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Developing case-specific checklists for standardized-patient-based assessments in internal medicine: A review of the literature.

PURPOSE: To review the literature on the methods used in writing case-specific checklists for studies of internal medicine physicians' performances that were assessed by standardized patients. METHOD: The authors searched Medline, Embase, Psychlit, and ERIC for articles in English published between 1966 and February 1998. The following search string was used: "[(standardi(*) or simulat(*) or programm(*)) near (patient(*) or client(*) or consultati(*))] and internal medicine." The authors then searched the reference lists of papers retrieved from the database searches, as well as those from seven proceedings of the International Ottawa Conference on Medical Education and Assessment. RESULTS: The procedure yielded 29 relevant articles: database searches yielded 14 published reports dealing with case-specific checklists, 11 articles were culled from the reference lists of these papers, and the Ottawa Conference proceedings yielded four articles. Only 12 articles reported specifically on the development of checklists. In general, there were three sources used for developing checklists: panels of experts, the investigators themselves, and responses from expert physicians to written protocols. No article indicated that researchers had relied exclusively on data from the literature to compose their checklists. Only three articles indicated that literature sources had informed their checklist development. All articles except one relied on explicit criteria for the inclusion of items on the checklists. In 21 of the 29 articles, the checklists had been scored by SPs, but the scoring of specific items on the checklists varied according to the purpose of the SP-physician encounter. Only four of the articles made the checklists available or indicated that the checklists could be obtained from the authors. CONCLUSION: The development of case-specific checklists for SP examinations of physicians' performance has received little attention. To judge the validity of studies of physicians' performances that use SPs, the development processes for the checklists need to be more fully described to enable readers to evaluate the validity and reliability of the studies.

Clinical Competence↗

The GP dilemma. Recommendations and synopsis of a student conference.

The proceedings of a conference organised by students are reported. The present standing of the general practitioner and his need in different societies are equated and the obvious deficiencies are considered. Such themes as maldistribution, service and education are discussed. Resolutions derived from the conference are reported in full.

Congresses as Topic↗

Updates from the British Association of Dermatologists 84th annual meeting, 6-9 July 2004, Belfast, U.K.

Herein is a synopsis of the main research and clinical findings presented at the British Association of Dermatologists meeting held during 6-9 July 2004, in Belfast, U.K. The conference highlighted the progress that has been made in understanding the increasing biological, epidemiological and therapeutic advances that have been made recently in the field of dermatology. The authors highlight the more important advances or summaries, but this is not meant as a substitute for reading the conference proceedings and related references quoted in this article.

Adult↗

Executive summary: conference on Dietary Supplement Use in the Elderly--proceedings of the conference held January 14-15, 2003, Natcher Auditorium, National, Institutes of Health, Bethesda, MD.

Several issues prompted the need for this conference. Among these were the reported high prevalence (> 50%) of use of supplements among individuals over 50 years of age, inadequate scientific evidence supporting the safety and benefits of use among these individuals, and a report issued by the General Accounting Office (GAO) in 2001. This GAO report entitled "Health Products for Seniors: 'Anti-Aging' Products Pose Potential for Physical and Economic Harm," arose from concerns among legislators that seniors were spending money from their limited incomes on products that were not only ineffective but also potentially harmful. The conference was organized around three sessions to address the issues highlighted above, which were usage of dietary supplements among the elderly, age-related changes and issues that affect the use of supplements, and the evidence base supporting the use of supplements in disease prevention and health maintenance. Each session was followed by a panel discussion. This Executive Summary is organized around the three major discussion topics. The summary does not explicitly follow the order of the conference presentations; rather it is intended to capture and examine the current research gaps in knowledge and identify future research opportunities. These research opportunities, as expressed by the conference speakers, panelists, and attendees are summarized at the end of this paper under five thematic areas: usage behaviors, methodology, pre-clinical studies and clinical studies, informational databases, and education and dissemination.

Aged↗

Processes and methodologies for research validation of nursing diagnoses.

TOPIC: Research validation of nursing diagnoses. PURPOSE: To provide a historical review of processes and methodologies for research validation of nursing diagnoses and suggested directions for future nursing diagnosis research. SOURCES: Nursing diagnosis research methodologies and processes from the Invitational Conference on Research Methods for Validating Nursing Diagnoses, Nursing Diagnosis: The Journal of Nursing Language and Classification, and the North American Nursing Diagnosis Association (NANDA) conference proceedings for the first through the 12th conference. CONCLUSIONS: Future nursing diagnosis research should include concept analysis, expert validation, clinical validation, instrument development, larger studies, powerful statistical analyses, replication and comparison of studies, and concerted efforts to support group research activities that target priority areas of research.

Data Interpretation, Statistical↗

Conference overview: molecular mechanisms of metal toxicity and carcinogenesis.

