Results for “statement” — Page 6

PubMed1998

Verification of statements about story worlds that deviate from normal conceptions of time: what is true about Einstein's Dreams?

College students read chapters from a novel written by Alan Lightman (Einstein's Dreams) and later provided verification judgments on the truth/falsity of test statements. Each chapter described a different fictional village that incorporated assumptions about time that deviate from our normal TIME schema, e.g., citizens knowing exactly when the world will end, time flowing backward instead of forward. These novel assumptions about time provided interesting insights about life and reality. In two experiments, we examined whether readers could accurately incorporate these novel assumptions about time in the fictional story worlds, as manifested in the verification judgments for statements after story comprehension. The test statements included verbatim typical, verbatim atypical, inference typical, and inference atypical information from the perspective of mundane reality that meshes with a normal TIME schema. Verification ratings were collected on a 6-point scale in Experiment 1, whereas Experiment 2 used a signal-response technique in which binary true/false decisions were extracted at-.5, 1.5, 3.5, 5.5, and 10.0 s. The college students were measured on literary expertise, reading skill, working memory span, and reading time. Readers with comparatively high literary expertise showed truth discrimination scores that were compatible with a schema copy plus tag model, which assumes that readers are good at detecting and remembering atypical verbatim information; this model predicts better (and faster) truth discrimination for verbatim atypical statements than for verbatim typical statements. In contrast, fast readers with comparatively low literary expertise were compatible with a filtering model; this model predicts that readers gloss over (or suppress) atypical verbatim information and show advantages for verbatim typical information. All groups of readers had trouble inferentially propagating the novel assumptions about time in a fictional story world, but the slower readers were more accurate in their verification of the atypical inferences. A construction-integration model could explain the interactions among literary expertise, reading time, and the typicality of test statements.

Humans↗

PubMed2000

The bottom line: the effect of written expert witness statements on juror verdicts and information processing.

Mock jurors recruited from jury rolls were either not given written statements of expert witnesses' direct testimony or were provided with such statements before or after the presentation of that testimony. Presentation of the statements before the testimony and cross-examination provided jurors with a schema that allowed them to distinguish more effectively among the claims of four differentially worthy plaintiffs because they processed more probative evidence than other jurors. Jurors in receipt of written statements before the testimony found the evidence to be more comprehensible than other jurors. Jurors provided with written statements following testimony and cross-examination were able to differentiate between the most and least severely injured plaintiffs, whereas jurors not in receipt of any written statements were unable to differentiate among any of the differentially worthy claimants. The limitations of this case management technique and of the study are discussed.

Adult↗

PubMed1999

Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Although many studies in animals and volunteers have demonstrated that multiple-dose activated charcoal increases drug elimination significantly, this therapy has not yet been shown in a controlled study in poisoned patients to reduce morbidity and mortality. Further studies are required to establish its role and the optimal dosage regimen of charcoal to be administered. Based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. With all of these drugs there are data to confirm enhanced elimination, though no controlled studies have demonstrated clinical benefit. Although volunteer studies have demonstrated that multiple-dose activated charcoal increases the elimination of amitriptyline, dextropropoxyphene, digitoxin, digoxin, disopyramide, nadolol, phenylbutazone, phenytoin, piroxicam, and sotalol, there are insufficient clinical data to support or exclude the use of this therapy. The use of multiple-dose charcoal in salicylate poisoning is controversial. One animal study and 2 of 4 volunteer studies did not demonstrate increased salicylate clearance with multiple-dose charcoal therapy. Data in poisoned patients are insufficient presently to recommend the use of multiple-dose charcoal therapy for salicylate poisoning. Multiple-dose activated charcoal did not increase the elimination of astemizole, chlorpropamide, doxepin, imipramine, meprobamate, methotrexate, phenytoin, sodium valproate, tobramycin, and vancomycin in experimental and/or clinical studies. Unless a patient has an intact or protected airway, the administration of multiple-dose activated charcoal is contraindicated. It should not be used in the presence of an intestinal obstruction. The need for concurrent administration of cathartics remains unproven and is not recommended. In particular, cathartics should not be administered to young children because of the propensity of laxatives to cause fluid and electrolyte imbalance. In conclusion, based on experimental and clinical studies, multiple-dose activated charcoal should be considered only if a patient has ingested a life-threatening amount of carbamazepine, dapsone, phenobarbital, quinine, or theophylline.

