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At least 19 recordsLinked to original sources
PubMed2003

To what extent do evaluations of facial paralysis by physicians coincide with self-evaluations by patients: comparison of the Yanagihara method, the House-Brackmann method, and self-evaluation by patients.

OBJECTIVES: To understand to what extent evaluations of facial paralysis by physicians coincide with self-evaluations by patients. STUDY DESIGN: Prospective clinical study. PATIENTS: One hundred thirty-one patients (68 male patients and 63 female patients) with facial paralysis were included in the study. INTERVENTIONS: The relationship between the evaluation of facial paralysis using the Yanagihara system, the House-Brackmann grading system, and self-evaluation by patients was studied. MAIN OUTCOME MEASURES: The paralysis scores and grade determined by physicians using the above two systems were well correlated with the self-evaluations by patients. RESULTS The evaluation of subjective symptoms differed among individuals. Even patients who were evaluated as either completely paralyzed or cured according to the Yanagihara and House-Brackmann methods did not always rate their subjective symptoms as being consistent with these scores. CONCLUSION: Evaluations with the two systems correlated significantly with self-evaluations by patients on the whole. These two methods of evaluation are considered appropriate not only for physicians but also for patients. In contrast, some discrepancies were observed. This point should be taken into account in routine patient care.

Adolescent↗
PubMed1990

[Preliminary study and clinical evaluation method of ioversol in angiocardiography--establishment of safety evaluation parameters and reliability of radiographic quality evaluation].

A multi-center clinical study of a new nonionic iodinated contrast medium (ioversol) was performed in 26 patients undergoing left ventriculography (LVG) and coronary angiography (CAG) at four centers. The aims of this study were to try to establish a clinical evaluation method on contrast media in angiocardiography and to determine radiographic efficacy and safety of ioversol. The reliability of the method evaluating the radiographic quality of the contrast medium was also examined with statistical analysis. Excellent radiographic efficacy was observed with ioversol and morphological diagnosis was possible in all cases. The electrocardiograms (ST-segment deflection, T-wave amplitude, QT interval, corrected QT interval, arrhythmia and heart rate) and the hemodynamic parameters (left ventricular systolic and end diastolic pressures, left ventricular dp/dt max, aortic systolic and diastolic pressures) indicated no clinically significant changes. This study suggested that the monitoring of the ECGs and hemodynamic parameters for up to three minutes after injection of the contrast medium is sufficient for the evaluation in LVG and CAG, and that the monitoring in CAG during the first injection into each left and right coronary artery is also sufficient for the purpose. Heat sensation during injection was mild. A patient had a symptom of nausea after ioversol administration, but it was mild and transient and resolved spontaneously. There were no abnormal clinical laboratory data related to ioversol. The reliability of the radiographic quality evaluated by the individual clinical investigators was considered to be high and adaptable. However, the evaluation in the blinded cinefilms by the committee members involving all investigators would be more preferable for the higher objectivity. The study results suggest that ioversol is considered to be the efficacious and safe contrast medium for the cardiovascular angiography.

Adolescent↗
PubMed2004

[CT evaluation of response to chemotherapy and/or radiotherapy in primary lung cancer: comparison of response evaluation criteria in solid tumors (RECIST) and the WHO criteria, and comparison of both methods with the histological evaluation].

PURPOSE: The new RECIST criteria for evaluation of tumor response to chemotherapy and/or radiotherapy were proposed in 1999. We compared RECIST with the WHO criteria and also compared both methods with the histological findings, to evaluate RECIST. SUBJECTS AND METHODS: The subjects were 32 primary lung cancer patients operated on after chemotherapy and/or radiotherapy. Two radiologists measured the diameter of the tumors and compared the RECIST and WHO criteria using the McNemar test. We also compared both criteria with the histological results. RESULTS: Using RECIST, partial response (PR) was assessed in 12 cases, stable disease (SD) in 18, and progressive disease (PD) in 2. With the WHO criteria, PR was seen in 15, no change (NC) in 15, and PD in 2. The two evaluations corresponded in 29 of 32 cases, and the p-value was 0.2500. Ef.1b-2 (good histological effect) was much higher in PR, and to evaluate the size of the tumors was useful, although more than half of SD was Ef.1b-2. CONCLUSION: RECIST criteria corresponded almost perfectly with the WHO criteria, suggesting that RECIST is accurate and useful.

