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At least 1,243 records · Page 69Linked to original sources

PubMed2006

Measurement of electrical skin impedance of dermal-visceral zones as a diagnostic tool for disorders of the immune system.

Among complementary medicine approaches, diagnostic screening tools based on neuroreflexology have been recently developed. Such techniques are based on the rationale that measurement of electrical impedance of specific dermal zones might reflect the occurrence of pathological states in the corresponding internal organs or systems. Our objective was to evaluate the reliability of a neuroreflexology-based diagnostic test in diagnosing immune-mediated diseases in a blinded single centre study. Seventy-eight patients with immune-mediated diseases (38 patients with autoimmune diseases (AD), and 40 allergic patients) were included in the study. Thirty age and sex matched healthy subjects were also evaluated as a control group. All the patients and subjects underwent conventional medical history and physical examination. We evaluated a device manufactured by Medex Screen Ltd (Arad, Israel). The Medex Test analysis was carried out by a second physician who was blinded to the previous diagnosis. A high correlation between the formal clinical diagnosis and the results of the measurement of electrical skin impedance was reported, with a specificity of 93.3% and a sensitivity of 81.2%. Both sensitivity and specificity dropped when analysing the autoimmune and the allergic group separately, but remained significant for the autoimmune diseases. Degree of activity of the allergic disorders, or specific treatment, did not affect the diagnostic properties of the described device. The Medex Test neurophysiology based technique has the potential to serve as a diagnostic tool for immune based pathologies. Future studies will define this tool place in routine evaluation and potential screening ability.

Adult↗

PubMed2004

Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you?

AIMS: Dyspnea is the most common symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and is linked to decreases in patient activity levels and quality of life. Use of standardized tools to measure dyspnea has a long history in respiratory care. However, in many cases it is not clear what is being quantified when using a particular tool. This review will consider the definition of and mechanisms believed to contribute to dyspnea, attempting to clarify what is being quantified in common tools currently available for dyspnea measurement.

Dyspnea↗

PubMed2004

Object-oriented design tools for supramolecular devices and biomedical nanotechnology.

Nanotechnology provides multifunctional agents for in vivo use that increasingly blur the distinction between pharmaceuticals and medical devices. Realization of such therapeutic nanodevices requires multidisciplinary effort that is difficult for individual device developers to sustain, and identification of appropriate collaborations outside ones own field can itself be challenging. Further, as in vivo nanodevices become increasingly complex, their design will increasingly demand systems level thinking. System engineering tools such as object-oriented analysis, object-oriented design (OOA/D) and unified modeling language (UML) are applicable to nanodevices built from biological components, help logically manage the knowledge needed to design them, and help identify useful collaborative relationships for device designers. We demonstrate the utility of these systems engineering tools by reverse engineering an existing molecular device (the bacmid molecular cloning system) using them, and illustrate how object-oriented approaches identify fungible components (objects) in nanodevices in a way that facilitates design of families of related devices, rather than single inventions. We also explore the utility of object-oriented approaches for design of another class of therapeutic nanodevices, vaccines. While they are useful for design of current nanodevices, the power of systems design tools for biomedical nanotechnology will become increasingly apparent as the complexity and sophistication of in vivo nanosystems increases. The nested, hierarchical nature of object-oriented approaches allows treatment of devices as objects in higher-order structures, and so will facilitate concatenation of multiple devices into higher-order, higher-function nanosystems.

Baculoviridae↗

PubMed2005

Performance of a population-based cardiac risk stratification tool in Asian patients with chest pain.

OBJECTIVES: Most contemporary cardiac risk stratification tools have been derived and validated in mixed-race populations. Their validity in single-race populations has not been tested. The authors sought to compare the performance of a risk stratification tool between a mixed-race U.S. patient population and an Asian patient population. METHODS: This study is an analysis of data from the Internet Tracking Registry for Acute Coronary Syndromes (i(*)trACS) registry of patients with chest pain presenting to the emergency departments of eight U.S. centers and one site in Singapore. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) was computed for included patients, and its performance in predicting acute coronary syndrome (ACS) was compared between patients from the United States and Singapore. RESULTS: Of the 11,991 included patients, 1,120 experienced ACS. Although the ACI-TIPI demonstrated similar accuracy among groups (area under the curve, 0.729 [U.S.] vs. 0.719 [Singapore]; p = 0.5611), sensitivity and specificity were different when equal ACI-TIPI thresholds were considered. Recreating the logistic regression models used to create the ACI-TIPI showed similar results between the derived parameters and the parameters estimated for the U.S. group. In contrast, age older than 50 years (log-odds ratio [LOR], 0.107; 95% confidence interval [CI] = 0.518 to 0.713), male gender (LOR, 0.487; 95% CI = 0.149 to 1.122), and chest pain as a primary complaint (LOR, 0.237; 95% CI = 0.139 to 0.613) had little predictive power in patients from Singapore. CONCLUSIONS: Differences exist in presentation and factors associated with ACS among patients from the United States and Singapore that may affect the performance of risk stratification tools. These findings suggest that cardiac clinical decision rules need international validation.

