Detailed Evaluation Method Research Articles

The 2009 Helene Hudson Memorial Lectureship: Creating opportunities to support oncology nursing practice: Surviving and thriving

There is a growing body of evidence to support that specialization in nursing leads to improved outcomes for patients, including increased QOL, improved symptom management, and fewer hospital admissions. Oncology nurses face several challenges in pursuing specialization, due to individual and system issues such as limited time and resources. To address these challenges, de Souza Institute launched a province-wide study group for nurses in Ontario who planned to write the Canadian Nurses Association (CNA) Oncology Certification Exam. The study group was led by educators from de Souza and Princess Margaret Hospital and drew expertise from nursing leaders across Ontario who shared the same vision of oncology nursing excellence. The study group was innovative by embracing telemedicine and web-based technology, which enabled flexibility for nurses' work schedules, learning styles, physical location and practice experience. The study group utilized several theoretical perspectives and frameworks to guide the curriculum: Adult Learning Theories, Cooperative Learning, Generational Learning Styles, CANO standards for practice and the CNA exam competencies. This approach enabled 107 oncology nurses across the province in 17 different sites to connect, as a group, study interactively and fully engage in their learning. A detailed evaluation method was utilized to assess baseline knowledge, learning needs, cooperative group process, exam success rates, and document unexpected outcomes. Ninety-four per cent of participants passed the CNA Oncology Exam. Lessons learned and future implications are discussed. The commitment remains to enable thriving through generating new possibilities, building communities of practice, mentoring nurses and fostering excellence in oncology practice.

MRI for the evaluation of gastric physiology

Background:Evaluation of gastric physiology (gastric emptying and motility) is important for the diagnosis of disturbances such as functional dyspepsia. MRI is a non-invasive technique that allows simultaneous registration of gastric emptying and motility.Aim:To provide an overview of the literature of studies that used MRI as a tool for evaluation of gastric function in both research and clinical settings.Materials and methods:A MEDLINE search was performed (1990–2008) directed at the radiology and gastroenterology literature on gastric physiology. Key words that were used included: functional tests, gastric emptying, gastric motility, gastric physiology and MRI. Twenty-five articles fulfilled the inclusion criteria and were included in the analysis.Results and conclusion:Over the last decade, MRI has developed as a reliable, non-invasive method for detailed evaluation of gastric emptying and motility without the disadvantages of ionizing radiation and without the use of intragastric catheters that influence gastric physiology.

Method for detailed evaluation of yield of Nb Josephson junctions

We have developed a method for evaluating Ic (critical current) spreading and yield of Nb Josephson junctions (JJ) through detailed current–voltage (I–V) measurements and applied the method to evaluation of 1000 serial arrays. Digitizing the stepwise I–V curve, we deduced the Ic value at each voltage step. This allowed us to easily detect irregularities such as junction shortages or Ics that were larger than those of the main distribution by reducing the resolution limit to 1JJ. Using this method we can take into account very low frequency (<1%) failures in evaluating fabrication processes.

診療ガイドラインおよびＭｉｎｄｓにおける医学文献の評価選定基準について

Clinical practice guidelines have been developed by official organizations to help healthcare workers with clinical decision-making. The use of these guidelines is expected to improve patients' outcomes. Critical appraisal of the clinical studies used to form a knowledge base is a crucial step in the process of developing guidelines. The guality of evidence depends on the study design, with randomized controlled trials providing the most reliable evidence. A meta-analysis of randomized controlled trials can reduce the chance of a statistical error and provides better evidence than a single trial. Only randomized controlled trials can provide a definite answer as to whether a specific intervention can improve the outcomes with clinical relevance. Evidence based on non-randomized clinical trials is weaker than that provided by randomized controlled trials. A hierarchical evaluation system according to study design, with meta-analyses at the top and experts' opinions at the bottom, has been used to determine the strength of recommendations. However, even randomized controlled trials are not immune to various biases. A more precise and detailed evaluation method for selecting clinical studies that are meaningful, valid, reliable, and relevant is needed. The Japan Council for Quality Health Care has developed the Medical Information Network Distribution Service (Minds) for Japanese. healthcare workers and the public. An evaluation system for this service is currently under development.