Acute Disease↗

PubMed1998

Fundamentals of financial statement analysis for academic physician managers.

Academic medical centers (i.e., teaching hospitals) and academic medical practices are under pressure to control costs to compete with for-profit health care institutions. The authors explain how academic physician managers who want to control costs wisely must first understand the cost structure of the medical center or practice and compare that structure with those of for-profit institutions. Doing this requires a firm understanding of how to use a valuable tool, financial statement analysis, to assess an institution's health and performance. Such analysis consists of calculating a variety of financial ratios (e.g., operating income divided by revenues; net income divided by total assets) and then comparing them with the corresponding ratios that are considered industry norms. Three types of financial statements (defined in detail) lend themselves to this approach: the balance sheet, income statement, and statement of cash flows. The authors define standard financial ratios, point out their uses and limitations, and emphasize that a ratio's meaning derives from comparing it with the corresponding benchmark ratio in the industry as a whole. Ratios should be used not as the end point of assessing financial status, but as ways to identify possible problems that require further investigation. Analysis of trends of ratios over time within an institution is a complementary approach. The authors then discuss the use of ratios in three standard types of institutional evaluation: of performance, of liquidity and leverage, and of strategic planning. In addition, they present the financial statement of a fictitious academic medical center as an example of how to use ratios for financial statement analysis. The authors emphasize that the key to using the ratios they discuss and hundreds of others is first to decide what question needs answering and then to choose the relevant ratios to provide a basis for finding the answer.

Academic Medical Centers↗

PubMed1993

Effect of rational and irrational statements on intensity and 'inappropriateness' of emotional distress and irrational beliefs in psychotherapy patients.

Ellis's rational-emotive theory postulates that since irrational statements augment emotional distress, replacing irrational with rational statements should lessen distress. This hypothesis was tested in the initial stages of psychotherapy by having 13 and 14 clinical out-patients respectively repeat for one minute either rational or irrational statements about their major presenting psychological problem. The distinction by Ellis & Harper (1975) that 'inappropriate' emotions differ qualitatively from 'appropriate' emotions was also examined. Although the experimental intervention had no effect on a post-test measure of irrational beliefs, patients repeating rational statements had significantly lower appropriate and inappropriate negative emotions at post-test, suggesting that inappropriate emotions do not differ qualitatively from appropriate emotions and that making rational statements may lower emotional distress in patients. Patients reiterating irrational statements showed no change in emotions, implying that these kinds of irrational cognitions may have already been present.

Adult↗

PubMed1995

Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.

