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[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

Evaluating evaluation: assessment of the American Board of Internal Medicine Resident Evaluation Form.

The American Board of Internal Medicine suggests use of a standard form to rate residents on nine dimensions (such as clinical judgment and overall clinical competence) on a scale of 1 to 9. The authors examined the psychometric evidence for reliability and validity of 1,039 ratings of 85 residents by 135 attendings in a single internal medicine residency program. Of these ratings, 95.6% were from 6 to 9. Factor analysis revealed that high correlations among the nine dimensions (r ranged from 0.72 to 0.92) resulted from a single global factor accounting for 86% of the variance. The study also examined whether the form reliably distinguishes among residents scoring between 6 and 9. Agreement among attendings rating the same individual was weak (average reliability = 0.64, by the method of James). The rating method fails to discriminate dimensions of clinical care and has low reliability for distinguishing among competent residents.

Clinical Competence

Human evaluative conditioning: acquisition trials, presentation schedule, evaluative style and contingency awareness.

Two different processes may be operative in human Pavlovian conditioning: signal learning and evaluative learning. Whereas most studies on evaluative conditioning focused on a mere demonstration of the phenomenon or on a theoretical analysis of the underlying processes, some basic parameters of evaluative learning are still unexplored. Hence, using the standard neutral picture--(dis)liked picture pairing paradigm (Baeyens, Eelen & Van den Bergh, 1990), in this study the effect of two parameters of evaluative conditioning was assessed on a between-subjects base, namely the Number of Acquisition Trials (2/5/10/20) and the Presentation Schedule of the stimulus pairs (blockwise or random). Additionally, the study included an exploratory analysis of the potential effects of the Evaluative Style of subjects (Feelers vs Thinkers, operationalized in terms of speed of emitting evaluations). Finally, the relationship between contingency awareness and evaluative learning was reassessed. Neutral-liked conditioning was found to be quadratically related to the number of acquisition trials (increase in effect up to 10 trials, decrease from 10 to 20 trials), whereas neutral-disliked conditioning linearly increased with increasing numbers of trials. Randomized vs blockwise presentation schedules of the stimulus pairs did differentially affect the overall pattern of conditioning, but in a way which was both unexpected and difficult to account for theoretically. Both the Evaluative Style of subjects and contingency awareness were demonstrated to be generally orthogonal to conditioned shifts in CS valence. Based on these findings, some practical suggestions are provided for the application of evaluating conditioning based therapeutical interventions to affective-behavioral disorders which are centred around inappropriate (dis)likes.

Adult

Issues in evaluation: evaluating assessments of elderly people using a combination of methods.

In evaluating a health service, individuals will give differing accounts of its performance, according to their experiences of the service, and the evaluative perspective they adopt. The value of a service may also change through time, and according to the particular part of the service studied. Traditional health care evaluations have generally not accounted for this variability because of the approaches used. Studies evaluating screening or assessment programmes for the elderly have focused on programme effectiveness and efficiency, using relatively inflexible quantitative methods. Evaluative approaches must reflect the complexity of health service provision, and methods must vary to suit the particular research objective. Under these circumstances, this paper presents the case for the use of multiple triangulation in evaluative research, where differing methods and perspectives are combined in one study. Emphasis is placed on the applications and benefits of subjectivist approaches in evaluation. An example of combined methods is provided in the form of an evaluation of the Newcastle Care Plan for the Elderly.

Aged

Self-evaluation and its relationship to clinical evaluation.

An exploratory study was undertaken in a three-year nursing diploma program to determine instructor and student perceptions of self-evaluation (SE) and its relationship to clinical evaluation. A cross-section of instructors (n = 9) participated in three rounds of a Delphi survey. From this validated data base a questionnaire was developed and distributed to a stratified sample of 145 students. Combined results were then analyzed and compared. Results indicated that both students and instructors perceive self-evaluation more positively than negatively and they see the main purpose as providing direction for learning. Contrary to the literature and perceptions of surveyed instructors, students did not perceive self-evaluation as a factor in promotion of professional growth. Although students value a participatory role in clinical evaluation, the process of self-evaluation generates anxiety and underrating of performance. The authors conclude that self-evaluation is a developmental skill requiring guidelines and practice, and offer recommendations for its use.

Alberta

Faculty evaluation: a closer look at peer evaluation.

As long as there have been academic institutions, administrators, faculty, and students, there have been evaluations. Evaluation involves placing a value or making a judgement about some aspect(s) of performance. Evaluation in nursing education has been studied extensively with respect to nursing students' academic and clinical performance. However, it is only in the last 2 decades that the issue of faculty evaluation has gained increased attention. Trends in nursing education with respect to the development of the overall concept and sources of input for evaluation of the nurse educator are discussed in this paper. Specific attention is focused on the process of peer evaluation and a tool to facilitate the peer evaluation process is included.

Employee Performance Appraisal

From rarity to evaluative extremity: effects of prevalence information on evaluations of positive and negative characteristics.

