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PubMed1995

Pseudomemories: the standard of science and the standard of care in trauma treatment.

The pseudomemory (PM) debate has focused on individuals who do not remember sexual abuse and later recover these memories, often in therapy. This paper critically reviews experimental research on stress and memory and on suggestibility and memory in terms of its applicability to PM production in therapy. Three different kinds of suggestibility are identified--hypnotizability, postevent misinformation suggestibility, and interrogatory suggestibility. It is hypothesized that interrogatory suggestibility alone or the interaction of all three pose significant risk for PM production. It is argued that a better standard of science is needed before claims can be made about PM production in therapy, since no experimental studies have been conducted on memory performance or suggestibility effects in therapy. However, the findings derived from memory research on other populations, nevertheless, are useful to inform the standard of care in treating recovered memory patients.

Adult↗

PubMed1997

Performance of "standardized examinees" in a standardized-patient examination of clinical skills.

PURPOSE: As a first step in testing the utility of using trained "standardized examinees" (SEs) as a quality-assurance measure for the scoring process in a standardized-patient (SP) examination, to test whether medical residents could simulate students in an SP examination and perform consistently to specified levels under test conditions. METHOD: Fourth-year students from the Baltimore-Washington Consortium for SPs participated in a National Board of Medical Examiners Prototype Examination of clinical skills consisting of twelve 15-minute student-patient encounters in 1994-95. For this examination, internal medicine residents were trained to act as ordinary candidates and to achieve target scores by performing to a set level on specific checklist items used by SPs for recording interviewing, physical-examination, and communication skills. The "strong SEs" were trained to score 80% correct on six of the examination's 12 cases (study cases), and the "weak SEs" were trained to score 40% correct on the same six cases. The strong and weak SEs' checklist scores on the study cases were compared through independent, two-tailed t-tests. When there was less than 85% agreement on specific checklist items in each case between the SE training and the SP recording, videotapes of the cases were reviewed; in such cases an SE's performance was the final score agreed upon after review. RESULTS: Seven SEs took the SP examination and were not detected by the SPs. There was a total of 84 discrepancies between predicted and recorded checklist scores across 659 checklist items in 40 encounters scored by the SPs. After correcting the discrepancies based on videotape review, the estimated actual mean score was 77.3% for the strong SEs and 44.0% for the weak SEs, and was higher for the strong SEs in each study case. The overall fidelity of the SEs to their training was estimated to be 97%, and the overall SP accuracy was estimated to be 91%. The videotape review revealed 47 training-scoring discrepancies, most in the area of communication skills. CONCLUSION: This study suggests that SEs can be trained to specific performance levels and may be an effective internal control for a high-stakes SP examination. They may also provide a mechanism for refining scoring checklists and for exploring the validity of SP examinations.

Clinical Competence↗

PubMed2000

Environmental dosimetry performance criteria: pilot test of proposed ANSI draft standard N13.29. American National Standards Institute.

American National Standards Institute (ANSI) standards are a source of technical guidance on the application of passive radiation detectors in personnel and environmental monitoring programs. The proposed new ANSI Draft N13.29 describes performance tests for environmental dosimetry providers that are analogous to those now required in personnel dosimetry. The objective of this study was to pilot test the procedural specifications before Draft N13.29 is submitted for final balloting. The results of the performance tests are relevant to environmental surveillance programs, which may be affected if Draft N13.29 is approved. Seven environmental dosimetry providers submitted dosimeters for the pilot test, which included two phases. The first phase involved exposing dosimeters to laboratory gamma, beta, and x-ray sources at routine and accident dose levels. In the second phase, dosimeters were subjected to 90 d of simulated environmental conditions in a chamber that cycled through prescribed temperature and humidity parameters and lighting conditions. Two participants passed all categories of the laboratory test phase, and all seven passed the environmental test phase. We report here on the results of the performance tests; additional results relevant to finalizing Draft N13.29 are detailed elsewhere.

Environmental Monitoring↗

PubMed2000

Use of pattern standard deviation instead of corrected pattern standard deviation in Anderson's criteria.

