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PubMed1993

A 3-D radiosurgical methodology for complex arteriovenous malformations.

A 3-D methodology, the associated targets methodology, for planning radiosurgical irradiations of complex arteriovenous malformations (AVMs) is presented. It uses the ARTEMIS-3D treatment planning system and has been devised and adopted by our group since January 1990. Its main features are: (a) prescription and delivery of a minimal target dose on the surface of the lesion, corresponding to a 60-70% isodose range. The dose to adjacent functional neurological structures is taken into account as well as the maximum dose to the lesion; (b) An optimisation approach consisting of obtaining the optimal superimposition of the isodose surface and the 3-D contour of the lesion and sharp fall-offs by interactive manipulation of the treatment parameters. The clinical choice of the treatment plan is based on a compromise between the optimal reference isodose surface encompassing the lesion and the minimisation of the volumetric dose fall-off. In complex AVMs the angiographic results have been significantly improved in comparison with our previous experience because of the better achieved lesion encompassing.

Humans↗
PubMed1992

A randomized, double-blind, placebo-controlled comparison of the impact of low-dose and triphasic oral contraceptives on follicular development.

OBJECTIVE: This investigation tests the hypothesis that triphasic oral contraceptives are associated with the development of large, persistent ovarian cysts. STUDY DESIGN: Weekly vaginal ultrasonography was used in a randomized, double-blind, placebo-controlled, parallel-group, single-center study that compared the incidence, risk, size, and time to resolution of ovarian follicles in healthy women who took Estrostep or Loestrin oral contraceptives (manufactured by Parke-Davis) or a placebo during three consecutive menstrual cycles. RESULTS: Sixty-three percent of placebo-treated subjects developed follicles greater than 18 mm, compared with 39% and 23% in the Estrostep and Loestrin groups. The risks for each group of developing a large follicle during a single cycle were not different. No dominant follicle persisted for greater than 2 weeks for any subject. CONCLUSION: These results demonstrate that follicular development continues during treatment with oral contraceptives. In addition, the findings fail to support the hypothesis that triphasic oral contraceptives result in persistent ovarian cysts.

Adult↗
PubMed1999

Measuring patient satisfaction--be prepared.

This article describes the approach used by the Queen Elizabeth II Health Sciences Centre to measure inpatient satisfaction at the recently merged institution. It presents some of the issues that arose in the planning stages, including use of prior consent. It is important to plan the methodology, the execution, the communication strategy and the follow-up before the process begins to ensure the results are credible, communicated and translated into quality improvement actions.

Humans↗
PubMed2002

Predicting patterns of mammography use: a geographic perspective on national needs for intervention research.

OBJECTIVE: To introduce a methodology for planning preventive health service research that takes into account geographic context. DATA SOURCES: National Health Interview Survey (NHIS) self-reports of mammography within the past two years, 1987, and 1993-94. Area Resource File (ARF), 1990. Database of mammography intervention research studies conducted from 1984 to 1994. DESIGN: Bayesian hierarchical modeling describes mammography as a function of county-level socioeconomic data and explicitly estimates the geographic variation unexplained by the county-level data. This model produces county use estimates (both NHIS-sampled and unsampled), which are aggregated for entire states. The locations of intervention research studies are examined in light of the statewide mammography utilization estimates. DATA EXTRACTION: Individual level NHIS data were merged with county-level data from the ARF. PRINCIPAL FINDINGS: State maps reveal the estimated distribution of mammography utilization and intervention research. Eighteen states with low mammography use reported no intervention research activity. County-level occupation and education were important predictors for younger women in 1993-94. In 1987, they were not predictive for any demographic group. CONCLUSIONS: Opportunities exist to improve the planning of future intervention research by considering geographic context. Modeling results suggest that the choice of predictors be tailored to both the population and the time period under study when planning interventions.

Black or African American↗
PubMed2002

Total body water measurement using bioelectrical impedance analysis, isotope dilution and total body potassium: a scoring system to facilitate intercomparison.

