Clinical trial experience by simulation: a workshop report.
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A new computer program for experimental design simulation was used in a three-day postgraduate workshop on clinical trials. Participants were given information on a fictitious new drug and asked to design a trial to evaluate it. On the first day they reviewed the data and designed a protocol, and results for these specifications were generated on the computer. The second day was spent analysing results, and on the last day the findings of the different studies were presented at a symposium. Flexibility of the program ensured a high degree of realism in all trials and emphasised the influence of design on results and conclusions. (+info)
Techniques for assessment of teratogenic effects: developmental enzyme patterns.
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Most studies designed for assessing teratogenic effects focus on only three of four types of final manifestations of abnormal development; namely intrauterine death, malformations, and growth retardation. Developmental toxicity evaluations generally do not include functional deficits. Current techniques are inadequate for assessing functional capability during perinatal development, and there is a need for improved measures. Thus, measurement of developmental enzyme patterns is proposed as an approach that directly evaluates acquisition of metabolic competence of fundamental organ systems. During ontogenesis most organs acquire their full complement of enzyme activities in a programmed sequence which corresponds to attainment of complete functional capability. The usual alterations in enzyme activity that characterize these patterns occur at one of three time periods, namely, late fetal, early neonatal, or late suckling. Qualitative or quantitative changes in these patterns at any time by one or more key enzymes of a tissue could be indicative of developmental toxicity. Factors are outlined relating to consideration of developmental enzyme profiles as indices of maturation capable of reflecting the action of toxic agents. This presentation: (1) reviews the current state of the art for evaluating effects on development, (2) considers the applicability of enzyme patterns for biochemical assessment of development, (3) characterizes the target tissues and those metabolic pathways and/or specific enzymes most sensitive and adaptable to practical toxicity evaluations, and (4) describes the steps being taken to validate this system. The ultimate objective of this approach is to determine whether alterations in developmental enzyme profiles will provide a technique with improved capability for assessing developmental toxicity. (+info)
Assessment of current test procedures.
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The belief that screening tests for teratogenicity are of low predictive value has many supporters who point to the inconsistency with which malformations are induced. However, to fault the test systems when such inconsistency is predictable from both the inherently unstable nature of a malformation and from fundamental principles of teratology, is unrealistic, and, as is shown, perhaps the greater faults lie with the critics. It is suggested by examples that, if attention was concentrated not on the inconsistent malformations but on more consistent embryopathic effects which in one form or another are always associated with malformations, the predictive value of the screening tests would appear in a more favorable light. Thus, even if malformations are not demonstrated, the range of conditions (dosages) in which they might occur can be determined. Such information, used in conjunction with that obtained from other preclinical studies, can then form a reasonably sound basis for extrapolation to man. (+info)
Occupational stress in human computer interaction.
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There have been a variety of research approaches that have examined the stress issues related to human computer interaction including laboratory studies, cross-sectional surveys, longitudinal case studies and intervention studies. A critical review of these studies indicates that there are important physiological, biochemical, somatic and psychological indicators of stress that are related to work activities where human computer interaction occurs. Many of the stressors of human computer interaction at work are similar to those stressors that have historically been observed in other automated jobs. These include high workload, high work pressure, diminished job control, inadequate employee training to use new technology, monotonous tasks, por supervisory relations, and fear for job security. New stressors have emerged that can be tied primarily to human computer interaction. These include technology breakdowns, technology slowdowns, and electronic performance monitoring. The effects of the stress of human computer interaction in the workplace are increased physiological arousal; somatic complaints, especially of the musculoskeletal system; mood disturbances, particularly anxiety, fear and anger; and diminished quality of working life, such as reduced job satisfaction. Interventions to reduce the stress of computer technology have included improved technology implementation approaches and increased employee participation in implementation. Recommendations for ways to reduce the stress of human computer interaction at work are presented. These include proper ergonomic conditions, increased organizational support, improved job content, proper workload to decrease work pressure, and enhanced opportunities for social support. A model approach to the design of human computer interaction at work that focuses on the system "balance" is proposed. (+info)
Epidemiology of job stress and health in Japan: review of current evidence and future direction.
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With the increasing concern about job stress, there is a growing body of literature addressing psychosocial job stress and its adverse effects on health in Japan. This paper reviews research findings over the past 15 years concerning the assessment of job stress, the relationship of job stress to mental and physical health, and the effects of worksite stress reduction activities in Japan. Although studies were conducted in the past using ad-hoc job stress questionnaires, well-established job stressor scales have since been translated into Japanese, their psychometric properties tested and these scales extensively used in recent epidemiologic studies. While the impact of overtime and quantitative job overload on mental health seems moderate, job control, skill use and worksite support, as well as qualitative job demands, had greater effects on psychological distress and drinking problems in cross-sectional and prospective studies. These job stressors also indicated a strong association with psychiatric disorders, including major depression, even with a prospective study design. Long working hours were associated with a higher risk of myocardial infarction, diabetes mellitus and hypertension. There is evidence that the job demands-control model, as well as the use of new technology at work, is associated with higher levels of blood pressure and serum lipids among Japanese working populations. Fibrinolytic activity, blood glucose levels, immune functions and medical consultation rates were also affected by job stressors. It is further suggested that Japanese workers tend to suppress expression of positive feelings, which results in apparently higher psychological distress and lower job satisfaction among Japanese workers compared with workers in the U.S. Future epidemiologic studies in Japan should focus more on a prospective study design, theoretical models of job stress, job stress among women, and cultural difference and well-designed intervention studies of various types of worksite stress reduction. (+info)
MR contrast media in neuroimaging: a critical review of the literature.