PURPOSE: To determine whether the use of pattern standard deviation instead of corrected pattern standard deviation, as part of Anderson's criteria, makes a difference in categorizing a single field printout using the full threshold strategy on the Humphrey's Field Analyzer. MATERIALS AND METHODS: Forty-eight patients with glaucomatous field defects of varying severity underwent full threshold perimetry on the Humphrey's Field Analyzer. The third field of one eye was used for the study. The agreement between CPSD and PSD alone was determined. Each field was then categorized using Anderson's criteria first using CPSD and then PSD. The kappa statistic was used to determine agreement in both situations. RESULTS: The agreement between CPSD and PSD alone, as determined by kappa, was 0.77. The kappa statistic for categorization using Anderson's criteria was 0.82; the weighted kappa was 0.92. CONCLUSION: There was almost perfect agreement using the PSD instead of CPSD as part of Anderson's criteria. This substitution seems valid for the spectrum of field defects used in this series, at least for the full threshold programs.

Adult↗

PubMed1995

The report of the clinical standard advisory group: standards of care for people with schizophrenia in the UK and implications for mental health nursing.

The Clinical Standards Advisory Group Schizophrenia Committee has spent two years (1993-1995) developing a standards protocol to assist all Purchasers and Providers with the task of producing optimum services for people with schizophrenia and other serious and enduring mental illnesses. This work has been underpinned by research that included visits to a representative sample of services throughout the UK. The report of this initiative, which was published in the summer of 1995, has many implications for mental health nursing. These include the continuing necessity to focus on serious mental illness; more effort to develop multidisciplinary working and the use of the Care Programme Approach; an increased focus on relevant training in case management and psychosocial interventions; the need to recognize physical health problems; the importance of medication management; and, as the Review of Mental Health Nursing emphasized, the issue of leadership should be targeted as a priority for action.

Clinical Protocols↗

PubMed1969

Standardized viral hemagglutination and hemagglutination-inhibition tests. I. Standardization of erythrocyte suspensions.

A spectrophotometric procedure for standardizing red blood cell suspensions for use in viral hemagglutination tests is described. The procedure is based on highly reproducible cyanmethemoglobin absorbance readings at 540 nm on any suitable spectrophotometer. Target values for milligrams of cyanmethemoglobin per 100 ml are given for the red cell suspensions of all mammalian and avian species employed in viral hemagglutination tests. By use of these values and a cyanmethemoglobin standard curve for a particular photometer, approximate 4% erythrocyte suspensions can be diluted to any lesser concentration. Coefficients of variation for the various diluted suspensions range from 4 to 7%.

Animals↗

PubMed1998

Comparison of a 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-t etrazolium hydroxide (XTT) colorimetric method with the standardized National Committee for Clinical Laboratory Standards method of testing clinical yeast isolates for susceptibility to antifungal agents.

MICs for clinical Candida and Cryptococcus isolates were determined by a method incorporating the colorimetric indicator 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl] -2H-tetrazolium hydroxide (XTT), and the results were compared with MICs obtained by the National Committee for Clinical Laboratory Standards approved standard method (M27-A). One hundred percent of all isolates demonstrated agreement within 2 dilutions between the MICs of amphotericin B, fluconazole, itraconazole, ketoconazole, and flucytosine obtained by the two methods. These data suggest that an XTT-based method could provide a useful means for the determination of antifungal susceptibility of yeasts.

Amphotericin B↗

PubMed1979

Standardization of radioallergosorbent test (RAST) and allergen extracts in terms of the WHO standard for IgE.

An 131I-labelled IgE myeloma, standardized against the WHO reference serum for IgE was bound in varying concentrations to discs bearing anti-human light chain. These were used to construct a calibration curve for the subsequent binding of 125I-labelled anti-IgE, thus relating 125I counts to WHO IgE units. The calibrated anti-IgE could then be used to measure the actual amount of specific IgE bound to an allergen disc in the radioallergosorbent test. Using this standardized system, soluble allergen extracts could then be assayed by their ability to inhibit the binding of a defined amount of specific IgE, thereby enabling their activity to be expressed in WHO IgE units.

Allergens↗

PubMedDate not supplied

Establishing electronic patient record standards using paper-based record functions and standards.