OBJECTIVES: (1) To develop a scale that is useful in evaluating the accuracy of multifrequency bioelectrical impedance analysis (MF-BIA) in the assessment of body water volumes against the accepted gold standard measurements based on isotope-dilution and total body potassium (TBK). (2) To perform a pilot test of the scale. DESIGN: A scale was developed to evaluate the accuracy of MF-BIA in the assessment of body water volumes. Questions were obtained from reading the scientific literature and discussions involving the four authors. Three of these and two additional independent readers pre-tested the scale. A weighting was identified for each question and a pilot test with a sample of 10 articles (different to those used for the questionnaire performance) was conducted. A further validation was carried out with a second set of 20 articles and two additional independent readers. RESULTS: The kappa statistic expressing the level of agreement between pairs of the first three authors using this scale with 10 articles, was 0.3, 0.4 and 0.6 after the first attempt. A second evaluation after specific changes improved the agreement to 0.8, 0.6 and 0.8. The mean score for 10 articles was 252+/-36 points from a total score of 400 (63+/-9%). The evaluation with the second set of 20 articles resulted in a kappa of 0.7 from two pairs of authors. The evaluation with two additional reviewers resulted in a kappa=0.7. CONCLUSION: A tool has been developed to assess the accuracy of the MF-BIA technique and to identify methodological components, plan future studies and critically evaluate data in this area. It is likely that this tool may also be used to assess the accuracy of single frequency studies.

Body Water↗
PubMed2000

Suicide risk assessment: a review of procedures.

Suicide risk assessment is an important part of the nurse's role. Suicide screening is an integral component of the assessment process. It should be systematic and follow a prescribed procedure: client self assessment, holistic assessment and diagnosis. The Gatehouse Assessment Centre in Warrington, UK, a predominantly nurse led centre, was opened in 1995, operates 365 days, 9 am till 9 pm, with open referral. The Centre offers psychiatric assessment, short-term treatments or referral on without hospital beds. In line with local and national policy, the Gatehouse team have introduced suicide rating scales as part of their risk screening process. However, the team have encountered problems using their designated scale, adapted from the Suicide Intent Scale, Pierce (1981). The major problem with the use of a rating scale was that, as a one off scoring system, it did not reflect the dynamic nature of suicidal behaviour. Furthermore, it is questionable whether a tool developed for research purposes would be used in the same way in practice. From a clinical perspective, the tool was capable of measurement only and failed to assist a dynamic holistic assessment required by practitioners. It was, therefore, necessary to review and evaluate the risk assessment procedure. In order to address these problems an assessment procedure which is more than a once only 'score' was piloted. The procedure incorporated risk screeners. Rather than rely on a value weighting system, or a positive or negative conclusion, it took account of the continuum of risk which is contingent on a broad range of factors. It took account of the accumulation of risk factors which may be increased or reduced in the light of unfolding events. Details of the new procedure, how it has been incorporated into the assessment process and subsequent management plan, and methodological considerations for further study are detailed.

Adult↗
PubMedDate not supplied

Analysis of contraceptive discontinuation in six developing countries from durations of use at survey.

We conduct a cross-national study of contraceptive discontinuation among currently married nonsterilized contracepting women in Bolivia, Egypt, Kenya, Sri Lanka, Thailand, and Zimbabwe using the Demographic and Health Surveys (DHS). Since the DHS contains no true completed epochs of contraceptive use, the distribution of use times at survey is used to approximate the distribution of the completed epochs using the renewal theorem. Two techniques based on this approximation are used. The first technique uses local linear regression smoothing of a histogram estimate of the use time at survey pdf which is converted into an estimate of the discontinuation probability function. The second technique poses a proportional hazards Weibull distribution for the discontinuation probability function which is then converted into a model for the use times at survey. This second technique is used to model the observed variations in use across countries while controlling for other sociodemographic factors such as children ever born, age, and education, as well as a variable which encodes knowledge of the fertility cycle. Pill discontinuation probabilities range from 0.12 to 0.47 in the first year. IUD discontinuation probabilities range from 0.18 to 0.53 in the first year. Discontinuation probabilities in Egypt over all methods are in agreement with those reported in Ali and Cleland (1995). Logged relative risks of pill discontinuation range from -0.94 (Sri Lanka) to 0 (Kenya), while logged relative risks of IUD discontinuation range from -0.53 (Sri Lanka) to 0.41 (Zimbabwe). The ordering of risks of pill discontinuation among the six countries considered is in agreement with the ordering of total fertility rates excerpted from Westoff (1991).