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BACKGROUND AND PURPOSE: MR contrast media are commonly used but do not have evidence-based guidelines for their application. This investigation seeks to define specific methodological problems in the MR contrast media literature and to suggest guidelines for an improved study design. METHODS: To evaluate the reported clinical efficacy of MR contrast media in neuroimaging, we performed a critical review of the literature. From 728 clinical studies retrieved via MEDLINE, we identified 108 articles that evaluated contrast media efficacy for a minimum of 20 patients per study. The articles were randomly assigned to four readers (a fifth reader reviewed all of the articles) who were blinded to article titles, authors, institutions, and journals of publication. The readers applied objective, well-established methodological criteria to assign each article a rating of A, B, C, or D. RESULTS: One hundred one of 108 articles received a D rating, six received a C rating, and one received a B rating. In general, the Methods sections of the evaluated articles did not contain details that would allow the reader to calculate reliable measures of diagnostic accuracy, such as sensitivity and specificity. Specifically, a common problem was failure to establish and uniformly apply an acceptable standard of reference. In addition, images were not always interpreted independently from the reference standard. Radiologists and clinicians need to determine the applicability of any published study to their own practices. Unfortunately, the studies we reviewed commonly lacked clear descriptions of patient demographics, the spectrum of symptomatology, and the procedure for assembling the study cohort. Finally, small sample sizes with inadequate controls were presented in almost all of the articles. CONCLUSION: Although MR contrast media are widely used and play an essential role in lesion detection and confidence of interpretation, no rigorous studies exist to establish valid sensitivity and specificity estimates for their application. On the basis of this review, we herein describe basic methods to document improvements in technology. Such studies are essential to devise measures of diagnostic accuracy, which can form the basis for further studies that will assess diagnostic and therapeutic impact and, ultimately, patient outcomes. (+info)
Western-type diets induce insulin resistance and hyperinsulinemia in LDL receptor-deficient mice but do not increase aortic atherosclerosis compared with normoinsulinemic mice in which similar plasma cholesterol levels are achieved by a fructose-rich diet.
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The role of insulin resistance (IR) in atherogenesis is poorly understood, in part because of a lack of appropriate animal models. We assumed that fructose-fed LDL receptor-deficient (LDLR-/-) mice might be a model of IR and atherosclerosis because (1) fructose feeding induces hyperinsulinemia and IR in rats; (2) a preliminary experiment showed that fructose feeding markedly increases plasma cholesterol levels in LDLR-/- mice; and (3) hypercholesterolemic LDLR-/- mice develop extensive atherosclerosis. To test whether IR could be induced in LDLR-/- mice, 3 groups of male mice were fed a fructose-rich diet (60% of total calories; n=16), a fat-enriched (Western) diet intended to yield the same plasma cholesterol levels (n=18), or regular chow (n=7) for approximately 5.5 months. The average cholesterol levels of both hypercholesterolemic groups were similar (849+/-268 versus 964+/-234 mg/dL) and much higher than in the chow-fed group (249+/-21 mg/dL). Final body weights in the Western diet group were higher (39+/-6.2 g) than in the fructose- (27.8+/-2.7 g) or chow-fed (26.7+/-3.8 g) groups. Contrary to expectation, IR was induced in mice fed the Western diet, but not in fructose-fed mice. The Western diet group had higher average glucose levels (187+/-16 versus 159+/-12 mg/dL) and 4.5-fold higher plasma insulin levels. Surprisingly, the non-insulin-resistant, fructose-fed mice had significantly more atherosclerosis than the insulin-resistant mice fed Western diet (11.8+/-2.9% versus 7.8+/-2. 5% of aortic surface; P<0.01). These results suggest that (1) fructose-enriched diets do not induce IR in LDLR-/- mice; (2) the Western diets commonly used in LDLR-/- mice may not only induce atherosclerosis, but also IR, potentially complicating the interpretation of results; and (3) IR and hyperinsulinemia do not enhance atherosclerosis in LDLR-/- mice, at least under conditions of very high plasma cholesterol levels. The fact that various levels of hypercholesterolemia can be induced in LDLR-/- mice by fat-enriched diets and that such diets induce IR and hyperinsulinemia suggest that LDLR-/- mice may be used as models to elucidate the effect of IR on atherosclerosis, eg, by feeding them Western diets with or without insulin-sensitizing agents. (+info)
Relation between experimental and non-experimental study designs. HB vaccines: a case study.
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STUDY OBJECTIVE: To examine the relation between experimental and non-experimental study design in vaccinology. DESIGN: Assessment of each study design's capability of testing four aspects of vaccine performance, namely immunogenicity (the capacity to stimulate the immune system), duration of immunity conferred, incidence and seriousness of side effects, and number of infections prevented by vaccination. SETTING: Experimental and non-experimental studies on hepatitis B (HB) vaccines in the Cochrane Vaccines Field Database. RESULTS: Experimental and non-experimental vaccine study designs are frequently complementary but some aspects of vaccine quality can only be assessed by one of the types of study. More work needs to be done on the relation between study quality and its significance in terms of effect size. (+info)