Panel Assessment Research Articles

Transient ischaemic attack and ischaemic stroke: constructing episodes of care using hospital claims data

BackgroundStroke patients may have multiple hospital separations relating to the same stroke. Understanding the pattern of hospitalisations for these patients enables first and recurrent events to be distinguished to better understand care. The aim of this study was to investigate reasons for hospital separations after transient ischaemic attack (TIA) or ischaemic stroke and construct episode of care criteria.MethodsA retrospective observational study was conducted using the Australian Government Department of Veterans’ Affairs administrative claims database. All patients hospitalised for TIA or ischaemic stroke in 2008–2009 were included. Reasons for hospital separations in the 60 days after TIA or ischaemic stroke were classified by a clinical panel as ‘probably’, ‘possibly’ or ‘unlikely’ to be related to the index separation. Based on panel assessment and time between separations, episode of care criteria for TIA and ischaemic stroke were constructed.ResultsOf the 4520 veterans alive after the index separation, 32% of TIA patients (n=782) and 63% of ischaemic stroke patients (n=1323) had another separation within 60 days. The clinical panel reviewed 460 unique reasons for readmission. Of the 3263 separations, 55% and 85% were classified as related to the index TIA and ischaemic stroke separation, respectively.ConclusionsPatients hospitalised for ischaemic stroke are likely to have multiple hospital separations for treatment of the same event. Multiple separations for treatment of TIA were less frequent. Consideration of these related separations is recommended when assessing health service utilisation from claims databases.

Redefining Entrepreneurial Learning Paradigms in Developing Countries

In a rapidly changing world of knowledge exchange, innovation and technological advancements, entrepreneurship continues to fuel economic growth in both developed and developing countries. In the developed world, an increased influx of graduate entrepreneurs sustains economic growth whilst, in contrast, developing countries continue to suffer from a dearth of entrepreneurial learning mechanisms. To remedy this situation in Ghana a collaborative and interdisciplinary venture, involving the Business School of the Kwame Nkrumah University of Science and Technology and an international panel of experts, has developed the Kite Vision Actualization Laboratory (KVAL). The raison d'être of the KVAL is to support and nurture talent, develop and implement business solutions and innovations, encourage the development of entrepreneurial undergraduate and postgraduate programmes and stimulate graduate business start-ups. The KVAL integrates four development stages of entrepreneurial learning: knowledge transfer and exchange; innovations and inventions; technology and enterprise development; and panel review, assessment and final approval protocols. The innovative KVAL framework mirrors demand-led transformation and self-actualization processes that represent a departure from traditional offerings in entrepreneurship education.

An Expert Panel Approach on Developing a Unified System Authentication Benchmarking Index

Network-based applications still rely heavily on password-based authentication methods to control access. In a recent study, a benchmarking instrument was used to assess authentication methods used in such systems. The authors’ instrument was built on an extensive literature foundation and was validated with an expert panel assessment. This paper reports on the development of the instrument and the expert panel assessment. The initial draft of the instrument was derived from literature to assess 1) password strength requirements, 2) password usage methods, and 3) password reset requirements. Criteria within the index were evaluated by an expert panel, who also provided opinions on the relative weights of the criteria and measures. The expert panel results were analyzed using Multi-Criteria Decision Analysis (MCDA) techniques. Their results revealed that out of 100% allocation, Password Strength Measure (PSM) was the dominant factor in the aggregated perception of the panel of experts with weight of 43.1%, followed by Password Initialization and Reset Measure (PIRM) with weight of 29.2%, and Password Usage Measure (PUM) with weight of 27.7%. They concluded with discussions on how criteria were assembled, how the panel was conducted, and results from the panel. The results reported include the relative weights of the three measures within the unified system authentication benchmarking index.

Consensus Panel's Assessment and Recommendations on the Use of 3 Botulinum Toxin Type A Products in Facial Aesthetics

In this summary article, the authors discuss the characteristics of abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA. With 3 neuromodulators available in the US market, comparisons between and among products will invariably be made, so arguments for the most effective facial aesthetic uses of each neuromodulator are presented. Topics addressed in this article include patient expectations, toxin reconstitution and preparation, patient positioning, differences among products, the role of complexing proteins, and dosing and injection strategies. Recommendations are also provided by treatment area.

