[Technics and guidelines in nursing observation (specific areas of assessment: items of observation and their significance). Psychiatric and psychological observations].
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Humans↗
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[Nursing diagnosis: observation. Observation at bedside and nursing planning-observation of the patient with depression].
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Attention↗
HOME inventory and NCATS: relation to mother and child behaviors during naturalistic observations. Home Observation for Measurement of the Environment. Nursing Child Assessment Teaching Scale.
The purpose of this study was to determine the relationships among the Nursing Child Assessment Teaching Scale (NCATS), the Home Observation for Measurement of the Environment (HOME) inventory, and interactive behaviors observed in the home for fifty-three 3-year-old, prematurely born children and their mothers. The total HOME score showed high internal consistency, with moderate subscale levels. NCATS total score showed high internal consistency, but low to moderate subscale consistency. Combining NCATS subscales into a mother subscale and child subscale improved internal consistency. The HOME and the NCATS mother subscale correlated with observed maternal behaviors, but the NCATS child subscale was unrelated to child behaviors. Relationships between observed behaviors and HOME scores did not differ for high- and low-education mothers or for Caucasians and African Americans, but only low-education mothers and African Americans exhibited correlations between NCATS scores and observed behaviors. These results show the HOME, NCATS, and naturalistic observations measure related, but not overlapping, aspects of the mother's contribution to her relationship with her child, but the NCATS child subscale should be used with caution with 3-year-olds.
Adult↗
Modulation of motor cortex excitability in the left hemisphere during action observation: a single- and paired-pulse transcranial magnetic stimulation study of self- and non-self-action observation.
Motor system excitability was tested by transcranial magnetic stimulation (TMS), and F-wave and H-reflex evaluation in different action observation tasks. Our aim was to investigate the effects produced by self- versus non-self-hand movement observation (MO). No significant differences were found between the self- and non-self-conditions. Movement observation significantly modulated motor cortex excitability, producing an increase in the amplitude of motor evoked potentials (MEPs) with a single magnetic pulse and a reduction in intracortical inhibition (ICI) with paired-pulse stimulation. No significant changes were found in motor cortex excitability during the observation of geometric objects. Motor imagery produced similar effects to those of action observation; no significant differences in modulation of motor system excitability between motor imagery and action observation were found in those muscles involved in actual motor execution. No significant effect on spinal excitability was found in any of the test conditions.
Adult↗
Very-long-baseline radio interferometry (VLBI) observations of gamma-ray blazars: results from millimeter-VLBI observations.
VLBI observations of the extremely gamma-bright blazar PKS 0528+134 at 8, 22, 43, and 86 GHz reveal a strongly bent one-sided-core jet structure with at least three moving and two apparently stationary jet components. At the highest observing frequencies the brightest and most compact jet component (the VLBI core) is unresolved with an upper limit to its size of approximately 50 microarcsec corresponding to approximately 0.2 parsec [H0 = 100 km.s-1.Mpc-1 (megaparsec-1), q0 = 0.5, where H0 is Hubble constant and q0 is the deceleration parameter]. Two 86-GHz VLBI observations performed in 1993.3 and 1994.0 reveal a new jet component emerging with superluminal speed from the core. Linear back-extrapolation of its motion yields strong evidence that the ejection of this component is related to an outburst in the millimeter regime and a preceding intense flare of the gamma-flux density observed in early 1993. This and the radio/optical "light curves" and VLBI data for two other sources (S5 0836+710 and 3C 454.3) suggest that the observed gamma-radiation might be Doppler-boosted and perhaps is closely related to the physical processes acting near the "base" of the highly relativistic jets observed in quasars.
Journal Article↗
The Behavior Observation Instrument: a method of direct observation for program evaluation.
The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.
Activities of Daily Living↗
Observation procedure, observer gender, and behavior valence as determinants of sampling error in a behavior assessment analogue.
Several factors thought to influence the representativeness of behavioral assessment data were examined in an analogue study using a multifactorial design. Systematic and unsystematic methods of observing group behavior were investigated using 18 male and 18 female observers. Additionally, valence properties of the observed behaviors were inspected. Observers' assessments of a videotape were compared to a criterion code that defined the population of behaviors. Results indicated that systematic observation procedures were more accurate than unsystematic procedures, though this factor interacted with gender of observer and valence of behavior. Additionally, males tended to sample more representatively than females. A third finding indicated that the negatively valenced behavior was overestimated, whereas the neutral and positively valenced behaviors were accurately assessed.
Journal Article↗
Observations on structural features and characteristics of biological apatite crystals. 9. Observation on dissolution of carious enamel crystals.