Adenocarcinoma↗
PubMed1997

Evaluation of the Short Parkinson's Evaluation Scale: a new friendly scale for the evaluation of Parkinson's disease in clinical drug trials.

The extensive use of the Unified Parkinson's Disease Rating Scale (UPDRS) has revealed low interrater reliability in some items and redundancy in others. In view of these shortcomings, we have structured a new scale that includes a zero-to three-point scale for each item in the evaluation of PD. The mental axis includes memory, thought disorders, and depression. Activities of daily living (ADL) includes eight items: speech, eating, feeding, dressing, hygiene, handwriting, walking, and turning in bed. The motor examination includes eight items: speech, tremor, rest and posture, rigidity, finger tapping, arising from chair, gait, and postural stability. Complications of therapy were also included: dyskinesias, dystonia, motor fluctuations, and freezing episodes, collected by history. In addition, a global scoring for motor fluctuations that should complement the Hoehn and Yahr Scale was incorporated. In this report, we present a statistical analysis of the ADL, motor evaluation, and complications of therapy sections. Concerning the interrater reliability mean, Kendall's W values were >0.9 for most of the items in the Short Parkinson's Evaluation Scale (SPES). Kendall's W <0.8 (motor evaluation) was found for two items of the SPES and nine items of the UPDRS. The mean interrater reliability for both scales across all seven centers (seven Kendall's W for seven centers) (Mann-Whitney test) showed no statistical differences between the scales. Spearman's correlations between items of both scales were significant. Factor analysis of the SPES and UPDRS data revealed a four-factor solution that explained approximately 60% of the data. All participating centers found the SPES easier to apply and quicker to complete, when compared with the UPDRS. The results obtained strongly favor the introduction of SPES for clinical practice.

Activities of Daily Living↗
PubMed2002

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma.

OBJECT: Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. METHODS: A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. CONCLUSIONS: Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Adenoma↗
PubMed2005

Are anonymous evaluations a better assessment of faculty teaching performance? A comparative analysis of open and anonymous evaluation processes.

OBJECTIVE: We compared teaching performance of medical school faculty using anonymous evaluations and open evaluations (in which the evaluator was not anonymous) and examined barriers to open evaluation. METHODS: Residents and medical students evaluated faculty using an open evaluation instrument in which their identity was indicated in the evaluation. Following this, they completed anonymous evaluation on the same faculty members. Aggregate outcomes using the two evaluation systems were compared. Outcomes by group of evaluators (residents and students) were analyzed. Trainees were also asked to rate the barriers to the open evaluation process. RESULTS: A statistically significant difference between the open and anonymous evaluations was noted across all items, with faculty receiving lower scores on the anonymous evaluations. The mean score for all the items on the open evaluations was 4.45 +/- 0.65, compared to mean score of 4.07 +/- 0.80 on the anonymous evaluations. There was also a statistically significant difference between open and anonymous evaluations in five clinical teaching domains that were evaluated individually. Residents perceived that the three most common barriers to optimal evaluation were an apprehension of possible encounters with the same attending physician in the future, destruction of working relationships with the attending, and a feeling of frustration with the evaluation system. CONCLUSIONS: The evaluation of faculty teaching performance is complex. Most academic medical centers use the open evaluation format. This study supports the case for the use of the anonymous evaluation method as a more accurate reflection of teaching performance.

Education, Medical↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMed2005

[The relationship between subjective evaluation and objective evaluation on the examination for the residual ridge height of edentulous patients].