BACKGROUND AND PURPOSE: Indications for carotid endarterectomy have engendered considerable debate among experts and have resulted in publication of retrospective reviews, natural history studies, audits of community practice, position papers, expert opinion statements, and finally prospective randomized trials. The American Heart Association assembled a group of experts in a multidisciplinary consensus conference to develop this statement. METHODS: A conference was held July 16-18, 1993, in Park City, Utah, that included recognized experts in neurology, neurosurgery, vascular surgery, and healthcare planning. A program of critical topics was developed, and each expert presented a talk and provided the chairman with a summary statement. From these summary statements a document was developed and edited onsite to achieve consensus before final revision. RESULTS: The first section of this document reviews the natural history, methods of patient evaluation, options for medical management, results of surgical management, data from position statements, and results to date of prospective randomized trials for symptomatic and asymptomatic patients with carotid artery disease. The second section divides 96 potential indications for carotid endarterectomy, based on surgical risk, into four categories: (1) Proven: This is the strongest indication for carotid endarterectomy; data are supported by results of prospective contemporary randomized trials. (2) Acceptable but not proven: a good indication for operation; supported by promising but not scientifically certain data. (3) Uncertain: Data are insufficient to define the risk/benefit ratio. (4) Proven inappropriate: Current data are adequate to show that the risk of surgery outweighs any benefit. CONCLUSIONS: Indications for carotid endarterectomy in symptomatic good-risk patients with a surgeon whose surgical morbidity and mortality rate is less than 6% are as follows. (1) Proven: one or more TIAs in the past 6 months and carotid stenosis > or = 70% or mild stroke within 6 months and a carotid stenosis > or = 70%; (2) acceptable but not proven: TIAs within the past 6 months and a stenosis 50% to 69%, progressive stroke and a stenosis > or = 70%, mild or moderate stroke in the past 6 months and a stenosis 50% to 69%, or carotid endarterectomy ipsilateral to TIAs and a stenosis > or = 70% combined with required coronary artery bypass grafting; (3) uncertain: TIAs with a stenosis < 50%, mild stroke and stenosis < 50%, TIAs with a stenosis < 70% combined with coronary artery bypass grafting, or symptomatic, acute carotid thrombosis; (4) proven inappropriate: moderate stroke with stenosis < 50%, not on aspirin; single TIA, < 50% stenosis, not on aspirin; high-risk patient with multiple TIAs, not on aspirin, stenosis < 50%; high-risk patient, mild or moderate stroke, stenosis < 50%, not on aspirin; global ischemic symptoms with stenosis < 50%; acute dissection, asymptomatic on heparin. Indications for carotid endarterectomy in asymptomatic good-risk patients performed by a surgeon whose surgical morbidity and mortality rate is less than 3% are as follows. (1) Proven: none. As this statement went to press, the National Institute of Neurological Disorders and Stroke issued a clinical advisory stating that the Institute has halted the Asymptomatic Carotid Atherosclerosis Study (ACAS) because of a clear benefit in favor of surgery for patients with carotid stenosis > or = 60% as measured by diameter reduction. When the ACAS report is published, this indication will be recategorized as proven. (2) acceptable but not proven: stenosis > 75% by linear diameter; (3) uncertain: stenosis > 75% in a high-risk patient/surgeon (surgical morbidity and mortality rate > 3%), combined carotid/coronary operations, or ulcerative lesions without hemodynamically significant stenosis; (4) proven inappropriate: operations with a combined stroke morbidity and mortality > 5%.

Arterial Occlusive Diseases↗

PubMed1997

Position statement: ipecac syrup. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Syrup of ipecac should not be administered routinely in the management of poisoned patients. In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential.

Acetaminophen↗

PubMed1997

Position statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Gastric lavage should not be employed routinely in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. There is no certain evidence that its use improves clinical outcome and it may cause significant morbidity. Gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion. Even then, clinical benefit has not been confirmed in controlled studies. Unless a patient is intubated, gastric lavage is contraindicated if airway protective reflexes are lost. It is also contraindicated if a hydrocarbon with high aspiration potential or corrosive substance has been ingested.

Acetaminophen↗

PubMed1997

Position statement: single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Single-dose activated charcoal should not be administered routinely in the management of poisoned patients. Based on volunteer studies, the effectiveness of activated charcoal decreases with time; the greatest benefit is within 1 hour of ingestion. The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour of ingestion. There is no evidence that the administration of activated charcoal improves clinical outcome. Unless a patient has an intact or protected airway, the administration of charcoal is contraindicated.

