Developing quality measures for adolescent care: validity of adolescents' self-reported receipt of preventive services.
OBJECTIVE: To demonstrate the feasibility of directly surveying adolescents about the content of preventive health services they have received and to assess the validity of adolescent self-reported recall. DATA SOURCES/SETTING: Audiotaped encounters, telephone interviews, and chart reviews with 14-21 year olds being seen for preventive care visits at 15 pediatric and family medicine private practices, teaching hospital clinics, and health centers. DESIGN: 537 adolescents presenting for well visits were approached, 400 (75 percent) consented, 374 (94 percent) were audiotaped, and 354 (89 percent) completed telephone interviews either two to four weeks or five to seven months after their visits. Audiotapes were coded for screening and counseling across 34 preventive service content areas. Intraobserver reliability (Cohen's kappa) ranged from 0.45 for talking about peers to 0.94 for discussing tobacco. The sensitivity and specificity of the adolescent self-reports were assessed using the audiotape coding as the gold standard. RESULTS: Almost all adolescents surveyed (94 percent) remembered having had a preventive care visit, 93 percent identified the site of care, and most (84 percent) identified the clinician they had seen. There was wide variation in the prevalence of screening, based on the tape coding. Adolescent self-report was moderately or highly sensitive and specific at two weeks and six months for 24 of 34 screening and counseling items, including having discussed: weight, diet, body image, exercise, seatbelts, bike helmet use, cigarettes/smoking, smokeless tobacco, alcohol, drugs, steroids, sex, sexual orientation, birth control, condoms, HIV, STDs, school, family, future plans, emotions, suicidality, and abuse. Self-report was least accurate for blood pressure/cholesterol screening, immunizations, or for having discussed fighting, violence, weapon carrying, sleep, dental care, friends, or over-the-counter drug use. CONCLUSION: Adolescents' self-report of the care they have received is a valid method of determining the content of preventive health service delivery. Although recall of screening and counseling is more accurate within two to four weeks after preventive care visits, adolescents can report accurately on the care they had received five to seven months after the preventive health care visits occurred. (+info)
Experience with external quality control in spermatology.
Results are presented from participation in an external quality control (EQC) programme for semen analysis (UK NEQAS). Formalin-fixed semen samples and videotapes of motile spermatozoa were distributed four times a year over a 3-4 year period. Over the entire period there was close agreement for sperm concentration with, initially, the average of values from the other groups participating in the scheme, and later, values designated as reference values obtained from six laboratories of several chosen that consistently agreed with each other. The initial underestimation of the percentage of normal forms was abolished at the time of change in derivation of designated values and this largely eliminated the difference to establish closer agreement with the designated values. A consistent bias in the assessment of different categories of progressive sperm motility appeared to be resolved by a conscious decision to consider most spermatozoa as grade b and the exceptions as grade a, rather than the converse. Feedback of results to the technicians of the laboratory participating in an external quality control programme leads to reappraisal of subjective evaluation and to harmonization of results between laboratories. (+info)
Cognitive functioning in people with epilepsy plus severe learning disabilities: a systematic analysis of predictors of daytime arousal and attention.
In spite of the high prevalence of epilepsy and the importance of preserving cognitive function in people with learning disabilities, this population has received relatively little research attention. This study sets out systematically to investigate possible predictive factors of inter-ictal states of arousal and attention. The daytime function of 28 people with epilepsy and severe learning disabilities was assessed by performance on a two-choice reaction time vigilance task, behavioural analysis of time-sampled video recordings taken in naturalistic settings, and carer ratings on visual analogue scales. This methodology yielded eight discrete functional measures, from which two further index measures were derived after principal components analysis. A range of clinical and psychosocial assessments was completed and subjects had 36 hour ambulatory EEG and sleep EEG monitoring. Regression models identified significant predictors of cognitive function from a range of potential explanatory variables i.e. demographic, clinical, pharmacological, background EEG rhythms and sleep parameters. Results indicated that greater severity of learning disability, longer bedtime periods, poor sleep efficiency, frequent seizures and antiepileptic drug polytherapy were significant predictor variables. Explained variance (adjusted R2) was greater than 50% for six of 10 outcome variables (range up to 85%). Furthermore, significant regression equations (P < 0.05) were obtained for all but one variable. Thus, these results appear reasonably robust. Results support an interactional model of daytime arousal and attention in people with epilepsy plus severe learning disabilities. Inter-ictal cognitive function appears to be mediated by a combination of organic, circadian (sleep wake), clinical and pharmacological factors. (+info)
Semi-automated detection of emesis in the rhesus monkey.
The use of a video recorder and the inclusion of a marker dye in material fed to rhesus monkeys has eliminated the need for the constant presence of an observer to detect an emetic response. (+info)
Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy.
