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A standard aminophylline intravenous solution with flow rate label adapted to a manufacturer's standard solution.

The development of a standard aminophylline intravenous solution system utilizing a flow rate label is described. The original system was developed using 500 mg aminophylline in 250 ml of 5% dextrose injection in a polyvinyl chloride bag (PVC). An ancillary label was developed to be affixed to the bag to assist in maintaining flow rates. Later, this system was adapted to a premixed solution prepared by Travenol Laboratories. The difference, though, was the fact that a solution of 400 mg theophylline (equivalent to 500 mg of aminophylline) in 250 ml of 5% dextrose solution (PVC) was used. Hence, a new auxiliary label indicating flow rates between aminophylline and theophylline was developed. The success of both systems gave us more advantages than disadvantages. This was especially true with the premixed system. We feel that the auxiliary flow rate label helped maintain rates whether the physicians orders were written in theophylline or aminophylline. With proper nursing inservice, this standard aminophylline program could be successful using this auxiliary flow rate label.

Aminophylline↗

Medicare program; physician performance standard rate of increase for federal fiscal year 1990--HCFA. Announcement of physician performance standard rate of increase.

This notice announces the Federal fiscal year 1990 performance standard rate of increase for expenditures and volume of physician services under the Medicare Supplementary Medical Insurance (Part B) program as required by section 0102 of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239). The physician performance standard rate of increase for Federal fiscal year 1990 is 9.1 percent.

Centers for Medicare and Medicaid Services, U.S.↗

Proposals from the IFCC Committee on Standardization of Markers of Cardiac Damage (C-SMCD): strategies and concepts on standardization of cardiac marker assays.

The search for sensitive and specific biochemical markers of cardiac damage has resulted in development of methods for the measurement of cardiac markers such as myoglobin, CK-MB mass and the cardiac troponins (cardiac troponin I and cardiac troponin T). There have been new clinical applications of already known markers based on improved, reformulated methods which often depend on advanced technologies. These developments are connected with analytical and interpretative challenges for the laboratory manager and for the clinician. In this situation, it is essential that international professional societies develop comprehensive and carefully elaborated guidelines for the quality management and use of these measurements and their results. Several professional associations have formed committees working on different issues regarding the measurement of biochemical markers of cardiac damage. Recognizing the huge interest in this field and substantial diagnostic relevance of these markers, the IFCC has established the Committee on "Standardization of Markers of Cardiac Damage" (C-SMCD) in 1997 inviting the already operating American and European groups to designate some of their members into the new committee. The task of the IFCC C-SMCD is to coordinate the different activities of the national groups, with preparation of international documents and recommendations under the auspices of IFCC and to initiate various standardization activities. The establishment of consensus/reference methods as well as development of primary and secondary matrix reference materials for markers of cardiac damage are extremely important in order to achieve comparability of test results, thus leading to an effective patient care.

Biomarkers↗

Average recovery time from a standardized intravenous sedation protocol and standardized discharge criteria in the general dental practice setting.

Intravenous sedation has been used in dentistry for many years because of its perceived advantages over general anesthesia, including shorter recovery times. However, there is limited literature available on recovery from intravenous dental sedation, particularly in the private general practice setting. The aim of this study was to describe the recovery times when sedation was conducted in private dental practice and to consider this in relation to age, weight, procedure type, and procedure time. The data were extracted from the intravenous sedation records available with 1 general anesthesia-trained dental practitioner who provides ambulatory sedation services to a number of private general dental practices in the Perth, Western Australia Metropolitan Area. Standardized intravenous sedation techniques as well as clear standardized discharge criteria were utilized. The sedatives used were fentanyl, midazolam, and propofol. Results from 85 patients produced an average recovery time of 19 minutes. Recovery time was not associated with the type or length of dental procedures performed.

Adolescent↗

The accuracy of digital-video retinal imaging to screen for diabetic retinopathy: an analysis of two digital-video retinal imaging systems using standard stereoscopic seven-field photography and dilated clinical examination as reference standards.