PURPOSE: Appropriate examination of the height of the residual ridge is critical in complete denture treatment. To clarify the possibility of establishing standards for improving the reproducibility of subjective evaluation, the relationship between conventional subjective evaluation by several dentists and objective evaluation by model measurement was evaluated. METHODS: Locations for evaluation were the sites corresponding to the central fossa of the right and left first molars in study models (100 sets) of edentulous maxillas and mandibles. Subjective evaluation with a three-grade scale was performed by some dentists and objective evaluation was performed with digital vernier calipers. The relationship between objective evaluation and subjective evaluation was studied separately in dentists with less than 3 years of clinical experience and those with more than 7 years. Discrimination values for objective evaluation were determined at changeover points of the rate of subjective evaluation. In addition, we studied the correction between subjective evaluation and objective evaluation with the discrimination values. RESULTS: Marked variations were noted in subjective evaluation depending on the individual and number of years of clinical experience. Discrimination values were obtained from subjective evaluation for dentists with more than 7 years of clinical experience: for the maxilla, "low" and "middle" were 6 mm and "middle" and "high" were 10 mm; for the mandible, "low" and "middle" were 0 mm and "middle" and "high" were 5 mm. The correlation between subjective evaluation and objective evaluation based on these discrimination values was extremely low regardless of the individual's clinical experience. CONCLUSIONS: Reproducibility of subjective evaluation of the residual ridge height was low. To improve the universality and reproducibility of the examination, subjective evaluation must be performed by referring to the discrimination values.

Aged↗
PubMed1997

A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans. Comprehensive Clinical Evaluation Program Evaluation Team.

In response to the health concerns of Gulf War veterans, the Department of Defense instituted the Comprehensive Clinical Evaluation Program (CCEP). Although not designed as a research study, the CCEP provided valuable clinical data. An analysis was conducted of CCEP findings from systematic and comprehensive examinations of 20,000 U.S. Gulf War veterans. Among 20,000 participants, the types of primary and secondary diagnoses varied widely. Also, among veterans with an ICD-9-CM diagnosis of "symptoms, signs, and ill-defined conditions," no single subcategory of illness predominated, and no characteristic physical sign or laboratory abnormality was identified. In-total, there were 74 (0.4%) cases of connective tissue disease; 52 (0.3%) noncutaneous malignancies; 42 (0.2%) peripheral neuropathies; 14 (0.07%) cases of interstitial pulmonary fibrosis; 12 (0.06%) cases of renal insufficiency; and no new cases of viscerotropic leishmaniasis. No clinical indication of a new or unique illness was identified in this self-referred population, and the types of physiologic disease that could result from postulated hazardous wartime exposures were uncommon.

Adolescent↗
PubMed2004

Accuracy of foreign dairy bull evaluations in predicting United States evaluations for yield.

Combining foreign daughter data with domestic information in dairy bull genetic evaluations has been shown to improve prediction of future domestic evaluations for US bulls. This study focused on the accuracy of Interbull evaluations of bulls with only foreign daughters, in predicting the latest domestic evaluations (based on US daughters). August 2003 USDA evaluations based only on US daughters were matched with the most recent February or August Interbull evaluations without US daughters. A minimum reliability of at least 80% for yield and 70% for somatic cell score (SCS) was required in both evaluations. This provided pairs of evaluations based on different daughters (foreign or US) for 286 bulls (60 bulls for SCS). Mean Interbull reliabilities on the US scale were 88% for yield and 84% for SCS, and the mean US reliability for the current evaluations was 91% for yield and 80% for SCS. Correlations between the Interbull and domestic evaluations were 0.90, 0.87, 0.90, and 0.87 for milk, fat, protein, and SCS respectively. Expected correlations were 0.89 for yield and 0.82 for SCS. Mean differences between the Interbull and current domestic evaluations were near zero. These foreign bulls had graduated from progeny test programs (selected for positive Mendelian sampling) before being marketed in the United States. Thus, parent average was a substantial underestimate of merit. The small average differences between evaluations from foreign and US daughters and high correlations indicate that Interbull evaluations based solely on foreign daughters are useful predictors of the US evaluations for yield and SCS, providing accuracy in agreement with reliabilities and much better estimates than the alternative, parent averages.

