Purpose Of Clinical Evaluation Research Articles

Comparison of three measures for insomnia in ischemic stroke patients: Pittsburgh sleep quality index, insomnia severity index, and Athens insomnia scale.

This study investigated the consistency and determined the optimal threshold values of three scales in the diagnosis of insomnia of ischemic stroke (IS) patients. Participants in this study consisted of 569 acute IS patients. All 569 patients completed the assessment of the three insomnia scales. Insomnia of IS patients were assessed by Pittsburgh sleep quality index (PSQI), Insomnia Severity Index (ISI), and Athens insomnia scale (AIS). Also, basic patient information, neurological function, and activities of daily living were assessed. General information was compared between the insomnia group and the no-insomnia group. Cronbach's α coefficients, Cohen's Kappa consistency, Receiver operating characteristic (ROC) curve and DeLong's test analysis were used to analyze the reliability and diagnostic validity of PSQI, ISI, and AIS. The PSQI and ISI showed high reliability with Cronbach's α of 0.875 and 0.858, respectively, while the AIS had an α coefficient of 0.734, demonstrating acceptable reliability. The PSQI, ISI, and AIS showed outstanding diagnostic ability with an AUC of 0.960 (95% CI: 0.946, 0.974), 0.911 (95% CI: 0.882, 0.941), and 0.876 (95% CI:0.837, 0.916). The best diagnostic cutoffs for PSQI, ISI, and AIS are ≥9, ≥15, and ≥8. Each of the three questionnaires has advantages and disadvantages when assessing insomnia. In the evaluation of insomnia in IS patients, the best questionnaire selection should be made according to the purpose of clinical evaluation and considering the sensitivity and specificity.

Implication of ZNF217 in Accelerating Tumor Development and Therapeutically Targeting ZNF217-Induced PI3K-AKT Signaling for the Treatment of Metastatic Osteosarcoma.

We previously identified ZNF217 as an oncogenic driver of a subset of osteosarcomas using the Sleeping Beauty (SB) transposon system. Here, we followed up by investigating the genetic role of ZNF217 in osteosarcoma initiation and progression through the establishment of a novel genetically engineered mouse model, in vitro assays, orthotopic mouse studies, and paired these findings with preclinical studies using a small-molecule inhibitor. Throughout, we demonstrate that ZNF217 is coupled to numerous facets of osteosarcoma transformation, including proliferation, cell motility, and anchorage independent growth, and ultimately promoting osteosarcoma growth, progression, and metastasis in part through positive modulation of PI3K-AKT survival signaling. Pharmacologic blockade of AKT signaling with nucleoside analogue triciribine in ZNF217+ orthotopically injected osteosarcoma cell lines reduced tumor growth and metastasis. Our data demonstrate that triciribine treatment may be a relevant and efficacious therapeutic strategy for patients with osteosarcoma with ZNF217+ and p-AKT rich tumors. With the recent revitalization of triciribine for clinical studies in other solid cancers, our study provides a rationale for further evaluation preclinically with the purpose of clinical evaluation in patients with incurable, ZNF217+ osteosarcoma.

Convergent and Concurrent Validity between Clinical Recovery and Personal-Civic Recovery in Mental Health.

Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess convergent-concurrent validity between clinical recovery, citizenship and personal recovery. Recovery-oriented mental health care and services are particularly recognizable by the presence of Peer Support Workers, who are persons with lived experience of recovery. Upon training, they can personify personalized mental health care and services, that is to say services that are centered on the person’s recovery project and not only on their symptoms. Data from our overall research strategy will lay the ground for the evaluation of the effects of the intervention of Peer Support Workers on clinical recovery, citizenship and personal recovery.

