New WHO 5 Keys Strategy for safer food.
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The usefulness of RDC and DSM-III diagnostic subtypes as predictors of response to ECT was examined in a multi-observer, multi-factorial study of 44 depressed patients. Most of the patients met criteria for "endogenous" and/or "melancholic" subtypes of major depressive disorders. None of the RDC or DSM-III subtypes (reactive, secondary, nonpsychotic) identified the least responsive patients. Thus, the presence of "reactive" factors, the absence of psychotic symptoms, or the presence of other illnesses did not reduce the likelihood or degree of immediate response to ECT in patients with major depression.
The present and past symptomatology of 31 chronic schizophrenics was rated by four independent judges, two experienced clinical psychiatrists and two psychiatric residents, in a context more representative of actual clinical practice than most research studies. Ratings were made on 64 symptoms derived from 12 diagnostic systems, based on either live or videotaped interviews for present symptomatology and case records for past symptomatology. Inter-rater reliabilities were higher for present than for past symptoms, and in general did not approach those reported for highly trained raters. There were no differences between live and videotaped interviews. Diagnostic systems differed widely in rater agreement. The most consistent across both past and present symptomatology were the systems of Langfeldt, Schneider, and DSM-III, for which the level of reliability was consistent with other studies.
The development and implementation of a two-month inservice training program for hospital pharmacy supportive personnel is discussed. A task-oriented approach was used to define the instructional objectives of the program. To emphasize the job-related nature of the instruction, conferences and workshops were selected as the primary teaching methods. A specific instructional plan was designed for drug conferences, giving the trainee an active role in the learning of drug names and dosage forms. On-the-job experience, comprising 30% of the training time, gradually was incorporated into the program. Staff pharmacists and supervisors assumed the teaching responsibilities. During weekly evaluation sessions with each trainee, the coodinator discussed the trainee's performance, pin-pointed deficiencies and suggested means of improvement. The benefits of the program, in terms of selection and sequence of instructional programs, student assessment and program evaluation, are discussed.
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During two days in November 1974 TV-tapes of psychiatric interviews were demonstrated and the psychopathology was documented on AMP-record sheet 3. It was a purpose of the discussion to get stimulation for the improvement of the AMP-manual and to decrease the interrater-variance. It was only the first tape which was not followed by a discussion. This film was presented a second time at the end of the seminar in order to examine the training effects. Both record-sheets were compared with each other. Generally the variance decreased. The discussion as to an improvement of the AMP-manual lead to the following suggestions: In defining a psychopathological item it is important to differentiate more precisely between the patient's subjective experience and his behaviour, to find better criteria concerning the rating of different intensities and to improve discrimination between singular items. Furthermore the logic of documentation procedure should be unequivocal and more practical. Following the seminar there was a symposion discussion more general and some specific methodological problems of the further development of the AMP-system. Finally study groups were formed to elaborate on the topics "AMP-manual", "rater-training", "social data" and "electronic data processing".
Medicine is a literature-based discipline. Ensuring that the literature review which precedes a significant piece of medical research has met predetermined standards is essential. A list of items reviewed carries no guarantees that all appropriate items have been included in the survey of the literature, or that appropriate sources have been efficiently searched. This would be a matter for concern in any discipline. In medicine it is a matter of life and death. Quality assurance procedures that offer guarantees of the standards built into the process, rather than quality control which measures only outputs, can provide the necessary reassurance. The ISO 9000 quality standard offers a much needed quality assurance process. A methodology for applying the ISO 9000 standard to the task of searching the medical literature is outlined in this paper. A new role for medical librarians in promoting a rigorous methodology in the literature review equal to that of the research it supports is defined.
Studies of psychodynamic psychotherapy require an instrument to measure the application of the prescribed therapeutic techniques during ongoing treatment. The authors describe the development of such an instrument, the Therapist Verbal Intervention Inventory (TVII), designed specifically for use in the study of the treatment of patients with borderline personality disorders. The TVII was designed, in addition, to test the hypothesis that psychodynamic techniques defined at a middle level of inference could be reliably rated by trained clinicians. The authors present data on the inter-rater reliabilities and inter-rater agreements obtainable with the TVII in the hands of highly experienced clinicians and in the hands of an independent group of junior clinicians trained in its use. The TVII appears to be a potentially useful tool for monitoring psychotherapy techniques in ongoing studies of the treatment of patients with severe personality disorders. Psychiatrists at the advanced resident level or immediate postresidency level have been trained to use the TVII to rate videotaped therapy sessions reliably.
The authors evaluated four sets of diagnostic criteria, the Newcastle Index, DSM-III, RDC, and the Michigan Diagnostic Index, for the diagnosis of melancholia. Forty-nine depressed inpatients, all of whom met RDC for major depression, also received consensus diagnostic assessment for melancholia. The dexamethasone suppression test (DST) was administered before drug treatment began. Results showed that the sensitivity of the DST ranged from 39% to 48%, specificity from 80% to 100%, and diagnostic confidence from 66% to 100%. All four scales received validation, but DSM-III showed the lowest specificity and predictive value.
The authors field-tested proposed criteria for diagnoses of psychoactive substance use disorders in the revision of DSM-III (DSM-III-R) and compared them with DSM-III criteria in a treated group of 83 patients. They found a high level of agreement between the diagnostic systems in rates of diagnosis and in the individuals receiving the diagnosis. The greatest cross-system agreement occurred when the minimum number of symptoms required to make the DSM-III-R diagnosis was set at three. Discrepant diagnoses between systems related to removal of social consequences as a requirement for the DSM-III-R diagnoses, less emphasis on physiological tolerance in DSM-III-R, and disagreement in subjects with mild symptoms.
The study examined clinician matching of diagnostic criteria to selected DSM-IV Axis I and II disorders. A national sample of clinical psychologists and psychiatrists assigned symptom criteria, presented in scrambled order by axis, to DSM-IV diagnoses with which they believed the criteria belonged, without using the DSM. On average, clinicians assigned 69% of Axis I criteria and 75% of Axis II criteria to the designated DSM-IV diagnosis. The Axis II data represent increased agreement over the 66% found for DSM-III-R. Reasons for the increase are discussed, focusing on modifications made in DSM-IV and increased familiarity with personality disorders. The significantly higher rate of agreement for Axis II over Axis I contrasts with typical reliability data which suggests that Axis I disorders are better defined. Specific points of disagreement between clinician criteria assignments and the DSM-IV are discussed.
This Federal Register notice sets forth the recently issued model compliance plan for clinical laboratories developed by the Office of Inspector General in cooperation with, and input from, several provider groups and industry representatives. Many providers and provider organizations have expressed an interest in better protecting their operations from fraud through the adoption of compliance plans. We believe the development of this initial model compliance plan for clinical laboratories will serve as a positive step towards promoting a higher level of ethical and lawful conduct throughout the health care industry.
The need for corporate compliance programs in health care delivery systems is ever increasing. This article identifies the key items a good program should contain, and addresses issues raised by the existence of a program as well as its implementation.
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