PURPOSE: To evaluate the accuracy of two digital-video retinal imaging (DVRI) systems to detect diabetic retinopathy. METHODS: A prospective, masked, technology assessment was conducted for two DVRI systems at a tertiary care Veterans Affairs Medical Center. Group A (n = 151 patients) was imaged with a 640x480 resolution system and group B (n = 103 patients) with an 800x600 resolution system. Four retinal evaluations were performed on each patient: DVRI with undilated pupils using one imaging field (U-DVRI), DVRI with dilated pupils using three imaging fields (D-DVRI), dilated clinical examination, and Early Treatment Diabetic Retinopathy Study stereoscopic seven-field photography (ETDRS-P). Two analyses of accuracy were conducted, one using ETDRS-P as a "gold standard" (ETDRS-GS) and one using dilated clinical examination as a "gold standard" (C-GS). RESULTS: For group A, using the ETDRS-GS, sensitivities of U-DVRI and D-DVRI were 0.66 and 0.66; specificities of U-DVRI and D-DVRI were 0.66 and 0.86. Using the C-GS, sensitivities of U-DVRI and D-DVRI were 0.79 and 0.80; specificities of U-DVRI and D-DVRI were 0.68 and 0.85. For group B, using the ETDRS-GS, sensitivities of U-DVRI and D-DVRI were 0.76 and 0.85; specificities of U-DVRI and D-DVRI were 0.45 and 0.80. Using the C-GS, sensitivities of U-DVRI and D-DVRI were 0.81 and 0.87; specificities of U-DVRI and D-DVRI were 0.45 and 0.69. For both groups, dilation significantly improved specificities. CONCLUSIONS: The 800x600 resolution DVRI system offers an accurate method of detecting diabetic retinopathy, provided there is adequate pupillary dilation and three retinal images are taken. DVRI technology may help facilitate retinal screenings of growing diabetic populations.

Aged↗

How standardized are standardized patients?

The accuracy and reproducibility of the standardized patient's presentation of a clinical problem was evaluated in 15 cases used in the evaluation of fourth year medical students in two universities. There were differences in the quality of standardized patient presentation between institutions and among the cases presented.

Clinical Competence↗

Suggested standards for reports dealing with lower extremity ischemia. Prepared by the Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery.

Reports in the vascular surgery literature are often difficult to assess and compare with each other because of poorly defined terms, imprecise categorization, lack of indices for gauging the severity of the disease or the presence of risk factors capable of affecting outcome, and varying criteria for success or failure--in essence, a lack of standardized reporting practices. The joint councils of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery have appointed an ad hoc committee to deal with this problem. This report represents the recommendations of the first of its several subcommittees, that is, the one dealing with reports on lower extremity ischemia. Certain terms are defined and criteria offered for uniformly gauging the severity of disease, the findings of diagnostic studies, the types of therapeutic interventions, and the outcome of such treatments. Although future modifications may further improve on this effort, it is hoped that this committee's recommendations will help establish reporting standards for articles dealing with lower extremity ischemia.

Acute Disease↗

Prothrombin time standardization: report of the expert panel on oral anticoagulant control. The International Committee on Thrombosis and Haemostasis, The International Committee for Standardization in Hematology.

In collaborative experiments in 199 laboratories, nine commercial thromboplastins, four thromboplastins held by the National Institute for Biological Standards and Control (NIBS & C), London and the British Comparative Thromboplastin were tested on fresh normal and coumarin plasmas, and on three series of freeze-dried plasmas. One of these was made from coumarin plasmas and the other two were prepared from normal plasmas; in each series, one plasma was normal and the other two represented different degrees of coumarin defect. Each thromboplastin was calibrated against NIBS & C rabbit brain 70/178, from the slope of the line joining the origin to the point of intersection of the mean ratios of coumarin/normal prothrombin times when the ratios obtained with the two thromboplastins on the same fresh plasmas were plotted against each other. From previous evidence, the slopes were calculated which would have been obtained against the NIBS & C "research standard" thromboplastin 67/40, and termed the "calibration constant" of each thromboplastin. Values obtained from the freeze-dried coumarin plasmas gave generally similar results to those from fresh plasmas for all thromboplastins, whereas values from the artificial plasmas agreed with those from fresh plasmas only when similar thromboplastins were being compared. Taking into account the slopes of the calibration lines and the variation between laboratories, precision in obtaining a patient's prothrombin time was similar for all thromboplastins.

Administration, Oral↗

Standardization of blood specimen collection procedure for reference values. International Committee for Standardization in Haematology (ICSH).