Telehealth Is Transforming Health Care: What You Need to Know to Practice Telenutrition

Continuing Professional Education (CPE) Information The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and through www.jandonline.org (click on “CPE” in the menu and then “Academy Journal CPE Articles”). Log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] . There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published. “Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, and public health and health administration,” according to the Academy of Nutrition and Dietetics (Academy) Definition of Terms List. 1 Academy of Nutrition and Dietetics. Practicing telehealth. Definition of terms list. Reviewed April 2018. https://www.eatrightpro.org/practice/practice-resources/telehealth/practicing-telehealth. Accessed July 7, 2019. Google Scholar Telehealth communication tools may include video conferencing, e-mail, and mobile or app-enabled technology, as well as store-and-forward or asynchronous technologies that securely transmit clinical information (data, image, sound, and video) collected from wearable devices or by other sources for the purpose of clinical evaluation. The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and through www.jandonline.org (click on “CPE” in the menu and then “Academy Journal CPE Articles”). Log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] . There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published. T. Peregrin is an editor and writer for a Chicago-based medical association and a freelance writer in Chicago, IL.

Acute Assessment of Traumatic Brain Injury and Post-Traumatic Stress After Exposure to a Deployment-Related Explosive Blast.

IntroductionTraumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are two of the signature injuries in military service members who have been exposed to explosive blasts during deployments to Iraq and Afghanistan. Acute stress disorder (ASD), which occurs within 2–30 d after trauma exposure, is a more immediate psychological reaction predictive of the later development of PTSD. Most previous studies have evaluated service members after their return from deployment, which is often months or years after the initial blast exposure. The current study is the first large study to collect psychological and neuropsychological data from active duty service members within a few days after blast exposure.Materials and MethodsRecruitment for blast-injured TBI patients occurred at the Air Force Theater Hospital, 332nd Air Expeditionary Wing, Joint Base Balad, Iraq. Patients were referred from across the combat theater and evaluated as part of routine clinical assessment of psychiatric and neuropsychological symptoms after exposure to an explosive blast. Four measures of neuropsychological functioning were used: the Military Acute Concussion Evaluation (MACE); the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); the Headminder Cognitive Stability Index (CSI); and the Automated Neuropsychological Assessment Metrics, Version 4.0 (ANAM4). Three measures of combat exposure and psychological functioning were used: the Combat Experiences Scale (CES); the PTSD Checklist-Military Version (PCL-M); and the Acute Stress Disorder Scale (ASDS). Assessments were completed by a deployed clinical psychologist, clinical social worker, or mental health technician.ResultsA total of 894 patients were evaluated. Data from 93 patients were removed from the data set for analysis because they experienced a head injury due to an event that was not an explosive blast (n = 84) or they were only assessed for psychiatric symptoms (n = 9). This resulted in a total of 801 blast-exposed patients for data analysis. Because data were collected in-theater for the initial purpose of clinical evaluation, sample size varied widely between measures, from 565 patients who completed the MACE to 154 who completed the CES. Bivariate correlations revealed that the majority of psychological measures were significantly correlated with each other (ps ≤ 0.01), neuropsychological measures were correlated with each other (ps ≤ 0.05), and psychological and neuropsychological measures were also correlated with each other (ps ≤ 0.05).ConclusionsThis paper provides one of the first descriptions of psychological and neuropsychological functioning (and their inter-correlation) within days after blast exposure in a large sample of military personnel. Furthermore, this report describes the methodology used to gather data for the acute assessment of TBI, PTSD, and ASD after exposure to an explosive blast in the combat theater. Future analyses will examine the common and unique symptoms of TBI and PTSD, which will be instrumental in developing new assessment approaches and intervention strategies.