Ｎｂ３Ａｌ導体の電磁力下での圧力損失特性―圧力損失特性と撚線剛性の関係―

The Japan Atomic Energy Research Institute (JAERI) has demonstrated the superconducting performance of a large coil using a newly developed cable-in-conduit Nb3Al conductor comprised of 1,152 superconducting strands bundled on a central cooling channel. The conductor was developed as one of the R&D activities of the International Thermonuclear Experimental Reactor (ITER). The hydraulic performance of the Nb3Al conductor under electromagnetic force was studied to clarify the relation between pressure drop under electromagnetic force and cable stiffness. Under an electromagnetic force of 500 kN/m, the pressure drop of the Nb3Al conductor decreased by 5%, which is smaller than the 13% decrease measured for a Nb3Sn conductor. This characteristic was well simulated by taking into account the high stiffness of the Nb3Al cable as related to the high strength and stiffness of Nb3Al strand. Furthermore, the pressure drop of several Nb3Sn conductors tested in previous R&D studies was investigated by means of the same evaluation method to study the effect of cable types. It was concluded that the pressure drop under electromagnetic force can be explained by taking the cable stiffness of any type of CIC conductor into account. This paper describes the measurement results, detailed evaluation method, and considerations that led to this conclusion.

Localization of insulinomas. Comparison of conventional arterial stimulation with venous sampling (ASVS) and superselective ASVS.

To examine the value of superselective arterial stimulation venous sampling (ASVS) to localize insulinomas. Superselective ASVS (SS-ASVS) was performed in 9 patients with insulinoma. Injection of secretagogue (calcium gluconate: 0.01 mEq Ca++/kg) was performed into the gastroduodenal, splenic (proximal and distal), and superior mesenteric arteries in 9 patients and additionally into the dorsal pancreatic artery in 6 patients. Sampling from the hepatic vein was performed to measure serum insulin concentrations at 30, 60 and 120 s after each injection of secretagogue into these arteries. SS-ASVS results were correlated with surgical findings, compared to those of conventional ASVS. Insulinomas were correctly localized to the head, body or tail of the pancreas by SS-ASVS in 8 patients (89%). Conventional ASVS detected insulinomas in 7 patients (78%), although it could not distinguish whether the insulinoma was located in the pancreatic body or tail in 4 of the 7 patients. There were eight-fold or more increases in serum insulin levels in hepatic venous samples related to the artery supplying the tumor in 8 patients. Localization of the insulinomas was verified at surgery in all patients. SS-ASVS is a useful method for detailed evaluation of overproduction of insulin from pancreatic insulinomas and their localization. When the pancreatic insulinoma is situated in the pancreatic body or tail, the localization is more accurately made by SS-ASVS than by conventional ASVS.

LOCALIZATION OF INSULINOMAS. Comparison of conventional arterial stimulation with venous sampling (ASVS) and superselective ASVS

Purpose: To examine the value of superselective arterial stimulation venous sampling (ASVS) to localize insulinomas. Material and Methods: Superselective ASVS (SS-ASVS) was performed in 9 patients with insulinoma. Injection of secretagogue (calcium gluconate: 0.01 mEq Ca++/kg) was performed into the gastroduodenal, splenic (proximal and distal), and superior mesenteric arteries in 9 patients and additionally into the dorsal pancreatic artery in 6 patients. Sampling from the hepatic vein was performed to measure serum insulin concentrations at 30, 60 and 120 s after each injection of secretagogue into these arteries. SS-ASVS results were correlated with surgical findings, compared to those of conventional ASVS. Results: Insulinomas were correctly localized to the head, body or tail of the pancreas by SS-ASVS in 8 patients (89%). Conventional ASVS detected insulinomas in 7 patients (78%), although it could not distinguish whether the insulinoma was located in the pancreatic body or tail in 4 of the 7 patients. There were eight-fold or more increases in serum insulin levels in hepatic venous samples related to the artery supplying the tumor in 8 patients. Localization of the insulinomas was verified at surgery in all patients. Conclusion: SS-ASVS is a useful method for detailed evaluation of overproduction of insulin from pancreatic insulinomas and their localization. When the pancreatic insulinoma is situated in the pancreatic body or tail, the localization is more accurately made by SS-ASVS than by conventional ASVS.

The Prevalence, Assessment and Associations of Falls in Dementia with Lewy Bodies and Alzheimer’s Disease

Falls were assessed for 3 months using a daily fall diary in 65 (30 dementia with Lewy bodies, DLB; 35 Alzheimer’s disease, AD) dementia patients from a case register, diagnosed using operationalised clinical criteria, with established accuracy against post-mortem. Multiple falls (>5) occurred in 37% of DLB patients and 6% of those with AD, often resulting in injury. None of the standard risk assessment tools identified fallers, but they did identify multiple fallers. More detailed evaluation methods examining gait patterns, sway and neurovascular instability were not helpful. Multiple falls were associated with DLB, parkinsonism, previous falls, greater impairment of activities of daily living and older age. Falls are particularly common in DLB sufferers and may aid diagnosis. Treatment studies evaluating fall reduction strategies are a priority.