Big hits on the small screen: an evaluation of concussion-related videos on YouTube

BackgroundYouTube is one of the largest social networking websites, allowing users to upload and view video content that provides entertainment and conveys many messages, including those related to health conditions,...

Sensory analysis of broccoli over time: Consumer defined critical attributes and evaluation of digital photographs in comparison to real product appearance

The objectives of the present work were: (a) define the critical attribute of broccoli from a consumers’ perspective and (b) for broccoli compare the trained panel sensory evaluation of real products versus the sensory evaluation of the corresponding digital photographs. A panel of broccoli consumers evaluated appearance, aroma and flavor acceptability of broccoli with different storage times. Appearance acceptability was the only attribute where there were significant differences between storage times. Thus appearance was the critical attribute as evaluated by consumers. A panel of assessors measured the appearance of broccoli samples with different storage times using the quality scoring method (QSM). A month after having measured the real product the same assessors measured the appearance of digital photographs of the same samples using the QSM. Analysis of variance showed that there were no significant differences between evaluations of the real broccoli and the corresponding photograph.

Immediate transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction in underweight Asian patients

TRAM breast reconstruction is commonly thought to be inadequate for underweight patients and LD flap with implant is usually recommended. However, it is often difficult to find an appropriate implant for thin Asian women with small breasts. The authors present the results of using TRAM flap alone for immediate breast reconstruction in underweight Asian patients. Between September 2001 and October 2006, 564 patients underwent immediate TRAM flap-only breast reconstruction. Among these, 18 were underweight (BMI <18.5 kg/m(2)) and 317 were normal weight (18.5 kg/m(2) ≤ BMI < 23.0 kg/m(2)). Complications were classified as systemic, breast, and donor site. Complication rate, oncologic outcome and overall satisfaction and recommendation were compared between two groups. Standardized postoperative photographs were also subject to a panel for cosmetic assessment. the overall complication rate was 22.2 % in underweight group and 27.1 % in normal weight group (p = 0.32). There was a tendency that the breast complication rate was higher in the normal weight group and the abdominal complication rate was higher in the underweight group. However, neither of these was statistically significant. Mean satisfaction was not statistically different, either (8.44 vs. 8.60, p = 0.54). Panel assessment for overall cosmesis, symmetry and scarring showed no significant between-group differences. Immediate breast reconstruction using TRAM flap alone can be performed with acceptable complication rates and comparable patients' satisfaction score in a well selected underweight Asian women as in a normal weight group.

Best clinical care versus the common good of research: a solution for challenging surgical trials

Randomised controlled trials (RCTs) in surgery are expensive and labour intensive, yet considerable concern remains about applicability of results in clinical practice. Apart from quality issues, this lack of applicability is often due to strict eligibility criteria leading to selection bias. In addition, only a small proportion of eligible patients are randomised, since both clinicians and patients are rarely in equipoise and do not feel comfortable being excluded from the decision making process, especially when substantially different procedures (such as open versus minimally invasive or operative versus non-operative interventions) are compared or surgical innovations are involved.The Patient Eligibility Assessment through Clinical Equipoise (PEACE) methodological framework is introduced. In this framework, every provisionally eligible patient is regarded as a complex case which is assessed on line by an expert panel. Collected opinions including that of the submitting surgeon are processed to calculate the level of clinical equipoise. A sufficient level of equipoise for random treatment allocation is confirmed or a panel consensus in preference for a certain treatment is advised.The proposed framework was developed and panel assessment tested in collaboration with a national multicentre trauma randomised controlled trial comparing operative and non-operative interventions. 12 surgeons from nine hospitals acting as principal investigators in the trial formed the expert panel and assessed 77 real clinical cases eligible according to standard inclusion and exclusion criteria during the 3 year course of the trial.Because every case is assessed for eligibility, initial entrance criteria can be pragmatic and less specific than with the standard approach. A treating surgeon is involved in the decision process through submitting an opinion and has the backing of an expert panel when treatment options and trial participation is discussed with a patient. Cases where there is treatment consensus can also be researched, but should not be randomised on ethical grounds. FundingWarwick Medical School.