Stakeholder consensus on the purpose of clinical evaluation of electronic health records is required

ObjectiveTo explore the purpose and performance of clinical evaluation of electronic health records (EHRs) among stakeholders in order to identify any need for regulatory actions or guidelines. MethodsThis was a qualitative study of information collected in semi-structured interviews (n=28) of representatives of the five largest EHR vendors in Sweden, healthcare provider IT managers, users, and representatives of national authorities. ResultsWe found a difference between the stated purpose of clinical evaluation of EHRs by the authorities and the perception of the purpose by the vendors, IT managers, and the users. The respondents gave divergent answers about the medical purpose of the application: e.g. availability of data, overview and documentation, patient safety, process efficiency, decision support, a working tool, and an aid to communication and follow-up. Several vendors found it difficult to put the term clinical evaluation in its specific context, instead referring to literature reviews, risk analyses, risk-management processes, acceptance tests, test facilities, pilot tests, and proven experience. ConclusionsStakeholders need to agree on a mutually acceptable, consistent method to guide regulatory decisions. The lack of consensus regarding the purpose and performance of clinical evaluation of EHRs could impact negatively on a safe and efficient documentation in healthcare. Thus, there is a need for more consistent use of terms and concepts in, and a more systematic approach to, clinical evaluation of EHRs. To ensure that the implementation of IT in healthcare meets expectations, delivers the desired outcome, and does not create new problems, it should be evaluated.

Preliminary evaluation of image quality in a new clinical ToF-PET/MR scanner.

A new ToF-PET/MR scanner has recently been deployed at the University Hospital of Zurich for clinical evaluation purposes. The goal of the present work was to compare the image quality obtained on this system with that of equivalent state-of-the-art standalone scanners. The GE Signa PET/MR is a whole-body scanner combining a 3T wide-bore MR system with a 25 cm PET detector ring based on SiPM technology and mounted on a customized radiofrequency coil. MR image quality of this system was tested by scanning two volunteers: One with a brain protocol and another with a whole-body protocol. The same scans were repeated before and after PET detectors were installed on the system. A baseline measurement was acquired on a Discovery 750w scanner with the same volunteers. PET image quality was tested on patients referred for an FDG PET/CT scan. After 15-20 minutes of PET/CT, the patients were moved to the PET/MR, where an equivalent acquisition was performed. Data were reviewed by nuclear medicine and radiology physicians. As seen in Figure ​Figure1,1, MR image quality in the brain is identical between PET/MR (pre- and post-insert) and MR750w. In whole-body scans, shading on the images due to different receive coil sensitivity were observed. These are explained by the replacement of the bed-mounted posterior array coil by a central matrix array at the scanner iso-center. Figure ​Figure22 illustrates the differences in PET, showing equivalent or better quality in the PET/MR data, despite latter acquisition, justified by the increased sensitivity of the scanner. Figure 1 Coronal 2D MERGE views of a healthy volunteer scanned on a Discovery 750w (left), on the PET/MR before the installation of the PET insert (center) and on the same scanner once the insert was in place and online (right). Figure 2 Three-dimensional maximum intensity projection of a PET/CT acquisition (left) and posterior PET/MR acquisition (right) of the same patient. Our results show that the image quality of clinical MR sequences is not affected by the presence of the PET detector insert. PET image quality shows great promise, but will require further testing to confirm this quantitatively.