Experiments showed a scarcity principle in evaluative judgments such that the identical characteristic is evaluated more extremely the lower its perceived prevalence. In Study 1, Ss evaluated a fictitious medical condition that was described as either beneficial or detrimental to health and as occurring in either 30% or in one half of 1% of a test population. The condition was evaluated more extremely--as as a more positive health asset or a more negative health liability--in the low-prevalence than in the high-prevalence conditions. Study 2 demonstrated the same effect in self-evaluations and with a different manipulation of perceived prevalence. Ss were told that they actually had the fictitious medical condition, that it was either beneficial or detrimental to their health, and either that they were the only 1 of 5 Ss who had it or that 4 of the 5 did. Low-prevalence Ss exhibited more extreme evaluative, affective, and behavioral reactions to the medical condition than did high-prevalence Ss. The origins and validity of the scarcity principle are discussed, as are its implications for uniqueness theory, reactance theory, and social evaluation theories.

Adult

Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension.

A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension was jointly funded by the Veterans Administration and the National Heart, Lung and Blood Institute. Its clinical phase has been completed, and it demonstrated 1. that the required relatively young asymptomatic population could be enrolled in the study and 2. that it could be persuaded to adhere to the protocol for 2 years; however, it was evident that intensive efforts would be required in both areas. The feasibility trial screened almost 120,000 potential subjects over a period of 16 months to randomize about 1,000 subjects at four clinical centers. These men and women were 21 to 50 years old, had diastolic pressures from 85 to 105 mm Hg as outpatients, and had no evidence of cardiovascular renal abnormalities. They were randomized in double-blind fashion into active drug therapy and placebo groups. Stepped care therapy involved 50 mg chlorthalidone (Step 1), 100 mg chlorthalidone (Step 2) and 100 chlorthalidone plus 0.25 mg reserpine (Step 3). Death, myocardial infarction, stroke, angina pectoris, and congestive heart failure were the "major" morbid events that were looked for; also recorded were "minor" morbid events consisting primarily of electrocardiographic arrhythmias. The development of significant hypertension was considered a treatment failure. Side effects were carefully tabulated in both active drug and placebo groups. The study revealed an average drop in diastolic pressure of almost 12 mm Hg for active drug group and less than half of that for the placebo group; once established 6 months after randomization, the new pressure levels persisted almost without change throughout the study. Although the feasibility trial was not designed to answer the primary question regarding the benefits of treatment, the events were tabulated for each group. A total of 12 placebo-treated subjects developed significant hypertension and were put on active drug. There was not a significant difference between the two groups in the incidence of "major" morbid events; a total of eight active and five placebo patients developed myocardial infarction or died suddenly. There, however, was an excess of arrhythmias among the active drug subjects (17 in the active group versus 8 in the placebo group on the basis of preliminary data). Finally, there were twice as many side effects and 20 times as many chemical abnormalities among the active as among the placebo subjects. A protocol for a full scale study of the benefits of pharmacologic therapy in mild hypertensives has been prepared and is ready for implementation as needed; it involves relatively minor modifications of the protocol tested in the feasibility trial.

Adult

Conference evaluation: development of an evaluation tool.

The development and application of an evaluation tool based on Stufflebeam's model is described. This used the four areas of Context, Input, Process and Product as areas to evaluate. The tool was developed for the evaluation of an English National Board national study conference for Mental Health Nursing entitled 'Towards 2000', held at Ripon, 24-27 July 1989. A wealth of data, both quantitative and qualitative, was generated. The use of Stufflebeam's model for evaluation was found to be useful. However, a shorter evaluation form is needed for general use.

Congresses as Topic

[A reliable method for evaluating the masticatory function in complete denture wearers, concerning a masticatory function evaluation chart based on food hardness].

The purpose of this study was to construct an evaluation chart to objectively and simply determine the extent of the masticatory function of complete denture wearers in daily clinical practice, and to describe the chart's clinical application. 58 different types of food were selected according to two criteria: their frequency of ingestion by complete denture wearers, and their convenience for determining the masticatory function. Then an anatomical artificial porcelain set of dentures was used to bite each food item, using only bicuspids and molars. Dentures were installed on an Instron Universal Testing Instrument to compression-cut the food. Food requiring the highest pressure was considered the hardest food. Then the masticatory function evaluation chart was constructed by using the hardness of the food as an index of relative masticatory difficulty. Using this chart, 95 complete denture wearers were tested to determine the masticatory function of their dentures. The following results were obtained: 1. The mean hardness of the 58 food items tested was 7.85 +/- 11.29 kg. The mean hardness of the 38 food items frequently ingested by complete denture wearers was 5.24 +/- 5.41 kg. 2. The differences in hardness of the foods tested were statistically processed, and the 58 food items were classified into 5 groups (I-V). This five-fold classification was used as a range for determining masticatory function. 3. A correlation coefficient of -0.697 (p less than 0.01) was found between the hardness of the food and the ease of eating the food. 4. A correlation coefficient of 0.548 (p less than 0.01) was found between the hardness of the food and the frequency of ingestion. 5. The masticatory function was determined on a 5-point scale from A to E according to the total number of food types that the subjects said that they could eat easily. The masticatory function increased progressively from A to E. The results of determining the masticatory function of the 95 complete denture wearers were as follows: Rank A 1.1%, B 10.5%, C 34.7%, D 29.5% and E 24.2%. 6. Persons who evaluated their own dentures positively comprised 86.0% of ranks D and E. On the other hand, persons who evaluated their own denture negatively were widely distributed from rank A through E, indicating that there were considerable individual differences. 7. It was concluded that the masticatory function evaluation chart was a reliable means of objectively and simply determining the masticatory function of complete denture wearers.

