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At least 217 records · Page 12Linked to original sources
PubMed1998

Comparison of p-fluoroketorolac and [18O3]ketorolac for use as internal standards for the determination of ketorolac by gas chromatography/mass spectrometry (GC/MS).

A chemical and a stable-isotope analog, p-fluoroketorolac and [18O3]ketorolac respectively, were directly compared for applicability as internal standards for the determination of ketorolac in plasma samples using gas chromatography/mass spectrometry (GC/MS) with selective-ion-monitoring detection, following derivatization to form the methyl esters. This comparison involved analyzing ketorolac calibration standards and spiked plasma samples that contained both internal standard candidates. The response for ketorolac and each internal standard was monitored simultaneously and electronically integrated peak heights were obtained. Thus, for each analysis performed, a response ratio was obtained for each internal standard relative to an identical ketorolac response. Linearity of response for ketorolac calibration standards and accuracy for spiked plasma sample analysis were compared using each internal standard. The use of [18O3]ketorolac as the internal standard provided superior accuracy data for the analysis of ketorolac in plasma samples.

Analgesics, Non-Narcotic↗
PubMed1999

Cost-effectiveness of stress-echocardiography.

Because of constraints on the costs of providing medical care, cardiologists in the future will find themselves challenged to provide care for their patients in the most cost-effective manner possible. Although stress-echocardiography has been shown to compare favorably with other tests in diagnostic accuracy, data on cost-effectiveness are scarce. In this article, general concepts of cost-effectiveness as they relate to stress-echocardiography are reviewed and the available literature is summarized. Although definitive data are lacking, there is evidence to suggest that stress-echocardiography may prove to be cost-effective in several clinical situations.

Cardiovascular Diseases↗
PubMed1993

Assessment of tumorous mandibular involvement by transcutaneous ultrasound and flexible endosonography.

Tumorous involvement of the mandible affects the prognosis and choice of treatment. To evaluate the usefulness of transcutaneous ultrasound and recently-developed flexible endosonography and their ability to display bone invasion in the lower jaw, we studied 33 non-selected patients with extensive, histologically-verified oral and oropharyngeal carcinomas. Both sonographic examinations were performed prospectively in all patients prior to surgery, without knowledge to the sonographer of the results of other imaging methods. Histological findings served as gold standards and offered 14 mandibular involvements. Flexible endosonography is characterized by high accuracy data in assessment of mandibular involvement occurring in tumors of the floor of the mouth and of the tonsil. On the other hand acceptable results by transcutaneous ultrasound could only be obtained in assessing bone invasion of oral tumors. However, osseous destruction in patients with oropharyngeal tumors were not detectable as the involved medial surface of the mandibular ramus was inaccessible to the extraorally placed transducer. Both sonographic methods, especially endosonography, enabled the examiner to differentiate cortical bone as opposed to spongiosa involvement in many cases, but failed in assessment of tumorous periosteal involvement. Pitfalls in detection and differentiation of bone invasion with false positive and false negative findings are discussed with regard to mandibular anatomy, for both intra- and extraoral examination.

Bone Marrow↗
PubMed1994

Implementing TQM in a military hospital in Saudi Arabia.

BACKGROUND: Health care services in the Kingdom of Saudi Arabia are unique not only in the varied patient population served and multinational staff recruited to provide services, but also because they are not driven by financial or medicolegal constraints. As part of a five-year plan (carried out in four phases) to improve the quality of health care provided in the Kingdom, the North West Armed Forces Hospitals (NWAFH) in Tabuk became the first health care facility in the Kingdom to implement total quality management (TQM). This was not an implementation de novo, but a well-coordinated transition from quality assurance (QA) to TQM. The hospital leadership believe that TQM is best implemented when there is a strong foundation of QA to provide a pre-existing process for data collection and performance measurement. METHODS: Using the eight-step model for implementing TQM adapted from Joint Commission standards and The Health Care Manager's Guide to Continuous Quality Improvement, the QA staff identified the customers of the QA department, their needs, and professional requirements; implemented changes to meet these needs; identified internal monitors to evaluate the effectiveness of the operational changes and monitor performance; reported results and identified opportunities for improvement; and problem solved with FOCUS-PDCA. RESULTS: These efforts yielded a customer satisfaction survey in the form of a report card. In addition, three case studies launched by the QA department to address abstract data accuracy and completion, nosocomial infection rates in cesarean-section patients, and receipt of hospital laboratory reports by peripheral clinics are described in detail. CONCLUSION: The NWAFH Program leadership believes that TQM is a pancultural concept and that these first successful efforts can provide a model for the expansion of TQM not only in Saudi Arabia but throughout the rest of the Middle East.