In a series of studies to investigate the basic structural features and characteristics of the biological apatite crystals using a transmission electron microscope, we examined the ultrastructure of the human enamel, dentin, and bone crystals through the cross and longitudinal sections at near atomic resolution. Subsequently, using the same approach, we have been able to directly examine the images of the lattice imperfections in the crystal lattices of the human tooth and bone crystals, and the images of the fusion of the crystals. In this research, furthermore, using transmission and scanning electron microscopes, we examined the dissolution of the enamel crystals caused by the carious enamel from the same viewpoint. The material used for the observation of the dissolution of the enamel crystals was obtained from the region which corresponds to the middle layer of the enamel at the portion near the wall of a carious cavity caused by the fissure caries on the occlusal surface of the lower first molars. Small cubes of the materials used for the observation by transmission electron electron microscope were fixed in glutaraldehyde and osmium tetroxide and embedded in epoxy resin using the routine methods. The ultrathin sections were cut with a diamond knife without decalcification. The sections were examined with the HITACHI H-800H type transmission electron microscope operated at 200 kV. Each crystal was observed at an initial magnification of 300,000 times and at a final magnification of 10,000,000 times and over. The material used for the observation by the scanning electron microscope was the fractured surface obtained from the carious enamel. The fractured carious enamel surfaces were coated with carbon and gold and observed with the HITACHI HHS-2R type scanning electron microscope operated at 25 kV. The crystals were observed at a final magnification of 50,000 times. As a result, we have confirmed that the dissolution of the enamel crystals caused by a caries occurs in the units of "hexagonal cell". We sincerely believe that the electron micrographs shown in this report are the first to show the images of the dissolution of the enamel crystals caused by a caries at near atomic resolution.
Dental Caries↗
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
OBJECTIVE: Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. PARTICIPANTS: Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. EVIDENCE: We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. CONSENSUS PROCESS: From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. CONCLUSIONS: The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
Epidemiology↗
Assessment of left ventricular volume and mass by cine magnetic resonance imaging in patients with anterior myocardial infarction intra-observer and inter-observer variability on contour detection.
Remodeling of the left ventricle after myocardial infarction can be documented by calculation of left ventricular volume and mass, using endocardial and epicardial tracings of multilevel multiphase short-axis cine magnetic resonance (MR) imaging series. We assessed left ventricular volume and mass from 8 slices and during 12 phases of the cardiac cycle in seven patients with an anterior wall myocardial infarction; one patient was studied twice, leaving eight MR examinations to be evaluated. Purpose of this study was to assess the intra-observer and inter-observer variability of epicardial volume, endocardial volume, and left ventricular mass from contours manually traced by two independent observers. For the eight MR examinations, epicardial volume was found to be 292 +/- 51 ml (mean +/- SD) at end-diastole, which decreased to 237 +/- 55 ml at end-systole. Endocardial volume was 141 +/- 31 ml at end-diastole, which decreased to 79 +/- 27 ml at end-systole. Left ventricular ejection fraction was 45 +/- 8%. Mean left ventricular mass, when averaged over all patient studies and all phases, was 159 +/- 30 g. Intra-observer and inter-observer variability were found to be 3.5% and 5.2% for endocardial volume, 2.0% and 2.5% for epicardial volume, and 3.6% and 3.6% for left ventricular mass, respectively. The contour analysis showed a statistically significant phase effect in the endocardial contour in the midventricular slices, which was resolved after establishing a more precise definition for the tracing of the endocardial border. In conclusion, left ventricular volume and mass in patients with an anterior wall myocardial infarction can be assessed with high reproducibility and reliability from manual contour tracings. A precise protocol for the definition of endocardial and epicardial contours is required to obtain reproducible and reliable results.
Humans↗
A prospective, observational study of a chest pain observation unit in a British hospital.
OBJECTIVES: To establish a chest pain observation unit, monitor its performance in terms of appropriate discharge after assessment, and estimate the cost per patient. METHODS: Prospective, observational, cohort study of patients attending a large, city, teaching hospital accident and emergency department between 1 March 1999 and 29 February 2000 with acute undifferentiated chest pain. Patients were managed on a chest pain observation unit, entailing two to six hours of observation, serial electrocardiograph recording, cardiac enzyme measurement, and, where appropriate, exercise stress test. Patients were discharged home if all tests were negative and admitted to hospital if tests were positive or equivocal. The following outcomes were measured-proportion of participants discharged after assessment; clinical status three days after discharge; cardiac events and procedures during the following six months; and cost of assessment and admission. RESULTS: Twenty three participants (4.3%) had a final diagnosis of myocardial infarction. All were detected and admitted to hospital. A total of 461 patients (86.3%) were discharged after assessment, 357 (66.9%) avoided hospital admission entirely. At review three days later these patients had no new ECG changes and only one raised troponin T measurement. In the six months after assessment, three cardiac deaths, two myocardial infarctions, and two revascularisation procedures were recorded among those discharged. The mean cost of assessment and hospital admission was 221 pound per patient, or 323 pound if subsequent interventional cardiology costs were included. CONCLUSIONS: The chest pain observation unit is a practical alternative to routine care for acute chest pain in the United Kingdom. Negative assessment effectively rules out immediate, serious morbidity, but not longer term morbidity and mortality. Costs seem to be similar to routine care.