Bite Force

[Clinical methods for evaluating infarct size and its anatomic correlations. Study carried out in 193 cases. III. Comparison of data on the evaluation of the infarct size using the QRS score and a method of maximal creatine kinase determination in the serum].

AIMS: To compare two methods concerning the clinical evaluation of infarct size--one using a QRS score, the other based on peak Ck values--applied to the same population. CONCEPT AND PLACE OF THE STUDY: to determine--based on previously established correlations between a QRS score and the anatomic total infarct size on one hand, and between the peak CK values and the anatomic recent infarct size on the other hand--which myocardial infarction subgroup constitutes the best indication for each method. The study took place in a Coronary Care Unit of a Central Hospital. MATERIAL AND METHODS: 193 patients who died successively of acute myocardial infarction through out 4 years were studied. After establishing the exclusion critéria, the QRS score was calculated according to the method of Selvester modified by Wagner, and peak CK values were evaluated. Infarct size, either recent or old, was determined by means of an anatomical method developed by the authors and based on Hackel's and Alonso's previous works. Correlations were established between data from each clinical method and those from the anatomical method. Several myocardial infarction subgroups were considered for comparison of the correlations found in each subset. RESULTS AND CONCLUSIONS: As long as QRS score was regarded, significant correlations were found between the evaluation by QRS score and anatomical infarct size in the subgroups of patients with severe pump failure, prior myocardial infarction, or total loss of ventricular muscle mass of at least 20 percent; however, a significant correlation was missing when the whole myocardial infarction group was taken into consideration. When peak CK value were considered, a weak significant correlation was found between the evaluation by enzyme determination and anatomical infarct size in the whole group of patients, but a stronger correlation was present in the subgroups of patients with survival longer than 24 hours, anterior wall myocardial infarction, free wall cardiac rupture, or first acute myocardial infarction. In conclusion the choice of the method to be used in the clinical evaluation of infarct size should take into account the type of population beeing studied, and follow the results obtained in different myocardial infarction subgroups as mentioned above.

Creatine Kinase

Differentiating impact evaluation from evaluation research: one perspective of implications for continuing nursing education.

Practitioners of continuing nursing education need to be able to distinguish between impact evaluation and evaluation research reported in the literature. Failure to do so may lead to invalid conclusions or faulty decision-making. This article defines impact evaluation and evaluation research, compares them across seven dimensions, and describes their strengths and weaknesses.

Decision Making

Nursing adaptation evaluation: a method for evaluating nursing care.

The Nursing Adaptation Evaluation method (NSGAE) is presented as a means by which psychiatric nurses can explicate and articulate their practice by, among other strategies, evaluating the effectiveness of nursing care. Having a method for evaluating patient improvement facilitates the evaluation of nursing care and, ultimately, contributes to an expansion of our theoretical base.

Adaptation, Psychological

Evaluation of emerging technologies for coronary revascularization. Participants in the National Heart, Lung, and Blood Institute Conference on the Evaluation of Emerging Coronary Revascularization Technologies.

Despite significant advances in coronary angioplasty, the problems of restenosis, chronic total occlusion, diffuse disease, and abrupt closure after the procedure remain to be solved. New devices that address these problems continue to evolve. Although a controlled clinical trial is the ultimate test of any device, rapid device design changes and resource limitations require evaluating which of the new devices justify a full clinical trial. A registry mechanism for this initial evaluation is proposed and detailed. Payment for procedures using new devices is a problem for industry, insurers, hospitals, and physicians. It is proposed that reimbursement be based on the service performed rather than the device used to perform it. Costs beyond the clinical costs should be borne by the sponsor of the device. Financial conflict of interest is a recognized problem in new device evaluation. It is not always practical to insist on exclusion from the evaluation process of individuals with a financial stake in the outcome, but disclosure of the presence of such a financial interest is recommended in the reporting of results.

Angioplasty, Balloon, Coronary

Project 2000 curriculum evaluation: the case for teacher evaluation.

Project 2000 has changed the role of nurse teachers. Thus evaluation of Project 2000 should incorporate a theoretical framework that not only evaluates the individual school/college of nursing curriculum but also enhances the teachers' professional development. This paper suggests that teacher professional development would be enhanced by teacher self-evaluation (action research). A collaborative approach between teachers and an evaluation co-ordinator would ensure that the quality of the curriculum is maintained (MacDonald 1991). It is argued that the implementation of monitored innovation would fulfil the criteria for the developing school/college of nursing put forward by Holly et al (1989).

Curriculum