Cesarean Section↗
PubMed2000

Bandage soft contact lens barrier function: a clinical research note.

Corneal thickness pre- and post-operatively was measured on 18 volunteer subjects within the context of a clinical investigation of laser refractive surgery. All measurements were taken with regard for time of day, in order to counter any complicating diurnal influence on data accuracy. Of the 18 subjects, six lost or had accidently displaced their overnight bandage soft contact lenses the first night immediately after surgery, and 12 retained theirs. The individuals with lost bandage lenses exhibited uniformly thick, swollen corneas. In contrast, the other 12 subjects, with retained lenses, exhibited a stable corneal thickness map, displaying the characteristic relatively thick periphery that transitions to a thinner central region. Moreover, in the six affected subjects, application of a new overnight bandage lens resulted in recovery of the normal thickness pattern on day 2, as opposed to the uniform swelling or oedema of the previous day. In combination, these findings indicate a fluid barrier function on behalf of the bandage soft contact lenses, which allowed the corneal endothelial pump mechanism to counteract any extreme swelling or fluid accumulation. This previously unreported phenomenon helps explain the historical effectiveness of this treatment regimen for corneal bullous, or excessive fluid-retention, conditions.

Journal Article↗
PubMed2002

Data quality probes-exploiting and improving the quality of electronic patient record data and patient care.

Increasing reliance is being placed on electronic medical records to support clinical care and achieve improved quality standards. In order for clinical information systems (CIS) to deliver excellence the data within it needs to be complete, consistent and accurate. This capture of data is critical but forms only part of the procedure in delivering quality health care during the clinician-patient encounter. A number of processes are involved in this encounter, each of which has to be performed flawlessly to deliver a perfect outcome. This paper outlines a method of assessing the quality of these processes involved in healthcare provision and data quality within a CIS. It proposes the principle of Data Quality Probes (DQP) to assess the performance of the whole encounter system. The main feature of this is the generation of a query which clinical knowledge predicts should not retrieve any cases in a system performing flawlessly. Any cases retrieved (which fail the DQP) indicate an error in either data quality or clinical judgment. This approach is applied practically within the paradigm of a UK family practice testing the hypothesis that a series DQPs can provide a valuable method for monitoring both the data accuracy of a CIS and the provision of quality patient care.

Delivery of Health Care↗
PubMed2003

Simultaneous liquid chromatography-tandem mass spectrometric determination of albendazole sulfoxide and albendazole sulfone in plasma.

This paper describes a simple, fast, sensitive and reliable method for the simultaneous determination of albendazole sulfoxide (ASOX) and albendazole sulfone (ASON), the two most important metabolites of the drug albendazole (ABZ), in plasma samples using liquid chromatography and tandem mass spectrometry. After liquid-liquid extraction with dichloromethane, the two albendazole metabolites and the internal standard phenacetin were resolved in a CN column using the mobile phase methanol-water (4:6, v/v) acidified with 1% acetic acid. Detection by electrospray mass spectrometry was carried out in the positive ion mode. The method was linear up to 2500 and 250 ng/ml for ASOX and ASON, respectively, with mean recoveries of more than 85%. The precision and accuracy data, based on within- and between-day variations over 5 days, were lower than 15%. The quantitation limits of 0.5 and 5.0 ng/ml for ASON and ASOX are low enough for the method to be suitable for pharmacokinetic studies. Pharmacokinetic data obtained with the proposed method following oral administration of ABZ to a patient with neurocysticercosis are also reported.

Albendazole↗
PubMed2003

Determination of anti-cancer drug actinomycin D in human plasma by liquid chromatography-mass spectrometry.

