonstrated the utility of a brief multidimensional measure of craving.

Adult↗

PubMed1998

Efficacy of the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) in identifying substance dependence disorders in clinical settings.

This article presents analyses on psychometric properties of a recent revision of the Substance Abuse Subtle Screening Inventory (SASSI-3). Participants were 772 individuals from a range of clinical settings who were independently diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association [APA], 1987) or DSM-IV (APA, 1994) criteria regarding the presence or absence of a substance-dependence disorder. A development sample (n = 391) was used to formulate SASSI-3 decision rules that yielded 95% agreement with clinical diagnoses of substance dependence. Correspondence with the criterion variable was shown to be 97% in a cross-validation sample (n = 381) from the same clinical settings. Convergent relations were demonstrated with a variety of other indexes of substance misuse, including clinical assessments of substance abuse history, alcohol and drug-related arrests, self-reported use of illicit drugs, and other instruments designed to screen for substance misuse. Further, logistic regression analyses indicated no significant differences in the overall accuracy of the SASSI-3 as a function of respondents' demographic characteristics or clinical ratings of respondents' level of adjustment and functioning (Global Assessment of Functioning ratings; APA, 1987, 1994).

Adult↗

PubMed1991

Online access to MEDLINE in clinical settings: impact of user fees.

The effect of introducing user fees on the frequency and quality of MEDLINE searching with GRATEFUL MED by physicians in clinical settings was tested. After training and free use (prior study), consenting participants were randomly allocated to pay searching costs (pay group) or continue without fees (no pay group). Fifty-nine physicians participated. Among the prior study's frequent searchers, the pay group searched at less than one third of the rate of those assigned to no pay. For less frequent searchers in the prior study, only 48% of those assigned to pay did any searches, compared with 85% for the no pay group (P = 0.006), and for those who did search, their frequency was almost half. However, there was no significant difference in the quality of searches; both groups demonstrated about equivalent recall (P = 0.77), but significantly lower precision (P = 0.03) than for the librarian's independent searches. Similarly, there was no difference in the proportion of searches affecting clinical decisions for the two groups. Thus, imposing user charges for online searching in clinical settings after a period of free use adversely affects searching quantity, but not quality. MEDLINE providers should consider whether user fees will undermine its benefits.

Fees and Charges↗

PubMed1997

Validation of play-conditioned audiometry in a clinical setting.

The aim of the present study was to investigate at what ages children were able to participate in play-conditioned audiometry in a clinical setting. Data concerning age and gender for 294 children (182 boys and 112 girls) were continuously recorded with details regarding audiometric method and number of successfully determined thresholds. Some children were tested more than once, resulting in a total of 449 examinations. The results are compared with those of other studies in which visual reinforced audiometry (VRA), condition-orientation reflex audiometry (COR) and play-conditioned audiometry are used, and show that in a clinical setting it is possible to determine at least one threshold in more than 35% of children tested at ages above 16 months. At 2 years of age, about 50% of the children are able to establish thresholds at least at three frequencies and from 3 years of age nearly 75% of the children could establish 6 thresholds or more. It is concluded that VRA, COR and play-conditioned audiometry should be considered along with objective hearing tests like brainstem audiometry (ABR) or measurement of otoacoustic emissions (OAE) when assessing hearing in infants and small children.

Audiometry, Pure-Tone↗

PubMed1996

Data-gathering tools for "real world" clinical settings: a multisite feasibility study.

OBJECTIVE: To determine the mental health needs and optimal treatments for children and families in "real world" settings, data-gathering strategies are needed that can be easily implemented across a variety of clinical settings. To address this need, the authors developed and piloted a "clinician-friendly" questionnaire that includes demographic, psychosocial, medical, and family history variables, such as those routinely gathered in standard clinical evaluations. METHOD: Optical scanning technology was used to encode data from more than 1,900 children, including 1,458 consecutive referrals in four military child psychiatry clinics, 285 consecutive admissions to a civilian psychiatric state hospital, 71 pediatric patients, and a community sample of 113 children. RESULTS: Despite geographic and logistic obstacles, clinical data were reliably obtained across multiple settings. Data analyses revealed meaningful differences across samples in subjects' presenting complaints, and a range of psychosocial, demographic, and background variables. Data were characterized by an apparently high degree of accuracy and completeness. CONCLUSIONS: Findings illustrate the importance and feasibility of standardized data-gathering approaches in routine clinical settings and clarify the hazards as well as the opportunities afforded by these research approaches. Such data-gathering tools appear to have significant merit and deserve further implementation and testing across a range of clinical and research settings.