Chronic exposure to many heavy metals and metal-derivatives is associated with an increased risk of cancer, although the mechanisms of tumorigenesis are largely unknown. Approximately 125 scientists attended the 3rd Conference on Molecular Mechanisms of Metal Toxicity and Carcinogenesis and presented the latest research concerning these mechanisms. Major areas of focus included exposure assessment and biomarker identification, roles of ROS and antioxidants in carcinogenesis, mechanisms of metal-induced DNA damage, metal signalling, and the development of animal models for use in metal toxicology studies. Here we highlight some of the research presented, and summarize the conference proceedings.

Animals↗

An update on graft-versus-host and graft-versus-leukemia reactions: a summary of the sixth International Symposium held in Schloss Ellmau, Germany, January 22-24, 2004.

The Sixth International Symposium on Graft-versus-Host and Graft-versus Leukemia Reactions was held in Schloss Ellmau (near Garmisch-Partenkirchen, Germany) between January 21 and 24, 2004. A total of 110 invited participants (scientists and clinicians working in the area of allogeneic stem cell transplantation) discussed current topics. Major topics of the 2004 meeting were: clinical results of donor lymphocyte infusions, basic biology, immunogenetics, function and clinical relevance of natural killer cells, haplo-identical stem cell transplantation, immune monitoring and immune modulation. Further highlights were: adoptive immunotherapy, vaccination and antibody-mediated strategies. As can be seen in the summaries of the individual presentations, important advances have occurred in our understanding of GVH and GVL reactions. Each session was followed by an animated discussion, which resulted in new ideas, insights and projects both for basic research and clinical transplantation. This year's symposium ('From Marrow Transplantation to Cell Therapy') was jointly organized by the Ludwigs-Maximilians-University of Munich (Sonderforschungsbereich 455), GSF (National Research Center for Environment and Health) and the EBMT Immunobiology Working Party. The organizers and authors of the conference proceedings would like to extend their gratitude to all participants for sharing their ideas, slides and manuscripts and making this event possible.

Graft vs Host Disease↗

Bridging the workforce gap for our aging society: how to increase and improve knowledge and training. Report of an expert panel.

The healthcare workforce is currently unprepared for the increasing number of older persons and the complexities of their healthcare needs. Too few healthcare workers are adequately trained in geriatrics, and developers of educational curricula across healthcare disciplines have been slow to incorporate or require geriatric training. In April 2003, leaders in geriatrics met in Washington, D.C., to discuss and recommend solutions to the growing shortage of an appropriately trained workforce for geriatric research, education, and patient care. After considering data, presenting statistics, and offering insights into the future, the conference concluded by formulating recommendations to meet specific challenges. This report is a summary of the conference proceedings and recommendations, and it serves as a reminder that demographic trends and an everexpanding geriatric knowledge base demand not only attention, but also action.

Clinical Competence↗

Findings of the Beijing 2000 IWA Chemical Industries Speciality Conference.

Critical Technologies to the World in the 21st Century: Pollution Control and Reclamation in Process Industries was a Chemical Industries Specialty Conference held in Beijing, China 18-22 September 2000. Set in China, the cradle of civilization, the conference hosted about 100 delegates from over twenty countries. Approximately 122 technical papers were presented covering a wide range of topic areas. This paper reviews significant findings presented. Perhaps the conference proceedings will serve as a point of reference for future evaluations and accomplishments. The 21st century offers both challenges and opportunities for progress towards sustainable development/production in the process industries. International cooperation and inter-disciplinary collaboration are essential for this goal to be realized.

Chemical Industry↗

Advances in treating metastatic bone cancer: summary statement for the First Cambridge Conference.

The First Cambridge Conference on Advances in Treating Metastatic Bone Cancer, a symposium held in Cambridge, Massachusetts, October 28 to 29, 2005, was convened to discuss recent advances and research related to the natural history of bone metastases and skeletal complications, bone cancer biology, treatment of myeloma and other solid tumors, and treatment-induced bone loss. The conference format combined brief presentations with extended periods of discussion. The conclusions reached during the 2-day meeting are summarized in this article and presented in more detail in the individual articles and accompanying discussion sessions that comprise the conference proceedings.

Bone Neoplasms↗

In-depth indexing of monograph literature for an on-line retrieval system: a pilot project.

One of the unique features of the State University of New York (SUNY) Biomedical Communication Network is the availability of depth-indexed monograph information for on-line retrieval. Approximately 8,000 titles from the Upstate Medical Center Library collection in Syracuse, New York, were indexed in depth, chapter-by-chapter, as to subject content using the control vocabulary Medical Subject Headings. Detailed indexing of monographic conference proceedings was considered of particular importance to the project. This attempt to make monograph literature more readily accessible to medical library patrons is interesting from both a philosophical and a technical point of view. This paper will discuss both of these aspects, giving an overall description of the nature of this innovative project.

Abstracting and Indexing↗

Innovations and challenges in melanoma: summary statement from the first Cambridge conference.