Actinomycin D is an anti-cancer drug commonly used in the treatment of paediatric malignancies such as Wilms' tumour, Ewing's sarcoma and rhabdomyosarcoma. Despite its long history of clinical use, little is known about the pharmacokinetics of actinomycin D in humans, largely due to problems in developing an analytical assay with the required sensitivity to measure relevant clinical concentrations. As actinomycin D treatment in children with cancer is associated with veno-occlusive disease (VOD), and as the dose intensity of actinomycin D treatment has been defined as a significant risk factor for the development of this potentially life-threatening hepatic toxicity, pharmacokinetic studies of actinomycin D may be beneficial in optimizing treatment with this drug. In order to investigate this issue, we developed a sensitive liquid chromatography-mass spectrometry (LC-MS) method for the determination of actinomycin D in human plasma samples. Extraction of analytical samples was carried out with acetonitrile and analysis performed on an API 2000 LC/MS/MS using an internal standard of 7-aminoactinomycin D. A limit of quantitation of 1.0 ng/ml was determined, allowing the reliable measurement of actinomycin D in plasma samples obtained from patients receiving this drug clinically. The method demonstrated good reproducibility, over the calibration curve range of 1.0-100 ng/ml, with intra- and inter-assay precision CVs of 2.7-11.3 and 2.3-7.8%, respectively. Accuracy data showed relative errors of 2.0-16.4 and 10.4-15.2% for intra-assay (n=10) and inter-assay (n=7) experiments, respectively. Initial results of actinomycin D pharmacokinetics in paediatric patients are shown.

Antibiotics, Antineoplastic↗
PubMed1997

The cost-effectiveness of magnetic resonance imaging for patients with equivocal neurological symptoms.

OBJECTIVE: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. DESIGNS AND METHODS: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. MAIN RESULTS: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. CONCLUSIONS: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).

Adult↗
PubMedDate not supplied

Windows-based guided data capture software for mass-scale thermophysical and thermochemical property data collection.

Guided data capture software (GDC) is described for mass-scale abstraction from the literature of experimental thermophysical and thermochemical property data for organic chemical systems involving one, two, and three components, chemical reactions, and chemical equilibria. Property values are captured with a strictly hierarchical system based upon rigorous application of the thermodynamic constraints of the Gibbs phase rule with full traceability to source documents. Key features of the program and its adherence to scientific principles are described with particular emphasis on data-quality issues, both in terms of data accuracy and database integrity.

Journal Article↗
PubMed1996

Rapid determination of amphotericin B in serum and urine by third-order derivative spectrophotometry.

A derivative spectrophotometric method for rapid monitoring of amphotericin B in serum and urine down to 30 ng/mliters is described. Samples are treated with acetonitrile, and amphotericin B is directly quantified in the crude extracts on the basis of the intensity of the peak that appears at 402 nm when the normal absorption spectrum is submitted to third-order derivative processing. Accuracy data suggested recoveries in the range of 84.3-94.9% for serum and 85.6-93.4% for urine. The precision of the method was better than 11.3% for serum and 9.2% for urine when samples contained as low as 29.6 ng/mliters of amphotericin B. Ease of applicability, short analysis time, low cost, and reliability are the main advantages of the method.

Amphotericin B↗
PubMed1997

List-context effects in evaluative priming.

Evaluative priming effects are often found in the evaluative decision task, in which persons judge the affective connotation (positive vs. negative) of a target word. The present experiments examined list-context effects to test whether evaluative and semantic priming follow the same laws. In Experiment 1, evaluative priming was found at prime-target stimulus onset asynchronies (SOAs) of 0 ms and 100 ms, but not at SOAs of--100, 200, 600, and 1,200 ms. Experiment 2 manipulated SOA (0, 200, and 1,200 ms) and the proportion (25%, 50%, and 75%) of the prime-target pairs that were evaluatively related. Contrary to the typical finding that increases in the proportion of related prime-target pairs lead to increased priming at long but not short SOAs, an effect of consistency proportion was found at SOAs of 0 ms (for reaction times) and 200 ms (in the accuracy data), but not at the 1,200-ms SOA. The pattern of results is discussed in relation to possible explanatory mechanisms of evaluative priming.

Adult↗
PubMed2000

Interresponse times in serial recall: effects of intraserial repetition.

The authors examined the effects of intraserial repetition on multitrial serial learning of random consonant lists, analyzing both learning rates and perfect trial interresponse times (IRTs). Lists varied along 3 dimensions: list length, presence or absence of a repeated element, and lag between repeated elements. After achieving a forward-recall criterion on a given list, participants (N = 20) attempted backward recall. At small lags, IRTs between the repeated elements were very short (compared with IRTs from identical positions in nonrepetition lists). At larger lags, the IRT to recall the second repeated item was substantially longer than in control lists. These results reveal a latency analogue of the Ranschburg pattern seen in accuracy data. A Ranschburg pattern was also found in participants' learning rates. These results both generalize the Ranschburg phenomenon and present further challenges to theories of serial order memory.

Adult↗
PubMed1996

The CODE theory of visual attention: an integration of space-based and object-based attention.