Contraception Behavior↗
PubMed2003

Use of a quantitative index of beam modulation to characterize dose conformality: illustration by a comparison of full beamlet IMRT, few-segment IMRT (fsIMRT) and conformal unmodulated radiotherapy.

A technique is presented for characterizing the degree of modulation in an intensity-modulated beam. It is shown that the modulation increases as dose conformality increases. Full intensity-modulated radiation therapy (IMRT) is compared with a two-weight-per-field technique and with simple geometrically conformal beams. It is suggested that each individual planning problem requires some comparative planning of this type because there is no simple answer to the question of the degree to which IMRT improves dose conformality. This depends on the problem geometry, the dose prescription, the cost function, the number of beams and other planning conditions. A methodology is presented for such comparative planning studies and this is illustrated with the solution of two planning problems.

Algorithms↗
PubMed2005

Optical tomography of the breast using a multi-channel time-resolved imager.

A time-resolved optical tomography system has been used to generate cross-sectional images of the human breast. Images are reconstructed using an iterative, nonlinear algorithm and measurements of mean photon flight time relative to those acquired on a homogeneous reference phantom. Thirty-eight studies have been performed on three healthy volunteers and 21 patients with a variety of breast lesions including cancer. We have successfully detected 17 out of 19 lesions, and shown that optical images of the healthy breast of the same volunteer display a heterogeneity which is repeatable over a period of months. However, results also indicate that the lack of accurate quantitation of optical parameters and limited morphological information limits the ability to characterize different types of lesions and distinguish benign from malignant tissues. Drawbacks of our current methodology and plans for overcoming them are discussed.

Adult↗
PubMed1994

Approaches to analysis of dietary data: relationship between planned analyses and choice of methodology.

Dietary intake cannot be estimated without error and probably never will be. The nature and magnitude of the error depends on both the dietary data collection methodology and the subjects studied. The impact of particular types of error depends on the question being asked and the analytical methodology used to address it. Examples of these phenomena are presented in this review paper. The future lies in improved estimation and understanding of the error terms and in the development of analytical and statistical methods of coping with these error terms rather than with "improvements" in dietary methodology per se.

Data Collection↗
PubMed1996

Developing a plan for primary health care facilities in Soweto, South Africa. Part I: Guiding principles and methods.

The new political era in South Africa offers unique opportunities for the development of more equitable health care policies. However, resource constraints are likely to remain in the foreseeable future, and efficiency therefore remains an important concern. This article describes the guiding principles and methods used to develop a coherent and objective plan for comprehensive primary health care facilities in Soweto. The article begins with an overview of the context within which the research was undertaken. Problems associated with planning in transition are highlighted, and a participatory research approach is recommended as a solution to these problems. The article goes on to describe how the research methods were developed and applied in line with the principles of participatory research. The methods were essentially rapid appraisal techniques which included group discussions, detailed checklists, observation, record reviews and the adaptation of international and local guidelines for service planning. It is suggested that these methods could be applied to other urban areas in South Africa and elsewhere, and that they are particularly appropriate in periods of transition when careful facilitation of dialogue between stakeholders is required in tandem with the generation of rapid results for policy-makers.

Community Health Planning↗
PubMed2006

A new method for assessment of craniofacial malformations.