Innovations and Challenges in Melanoma, chaired by Michael Atkins and cochaired by Ulrich Keilholz, John Kirkwood, and Jeffrey Sosman, was held July 15 to 16, 2005, in Cambridge, Massachusetts. The conference brought together leading experts in the fields of cancer research, medical oncology, surgical oncology, anatomic pathology, dermatology, and immunotherapy who wished to advance the field of melanoma treatment by exchanging information and perspectives regarding recent advances and recommendations for further study. The conference proceedings published in this educational supplement to Clinical Cancer Research are intended to provide timely information and recommendations on how genetics, biology, and data information can enhance our understanding of melanoma biology and help inform the use of therapies for this disease.

Humans↗

Galantamine for Alzheimer's disease.

BACKGROUND: Galantamine (also called galanthamine, marketed as Reminyl (Janssen)) can be isolated from several plants, including daffodil bulbs, and now synthesized. Galantamine is a specific, competitive, and reversible acetylcholinesterase inhibitor. It is also an allosteric modulator at nicotinic cholinergic receptor sites potentiating cholinergic nicotinic neurotransmission. A small number of early studies showed mild cognitive and global benefits for patients with Alzheimer's disease, and recently several multicentre clinical trials have been published with positive findings. Galantamine has received regulatory approval in Sweden, is available in Austria, and awaits marketing approval in the United States, Europe, and other countries. OBJECTIVES: The objective of this review is to assess the clinical effects of galantamine in patients with probable Alzheimer's disease, and to investigate potential moderators of an effect. SEARCH STRATEGY: The Cochrane Dementia Group specialized register of clinical trials was searched using the terms 'galantamine,' and 'galanthamine' (15 February 2000) as was the Cochrane Controlled Trials Register (2000, Issue 2). These terms were also used to search the following databases: EMBASE, MEDLINE, PsychLit; Combined Health Information Database, NRR (National Research Register), ADEAR (Alzheimer's Disease Education and Referral Centre clinical database, BIOMED (Biomedicine and Health), Glaxo-Wellcome Clinical Trials Register, National Institutes of Health Clinical Trials Databases, Current Controlled Trials, Dissertation Abstracts (mainly North American dissertations) 1961-1994, Index to UK Theses (British dissertations) 1970-1994. Published reviews were inspected for further sources. Additional information was collected from an unpublished investigational brochure for galantamine. SELECTION CRITERIA: Trials selected were randomized, double-blind, parallel-group, and unconfounded comparisons of galantamine with placebo for a treatment duration of greater than 4 weeks in people with Alzheimer's disease. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the reviewers and pooled where appropriate and possible. The pooled odds ratios (95%CI) or the average differences (95%CI) were estimated. Intention-to-treat and observed cases data were both reported, if the data were available to be reported. -Outcomes of interest include the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), clinical global impression of change (CIBIC-plus or CGIC), Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS-ADL), Disability Assessment for Dementia scale (DAD) and Neuropsychiatric Inventory (NPI). - Potential moderating variables of a treatment effect included trial duration and dose. MAIN RESULTS: Seven trials were identified that met criteria for entry, with 6 being Phase II or III industry-sponsored multicentre trials. One was of 12 weeks duration; one of 5 months; one of 29 weeks; and the rest of 6 months duration. Trials of 5 months or more were aggregated in the analyses as '6 months'. Overall, galantamine showed significant treatment effects at daily doses of 16-32 mg/d for trials of 3- to 6-months duration. For global ratings, trials of 3 months duration with doses of 24-32mg/d (Odds Ratio (OR) 2.2; 95%CI 1.4 to 3.7) and 36mg/d (OR 3.3; 95%CI 1.2 to 9.3) were statistically significant in favour of treatment. For trials of 6 months duration (5-months to 29 weeks), only doses of 8mg/d failed to be statistically significant (24mg: OR 2.0; 95%CI 1.5 to2.5; 32mg: OR 1.9; 95%CI 1.4 to 2.5). For cognitive function over 6 months duration: at a 24mg/d, improvements measured -3.5 points (k=3; 95%CI -4.3 to -2.8) on weighted mean difference on the ADAS-Cog scale, and -4.0 points at 32mg/d (k=2; 95%CI -5.0 to -3.0). Both observed cases (WMD 3.8; 95%CI 0.3 to 7.3) and intention to treat analyses using the Disability Assessment of Dementia gave statistically significant results in favour of treatment for daily doses of 32mg for 6 months duration. The small number of trials available for analysis, however, limited the power of analyses to detect differences. Galantamine consistently failed to show statistically significant treatment effects at doses of 8mg/day. Galantamine's adverse effects appear similar to those of other cholinesterase inhibitors, in that it tends to produce gastrointestinal effects acutely and with dosage increases. Overall, people treated with galantamine at doses of 24-32 mg/d were more likely to discontinue participation in most trials than were people treated with lower doses or placebo, but in the one trial with a slower rate of titration the discontinuation rate was not significantly greater than placebo for the 16 mg/day dose. (ABSTRACT TRUNCATED)

Alzheimer Disease↗