The South Australian Health Commission has embarked on a long term project to establish an Electronic Patient Record (EPR) for South Australia. The process requires extensive evaluation at the conclusion of each phase of development using a range of existing and purpose-developed evaluation tools. This paper describes a purpose-developed evaluation tool that uses the functional aspects of, and existing standards for, paper-based medical records in hospitals as its basis. The resulting EPR Standards are a tool which can be used to establish a benchmark against which to evaluate the efficiency and effectiveness of an electronic patient record.

Benchmarking↗

PubMed2005

Use of "standardized examinees" to screen for standardized-patient scoring bias in a clinical skills examination.

BACKGROUND: Clinical skills examinations using standardized patients (SPs) are important in documenting the proficiency of trainees. "Standardized examinees" (SEs) are individuals trained to a specific level of performance; they can be used as internal controls in a high-stakes, clinical skills examination. PURPOSE: The purpose of this study was to determine whether SEs can be trained to portray a specified level of confidence and whether SPs' checklist scoring is affected by the personal manner of the examinee. METHODS: Eight SEs were trained as "students" and trained to achieve a failing score on six cases in an National Board of Medical Examiners (NBME) Prototype Clinical Skills Examination. Four SEs were coached to be confident in manner, and 4 were coached to be insecure. Checklist scores were compared. Seven lay reviewers scored the SEs as confident or insecure on a behavioral assessment form. RESULTS: SEs were not detected as simulations. There was no difference between the checklist scores of confident versus insecure SEs, but their manner was rated as significantly different on all scales in the behavioral assessment. CONCLUSIONS: SEs can be trained to a specified performance level and a desired level of confidence. In this small study, personal manner did not affect SPs' checklist scoring. The use of the SEs provides a mechanism to screen for bias in high-stakes SP examinations.

Baltimore↗

PubMed1998

[Standardized tests of bone implant surfaces with an osteoblast cell culture system. I. Orthopedic standard materials].

The effect of standard orthopaedic materials on proliferation and differentiation of osteoblasts was examined using a standardised cell culture system. Osteoblasts hFOB 1.19 were cultured on stainless steel (SS), a chromium-cobalt-molybdenum alloy (CrCoMb) and commercially pure titanium (cpTi) for 12 days. Cell culture polystyrene (PS) was used as a reference. Cell numbers and cell viability were used as parameters of proliferation. Cell differentiation was assessed using alkaline phosphatase activity, collagen I and osteocalcin production. The parameters of proliferation showed earlier maximum values on PS and cpTi, while proliferation was delayed on SS and CrCoMb. The highest values of differentiation were found on cpTi. The development of alkaline phosphatase activity showed two peaks reflecting apoptosis and redifferentiation. The cell culture system hFOB 1.19 is thus suitable for revealing differences in proliferation and differentiation of osteoblasts on standard orthopaedic materials. The results correlate with previous in vivo findings. Using this system, the dynamic effect of the material surface on the differentiation process of osteoblasts can be demonstrated.

Cell Differentiation↗

PubMed2005

Setting site-specific water-quality standards by using tissue residue thresholds and bioaccumulation data. Part 2. Calculating site-specific selenium water-quality standards for protecting fish and birds.

In a companion paper, a method for deriving tissue residue-based site-specific water-quality standards (SSWQSs) was described. In this paper, the methodology is applied to selenium (Se) as an example. Models were developed to describe Se bioaccumulation in aquatic-dependent bird eggs and whole fish. A simple log-linear model best described Se accumulation in bird eggs (r2 = 0.50). For fish, separate hockey stick regressions were developed for lentic (r2 = 0.65) and lotic environments (r2 = 0.37). The low r2 value for the lotic fish model precludes its reliable use at this time. Corresponding tissue residue criteria (i.e., tissue thresholds) for bird eggs and whole fish also were identified and example model predictions were made. The models were able to predict SSWQSs over a wide range of water-tissue combinations that might be encountered in the environment. The models also were shown to be sensitive to variability in measured tissue residues with relatively small changes in variability (as characterized by the standard error) resulting in relatively large differences in SSWQSs.

Animals↗

PubMed2006

Risk assessment of the National Institute of Standards and Technology petroleum crude oil standard water accommodated fraction: further application of a copepod-based, full life-cycle bioassay.