Administration, Oral↗

PubMed1997

Position statement: cathartics. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. The administration of a cathartic alone has no role in the management of the poisoned patient and is not recommended as a method of gut decontamination. Experimental data are conflicting regarding the use of cathartics in combination with activated charcoal. No clinical studies have been published to investigate the ability of a cathartic, with or without activated charcoal, to reduce the bioavailability of drugs or to improve the outcome of poisoned patients. Based on available data, the routine use of a cathartic in combination with activated charcoal is not endorsed. If a cathartic is used, it should be limited to a single dose in order to minimize adverse effects.

Animals↗

PubMed1997

Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists.

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Whole bowel irrigation (WBI) should not be used routinely in the management of the poisoned patient. Although some volunteer studies have shown substantial decreases in the bioavailability of ingested drugs, no controlled clinical trials have been performed and there is no conclusive evidence that WBI improves the outcome of the poisoned patient. Based on volunteer studies, WBI may be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs. There are insufficient data to support or exclude the use of WBI for potentially toxic ingestions of iron, lead, zinc, or packets of illicit drugs; WBI remains a theoretical option for these ingestions. WBI is contraindicated in patients with bowel obstruction, perforation, ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients, or in patients with medical conditions that may be further compromised by its use. A single dose of activated charcoal administered prior to WBI does not appear to decrease the binding capacity of charcoal or to alter the osmotic properties of WBI solution. Administration of charcoal during WBI appears to decrease the binding capacity of charcoal.

Adolescent↗

PubMed2026

Translating evidence into practice: Developing Canada's first position statement on genomics-informed oncology nursing.

The integration of genomics in oncology care is accelerating in Canada, presenting new opportunities for nurses to improve cancer outcomes through enhanced screening, diagnosis, and targeted therapies. However, nurses have identified that they require policy guidance to clarify their roles and responsibilities as members of interprofessional teams delivering genomic services. In response, the Canadian Nursing and Genomics Initiative, in collaboration with the Canadian Association of Nursing in Oncology/Association Canadienne des Infirmières et Infirmiers en Oncologie, and an interdisciplinary working group developed the first pan-Canadian position statement to guide genomics-informed oncology nursing practice. To support further engagement and use of the position statement, we outline the rationale for developing the position statement and the role of position statements in supporting nursing practice and innovation in genomics-informed oncology nursing. We describe the governance structure and co-design methodology that facilitated its collaborative interdisciplinary development, and how this approach is critical for nursing advocacy, integrated knowledge translation, and ongoing engagement. Finally, we offer recommendations for oncology nurses to translate the position statement into practice changes. This position statement is a preliminary step toward advancing genomics integration in cancer care and ensuring nursing practice remains at the forefront of innovation.

genetics↗

PubMed1999

Empirical derivation of an electronic clinically useful problem statement system.

Problem lists are tools to improve patient management. In the medical record, they connect diagnoses to therapy, prognosis, and psychosocial issues. Computer-based problem lists enhance paper-based approaches by enabling cost-containment and quality assurance applications, but they require clinically expressive controlled vocabularies. Because existing controlled vocabularies do not represent problem statements at a clinically useful level, we derived a new canonical problem statement vocabulary through semi-automated analysis and distillation of provider-entered problem lists collected over 6 years from 74,696 patients. We combined automated and manual methods to condense 891,770 problem statements entered by 1961 care providers at Grady Memorial Hospital in Atlanta, Georgia, to 15,534 Canonical Clinical Problem Statement System (CCPSS) terms. The nature and frequency of problem statements were characterized, interrelations among them were enumerated, and a database capturing the epidemiology of problems was created. The authors identified 23,503 problem relations (co-occurrences, sign-symptom complexes, and differential diagnoses) and 22,690 modifier words that further categorized "canonical" problems. To assess completeness, CCPSS content was compared with that of the 1997 Unified Medical Language System Metathesaurus (containing terms from 44 clinical vocabularies). Unified Medical Language System terms expressed 25% of individual CCPSS terms exactly (71% of problems by frequency), 27% partially, and 48% poorly or not at all. Clinicians judged that CCPSS terms completely captured their clinical intent for 84% of 686 randomly selected free-text problem statements. The CCPSS represents clinical concepts at a level exceeding that of previous approaches. A similar national approach could create a standardized, useful, shared resource for clinical practice.