진동자극 방식이 뇌병변 환자의 상지경직에 미치는 영향

본 연구는 뇌병변으로 상지경직이 관찰되는 환자를 대상으로 자극방식에 따른 진동자극이 경직에 미치는 영향에 대하여 알아보고자 하였다. 뇌병변으로 인해 상지경직이 있는 21명의 환자가 연구에 참여하였고, 실험군 I: 길항근(상완삼두근)자극, 실험군II: 주동근(상완이두근)자극, 실험군III: 동시(상완삼두근 및 상완이두근)자극에 각 7명씩을 배정하여 진동자극을 실시하였다. 척수운동신경원 흥분성을 알아보기 위해 Neuro-EMG_Micro를 이용한 F파를 자극전, 자극 직후, 자극 10분 후, 자극 20분 후에 측정하였고, 임상적 평가로는 MAS(Modified Ashworth Scale)와 MFT(Manual Function Test)를 자극 전, 자극 20분 후에 평가하였다. 본 연구의 결과, MAS는 세군 모두 유의한 감소를 나타냈고, F파 진폭 및 F/M비에서는 세군 모두에서 자극 직후에서부터 유의한 감소를 나타냈으며, 실험군III에서 시간 경과상 변화량이 가장 크게 나타났다. MFT에서는 실험군II와 III에서 유의한 증가를 나타냈으며 특히, 실험군III에서 기능적 변화량이 가장 크게 나타났다. 이러한 결과는 경직근에 대한 진동자극시 경직 주동근이나 길항근에 대한 단일 자극 방식보다는 동시자극 방식이 척수운동신경원의 흥분성 감소 및 상지 운동 기능 향상에 더 효과적임을 확인할 수 있었다. We studied the effects of vibration stimulation method on upper limbs spasticity in patients with brain lesion. 21 patients with spasticity of the upper limbs selected and divided randomly 3 groups. And then vibratory stimulation was applied to the triceps brachii muscle in group I(n=7), to biceps brachii muscle in group II (n=7), and to both muscles in group III (n=7). Using Neuro-EMG_Micro to investigate the changes in spinal neuronal excitability, F-waves were measured at before and directly after stimulation, and 10 minutes later and 20 minutes later after stimulation especially. MAS(Modified Ashworth Scale) test for muscle tone and MFT(Manual Function Test) for the upper extremity motor function were performed before stimulation and 20 minutes later after stimulation for the purpose of clinical evaluation. In our study, MAS was significant decreased in all groups, F wave and F/M ratio parameters were decreased in all groups and more decreased specially in group III. MFT was increased in group II and III, and more increased specially in group III. Vibration stimulation reduced the neuronal excitability of spinal cord and also muscle tone, and improved the motor function of the upper extremity. These results suggested that vibration stimulation giving to both muscles(triceps and biceps brachii muscle) at the same time was more efficiency in reducing the neuronal excitability of spinal cord and improving the motor function of the upper limbs.

New calibration method for I-scan sensors to enable the precise measurement of pressures delivered by ‘pressure garments’

Accurate measurement of the pressure delivered by medical compression products is highly desirable both in monitoring treatment and in developing new pressure inducing garments or products. There are several complications in measuring pressure at the garment/body interface and at present no ideal pressure measurement tool exists for this purpose. This paper summarises a thorough evaluation of the accuracy and reproducibility of measurements taken following both of Tekscan Inc.’s recommended calibration procedures for I-scan sensors; and presents an improved method for calibrating and using I-scan pressure sensors. The proposed calibration method enables accurate (±2.1 mmHg) measurement of pressures delivered by pressure garments to body parts with a circumference ≥30 cm. This method is too cumbersome for routine clinical use but is very useful, accurate and reproducible for product development or clinical evaluation purposes.

Development of a clinical evaluation tool for baccalaureate nursing students

The purpose of clinical evaluation is to facilitate the development of students into safe, ethical and accountable practitioners. Evaluation measures should ensure fairness, consistency across settings and teachers, utilize indicators which reflect the realities of practice and education and facilitate deeper level student/teacher clinical discourse and learning. A new clinical evaluation tool was developed in a baccalaureate program in Ontario to address the variety of tools utilized and the need to demonstrate progression in depth and scope of practice. A consistent evaluation process was needed, leveled over the four years of the program and framed by the School's five program outcomes: knowledge worker, critical thinker, self-directed learner, evolving professional and effective communicator. A new tool was borne through an examination of relevant literature, the five program outcomes, College of Nurses of Ontario entry to practice competencies, practicum course outlines and various tools used in the undergraduate program. The process of tool development involved multiple drafts, ongoing dialogue and meetings with clinical teachers and course coordinators as well as feedback from students. Commitment, collaboration and collegiality were key elements in the construction of this tool.