Angina Pectoris↗
Using replicate observations in observer agreement studies with binary assessments.
By introducing replicate observations into observer agreement studies, one can obtain better measures of observer agreement than heretofore possible. New methodology based on the analysis of latent variables allows a separation of within- and between-observer variation for binary measures of assessment among pairs of observers. Maximum likelihood estimation and hypothesis testing are discussed. The methodology is illustrated using data on the assessment of dysplasia by pathologists.
Biometry↗
Consistencies and discrepancies in self- and observer-rated anxiety scales. A comparison between the self- and observer-rated Marks-Sheehan scales.
The Marks-Sheehan anxiety scales are the only scales where self-ratings and observer ratings are perfectly matched by the number, the content and the scaling of the items. Therefore these scales are an excellent tool to investigate the compatibility and to study different structures in self- and observer ratings. This was done by using the data material on the Marks-Sheehan scales of the Cross National Collaborative Panic Study. In this study 1168 outpatients who met the DSM-III criteria for panic disorder were randomly allocated either to alprazolam, imipramine or placebo treatment. Our results show that the Marks-Sheehan scales are highly comparable to other established rating scales. Both scales have a similar stable and consistent factor pattern for somatic symptoms but not for psychic symptoms of anxiety. Our results provide empirical evidence that the low consistencies between self- and observer ratings reported so far can be improved by using a rating scale which matches up item for self- and observer ratings. However, other sources of disagreement can only be solved by more elaborated item descriptions and training of patients as well as raters to obtain a better compatibility between self- and observer rating scales.
Adult↗
Fluorescence and photodynamic effects of bacteriochlorin a observed in vivo in 'sandwich' observation chambers.
Bacteriochlorin a (BCA), a derivative of bacteriochlorphyll a, is an effective photosensitiser in vitro and in vivo. BCA has a major absorption peak at 760 nm where tissue penetration is optimal. This property, together with rapid tissue clearance promises minor skin photosensitivity. The tissue localising and photodynamic properties of BCA were studied using isogeneic RMA mammary tumours, transplanted into subcutaneous tissue in transparent 'sandwich' observation chambers on the back of WAG/Rij rats. The fluorescence kinetics following an i.v. administration of 20 mg kg-1 BCA was assessed in blood vessels, tumour and normal tissue. Subsequently, the development of vascular- and tissue damage after a therapeutic light dose (760 nm, 600 J cm-2) was observed. Fifteen minutes post injection (p.i.), the fluorescence of BCA in the tumour reached a plateau value of 2.5 times the fluorescence in the normal tissue. From 1 h post injection the tumour fluorescence diminished gradually; after 24 h, the tumour fluorescence signal did not exceed that of the normal tissue. Following photodynamic therapy (PDT), 24 h p.i., complete vascular stasis was observed 2 h post treatment in the tumour only, with subsequent recovery. The presence of viable tumour cells following PDT was assessed by histology and re-transplantation of treated tumour tissue from the chamber into the flank immediately or 7 days after treatment. In both cases tumour regrowth was observed. BCA-PDT (20 mg kg-1, 760 nm, 100 J cm-2) 1 h after BCA administration, an interval which gives the optimal differential between tumour and normal tissue, was sufficient to prevent tumour regrowth. However, this only occurred when re-transplantation was performed 7 days after PDT. During PDT, 1 h p.i., vascular damage in tumour and normal tissue was considerable. Complete vascular shut-down was observed in the tumour 2 h after therapy and in the surrounding tissues at 24 h. Circulation damage was associated with vascular spasm and occlusion probably due to thrombi formation. Oedema was notable, especially following PDT with 600 J cm-2 at 24 h p.i.
Animals↗
Changes in student and teacher responses in observed and generalized settings as a function of supervisor observations.