This document has been prepared by an ICSH Task Force as a proposed ICSH Standard for Blood Specimen Collection for Reference Values. The procedures described are a model for standardization of blood specimen collection either for people confined to bed, or for those who are ambulant; they are intended for obtaining reference values using the principles described in the ICSH paper on the Theory of Reference Values (Clin. lab. Haemat. 3, 369-373, 1981). The document is based on recommendations by the Committee on Reference Values of the Scandinavian Society for Clinical Chemistry and Clinical Physiology as published in Scand. J. clin. lab. Invest. (35, Suppl. 144, 39-43, 1975); it has been prepared in collaboration with the Panel on the Theory of Reference Values of the Scientific Committee of the International Federation of Clinical Chemistry (IFCC). The responsible authorities of ICSH and IFCC have proposed that it should be the basis for joint recommendations by both organizations.

Blood Preservation↗

Entry-level standards for MRI technologists. The ASRT Task Force on Entry-Level Standards for Magnetic Resonance Technologists.

This special report describes the findings of two surveys designed to identify MRI technologists' opinions about entry-level standards. The surveys were conducted by the ASRT Task Force on Entry-Level Standards for Magnetic Resonance Technologists. Results show that MRI technologists believe those entering the profession should be registered radiologic technologists or Registry-eligible and should have formal MRI education.

Magnetic Resonance Imaging↗

In vivo recovery of factor VIII following transfusion: a survey of recent data and publications to assess the influence of standards used for potency assignment. On behalf of the Subcommittee on Factor VIII and IX of the Scientific and Standardization Committee of the ISTH.

In the therapy of factor VIII deficiency, experience has taught the value of achieving a target level of plasma coagulation factor VIII. There is a consensus that an empirical value of 2 iu/dl/iu/kg may be used to estimate recovery, and hence plasma levels, of factor VIII. This may be influenced by the methods used to assign label potency to the products and for assessment of patient post-infusion plasmas. To assess a possible influence of the standard used to assign product potency on in vivo recovery, a survey was undertaken of recent in vivo recovery studies. Analysis of submitted data, in combination with published studies over the last ten years, revealed a significant influence of the standard used to assign potency to products on the measured in vivo recovery. Furthermore, from limited data the potency determined in post-infusion patient plasmas was found not to be influenced by the use of one-stage or chromogenic assay methods.

Blood Component Transfusion↗

[Vienna standard in diagnosis of nicotine dependence: Vienna Standard Smoking Inventory].

The Standard Vienna Smokers' Inventory (VSSI) ("Wiener Standard Raucher-Inventar" [WSR]) is based on the authors' experience and was designed to optimize primary and additional diagnostic procedures associated with smoking cessation treatment. The aim of this inventory is to enable therapists interested in smoking cessation interventions to initiate diagnostic procedures as well as to use efficient therapeutic modalities. The study also highlights those areas of the patient's history which should be given special attention and the theoretical background of these areas. The various comprehensive sections of the WSR include general data pertaining to the patient's life, the basic situation (basic rate), especially with regard to nicotine dependence, pre-abstinence syndrome and "tar" exposition values, follow-up of smoking habits, earlier attempts to give up smoking, and possible barriers to cessation of smoking--such as insufficient motivation, "nocturnal sleep disturbing nicotine craving" or carbohydrate dependence. Furthermore, previous illnesses, pre-existing risk factors and regular intake of drugs are also discussed. Finally, the study emphasizes that the WSR should be used by the therapist according to his/her level of training and experience, thus providing the possibility to use specific, individual approaches to deal with specific individuals and situations.

Adult↗

Describing and estimating: use and abuse of standard deviations and standard errors.

Summarizing data using means and standard deviations (SDs) is commonplace in research reports. Many papers also present means and standard errors (SEs). Published reports are frequently confusing and inconsistent in their use of SDs and SEs. This short article clarifies the meaning and appropriate roles for these two important measures. The SD is used when describing study subjects and the SE is used when estimating the precision with which findings from the study sample can be extrapolated to other groups.

Confidence Intervals↗

Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia.

An International Working Group met to revise the diagnostic and response criteria for acute myelogenous leukemia originally published in 1990, as well as to provide definitions of outcomes and reporting standards to improve interpretability of data and comparisons among trials. Since the original publication, there have been major advances in our understanding of the biology and molecular genetics of acute leukemia that are clinically relevant and warrant incorporation into response definitions. Differences from the 1990 recommendations included a category of leukemia-free state, new criteria for complete remission, including cytogenetic and molecular remissions and remission duration. Storage of viable blasts for correlative studies is important for future progress in the therapy of these disorders.