This article presents a theory that integrates space-based and object-based approaches to visual attention. The theory puts together M.P. van Oeffelen and P.G. Vos's (1982, 1983) COntour DEtector (CODE) theory of perceptual grouping by proximity with C. Bundesen's (1990) theory of visual attention (TVA). CODE provides input to TVA, accounting for spatially based between-object selection, and TVA converts the input to output, accounting for feature- and category-based within-object selection. CODE clusters nearby items into perceptual groups that are both perceptual objects and regions of space, thereby integrating object-based and space-based approaches to attention. The combined theory provides a quantitative account of the effects of grouping by proximity and distance between items on reaction time and accuracy data in 7 empirical situations that shaped the current literature on visual spatial attention.

Attention↗
PubMed2004

A comparison of sequential sampling models for two-choice reaction time.

The authors evaluated 4 sequential sampling models for 2-choice decisions--the Wiener diffusion, Ornstein-Uhlenbeck (OU) diffusion, accumulator, and Poisson counter models--by fitting them to the response time (RT) distributions and accuracy data from 3 experiments. Each of the models was augmented with assumptions of variability across trials in the rate of accumulation of evidence from stimuli, the values of response criteria, and the value of base RT across trials. Although there was substantial model mimicry, empirical conditions were identified under which the models make discriminably different predictions. The best accounts of the data were provided by the Wiener diffusion model, the OU model with small-to-moderate decay, and the accumulator model with long-tailed (exponential) distributions of criteria, although the last was unable to produce error RTs shorter than correct RTs. The relationship between these models and 3 recent, neurally inspired models was also examined.

Choice Behavior↗
PubMed2003

The influence of schemas, stimulus ambiguity, and interview schedule on eyewitness memory over time.

The authors examined how a crime schema influenced the types of details witnesses recalled over multiple interviews that varied in delay before the initial interview and between subsequent interviews. Accuracy data showed that, in general, schema-irrelevant traces experienced greater decay than schema-consistent and schema-inconsistent traces after the initial interview and that delaying the initial interview negatively affected recall at the initial interview but led to less decay over subsequent interviews. Ambiguity of the crime stimulus was also manipulated. Witnesses used their schema to interpret ambiguous information and, as a result, made more schema-consistent intrusions and less correct responses and were more likely to report false memories that involved conscious recollection (using the remember-know paradigm).

Adolescent↗
PubMed2004

Inference generation during text comprehension by adults with right hemisphere brain damage: activation failure versus multiple activation.

Evidence conflicts as to whether adults with right hemisphere brain damage (RHD) generate inferences during text comprehension. M. Beeman (1993) reported that adults with RHD fail to activate the lexical-semantic bases of routine bridging inferences, which are necessary for comprehension. But other evidence indicates that adults with RHD activate multiple interpretations in various comprehension domains. In addition, the activation of contextually inappropriate interpretations is prolonged for many adults with RHD and predicts poor discourse comprehension. This study contrasted Beeman's activation failure hypothesis with the prediction that adults with RHD would generate multiple interpretations in text comprehension. The relation between activation of textually incompatible inferences and discourse comprehension was also investigated for this group. Thirty-seven adults with RHD and 34 without brain damage listened to brief narratives that required a bridging inference (BI) to integrate the text-final sentence. This final sentence, when isolated from its text, was strongly biased toward a contextually incompatible alternate interpretation (AI). Auditory phoneme strings were presented for lexical decision immediately after each text's initial and final sentence. Adults with RHD were both faster and more accurate in making lexical decisions to BI-related target words in final-sentence position than in initial-sentence position. Thus, contrary to the activation failure hypothesis, adults with RHD generated the lexical-semantic foundations of BIs where they were required by the text. AI generation was evident in accuracy data as well, but not in response time data. This result is partially consistent with the multiple activation view. Finally, greater activation for contextually incompatible interpretations was associated with poorer discourse comprehension performance by adults with RHD.

Aged↗
PubMed1985

Word recognition performance with modified CID W-22 word lists.

Abbreviated CID W-22 lists were administered to large groups of normal and hearing-impaired listeners to test the hypothesis, that fewer, judiciously chosen items can be used to test word recognition without compromising test accuracy. Data were analyzed by comparing each subject's performance on half- and 10-word lists to full-list scores. Sensitivity and specificity for various sublists and for several pass/fail criteria were calculated. Results show that fewer than the traditional 50 items can be used in word recognition test procedures if the words are sufficiently difficult and strict passing criteria are employed. We recommend terminating testing after 10 words if no errors occur and after 25 words if there are no more than four errors. Otherwise, a full 50-item list should be administered.

Hearing Disorders↗