Skin biopsy findings: Implications for the pathophysiology of fibromyalgia

The mechanisms responsible for symptom expression in fibromyalgia (FM) are complex. The most consistently detected objective abnormalities in FM involve pain-processing systems. Up to recently, central nervous system was a primary focus of investigations in FM. Although it is unlikely that FM occurs because of primary disorders of the peripheral tissues, there are still data to suggest that some abnormalities can be detected in the periphery. With the recognition of abnormalities in skin of some FM patients, it is now apparent that the role of peripheral nerve endings in FM is much greater than previously thought. The aim of this paper is to review literature concerning the skin biopsy findings of FM patients and discuss their potential relevance to FM. This paper suggests that patients with FM represent a state of the dysfunction of descending, antinociceptive pathways and low hypothalamic-pituitary-adrenal function. This state is further proposed to result in many skin biopsy findings associated with the disorder, including increased N-methyl-d-aspartate receptors subtype 2D expression, neurogenic inflammation and characteristic electron microscopic findings. Future direction of research would be identification of specific laboratory markers such as skin biopsy for diagnostic and clinical evaluation purposes in FM.

α1-Antitrypsin and fibromyalgia: new data in favour of the inflammatory hypothesis of fibromyalgia

alpha1-Antitrypsin (AAT) circulates in high serum concentrations, and impregnates most body tissues. AAT has a broad anti-inflammatory spectrum, and modulates most inflammatory reactions occurring in human body. Recently, a possible relationship between AAT deficiency (AAT-D) and fibromyalgia (FM) has been raised, with the finding that intravenous infusions of purified human AAT efficiently controlled FM symptoms in two patients with severe hereditary AAT-D. On the other hand, functional magnetic resonance imaging has detected a significant greater activity in pain sensitive areas of the brain in patients with FM, in response to cutaneous stimuli, providing further evidence for a physiological explanation for FM pain. In recent studies abnormal profiles of inflammation markers in serum and biopsies have been found in FM patients. Since most of these inflammation mediators can be inhibited by AAT, these observations would suggest that at least a subset of the FM syndrome could be related to an inflammatory process, possibly due to an imbalance between inflammatory and anti-inflammatory substances, in the soft body tissues. Future directions of research would be: (1) to develop epidemiological studies to determine the gene frequency of AAT deficiency alleles in FM patients; (2) implementation of a double-blind placebo-controlled clinical trial to determine the specific role of AAT augmentation therapy in AAT-D patients with FM; (3) identification of specific laboratory markers for diagnostic and clinical evaluation purposes in FM; (4) application of the newest medical imaging techniques for diagnosis; and (5) identification of genetic, familial, and environmental risk factors suspected to participate in the FM syndrome development.

Presenting, analysing & discussing the results

The purpose of clinical evaluation is to identify changes due to a treatment. The Results section is where these changes are presented as data summarised in tables, graphs and dots, so that any changes and their extent can be easily seen. Statistical tests are used to confirm that these changes are due to treatment and not due to chance. The choice of test depends on factors such as the measurement scales and data distribution and these are outlined. Finally, the meaning of the results and their ramifications are given in the Discussion section.