The U.S. National Institute of Standards and Technology (NIST) petroleum crude oil was used to generate NIST water-accommodated hydrocarbon fractions (WAFs) for standardized assessment of crude oil effects on the copepod Amphiascus tenuiremis. Effects were assessed using a 96-well microplate, full life-cycle test. Briefly, nauplii (age, 24 h) were reared individually to adults (n > or =120 nauplii/treatment) in microplate wells containing 200 microl of treatment solution (seawater control [0%] or 10, 30, 50, or 100% NIST-WAF). Nauplii were monitored through development to adulthood, and mature virgin male:female pairs mated in wells containing original treatments (<30 d). A second bioassay using 0, 10, 30, and 50% WAFs (n > or =60 nauplii/treatment) was conducted to assess the effects of ultraviolet (UV) light on naupliar endpoints (<16 d). In the first experiment, nauplius-to-copepodite survival in exposures to 100% WAF was 27% +/- 6% lower than in controls (92% +/- 1%), but copepodite-to-adult survival was greater than 90% across all treatments. Analysis of development curves showed that nauplii in the 10% WAF developed into copepodites 25% faster, whereas nauplii in the 50 and 100% WAFs developed 17% slower, than controls. Copepodite development into male and female copepods was significantly delayed (2 and 4 d, respectively) in the 100% WAF compared to controls. Although none of the WAF exposures had significant effects on fertilization success or total viable production (p > 0.05), embryo hatching in the 100% WAF was significantly less (70.0% +/- 21.2%) than that in controls (87.0% +/- 19.4%). Results from the UV bioassay showed that relatively short exposures (<14 d) to 30 and 50% WAFs in the presence of UV light caused negative effects on copepod survival and development. Naupliar-stage survival and developmental endpoints were the most sensitive indicators of exposure to the NIST crude oil WAF

Animals↗

PubMed2002

Toward a universal standard: comparing two methods for standardizing spotted microarray data.

DNA microarray technology has allowed the transcriptome to be studied to a depth that was inconceivable only 10 years ago. Until recently these studies were isolated because, without a universal standard, the results from experiment to experiment and laboratory to laboratory were not directly comparable. For human microarrays, this problem has been addressed by numerous methods, but only two are truly universal. The first method uses genomic DNA as a standard for comparison since it is, by definition, complete and universally available. The second method employs a highly representative total RNA pool such as the one currently available from Stratagene. To determine the advantages and disadvantages of both methods, they were directly compared by hybridization to the University of Texas Southwestern Medical Center's 4000- or 10800-member human cDNA array, using typical microarray techniques. The labeled analytes were 2 microg normal human genomic DNA labeled by nick translation or 20 microg total RNA pool labeled by reverse transcription. The resulting data were then background-subtracted, analyzed, and the number of spots above a background threshold was compared in each sample. Using the McNemar test and a Yate's correction with one degree of freedom, the samples were statistically identical with chi2 = 3.72.

DNA↗

PubMed2003

The beryllium "double standard" standard.

Brush Wellman, the world's leading producer and supplier of beryllium products, has systematically hidden cases of beryllium disease that occurred below the threshold limit value (TLV) and lied about the efficacy of the TLV in published papers, lectures, reports to government agencies, and instructional materials prepared for customers and workers. Hypocritically, Brush Wellman instituted a zero exposure standard for corporate executives while workers and customers were told the 2 microgram standard was "safe." Brush intentionally used its workers as "canaries for the plant," and referred to them as such. Internal documents and corporate depositions indicate that these actions were intentional and that the motive was money. Despite knowledge of the inadequacy of the TLV, Brush has successfully used it as a defense against lawsuits brought by injured workers and as a sales device to provide reassurance to customers. Brush's policy has reaped an untold number of victims and resulted in mass distribution of beryllium in consumer products. Such corporate malfeasance is perpetuated by the current market system, which is controlled by an organized oligopoly that creates an incentive for the neglect of worker health and safety in favor of externalizing costs to victimized workers, their families, and society at large.

Air Pollutants, Occupational↗

PubMedDate not supplied

Current standards of care for inpatient glycemic management and metabolic control: is it time for definite standards and targets?