Adolescent↗

PubMed1994

Small PACS for digital medical images--reliability and security in a clinical setting.

Recently we introduced a small Picture Archiving Communication System (PACS) for handling CT and MRI data. Our experience with this system has been useful in identifying potential problems in a clinical setting. Since the use of PACS raises both medical and social concerns, it cannot be instituted without addressing concerns related to the reliability and security issues. Although PACS is useful in the management of medical images, there are concerns about their reliability and security in a clinical setting. Reliability encompassed image quality, timeliness of the reports, and the PACS to the Radiological Information System (RIS) interface including the retrieval of the previously obtained images. The security of the patient's medical data is also essential.

Computer Security↗

PubMed1983

Goniometric reliability in a clinical setting. Elbow and knee measurements.

Reliability of goniometric measurements has been examined only under standardized conditions and usually with healthy subjects. The purpose of this study was to assess goniometric reliability in a clinical setting. The reliability of goniometric measurements of passive elbow and knee positions was assessed using patients as subjects. The effect of using the means of repeated measurements and the interdevice reliability of three common goniometers were also examined. Results showed that intratester reliability for flexion and extension of the knee and the elbow joints was high (r = .91 to .99). Intertester reliability was also high (r = .88 to .97) for these measurements except for measurements of knee extension (r = .63 to .70). Although previous investigators have suggested that using the means of multiple measurements improves reliability, our data indicate that this procedure never improves the correlation coefficient more than .12. The reliability was similar for all three devices. The results of this study indicate that for the knee and elbow joints, goniometric measurements performed in a clinical setting can be highly reliable. The method described in this study provides a simple protocol that can be used clinically to investigate goniometric reliability.

Elbow Joint↗

PubMed1989

An analysis of ethics consultation in the clinical setting.

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.

Ethicists↗

PubMed2002

Measurement of 4-hydroxynonenal in small volume blood plasma samples: modification of a gas chromatographic-mass spectrometric method for clinical settings.

4-Hydroxynon-2-enal (4-HNE) is one of the major aldehydic products of lipid peroxidation (LPO) and is involved in a number of pathophysiological processes. Since LPO products are useful indicators for oxidative stress in vivo, a number of detection methods for LPO products in biological tissues were developed. However, none of these methods is presently used in clinical settings. In order to introduce LPO products as biomarkers in clinical studies a suitable GC-MS method for 4-HNE detection was adapted to meet clinical requirements. As one result, the minimal sample volume could be decreased to 50 microl of plasma so that the method might even be suitable for pediatric purposes. The best internal standard (I.S.) for 4-HNE detection by GC-MS 9,9,9-D(3)-4-hydroxynon-2-enal was introduced by van Kuijk et al. [Anal. Biochem., 224 (1995) 420]. However, because of its limited availability, benzaldehyde-ring-d(5), 4-hydroxybenzaldehyde, and 2,5-dihydroxybenzaldehyde were tested to find an alternative. Out of these three, 4-hydroxybenzaldehyde was shown to serve best as I.S. To examine the applicability of the adapted method, tests on the stability of 4-HNE in samples during storage were carried out. It was shown that plasma samples need to be stored at -80 degrees C or less to avoid greater loss of 4-HNE. Samples with 4-HNE concentrations close to the physiological level were shown to be stable over 22 months at -80 degrees C. The introduction of a new and easily available I.S., reduction of the sample volume, and information about sample stability provided by this study facilitate 4-HNE determination in most clinical settings.

Aldehydes↗

PubMed2003

Comparison of conventional ERG parameters and high-intensity A-wave analysis in a clinical setting.