Animals↗
PubMed2005

An inventory of evaluation studies of information technology in health care trends in evaluation research 1982-2002.

OBJECTIVES: During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002. METHODS: The inventory is based on a systematic literature search in PubMed. Abstracts were included when they described an evaluation study of a computer-based component in health care. We identified 1035 papers from 1982 to 2002 and indexed them based on a multi-axial classification describing type of information system, study location, evaluation strategy, evaluation methods, evaluation setting, and evaluation focus. RESULTS AND CONCLUSIONS: We found interesting developments in evaluation research in the last 20 years. For example, there has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanatory research and quantitative methods have dominated evaluation studies in the last 20 years. Since 1982, the number of lab studies and technical evaluation studies has declined, while the number of studies focusing on the influence of information technology on quality of care processes or outcome of patient care has increased. We interpret this shift as a sign of maturation of evaluation research in medical informatics.

Evaluation Studies as Topic↗
PubMed2004

Pluralistic evaluation: a situational approach to service evaluation.

BACKGROUND: The increasing emphasis upon fiscal accountability within the British National Health Service has contributed to demand for evaluating the effectiveness of specific interventions and programmes of care. Whilst there is need for proficient measures of effectiveness, the achievement of this ideal is illusive. Issues of perspective, method and the social nature of healthcare contribute to the complexities of evaluation research. Presented with the task of evaluating the effectiveness of health services, academics and healthcare professionals are striving to seek responsive and adaptive methods of measuring success. AIM: This paper critically debates an approach to healthcare evaluation, which claims to respond to the dynamic and thorny issues that arise. Discussion clarifies whether a pluralistic approach to evaluation can measure success upon a criterion which represents the views of key stakeholders. METHOD: This paper is underpinned by a review of the literature and reflects health, research and management opinions. Literature search methods follow the custom of electronic databases, bulletins boards and the British Library Classification Scheme. Keywords searched are healthcare evaluation, evaluation research, pluralistic evaluation, organizational and policy evaluation. FINDINGS: The integration of policy perspectives and evaluation studies suggests that the pluralistic approach can formulate situational healthcare evaluation. However, there remains a likelihood of marginalizing the viewpoints of particular stakeholder groups. The role of the researcher is to co-ordinate reliable findings and safeguard against the bias associated with traditional professionally dominated methods of healthcare evaluation. CONCLUSION: Analysis suggests that pluralistic evaluation has the potential to develop a deep and real illustration of service provision and provide a basis upon which to develop recommendations.

Community Participation↗
PubMed2006

Learning while evaluating: the use of an electronic evaluation portfolio in a geriatric medicine clerkship.

BACKGROUND: Electronic evaluation portfolios may play a role in learning and evaluation in clinical settings and may complement other traditional evaluation methods (bedside evaluations, written exams and tutor-led evaluations). METHODS: 133 third-year medical students used the McGill Electronic Evaluation Portfolio (MEEP) during their one-month clerkship rotation in Geriatric Medicine between September 2002 and September 2003. Students were divided into two groups, one who received an introductory hands-on session about the electronic evaluation portfolio and one who did not. Students' marks in their portfolios were compared between both groups. Additionally, students self-evaluated their performance and received feedback using the electronic portfolio during their mandatory clerkship rotation. Students were surveyed immediately after the rotation and at the end of the clerkship year. Tutors' opinions about this method were surveyed once. Finally, the number of evaluations/month was quantified. In all surveys, Likert scales were used and were analyzed using Chi-square tests and t-tests to assess significant differences in the responses from surveyed subjects. RESULTS: The introductory session had a significant effect on students' portfolio marks as well as on their comfort using the system. Both tutors and students reported positive notions about the method. Remarkably, an average (+/- SD) of 520 (+/- 70) evaluations/month was recorded with 30 (+/- 5) evaluations per student/month. CONCLUSION: The MEEP showed a significant and positive effect on both students' self-evaluations and tutors' evaluations involving an important amount of self-reflection and feedback which may complement the more traditional evaluation methods.