Humans↗

PubMed1986

The use of fund accounting and the need for single fund reporting by institutional healthcare providers. Principles and Practices Board Statement No. 8. Healthcare Financial Management Association.

For many years, hospitals and other institutional healthcare providers used fund accounting as a basis for presenting their financial statements. Recently, authoritative literature has placed less emphasis on separate fund reporting. This is evidenced by the reduction of fund classifications specified in the literature. This trend seems to follow the recognition that institutional healthcare activities should be reported in a manner comparable to other businesses. The Principles and Practices Board (P&P Board) of the Healthcare Financial management Association believes that general purpose financial statements of institutional healthcare providers should be comparable to reporting by other businesses. That is, all assets, liabilities, and equity are presented in a single aggregated balance sheet without differentiation by fund. This form of presentation, referred to in this statement as single fund reporting, should be used by all institutional healthcare providers including those that are part of HMOs, universities, municipalities, and other larger entities when separate reports of the provider are issued. The P&P Board is studying other significant issues concerning the reporting of revenues and components of equity and changes therein. The conclusion in this statement can be implemented even though conclusions on these related subjects are not yet complete. The P&P Board recognizes that certain circumstances may require detailed records and reports for special purposes. This statement deals only with those general purpose financial statements on which an independent accountant's opinion is expressed.

Accounting↗

PubMed2001

Effect of a consensus statement on initial treatment for traumatic dental injuries.

The aim of this study was to investigate the influence of a consensus statement on dental practitioners' choice of initial treatment for traumatic dental injuries. Dental practitioners working at government dental clinics in eight cluster sample regions of mainland Tanzania were requested to participate in the study; that is, to record the treatment they provided to children aged 1-17 years seeking dental consultation after injury for a period of 12 months. Six months after the beginning of data collection, a consensus statement was introduced. After the dental practitioners received the consensus statement, the correct treatment they provided increased from 51% to 57%. The unnecessary treatments increased from 54% to 59%, while wrong treatments decreased from 55% to 42%. Only a small improvement was observed in the percentage of correct treatments, but there was a slightly significant improvement in the percentage of wrong treatments provided before and after introduction of the consensus statement. We conclude that the consensus statement had a slight influence on the dental practitioners' choice of initial treatment for dental trauma in the desired direction.

Adolescent↗

PubMed2003

National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15-17, 2002.

BACKGROUND: Despite advances in early detection and effective treatment, cancer remains one of the most feared diseases. Among the most common side effects of cancer and treatments for cancer are pain, depression, and fatigue. Although research is producing increasingly hopeful insights into the causes and cures for cancer, efforts to manage the side effects of the disease and its treatments have not kept pace. The challenge that faces us is how to increase awareness of the importance of recognizing and actively addressing cancer-related distress. The National Institutes of Health (NIH) convened a State-of-the-Science Conference on Symptom Management in Cancer: Pain, Depression, and Fatigue to examine the current state of knowledge regarding the management of pain, depression, and fatigue in individuals with cancer and to identify directions for future research. Specifically, the conference examined how to identify individuals who are at risk for cancer-related pain, depression, and/or fatigue; what treatments work best to address these symptoms when they occur; and what is the best way to deliver interventions across the continuum of care. State-of-the-Science Process: A non-advocate, non-Federal, 14-member panel of experts representing the fields of oncology, radiology, psychology, nursing, public health, social work, and epidemiology prepared the statement. In addition, 24 experts in medical oncology, geriatrics, pharmacology, psychology, and neurology presented data to the panel and to the conference audience during the first 1.5 days of the conference. The panel then prepared its statement, addressing the five predetermined questions and drawing on submitted literature, the speakers' presentations, and discussions held at the conference. The statement was presented to the conference audience, followed by a press conference to allow the panel to respond to questions from the media. After its release at the conference, the draft statement was made available on the Internet. The panel's final statement is available at http://consensus.nih.gov. CONCLUSIONS: The panel concluded that the available evidence supports a variety of interventions for treating cancer patients' pain, depression, and fatigue. Clinicians should routinely use brief assessment tools to ask patients about pain, depression, and fatigue and to initiate evidence-based treatments. Assessment should include discussion about common symptoms experienced by cancer patients, and these discussions should continue over the duration of the illness. Impediments to effective symptom management in cancer patients can arise from different sources and interactions among providers, patients and their families, and the health care system. Numerous factors could interfere with adequate symptom management. Among these factors are incomplete effectiveness of some treatments, a lack of sufficient knowledge regarding effective treatment strategies, patient reluctance to report symptoms to caregivers, a belief that such symptoms are simply a part of the cancer experience that must be tolerated, and inadequate coverage and reimbursement for some treatments. Additional research is needed on the definition, occurrence, the treatment of pain, depression, and fatigue, alone and in combination, in adequately funded prospective studies. The panel also concluded that the state of the science in cancer symptom management should be reassessed periodically.