12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland

To estimate the 12-month incidence, prevalence, and persistence of mental disorders among recently admitted assisted living (AL) residents and to describe the recognition and treatment of these disorders. Two hundred recently admitted AL residents in 21 randomly selected AL facilities in Maryland received comprehensive physician-based cognitive and neuropsychiatric evaluations at baseline and 12 months later. An expert consensus panel adjudicated psychiatric diagnoses (using DSM-IV-TR criteria) and completeness of workup and treatment. Incidence, prevalence, and persistence were derived from the panel's assessment. Family and direct care staff recognition of mental disorders was also assessed. At baseline, three-quarters suffered from a cognitive disorder (56% dementia, 19% Cognitive Disorders Not Otherwise Specified) and 15% from an active non-cognitive mental disorder. Twelve-month incidence rates for dementia and non-cognitive psychiatric disorders were 17% and 3% respectively, and persistence rates were 89% and 41% respectively. Staff recognition rates for persistent dementias increased over the 12-month period but 25% of cases were still unrecognized at 12 months. Treatment was complete at 12 months for 71% of persistent dementia cases and 43% of persistent non-cognitive psychiatric disorder cases. Individuals recently admitted to AL are at high risk for having or developing mental disorders and a high proportion of cases, both persistent and incident, go unrecognized or untreated. Routine dementia and psychiatric screening and reassessment should be considered a standard care practice. Further study is needed to determine the longitudinal impact of psychiatric care on resident outcomes and use of facility resources.

The Italian National External Quality Assessment Program in Molecular Genetic Testing: Results of the VII Round (2010-2011)

Since 2001 the Istituto Superiore di Sanità established a quality assurance programme for molecular genetic testing that covers four pathologies: Cystic Fibrosis (CF), Beta Thalassemia (BT), Fragile X Syndrome (FX), and Familial Adenomatous Polyposis Coli (APC). Since 2009 this activity is an institutional activity and participation is open to both public and private laboratories. Seven rounds have been performed until now and the eighth is in progress. Laboratories receive 4 DNA samples with mock clinical indications. They analyze the samples using their routine procedures. A panel of assessors review the raw data and the reports; all data are managed through a web utility. In 2010 the number of participants was 43, 17, 15, 5 for CF, BT, FX, APC schemes respectively. Genotyping results were correct in 96%, 98.5%, 100%, and 100% of CF, BT, FX, and APC samples, respectively. Interpretation was correct in 74%, 91%, 88%, and 60% of CF, BT, FX, and APC reports, respectively; however in most of them it was not complete but a referral to genetic counseling was given. Reports were satisfactory in more than 60% of samples in all schemes. This work presents the 2010 results in detail comparing our data with those from other European schemes.

Reporting and grading of complications after urologic surgical procedures: An ad hoc EAU guidelines panel assessment and recommendations

ContextThe incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology. ObjectiveTo review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien–Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes. Evidence acquisitionStandardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999–2000 and 2009–2010. Data identification for the systematic assessment of the Clavien–Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms. Evidence synthesisThe systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien–Dindo system. The latter system was not properly used in 72 papers (35.3%). ConclusionsUniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria.

Genetic parameters for concentrations of minerals in longissimus muscle and their associations with palatability traits in Angus cattle1

The objective of this study was to estimate genetic parameters for concentrations of minerals in LM and to evaluate their associations with beef palatability traits. Samples of LM from 2,285 Angus cattle were obtained and fabricated into steaks for analysis of mineral concentrations and for trained sensory panel assessments. Nine minerals, including calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc, were quantified. Restricted maximum likelihood procedures were used to obtain estimates of variance and covariance components under a multiple-trait animal model. Estimates of heritability for mineral concentrations in LM varied from 0.01 to 0.54. Iron and sodium were highly and moderately heritable, respectively, whereas the other minerals were lowly heritable except for calcium, copper, and manganese, which exhibited no genetic variation. Strong positive genetic correlations existed between iron and zinc (0.49, P < 0.05), between magnesium and phosphorus (0.88, P < 0.05), between magnesium and sodium (0.68, P < 0.05), and between phosphorus and potassium (0.69, P < 0.05). Overall tenderness assessed by trained sensory panelists was positively associated with manganese, potassium, and sodium and negatively associated with phosphorus and zinc concentrations (P < 0.05). Juiciness assessed by trained sensory panelists was negatively associated with magnesium and positively associated with manganese and sodium concentrations (P < 0.05). Livery or metallic flavor was not associated with any of the minerals (P > 0.05). Beefy flavor was positively associated with calcium, iron, and zinc and negatively associated with sodium concentration, whereas a painty or fishy flavor was positively associated with sodium and negatively associated with calcium and potassium concentrations (P < 0.05). Beef is a major contributor of iron and zinc in the human diet, and these results demonstrate sufficient genetic variation for these traits to be improved through marker-assisted selection programs without compromising beef palatability.

Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

BackgroundSkin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed.MethodsRetrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent) as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group), and analysis was done to identify factors affecting the highest patient satisfaction.ResultsThe mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%), ductal carcinoma in situ (n = 15, 23.1%), and others (n = 2, 3.1%). One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%), scarring (n = 8, 12.3%), and back pain (n = 6, 9.2%). Fifty patients (76.9%) were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P <0.001), nipple cosmesis (P <0.001), visual difference of bilateral breasts (P = 0.021), and panel assessment score (P <0.001) were factors that affected the highest patient satisfaction.ConclusionsOur SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient’s expectation.

Measuring and Addressing Texture Challenges in Healthy Baked Products

There is a continuing trend toward development of baked products with a healthy nutritional profile. However, to succeed in the market, it is essential that sensory properties of baked products not be compromised. Texture is an important aspect of this. Instrumental measurements are important tools for product developers that can complement sensory panel assessments and enable quantification of the effects of process variations. A range of testing protocols and instruments suitable for different product types is available. Compression between flat plates is appropriate for testing compressible products such as breads and cakes: initial loading provides information on firmness, and subsequent unloading and recompression measure properties such as cohesiveness. Examples are presented from trials evaluating salt content and bran supplementation in bread and for a gluten-free cake development project. Brittle products such as biscuits (cookies and crackers) can be tested using protocols such as three point be...

Temporal aspects of yoghurt texture perception

Temporal dominance of sensations (TDS) methodology was used to study the influence of yoghurt composition on sensory texture and to compare results with those from quantitative descriptive analysis (QDA). Eight yoghurts with different texture characteristics were formulated varying fat, modified starch and gelatine concentration. A trained assessor panel evaluated yoghurt texture using QDA and TDS. TDS provided information about the sequence of attributes that were dominant during consumption. This methodology was useful to characterise yoghurt texture, providing information about the influence of the evaluated formulation variables that was not gathered by QDA; starch did not significantly increase creaminess intensity but it led to an increase in its total dominance. Differences between attribute intensity and dominance were higher for complex texture attributes which were evaluated throughout consumption, such as creaminess and mouth coating.

Sensory analysis of enzyme- and membrane-treated peach juices

Introduction . The aim of this work was to develop a list of suitable sensory attributes and to perform sensory quality assessment of an unprocessed peach juice and a peach juice clarified by enzymatic treatment followed by membrane processes, using the attributes chosen by the trained panel. Materials and methods . A panel of assessors was selected and trained following the quantitative descriptive analysis methodology. A descriptive terminology with eight descriptors was successfully developed. Results and discussion . The sensory analysis showed that the juices were effectively clarified. Although the clarification by microfiltration in a bench-scale unit did not change juice taste attributes, the characteristic color and aroma of peach juice were also removed. The scale-up of the membrane clarification process affected all the sensory characteristics of the clarified juice, even taste. The unpleasant cooked fruit taste and aroma could be reduced by juice clarification by enzymatic and membrane processes. The kind of membrane, membrane geometry and transmembrane pressure used in the membrane clarification did not significantly affect the juice sensory characteristics.