Adult↗
PubMed2001

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

OBJECTIVE: The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. DESIGN: A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. METHODS: All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. RESULTS: During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. CONCLUSION: This study is the first effort to establish comprehensive criteria for evaluating handheld prescribing systems and to evaluate the performance and features of a handheld, electronic prescribing system. The results demonstrated that the evaluated system: 1) was simple to install; 2) successfully interfaced with a commonly used practice management system; 3) was user-friendly and easy to operate; 4) offered a robust variety of standard features; and, 5) resulted in a high rate of success for transmitting electronic prescriptions. The criteria established for the evaluation of features of an electronic prescribing system can be used to critically evaluate the performance and features of other handheld and personal computer-based electronic prescribing systems.

Adult↗
PubMedDate not supplied

Evaluating the evaluators: interrater reliability on EMT licensing examinations.

INTRODUCTION: Current methods of evaluating the technical competence of Michigan emergency medical technician (EMT) licensure candidates are subjective and potentially unreliable. Evaluators are required to attend a workshop before evaluating practical examination candidates. Despite the workshop, there is too much score variation and not enough observational consistency on the standardized examination. OBJECTIVE: To determine the level of rater reliability for evaluators of EMT practical examinations. METHODS: Data were collected from 104 licensed instructor-coordinators (ICs). Participants watched and scored two practical examinations simulated on videotape, one passing and one failing performance. Variation in student score and level of evaluator agreement concerning skill performance were determined. Michigan's basic EMT practical examination scoring instrument was used. RESULTS: Nine basic EMT, 9 EMT specialist, and 86 EMT-paramedic ICs participated. Thirty-four percent had high school diplomas, 43% associate's degrees, 19% bachelor's degrees, 3% master's degrees, and 1% a doctoral degree. The ICs averaged 14 years of provider experience, and 6.35 years as an IC. The average score for scenario 1 (passing) was 86.4% (SD = 9.15, range = 53). An 80% score is required to pass. Nine ICs (9%) failed the student. Scenario 1 evaluator agreement was 79.4%. The average score for scenario 2 (failing) was 60.9% (SD = 11.57, range = 57). Seventeen ICs (18%) gave the student a passing score. Scenario 2 evaluator agreement was 67.8%. There was no significant difference in student scores based on evaluator level of education, licensure, or evaluator workshop attendance for either scenario. CONCLUSION: Notable variation in scores given by evaluators for a single observed student, combined with low levels of evaluator agreement about skill performance, suggests that evaluators do not reliably rate student performance using the Michigan practical examination instrument.

Educational Measurement↗
PubMed2001

Evaluation of clinical information systems. What can be evaluated and what cannot?

The evaluation of clinical information systems is essential as they are increasingly used in clinical routine and may even influence patient outcome on the basis of reminder functions and decision support. Therefore we try to answer three questions in this paper: what to evaluate; how to evaluate; how to interpret the results. Those key questions lead to the discussion of goals, methods and results of evaluation studies in a common context. We will compare the objectivist and the subjectivist evaluation approach and illustrate the evaluation process itself in some detail, discussing different phases of software development and potential evaluation techniques in each phase. We use four different practical examples of evaluation studies that were conducted in various settings to demonstrate how defined evaluation goals may be achieved with a limited amount of resources. This also illustrates advantages, limitations and costs of the different evaluation methods and techniques that may be used when evaluating clinical information systems.

Decision Support Systems, Clinical↗