Many assessments of craniofacial malformations are generally undertaken to assist in surgical intervention including physical examination, cephalometric radiographs in anteroposterior and lateral views, stereolithographic models, and anthropometric measurements integrated with three-dimensional computed tomography (3-D CT) reconstructions to quantify skeletal deformities. In the present report, the use of 3-D Malformation Analysis, a three-dimensional methodology for planning craniofacial operative procedures, is presented. In addition to cephalometric and anthropometric databases, the measurements from 3-D surface reconstructions from CT were used intraoperatively to establish the correct position of skeletal segments.

Adolescent↗
PubMed2005

Functional magnetic resonance imaging for assessment of language and memory in clinical practice.

PURPOSE OF REVIEW: There has been considerable interest in the role that functional magnetic resonance imaging (fMRI) may play in the assessment of patients with epilepsy. This review considers recent progress in this field and the current role of fMRI in the preoperative assessment of language and memory function. RECENT FINDINGS: Many studies have compared fMRI with the intracarotid amytal test for establishing language dominance, with most showing over 90% concordance between the two tests. Atypical dominance is greater in patients with left temporal lobe epilepsy and has been shown to be associated with increased epileptic activity. Preoperative fMRI has been used to predict language deficits following left anterior temporal lobe resection. A variety of paradigms have been used to assess memory function, and novel paradigms have demonstrated robust medial temporal lobe activation. Different patterns of encoding activity have been observed between patients with unilateral temporal lobe epilepsy and control individuals. SUMMARY: The application of fMRI paradigms used in cognitive neuroscience to patients with epilepsy is complicated by several factors. Although fMRI is increasingly being used clinically to establish language dominance, further work is required to localize accurately those specific language functions that are most at risk following surgery. Memory paradigms are not yet validated for use in surgical planning, although methodological and technical advances should make this possible in the near future. Further studies looking at the reorganization of language and memory function after surgery are also required.

Epilepsy↗
PubMed1997

The neighborhood history calendar: a data collection method designed for dynamic multilevel modeling.

"This paper presents a new data collection method, called the Neighborhood History Calendar, designed to collect event histories of community-level changes over time. We discuss the need for and the uses of this method. We describe issues related to the design of instruments, collection of data, and data entry. We provide detailed examples from an application of this method to the study of marriage, contraception, and fertility in rural Nepal. The paper addresses applications of this same technique to other settings and research problems. We also extend the technique to collection of other forms of contextual-history data, including school histories and health service histories. Finally, we discuss how Geographic Information System (GIS) technology can be used to link together multiple sources of contextual-history data."

Asia↗
PubMed2000

On the need for monitor unit calculations as part of a beam commissioning methodology for a radiation treatment planning system.

This paper illustrates the need for validating the calculation of monitor units as part of the process of commissioning a photon beam model in a radiation treatment planning system. Examples are provided in which this validation identified subtle errors, either in the dose model or in the implementation of the dose algorithm. These errors would not have been detected if the commissioning process only compared relative dose distributions. A set of beam configurations, with varying field sizes, source-to-skin distances, wedges, and blocking, were established to validate monitor unit calculations for two different beam models in two different radiation treatment planning systems. Monitor units calculated using the treatment planning systems were compared with monitor units calculated from point dose calculations from tissue-maximum ratio (TMR) tables. When discrepancies occurred, the dose models and the code were analyzed to identify the causes of the discrepancies. Discrepancies in monitor unit calculations were both significant (up to 5%) and systematic. Analysis of the dose computation software found: (1) a coordinate system transformation error, (2) mishandling of dose-spread arrays, (3) differences between dose calculations in the commissioning software and the planning software, and (4) shortcomings in modeling of head scatter. Corrections were made in the beam calculation software or in the data sets to overcome these discrepancies. Consequently, we recommend incorporating validation of monitor unit calculations as part of a photon beam commissioning process.

Algorithms↗