OBJECTIVE: To review the available literature on the presence of diabetes in the inpatient population and its effect on outcomes. RESULTS: Diabetes is a progressively worsening epidemic in the United States. Patients with diabetes have a disproportionate representation among the inpatient population in this country, and their share of total health-care costs is both disproportionate and growing rapidly. Patients with diabetes are often admitted to the hospital not primarily because of their diabetes but rather because of the need for treatment of the end-stage complications of diabetes, such as cardiovascular, cerebrovascular, and peripheral vascular disease as well as diabetic nephropathy and retinopathy, or because of unrelated illnesses for which diabetes is a complication. Diabetes is a frequent comorbid condition and increases the duration of hospitalization by 1 to 2 days. Numerous organizations have issued guidelines for outpatient diabetes management and metabolic control and have updated them periodically; however, no such guidelines or standards have been formulated for inpatient diabetes management. CONCLUSION: In view of a rapidly growing body of evidence suggesting that enhanced glycemic control decreases morbidity and mortality in patients with hyperglycemia, such as those with new-onset diabetes, as well as in patients with previously established diabetes, the creation of clearly defined standards and targets for inpatient management of hyperglycemia and metabolic control seems important for improvement of outcomes in hospitalized patients with diabetes.

Blood Glucose↗

PubMed2003

Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization.

Despite enormous energies invested in authoring clinical practice guidelines, the quality of individual guidelines varies considerably. The Conference on Guideline Standardization (COGS) was convened in April 2002 to define a standard for guideline reporting that would promote guideline quality and facilitate implementation. Twenty-three people with expertise and experience in guideline development, dissemination, and implementation participated. A list of candidate guideline components was assembled from the Institute of Medicine Provisional Instrument for Assessing Clinical Guidelines, the National Guideline Clearinghouse, the Guideline Elements Model, and other published guideline models. In a 2-stage modified Delphi process, panelists first rated their agreement with the statement that "[Item name] is a necessary component of practice guidelines" on a 9-point scale. An individualized report was prepared for each panelist; the report summarized the panelist's rating for each item and the median and dispersion of rankings of all the panelists. In a second round, panelists separately rated necessity for validity and necessity for practical application. Items achieving a median rank of 7 or higher on either scale, with low disagreement index, were retained as necessary guideline components. Representatives of 22 organizations active in guideline development reviewed the proposed items and commented favorably. Closely related items were consolidated into 18 topics to create the COGS checklist. This checklist provides a framework to support more comprehensive documentation of practice guidelines. Most organizations that are active in guideline development found the component items to be comprehensive and to fit within their existing development methods.

Documentation↗

PubMed1999

Standardized medical record: a new outpatient osteopathic SOAP note form: validation of a standardized office form against physician's progress notes.

The accuracy and efficiency of recording information on a one-page standardized Outpatient Osteopathic SOAP Note Form (SNF) was compared with that obtained using the physician's progress notes (PPN). Use of the SNF in lieu of the PPN would assure the physician that proper clinical data were recorded to ensure proof of need and care in any instances of refused reimbursement. Moreover, standardized SNFs could be used to document and analyze present treatment protocols, enabling medical advances. Ten osteopathic physicians, who were skilled in osteopathic manipulative treatment (OMT), enrolled 300 patients. Initial and follow-up examinations totaled 959 visits (statistical cases); 76 statistical variables were compared. Essentially all information recorded in the PPN was recorded on the SNF. A significant difference (P < .05) was found between the PPN data set and the SNF data set in all but 17 of the 76 variables. Greater content of information almost always was found with the SNF data set. In addition, the SNF contained information not found in the PPN, most notably the severity and response to treatment of detected somatic dysfunctions. Participating physicians stated that the SNF takes about the same amount of time to fill in as the PPN. This makes the SNF a practical instrument for accurately and efficiently obtaining patient data in all physicians' offices. The validation study conducted demonstrated that the Outpatient Osteopathic SOAP Note Form easily and accurately reflected information recorded in the PPN and that data recorded may be used by physicians in their individual practices or for the conduct of osteopathic research.

Data Collection↗