Clinical Trials as Topic↗

Precise blood lead analysis using a combined internal standard and standard addition approach with disposable screen-printed electrodes.

We report here a highly accurate and efficient method for blood lead analysis (BLA) through the use of a disposable electrode. A new type of mercury-plated preanodized screen-printed carbon electrode, together with a thallium(III) internal standard, simplifies calibration and gives easily quantifiable signals for accurate BLA. A preanodization procedure improves the preconcentration ability of the working electrode through the effect of lead (Pb) complexing with an electrogenerated surface functional group, mainly >C=O. Under optimized conditions, the ratio of the anodic stripping peak currents of Pb and Tl (i.e., i(Pb)/i(Tl)) is linear against [Pb] in the window of 1-300 ppb with a correlation coefficient and detection limit (signal-to-noise ratio=3) of 0.999 and 0.23 ppb, respectively. This approach was used to analyze blood samples (n=55) from workers at a local battery factory. The results are consistent with those obtained from graphite furnace atomic absorption spectroscopy and confirm the applicability of the proposed method.

Carbon↗

Establishing equivalence for activity standards of short-lived radionuclides using the NPL secondary standard radionuclide calibrator.

Conventional comparison techniques used between National Metrology Institutes are not practicable for short-lived radionuclides because of geographical separations and transport difficulties. The NPL Secondary Standard Radionuclide Calibrator provides an alternative approach and a comparison was conducted with 18F to investigate its feasibility. The exercise was successful and the paper details the protocol used, the quality assurance mechanisms introduced to underpin the comparison and an analysis of the results. It was also demonstrated that this approach could be linked to the BIPM SIR system. Recommendations are presented for the extension of this work to other suitable, short-lived radionuclides.

Calibration↗

Electrocardiographic detection of left ventricular hypertrophy using echocardiographic determination of left ventricular mass as the reference standard. Comparison of standard criteria, computer diagnosis and physician interpretation.

Electrocardiographic findings of left ventricular hypertrophy were compared with echocardiographic left ventricular mass in 148 patients to assess performance of standard electrocardiographic criteria, the IBM Bonner program and physician interpretation. On echocardiography, 43% of the patients had left ventricular hypertrophy (left ventricular mass greater than 215 g). Sokolow-Lyon voltage-(S in V1 + R in V5 or V6) and Romhilt-Estes point score correlated modestly with left ventricular mass (r = 0.40, p less than 0.001 and r = 0.55, p less than 0.001, respectively). Sensitivity of Sokolow-Lyon voltage greater than 3.5 mV for left ventricular hypertrophy was only 22%, but specificity was 93%. Point score for probable left ventricular hypertrophy (greater than or equal to 4 points) had 48% sensitivity and 85% specificity, whereas definite hypertrophy (greater than or equal to 5 points) had 34% sensitivity and 98% specificity. Computer analysis resulted in 45% sensitivity and 83% specificity. Overall diagnostic accuracy of the IBM Bonner program (67%) was better than that of Sokolow-Lyon voltage (62%), but worse than the Romhilt-Estes point score (69% for greater than or equal to 4 points or 70% for greater than or equal to 5 points). Three cardiologists interpreted electrocardiograms independently and in a blinded fashion. Physician sensitivity was 56%, specificity 92% and accuracy 76%. Correlation with left ventricular hypertrophy was good (r = 0.70, p less than 0.001). It is concluded that: 1) computer diagnosis of left ventricular hypertrophy by the IBM Bonner program is no more accurate than diagnosis by Sokolow-Lyon or Romhilt-Estes criteria, and 2) physician recognition of left ventricular hypertrophy is more accurate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

SNOW: standard nomenclature wizard to help searching for (bio) chemical standardized names.

UNLABELLED: When developing bioinformatical tools dealing with enzymatic activity, metabolism or enzymatic networks, the problem of the lack of a clear nomenclature for biochemical compounds often arises. This problem leads us to develop a small web-based tool (SNOW, Standard NOmenclature Wizard) which may help to find recommended and trivial names or the correct closest spelling for a query compound name, if it exists. AVAILABILITY: Web-based interface available at http://ibb.uab.es/snow/ SUPPLEMENTARY INFORMATION: http://ibb.uab.es/snow/snow_moreinfo.html

Algorithms↗