Acute Disease↗

PubMed2006

Development of a specialty-wide web-based medical knowledge assessment tool for resident education.

Medical knowledge is one of six core competencies identified by the Accreditation Council for Graduate Medical Education. The authors present a tool for assessment of medical knowledge developed by the Council of Emergency Medicine Residency Directors. This tool is Internet based and consists of more than 50 online tests that emergency medicine residents are able to access. Test results are available to a resident's residency, along with the mean and standard deviation of all takers of that particular test. The result is a collaborative specialty-wide approach to the common problem of formatting tests to assess medical knowledge. The tool has been widely accepted by both residents and residencies.

Clinical Competence↗

PubMed2006

Reliability of a core competency checklist assessment in the emergency department: the Standardized Direct Observation Assessment Tool.

OBJECTIVES: A Council of Emergency Medicine Residency Directors task force developed the Standardized Direct Observation Assessment Tool (SDOT), a 26-item checklist assessment tool to evaluate Accreditation Council for Graduate Medical Education resident core competencies by direct observation. Each of the checklist items is assigned to one or more of five core competencies. The objective of this study was to test the interrater measurement properties of the SDOT instrument. METHODS: Two videos of simulated patient-resident-attending physician encounters were produced. Academic emergency medicine faculty members not involved in the development of the form viewed the two encounters and completed the SDOT for each. Faculty demographic data were collected. Data were collected from 82 faculty members at 16 emergency medicine residency programs. The checklist items were used to generate a composite score for each core competency of patient care, medical knowledge, interpersonal and communication skills, professionalism, and systems-based practice. RESULTS: Univariate analysis demonstrated a high degree of agreement between evaluators in evaluating residents for both videos. Multivariate analysis found no differences in rating by faculty when examined by experience, academic title, site, or previous use of the SDOT. CONCLUSIONS: Faculty from 16 emergency medicine residency programs had a high interrater agreement when using the SDOT to evaluate resident core competency performance. This study did not test the validity of the tool. This data analysis is mainly descriptive, and scripted video scenarios may not approximate direct observation in the emergency department.

Clinical Competence↗

PubMed2006

Validation of a self-administered, computerized tool for collecting and displaying the family history of cancer.

PURPOSE: A detailed family history is important for cancer risk assessment, but obtaining it is time consuming and infrequently accomplished in practice. The Genetic Risk Easy Assessment Tool (GREAT) conducts a computer-administered family history interview and immediately generates a pedigree diagram in digital form. The purpose of this study was to validate family cancer histories produced by patients using the computer tool in comparison with pedigrees made by genetic counselors. METHODS: Patients scheduled for genetics consultation recorded their family histories using the GREAT, separate from their genetic counseling session. The presence of each relative; presence, type, and age at diagnosis of cancers; and cancer geneticist's risk assessment were compared for 120 pairs of pedigrees produced by counselors versus computer tool. RESULTS: The automated telephone interview took a mean of 33.5 minutes and was highly acceptable to respondents. Ninety-four percent of first-degree relatives, 67% of second-degree relatives, and 38% of third-degree relatives were identical on paired pedigrees; computer-generated pedigrees included additional relatives. Sixty-three percent of all cancers were identified by both family histories, with 90% agreement on the type of cancer. There was very good agreement (kappa = 0.70; correlation = 0.77) between the geneticist's breast cancer risk assessments based on computer versus counselors' pedigrees. In a subsample of 61 users, test-retest reliability for the computer-administered questionnaire was high (phi = 0.94 for cancers in first-degree and phi = 0.91 in second-degree relatives). CONCLUSION: The GREAT computer-administered questionnaire provides an acceptable, reliable, and valid way of collecting an unverified but extensive family history of cancer and displaying it as a pedigree, in an entirely automated process.

Data Collection↗

PubMed2002

A review of the use of single-photon emission computerized tomography as a diagnostic tool in mild traumatic brain injury.

The aim of this literature review was to follow up on recommendations set forth in 1996 reviews by the Society for Nuclear Medicine Brain Imaging Council (SNMBIC) and the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) regarding the use of single-photon emission computerized tomography (SPECT) with mild traumatic brain injury (MTBI). An extensive review of databases was conducted to determine studies analyzing MTBI that used SPECT as a diagnostic tool between the years of 1966 and 2000. Although only 9 studies met the established criteria, the review suggests that SPECT may be a useful tool in the detection of MTBI and in treatment planning. However, because of the lack of consensus regarding SPECT's sensitivity, it is recommended that future researchers consider the possibility of multiple subtypes of MTBI, hemodynamically different types of contusions, and the need for complementary diagnostic tools.