The Autoantibody Response to Ro/SSA in Cutaneous Lupus Erythematosus

Seventeen patients with subacute cutaneous lupus erythematosus (SCLE) were compared with 15 patients with discoid lupus erythematosus (DLE) to evaluate the relationship of 60- and 52-kd Ro/SSA autoantibodies to the clinical diagnosis and to evaluate assays for anti-Ro/SSA. All serum samples from patients with SCLE had precipitating anti-Ro/SSA antibodies in immunodiffusion, and all had high titer anti-60-kd Ro/SSA in enzyme-linked immunosorbent assay. Immunoblotting was inadequately sensitive for detecting anti-60-kd Ro/SSA. Fifteen patients with SCLE had anti-52-kd Ro/SSA (11 high titer, four low titer). Only one of the 15 patients with DLE had precipitating, high-titer anti-Ro/SSA. Nine other patients with DLE had low-titer anti-60-kd Ro/SSA, and four had low-titer anti-52-kd Ro-SSA. Low-titer anti-Ro/SSA did not confer an increased risk for photosensitivity in the DLE group. High-titer, precipitating antibodies to Ro/SSA are typical of SCLE and unusual in DLE. Low-titer, nonprecipitating antibodies to Ro/SSA are common in DLE and could be an indication of pathogenic factors shared with SCLE. However, low titers of anti-Ro/SSA do not confer a significant risk for SCLE skin lesions. For the purpose of clinical evaluation of skin disease, immunodiffusion assays for anti-Ro/SSA are cost-effective and informative.

Occupational screening for neurotoxicity: Computerized techniques

Computer-administered testing systems for assessing the functional consequences of neurotoxicant exposure in the workplace have recently been developed. Mainly, they have been applied in laboratory studies of acute exposures, quasi-experimental field studies of acute and sub-acute exposures, and cross-sectional epidemiologic investigations of chronic exposures. Some automated tests appear quite sensitive and reliable in these situations where group comparisons are made. However, testing methods suitable for the purpose of clinical evaluation are not yet well developed. Programs of neurobehavioral surveillance in industry are necessry to provide reference data for clinical, screening and epidemiologic purposes and to provide essential baseline data for individuals at risk.

Evaluation of small acute blood loss in man

The accuracy and comparative results of hemoglobin, hematocrit, red cell blood count, I 131 HSA blood volume, blood pressure, and pulse in one hundred human subjects with measured acute blood loss have been studied. These studies were carried out in each donor prior to, immediately after, at ten minutes, and at forty-eight hours after donation of 460 to 480 ml. of whole blood. Hemoglobin, hematocrit, and red blood cell counts all showed a small but persistent drop with a small standard deviation of 2 to 5 per cent. The hematocrit, on the average, had a higher point drop of 1.21 per cent at ten minutes after donation and 3.75 per cent at forty-eight hours after donation, possibly allowing this to be the better of these three mentioned studies for clinical evaluation purposes. The red blood cell volume, plasma volume, and whole blood volume determinations had similar standard deviations of 10 per cent throughout. The red blood cell volume showed an average decrease of 141 ml. at ten minutes after donation and 102 ml. at forty-eight hours. The blood volume showed a decrease of 259 ml. at the ten minute postdonation period and a hypervolemia of 183 ml. at the forty-eight hour period due to the increased plasma volume.

CHARACTERISTICS OF POST-PARTUM MENTAL ILLNESS

In a study of non-dementing psychoses among older individuals encountered in private psychiatric practice, the senior authors( i) were impressed by the difficulties in classification of these cases for the purpose of clinical evaluation. In this group of older people certain epochal influences often seemed to be of factual significance although the accepted classification had no place for such qualification of the behavioral reaction; as in the case of a severe depressive reaction, more situational and psychoneurotic than would be implied in involutional reactions, and clinically differing from these, but occurring in the physical and psychological background of the involutional period in life. We were impressed with the generally accepted designation of a severe behavior disturbance of post-partum evolution as a postpartum psychosis by general practitioners, as if these reactions constitutedan epochal disease sui generi�. This probably stems from the circumstance that a severe mental aberration attributable to unusual stress, and particularly to the hazards of childbirth, is socially more acceptable than a similar mental illness arising without apparent cause and therefore implying some degenerative inheritablestigma. Onset of the mental illnessusually very soon after delivery is another factoraidingthisconcept. Furthermore, the psychological content of the illness is often related to the circumstance of maternity, such as expressions of overwhelming inadequacy and inability to care for the newborn infant. In the course of private hospital practice the senior authors gained the impression, without the salutary influence of any statistical analysis, that these patients responded rather well to energetic therapy begun early