Biomedical Research↗

PubMedDate not supplied

Once-daily antiretroviral therapies for HIV infection: Consensus Statement of an Advisory Committee of the International Association of Physicians in AIDS Care.

OBJECTIVE: Adherence is essential to successful virologic outcome of highly active antiretroviral therapy (HAART). Documented factors contributing to poor adherence include toxicity, food requirements, and pill burden. Once-daily antiretroviral therapies for HIV infection offer potential benefit by decreasing pill burden and dosing frequency, which may subsequently improve treatment adherence. This Consensus Statement is intended to offer guidance to physicians actively involved in HIV/AIDS care. PARTICIPANTS: Eight physicians with expertise in HIV medicine were invited by the International Association of Physicians in AIDS Care (IAPAC) to serve on an ad hoc Advisory Committee. CONSENSUS PROCESS: IAPAC convened the Advisory Committee in June 2002 to develop a draft Consensus Statement. Scientific and clinical research, and other data in published literature and abstracts from scientific conferences were considered by strength of evidence. A Subcommittee updated the Consensus Statement in October 2002 to reflect relevant data presented at the XIV International AIDS Conference and the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy. This document represents consensus agreement of the Advisory Committee. CONFLICT OF INTEREST DISCLOSURE: The International Association of Physicians in AIDS Care sponsored and coordinated the development of this Consensus Statement with an unrestricted educational grant from Bristol-Myers Squibb. The opinions expressed in this Consensus Statement represent only those of the Advisory Committee.

Anti-Retroviral Agents↗

PubMed1996

Influence of ECG measurement accuracy on ECG diagnostic statements.

Computer analysis of electrocardiograms (ECGs) provides a large amount of ECG measurement data, which may be used for diagnostic classification and storage in ECG databases. Until now, neither error limits for ECG measurements have been specified nor has their influence on diagnostic statements been systematically investigated. An analytical method is presented to estimate the influence of measurement errors on the accuracy of diagnostic ECG statements. Systematic (offset) errors will usually result in an increase of false positive or false negative statements since they cause a shift of the working point on the receiver operating characteristics curve. Measurement error dispersion broadens the distribution function of discriminative measurement parameters and, therefore, usually increases the overlap between discriminative parameters. This results in a flattening of the receiver operating characteristics curve and an increase of false positive and false negative classifications. The method developed has been applied to ECG conduction defect diagnoses by using the proposed International Electrotechnical Commission's interval measurement tolerance limits. These limits appear too large because more than 30% of false positive atrial conduction defect statements and 10-18% of false intraventricular conduction defect statements could be expected due to tolerated measurement errors. To assure long-term usability of ECG measurement databases, it is recommended that systems provide its error tolerance limits obtained on a defined test set.

Arrhythmias, Cardiac↗