Expert Panel Assessment of 57 Monocultivar Olive Oils Produced from the Tuscan Germplasm

An expert's panel according to the official method of International Olive Oil Council analyzed the organoleptic profile of the oils produced during one single harvesting season from 57 cultivars of the Tuscan germoplasm. The oils were grouped in three different clusters depending on the presence of different organoleptic features. The identified clus- ters of the extra virgin olive oils were compared for maturity index of the fruits and for the phenols content and acidic pro- file. Since phenols content and acidic profile depend on the genetic matrix hence the cultivar played a fundamental role on the overall quality. The majority of the varieties produced oils with the attributes requested by the local Protected Origin while others induced sensations, at the moment, not considered in the disciplinary of production like tomato or herbs. The presence of peculiar organoleptic attributes like tomato, sweet pepper, camomile or others is not common within the olive oils and they are present only to few varieties. The list of possible positive descriptors for the extra virgin olive oils could be enlarged or better specified including the terms of melon and chestnut flour. We proposed also the olfactory sensation of mushroom as reminiscent of the typical and pleasant odour of fresh cut mushroom as a possible new negative attribute of the extra virgin olive oil induced by the presence of antrachnose (Colletotrichum gloesporioides; Glomerella cingulata) on the olive fruits.

Genetic parameters for carnitine, creatine, creatinine, carnosine, and anserine concentration in longissimus muscle and their association with palatability traits in Angus cattle1

The objective of this study was to estimate genetic parameters for carnitine, creatine, creatinine, carnosine, and anserine concentration in LM and to evaluate their associations with Warner-Bratzler shear force (WBSF) and beef palatability traits. Longissimus muscle samples from 2,285 Angus cattle were obtained and fabricated into steaks for analysis of carnitine, creatine, creatinine, carnosine, anserine, and other nutrients, and for trained sensory panel and WBSF assessments. Restricted maximum likelihood procedures were used to obtain estimates of variance and covariance components under a multiple-trait animal model. Estimates of heritability for carnitine, creatine, creatinine, carnosine, and anserine concentrations in LM from Angus cattle were 0.015, 0.434, 0.070, 0.383, and 0.531, respectively. Creatine, carnosine, and anserine were found to be moderately heritable, whereas almost no genetic variation was observed in carnitine and creatinine. Moderate positive genetic (0.25, P < 0.05) and phenotypic correlations (0.25, P < 0.05) were identified between carnosine and anserine. Medium negative genetic correlations were identified between creatine and both carnosine (-0.53, P < 0.05) and anserine (-0.46, P < 0.05). Beef and livery/metallic flavor were not associated with any of the 5 compounds analyzed (P > 0.10), and carnitine concentrations were not associated (P > 0.10) with any of the meat palatability traits analyzed. Carnosine was negatively associated with overall tenderness as assessed by trained sensory panelists. Similar negative associations with overall tenderness were identified for creatinine and anserine. Painty/fishy was the only flavor significantly and negatively associated with creatinine and carnosine. These results provide information regarding the concentration of these compounds, the amount of genetic variation, and evidence for negligible associations with beef palatability traits in LM of beef cattle.

Moving beyond guidelines to ensure high-quality cancer care in the United States.

Moving beyond guidelines to ensure high-quality cancer care in the United States.

Impacts of a clay plaster on indoor air quality assessed using chemical and sensory measurements

Passive removal materials (PRMs) are building materials or furnishings that effectively control indoor pollution without substantial formation of chemical byproducts and without an energy penalty. Recent studies have suggested that clay might be an effective PRM for ozone. To assess clay wall plaster as a PRM for improving air quality by controlling ozone, perceived air quality (PAQ) was determined in the presence of eight combinations of an emitting and reactive pollutant source (new carpet), clay plaster applied to gypsum wallboard, and chamber air with and without ozone. A panel of 24 human subjects assessed air quality in twin 30m3 chambers using a continuous acceptability scale. Air samples were collected immediately prior to panel assessment to quantify concentrations of C5–C10 saturated n-aldehydes and two aromatic aldehydes that are commonly produced by reaction of ozone with carpet. Perceived air quality was most acceptable and concentrations of aldehydes were lowest when only clay plaster or both clay plaster and carpet were present in the chambers without ozone. The least acceptable PAQ and the highest concentrations of aldehydes were observed when carpet and ozone were present together; addition of clay plaster for this condition improved PAQ and considerably decreased aldehyde concentrations.