BACKGROUND AND PURPOSE: MR imaging, PET, and ictal SPECT have been studied extensively as individual techniques in the localization of epileptogenic foci, but only a few comparative studies have been done. We evaluated the concordance rates of ictal video/EEG, MR imaging, PET, and ictal SPECT to compare the sensitivities of these imaging methods in the lateralization of epileptogenic foci. METHODS: The study included 118 consecutive patients who underwent surgery for medically intractable epilepsy and who were followed up for 12 months or more. MR imaging was compared retrospectively with ictal video/EEG, FDG-PET, ictal 99mTc-HMPAO SPECT, and invasive EEG as to their ability to localize the epileptogenic focus; the pathologic findings served as the standard of reference. RESULTS: MR imaging was concordant with video/EEG, PET, and ictal SPECT in 58%, 68%, and 58% of patients, respectively. With the pathologic diagnosis as the standard of reference, MR imaging, PET, and ictal SPECT correctly lateralized the lesion in 72%, 85%, and 73% of patients, respectively. Of the patients with good outcomes, MR imaging, PET, and ictal SPECT were correct in 77%, 86%, and 78%, respectively. In the good outcome group, MR imaging was concordant with PET and ictal SPECT in 73% and 62% of patients, respectively. Of 45 patients who underwent invasive EEG, MR imaging was concordant with the invasive study in 47%; PET in 58%; and ictal SPECT in 56%. Of 26 patients with normal MR findings, PET and ictal SPECT correctly lateralized the lesion in 80% and 55%, respectively. CONCLUSION: Overall concordance among the techniques is approximately two thirds or less in lateralizing epileptogenic foci. PET is the most sensitive, even though it provides a broad approximate nature of the epileptogenic zone, which is not adequate for precise surgical localization of epilepsy. PET and/or ictal SPECT may be used as complementary tools in cases of inconclusive lateralization with ictal video/EEG and MR imaging. (+info)
The technique of diagnostic hysteroscopy has not yet been accepted generally as an ambulatory, well-tolerated office procedure. Especially in the infertile patient the standard hysteroscopic procedure is poorly tolerated in an office environment. Our prospective registration of 530 diagnostic office mini-hysteroscopies in infertile patients demonstrates that using an atraumatic insertion technique, watery distention medium and the new generation of mini-hysteroscopic endoscopes, hysteroscopy can be performed in an office set-up without any form of anaesthesia and with a high patient compliance. The significant number of abnormal findings (28.5%), the absence of complications and the low failure rate (2.3%) indicate that diagnostic office mini-hysteroscopy should be a first-line diagnostic procedure. Those results are compared with the registration of 4204 consecutive conventional diagnostic hysteroscopies in a routine gynaecological population performed between 1982 and 1989. We conclude that the mini-hysteroscopic system offers a simple, safe and efficient diagnostic method in the office for the investigation of abnormal uterine bleeding, to evaluate the cervix and uterine cavity in the infertile patient, for screening of endometrial changes in patients under hormone replacement therapy or anti-oestrogens as (adjuvant) treatment and, lastly, it may be very helpful for the interpretation of uncertain findings in other diagnostic techniques such as ultrasound, magnetic resonance imaging, blind biopsy or hysterosalpingography. (+info)
Ultrasonic characterization of ovulatory follicular evacuation and luteal development in heifers.
The characteristics of follicle evacuation during ovulation and the development of the corpus luteum until day 5 (day 0 = ovulation) were studied in seven nulliparous Holstein heifers using real-time ultrasonography. Ovulation was induced and synchronized with a single injection of PGF2 alpha followed in 36 h by GnRH. Continuous scanning and videotaping was performed from apparent stigma formation until antral fluid was no longer detected. The beginning of follicular evacuation (second 0) was defined, retrospectively, after the antral area decreased 10% or more in 1 s. The completion of evacuation was defined as the inability to detect the antrum (the beginning of luteal development, 0 h). Corpora lutea development was monitored at 0, 4 and 20 h, and every 24 h thereafter until day 5. Changes in the maximal cross-sectional area of the antrum, luteal tissue, and central luteal cavities and in the pixel intensity of luteal tissue were determined using a computerized image program. The initial antral fluid evacuation occurred in two patterns that could be readily separated: (1) rapid, means of 58 and 89% evacuation in 1 and 4 s, respectively (four heifers); and (2) slow, means of 17 and 35% in 1 and 4 s, respectively (three heifers). The initial loss that distinguished the two patterns involved about 4 and 20 s for rapid and slow evacuation, respectively. Thereafter, the loss patterns were similar for the two types. The time from the beginning to the completion of evacuation ranged from 6 s to 14.5 min. Mean luteal tissue area increased (P < 0.05) between completion of evacuation (91.2 +/- 6.5 mm2) and day 3 (164.4 +/- 13.7 mm2) and between day 3 and day 4 (263.4 +/- 26.6 mm2). The growth rate of the luteal tissue area between day 3 and day 4 (103.2 +/- 16.0 mm2 day-1) was greater (P < 0.05) than that between day 2 and day 3 (41.9 +/- 12.4 mm2 day-1) and between day 4 and day 5 (49.7 +/- 22.0 mm2 day-1). In contrast to increasing luteal tissue area, mean pixel intensity decreased (P < 0.05) progressively between the completion of evacuation (78.4 +/- 6.3) and day 2 (60.4 +/- 2.5) and did not change significantly thereafter. In conclusion, initial follicular fluid loss during ovulation occurred in two patterns, involving about 4 and 20 s, respectively. The most intensive luteal tissue growth occurred between day 3 and day 4, and the echogenicity of the luteal tissue decreased between day 0 and day 2. (+info)
Combining qualitative interviews with video-recorded consultations: gaining insight into GPs' decision-making.
BACKGROUND: Studies of GPs' decision-making are important for facilitating our understanding of GPs' consulting behaviours. We have used a novel combination of semi-structured interviews and video-recorded consultations to research the influences on decisions made by GPs during their consultations. OBJECTIVE: We describe the use of GPs' video-recorded consultations as a stimulus for focused, semi-structured interviews and to discuss how this research method compares with other approaches for studying GPs' decision-making during consultations. METHODS: GPs' surgery sessions were video-recorded and later they were shown video recordings of themselves consulting with smokers before participating in semi-structured interviews about these consultations. Interviews aimed to describe the factors which GPs perceived to influence their decisions to discuss or not discuss smoking with patients. DISCUSSION: This technique can be used to research decisions, which are made frequently by GPs. It is probably most appropriate for gaining insight into decision-making during mundane consultations, to which GPs would otherwise give little thought. (+info)