Brain Injuries↗

PubMed2001

How clean is the home environment?: a tool to assess home hygiene.

The role of the home environment in the transmission of infectious diseases has been well described in the developing world but has received less attention in developed countries. An increasing focus on home hygiene has emerged in debates regarding the use of antimicrobial products in the home and the potential for development of resistance and in discussions regarding "when is clean too clean" and "what is clean." Studies are clearly needed to further explicate the role of the home in the spread of infectious agents, but before these can be conducted, adequate measurement tools are essential. This article describes extensive psychometric testing undertaken to develop valid and reliable methods and tools to measure home hygiene and focuses on a neighborhood that was primarily Spanish speaking in New York City. The Home Hygiene Assessment Tool described in this article can be used by clinicians and researchers to further elucidate the role of the home environment in the prevention and control of infections.

Colony Count, Microbial↗

PubMed2002

The teacher and learner interactive assessment system (TeLIAS): a new tool to assess teaching behaviors in the ambulatory setting.

BACKGROUND: There are no objective tools to assess ambulatory teaching, an increasingly important component of medical education. PURPOSE: To develop and describe an objective ambulatory teaching tool. METHODS: Exactly 30 consecutive ambulatory teaching encounters were audio taped. Audio tapes were transcribed and teacher-learner utterances were qualitatively analyzed by 3 coders using a grounded theory approach. RESULTS: A total of 4,560 utterances were coded: 1/3 were devoted to case presentations, and the remainder to case discussion. Most learner utterances conveyed factual patient information; only 7% conveyed learner thoughts on diagnosis or management. Attending utterances were equally divided between questions, statements of fact, and management statements. Most attending questions (75%) asked patient or medical facts; few were of a higher-level asking learners to analyze, synthesize, or apply content. Feedback, although common (10%), consisted of mostly minimal statements such as "right" or "I agree." At the bedside, 80% of utterances were by the teacher. CONCLUSIONS: This is a feasible tool that reliably documents ambulatory teacher and learner behaviors and may be useful for educational research and faculty development.

Ambulatory Care↗

PubMed2004

Capnography in non-tracheally intubated emergency patients as an additional tool in pulse oximetry for prehospital monitoring of respiration.

UNLABELLED: Victims of minor trauma transported by paramedic-based rescue systems are usually monitored with pulse oximetry. Under the difficult surroundings of prehospital trauma care, pulse oximeters show considerable periods of malfunction. We tested the hypothesis that capnography is a good, easy to use tool for monitoring in nonintubated trauma victims. Seventy nonintubated trauma victims were included in this study. Vital variables and number and time of malfunctions were sampled for oximeter and capnometer recordings. Total number of alerts (63 versus 10), number of alerts per patient (3.3 [1.9] versus 0.3 [0.9]) (mean [SD]), total time of malfunction (191.5 [216.7] s versus 11.8 [40.2] s), time of malfunction per alarm (58.3 [71.4] s versus 5.5 [14.6] s), and the percentage of malfunction time during transport (13.2% [15.3%] versus 0.8% [2.8%]) differed significantly (P < 0.01) between oximetry and capnography. Although pulse oximetry is a standard method of monitoring in emergency care, we found capnography to be helpful as a monitoring device. We consequently recommend the use of capnography on transport as an additional monitoring tool to reduce periods lacking supervision of the vital variables. IMPLICATIONS: Capnography is a useful tool to improve respiratory monitoring in nonintubated trauma victims on emergency transport and an easy to use supplement to pulse oximetry.

Adult↗

PubMed2004

Passive tools for enhancing muscle-driven motion and locomotion.

Musculo-skeletal systems and body design in general have evolved to move effectively and travel in specific environments. Humans have always aspired to reach higher power movement and to locomote safely and fast, even through unfamiliar media (air, water, snow, ice). For the last few millennia, human ingenuity has led to the invention of a variety of passive tools that help to compensate for the limitations in their body design. This Commentary discusses many of those tools, ranging from halteres used by athletes in ancient Greece, to bows, skis, fins, skates and bicycles, which are characterised by not supplying any additional mechanical energy, thus retaining the use of muscular force alone. The energy cascade from metabolic fuel to final movement is described, with particular emphasis on the steps where some energy saving and/or power enhancement is viable. Swimming is used to illustrate the efficiency breakdown in complex locomotion, and the advantage of using fins. A novel graphical representation of world records in different types of terrestrial and aquatic locomotion is presented, which together with a suggested method for estimating their metabolic cost (energy per unit distance), will illustrate the success of the tools used.

Biomechanical Phenomena↗

PubMed2003

An evaluation of clinical tools to measure pain in older people with cognitive impairment.