Two studies are reported in which the effects of supervisor observations of teachers' performance rate and accuracy on both teachers' and severely handicapped students' behaviors were compared with baseline supervisor observations that did not specify rate and accuracy feedback. The latter observation procedure (nonspecific feedback) was more typical of the existing practices of school supervisors. The dependent variables for the teachers were rate and accuracy of teacher behaviors to student responses in individualized instructional settings involving discrete trials or task-analysis steps. The dependent variables for students were the rates of correct and incorrect responding to teacher presentations during the supervisor observation periods. Both studies used a multiple baseline design. The results of Study 1 showed that there were educationally significant changes in teacher and, in turn, student performance as a result of the use of the rate and accuracy procedure. The results of Study 2 replicated those of Study 1 while correcting limitations of Study 1. This latter study also demonstrated that the observation effects of the procedure generalized to teacher performance throughout the day. The results are discussed in terms of the efficiency and cost effectiveness of the procedure to train, monitor, and reinforce teacher effectiveness.
Adolescent↗
Intra-observer and inter-observer agreement of the manual examination of the lumbar spine in chronic low-back pain.
Examination is a cornerstone in the manual procedures leading to mobilisation/manipulation of the low back. The observer variation of the more specific segmental tests remains to be investigated. Two skilled specialists in manual medicine examined the segmental changes in the lumbar spine. The patients were unknown to the examiners and no information of the case history was given. All test results were recorded by an observer present in the room who ensured that no conversation was allowed during the examination. The primary outcome measures were the kappa values for each test. The matching was defined as acceptable (acc) within two neighbouring levels and perfect (per) on the same level. Intra-observer variation (tested in 33 patients and 10 subjects without low-back pain): The agreement between first and second segmental diagnosis examination was 70% (per) and 82% (per + acc). Kappa values were: segmental diagnosis 0.60 (per) and 0.70 (per + acc), multifidus test 0.51 (per) and 0.60 (per + acc), sideflexion 0.57 (per) and 0.69 (per + acc), and ventral flexion 0.31 (per) and 0.45 (per + acc). Inter-observer variation (tested in 60 patients): The agreement for segmental diagnosis between the examiner A and B was 42% (per) and 75% (per + acc). Kappa values were: segmental diagnosis 0.21 (per) and 0.57 (acc), multifidus test 0.12 (per) and 0.48 (acc), sideflexion 0.22 (per) and 0.45 (acc), and ventralflexion 0.22 (per) and 0.44 (acc). By manual tests, skilled examiners seem to be able to diagnose segmental dysfunctions in the low back. The clinical implication of these dysfunctions remains to be clarified.
Adolescent↗
Variability in observer performance studies experimental observations.
RATIONALE AND OBJECTIVES: The aim of the study is to assess variance components in observer performance studies and the possible impact on study results and conclusions. MATERIALS AND METHODS: Two previously performed retrospective receiver operating characteristic-type observer performance studies to evaluate the performance of seven radiologists in detecting interstitial disease on conventional posteroanterior chest films and nine radiologists in detecting interstitial disease on a high-resolution workstation were reanalyzed by using the Beiden, Wagner, and Campbell nine-component model to estimate the different variance components. We estimated case-, reader-, and mode-related components of the variance for the group as a whole and after excluding (round robin) each reader. Overall variance was evaluated, and the effect of individual readers on overall study conclusions was assessed. RESULTS: Overall results and conclusions of the reanalysis agreed with the original one in that, as a group, radiologists performed significantly better when using conventional films (P < .05) in both studies. Reader variability was large compared with all other components, and in one study, it was substantially larger for the workstation reading mode. Reader variability was affected substantially by one observer in each study, and in one study, reader-by-mode variability was affected by another reader who performed better on the workstation. CONCLUSION: Estimates of variance components can shed light on the appropriateness of study design, as well as the sensitivity of results to the inclusion (or exclusion) of individual observers.
Humans↗
Potential for inter-observer and intra-observer variability in x-ray review to establish stone-free rates after lithotripsy.
The potential for variability among observers interpreting diagnostic tests is well known but has not been well established for radiological imaging of urolithiasis. We measured the inter-observer and intra-observer variability in the reporting of plain abdominal films and tomograms from patients who had undergone extracorporeal shock wave lithotripsy (ESWL). Unlabeled copies of the plain abdominal films and tomograms for 58 patients were individually submitted to 3 different radiologists. Selected films from 25 patients were resubmitted to the same radiologists. We found differences among radiologists reporting plain abdominal films alone 52% of the time and even by the same radiologist rereading the films 24% of the time. Tomograms alone decreased the uncertainty but differences still occurred among radiologists 24% of the time and with themselves 16% of the time. When plain abdominal films and tomograms were read together there were differences among radiologists 28% of the time and with themselves 7% of the time but these were usually minor. We concluded from this study that the plain abdominal film alone was frequently difficult to interpret, resulting in uncertainty about the presence or absence of residual stone fragments. Tomograms alone or a plain abdominal film plus tomograms is superior to a plain abdominal film alone. Finally, radiological assessment with all modalities probably overestimates stone-free rates after ESWL even without consideration of the potential for reporting variability among observers.
Humans↗