Computational analysis of high-intensity a-waves yields direct information about the rod and cone receptor potential. However, it is not clear whether such information adds materially to the diagnostic value of the standard ERG in a routine clinical setting. We recorded both conventional ISCEV standard and computational high intensity ERG parameters from 38 patients referred to a clinical laboratory for ERG testing, and also from eight normal volunteers. The patients were grouped as: (1) macular dysfunction; (2) diffuse cone dysfunction; (3) diffuse rod-cone dysfunction. The results showed moderate variation in both conventional and computational parameters, but in general a similar pattern of normality or abnormality for both among the disease groups. There were only a few outlying subjects for which one or the other approach seemed more sensitive. We conclude that a-wave analysis is an important tool for clinical research and the study of special patients, but adding it to the standard ERG protocol does not, at our present state of knowledge, add markedly to clinical evaluations in a routine clinical setting.

Adult↗

PubMed1996

Nursing management and follow-up of the postoperative vascular patient in a clinic setting.

Patient follow-up after vascular surgery in a clinic setting provides prompt evaluation of patients, opportunity for education, and comprehensive care through direct patient and family teaching. These services are provided by a lead clinic RN experienced in medical/surgical care and a certified RN first assistant, who has specialized training and proficiency in perioperative nursing practice. Patients and their families depend on nurses in perioperative and outpatient settings to provide expertise, support, and understanding during the recovery process. This article presents a collaborative model of intervention, management, and follow-up by nurses in these settings.

Aftercare↗

PubMed2004

Pathogen growth in herbal teas used in clinical settings: a possible source of nosocomial infection?

In some clinical settings, herbal tea is used in patient care (eg, for oral hygiene). Teabags containing herbal tea were therefore tested with regard to the presence of microbial contamination before and after brewing. In addition, pathogen growth in intentionally contaminated brewed tea was investigated over time. Teabags and brewed tea were highly contaminated (maximum mean values of 1.9 x 10(8) CFU/g raw tea), and it was found that the pathogen load of intentionally contaminated tea increased significantly (by a maximum of 10(5) colony-forming units/mL brewed tea) over time, suggesting a possible risk of patients developing a nosocomial infection when used in patient care.

Bacteria↗

PubMed1986

'Situational hyperactivity' in a U.S. clinical setting.

Eight of 69 males referred to a Hyperactivity Clinic for participation in psychopharmacological trials were not rated hyperactive by their primary caretaker on a parent symptom questionnaire. In comparison to eight boys for whom both parent and teacher ratings of hyperactivity were high, the group differed only in caretaker status. 'Situational' children were less likely to be living with both biological parents (P less than 0.05). In contrast, direct observation and actometer measurement of activity did not differ significantly between the groups. The findings suggest that at least in clinical settings, a distinction between 'situational' and 'pervasive' hyperactivity reflects caretaker status or attitude and not characteristics of the child.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003.

BACKGROUND: The Centers for Disease Control and Prevention developed screening and diagnostic testing guidelines for chlamydia and gonorrhea at urethral, rectal, and pharyngeal sites for men who have sex with men (MSM). However, in most clinical settings, rectal chlamydial testing is not performed for MSM, and primarily sexually transmitted disease (STD) clinics alone perform routine rectal and pharyngeal gonorrhea screening for asymptomatic men. METHODS: We evaluated the prevalence of rectal, urethral, and pharyngeal chlamydial and gonococcal infections among MSM seen at the municipal STD clinic and the gay men's community health center. We also determined the proportion of asymptomatic rectal infections, described the patterns of single and multiple anatomic sites of infection, and evaluated the proportion of chlamydial infections that would be missed and not treated if MSM were not routinely tested for chlamydia. We tested specimens using previously validated nucleic acid amplification tests (NAATs). RESULTS: The prevalence of infection varied by anatomic site (chlamydia: rectal, 7.9%; urethral, 5.2%; and pharyngeal, 1.4%; for gonorrhea, rectal, 6.9%; urethral, 6.0%; and pharyngeal, 9.2%). Approximately 85% of rectal infections were asymptomatic supporting the need for routine screening. Because 53% of chlamydial infections and 64% of gonococcal infections were at nonurethral sites, these infections would be missed and not treated if only urethral screening was performed. In addition, >70% of chlamydial infections would be missed and not treated if MSM were tested only for gonorrhea. CONCLUSIONS: Because these infections enhance both HIV transmission and susceptibility, clinical settings serving MSM should evaluate the prevalence of chlamydial and gonococcal infections by anatomic site using validated NAATs.

Adult↗