Pain in older people with cognitive impairment is often untreated or under-treated despite the fact that the likelihood of having pain increases with advanced age. One reason that pain is poorly managed in older people is that it is not detected. Assessing pain is an integral part of clinical practice and is required for effective pain management. However, systematically measuring pain intensity and location with standardized tools in older people has not been well studied. This article will summarize tools used to assess pain in older people, inducing self-report scales measuring pain intensity, the presence or absence of pain, pain location and pain behaviour scales. Identifying the advantages and disadvantages of these clinical assessment tools has implications for nursing practice, research and education.

Aged↗

PubMedDate not supplied

Developing an oral assessment and intervention tool for older people: 1.

This is the first in a series of three articles relating to oral care for older people. The first article underlines the importance of oral assessment and evidence-based intervention for older people. It describes influences which can affect older people's ability to maintain oral healthcare practices. There is a need to examine closely issues surrounding poor oral hygiene practices and their associated ramifications for the older person. Identifying and implementing an appropriate oral assessment tool for older people should provide the foundation for the maintenance and improvement of standards of oral care practices within the clinical practice setting. The second article critically analyses oral care interventions; the third article critiques a number of published oral assessment tools with a view to developing and implementing a workable oral assessment tool for the practice setting.

Aged↗

PubMedDate not supplied

Developing an oral assessment and intervention tool for older people: 3.

This is the last in a series of three articles which have examined oral care practices for older people. The first article (Vol 9(17): 1124-7) highlighted the importance of effective oral care. The second article (Vol 9(18): 2033-40) examined oral care interventions in detail to identify oral care that is evidence based. This article looks at the factors which have an impact on oral health, and which must be considered when assessing a patient's oral health status. The correlation between holistic assessment and careful documentation is examined, together with its associated relationship with maintaining effective oral care. The article also critiques a collection of published oral assessment tools to identify whether they would be appropriate for rehabilitation client groups. After identifying the lack of a suitable oral assessment tool within the literature, the need to develop an appropriate one is addressed. An oral assessment and intervention tool which has been developed in the author's clinical area is outlined.

Aged↗

PubMedDate not supplied

Surgical wound benchmark tool and best practice guidelines.

Surgical wounds that heal by primary intention are expected to heal without complication (Watret and White, 2001). Patients are frequently subjected to a variety of treatment regimens, often based on individual practitioners' preferences. This article discusses how one acute hospital trust developed a multidisciplinary approach to devise best practice guidelines. This was achieved through consensus and expertise of a working party, and a clinical practice benchmark tool for patients with surgical wounds to standardize and ensure the implementation of evidence-based practice. Clinical practice benchmarking is "a process through which best practice is identified and continuous improvement pursued though comparison and sharing" (Department of Health (DoH), 1999). The work has led to the development of a standardized assessment and documentation tool, which the working party hopes will be used trust-wide. In addition, ward staff are encouraged to undertake the benchmark process as a method of identifying areas where the use of this tool would ensure that standards of care could be improved.

Acute Disease↗

PubMedDate not supplied

Assessment of chronic neuropathic pain and the use of pain tools.

Chronic neuropathic pain is experienced by a large number of patients. It can affect the individual physically, psychologically and socially. This review examines the evidence base for the assessment of chronic neuropathic pain and discusses some of the main tools and their suitability for use for this particular type of pain. The central role the nurse has in pain assessment and management to improve the patient's quality of life is explored. The evidence recommends that chronic pain be assessed using a multidimensional assessment tool. Currently the only tool specifically designed to measure neuropathic pain is the Neuropathy Pain Scale. The author describes how the evidence was applied to make changes in her own area of practice and why the Brief Pain Inventory was considered more suitable than the Neuropathy Pain Scale.

Chronic Disease↗

PubMed2004

Reliability and validity of DESIGN, a tool that classifies pressure ulcer severity and monitors healing.

OBJECTIVE: This study reviews the validity and reliability of DESIGN, a tool for classifying pressure ulcer severity and monitoring progression towards healing. Only the tool's healing progression component was evaluated. METHOD: Inter-rater reliability was evaluated by calculating the agreement rate of scores, based on eight photos of pressure ulcers and six actual ulcers, made by a panel of seven nurses. Validity was assessed, using the same eight photos, by comparing DESIGN scores with those made using the validated Pressure Sore Status Tool (PSST). RESULTS: The DESIGN inter-rater reliability results showed a high correlation of r = 0.98 for the photos and r = 0.91 for the real-life patients with pressure ulcers, respectively, for all seven raters based on total scores. For validity, a correlation greater than 0.91 was found between the DESIGN and PSST scores. CONCLUSION: Based on our results, DESIGN was found to have both high inter-rater reliability and high validity among the seven nurses who quantitatively evaluated the wound-healing progress of the pressure ulcers in this study.

Humans↗