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PubMed2000

Integration of radiologist peer review into clinical review workstation.

Professional peer review of random prior radiologist's interpretations is mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO expects documentation of 5% rate of random peer-review cases. Countless hours are spent in departments fulfilling these requirements. The integration of the peer-review process into the radiologist's interpretation workflow was expected to increase the percentage of documented peer review, yet decrease the time and effort for this documentation. radStation clinical review workstations are deployed at every reading station. When a requisition is bar-coded, radStation retrieves the patient's clinical information and automatically displays the prior comparison report. If the radiologist agrees with the prior report, a single click on a "quality assurance' agree box documents the agreement. In the case of a discordance, an additional dialog box automatically appears and the radiologist enters the reason for disagreement and then submits the case as a discrepancy. The system holds the discordance for 3 to 5 working days, then notifies the original radiologist via E-mail that a prior interpretation has been submitted for peer review, lists the submitted discrepancy reason, and provides a link to display the discordant report. The peer-review database is separate from the existing radiology information system (RIS). At the end of every month, summary reports of all peer-review activity are generated automatically. Initial benchmarks of our deployed system anticipate documentation of long-term random peer-review rate at greater than 50% of interpreted cases. The system enhances the peer-review process by integrating it with the normal interpretation workflow. The time to complete peer review using radStation is less than 1 second per normal case and less than 60 seconds for a discordant case. The E-mail notification system is fully automated, eliminating the need for secretarial involvement in the data collection. This system has completely replaced a manual paper-based system. The integration of peer review directly into the radiologist's interpretation workstation greatly enhances the capability to easily exceed JCAHO standards. The overall increase in peer-review documentation should continue to improve the ability to document a consistent high quality of patient care.

Computer Communication Networks↗
PubMed2002

An innovative partnership in service.

OBJECTIVE: Stimulated by the need for better alignment of educational content and goals with evolving societal needs, practice patterns, and scientific developments, many medical schools are implementing new and creative educational experiences for students. Tulane University School of Medicine and Apple Computers have established an innovative partnership in which Apple laptop computers support and enhance students' service learning projects. The partnership also provides a unique opportunity to meet the Medical School Objectives Project (MSOP) objectives in Medical Informatics and Population Health, as outlined in Report II.(1) DESCRIPTION: Apple Computers has a commitment to the New Orleans community as part of its corporate strategic plan to support educational programs at all levels; Tulane has a longstanding commitment to and experience with student-led service learning as part of the Foundations in Medicine Course.(2) Senior administrative personnel from Tulane and Apple discussed these common interests, resulting in a partnership to enhance the potential impact on the community served. Apple agreed to donate 20 G3 Powerbooks and a complete set of the Apple Learning series of software to support new and ongoing service-learning projects. A committee of Tulane faculty and students, information technology staff, and an Apple representative developed the project. To maximize students' access to the laptops while managing the administration's liability, the laptops were identically configured with standardized software packages (database development and maintenance, Web access, word processing, presentation development and execution, automated backup, and individual project access to protected server space). To maximize the use of the laptops, students from the service-learning organizations can check out the laptops on a just-in-time basis, because the projects have different needs over time. Student-service leaders are currently defining and developing the exact uses for the laptops. We anticipate that this project will enhance the administrative management of service-learning programs (e.g., schedules, directions to sites), the presentation of educational programs (e.g., teaching in schools), the creation of new media to support programs (e.g., our restaurant choking program has a partnership with the American Heart Association to create a video and training manual to be used nationwide), and data tracking (e.g., sites and clients served, outcomes achieved). Students' use of the laptops should support the achievement of several of the MSOP Report II Medical Informatics objectives. To assess that, all first-year medical students are completing a pre- and post-project survey based on those objectives. DISCUSSION: The availability of laptops and software should significantly enhance the service-learning programs. The students participating should gain important skills in the use of computer technology related to their roles as lifelong learners, educators and communicators, researchers, and managers.(1) We plan to report the results of the pre- and post-project surveys once they have been completed. Students' feedback on the project has been very positive, and we hope it can serve as a model for other medical school, corporate, and community partnerships.

Health Services↗
PubMed1996

Information technology in diabetes care 'Diabeta': 23 years of development and use of a computer-based record for diabetes care.

In this article we have stressed that a diabetes care information system should be useful to, usable and actually used by carers at the point of patient contact. Information resulting from such encounters should, at no extra cost, furnish the needs of communication, audit, research and management. Diabeta is a clinical record system for supporting the management of patients with diabetes. It has grown 'organically' within an academic clinical unit over a period of 23 years. It is used for each and every encounter with the clinicians in our diabetes team and as such, contains an immense amount of objective clinical experience. This experience can be interrogated very easily by computer-naive clinicians using a remarkable interactive program ('Datascan') which contains statistical procedures 'embedded' in the APL computer code, eliminating the need to 'export' the data into a statistical package. The latest PC-based version is incredibly fast and this immense amount of clinical experience can be carried around on a notebook PC and be available for exploration at any time. This makes 'evidence-based medicine' available in a remarkably flexible way since it shares the accumulated objective experience of literally 'dozens' of clinicians over a period which now extends to 23 years. It adds a completely new dimension to the term 'clinical experience' and is unattainable with manual records. It would be naive to assume that such systems are easy to design, build or implement, or that the initial capital outlay required will be small although costs are falling continuously. Medicine is a highly complex activity, the essential basis of which is human interaction. Introduction of a technology into this interaction requires sensitivity to the wishes and requirements of individuals, and protection of their exchanges from third parties. The potential of computers in diabetes care is so great that these issues must be addressed through continuing research, development, evaluation and funding of new systems. This must be led by the medical profession not the computer industry.

Ambulatory Care↗
PubMed1995

Reliability of computer-generated prediction tracing.

The reliability of a commercially available computer prediction program (Quick Ceph II) was evaluated using pretreatment and posttreatment cephalograms of 30 patients who were treated during an active period of growth. The computer prediction was compared with the actual treatment result, and the growth forecast with the computer program was compared with the growth forecast using a manual method. Using paired student's t-tests, predictions for 5 of the 10 variables measured were found to be statistically reliable. Comparing the relative accuracy of growth prediction in terms of absolute values, the computer came closer to the actual result in four of the nine variables, while the manual method came closer in three variables. Predictions for the other two variables were virtually the same using both methods. The manual method of prediction was sufficient to give a reasonably good graphic representation of growth changes to create a VTO. However, the computer offers the added advantages of quicker access to information and somewhat greater accuracy in producing the tracing, as well as its use in patient education.

Adolescent↗
PubMed1991

Case study: development of a forms-design guidebook.

Implementation of the approval and official format of medical record forms procedure along with the use of the forms-design guidebook will result in a forms-management program that will be efficient and effective. This program is sufficiently detailed to provide forms that are consistent and useful. The procedure will provide the necessary documentation for forms control and will facilitate an approval process that is standardized and faster than before. An overview of the steps taken to complete this project are listed in the box entitled "Steps for Revision of Forms-Control Process." The control of medical record forms will provide documents that are useful and accurate for purposes of communication and planning of quality patient care and will meet the requirements of licensing and accrediting agencies. Also, the concentration on the consideration of cost throughout this project will reduce costs by improved efficiency in the paperwork system and by reducing both the production and the usage costs of forms.

Forms and Records Control↗
PubMedDate not supplied

Reducing medical errors through barcoding at the point of care.

Medical errors are a major concern in health care today. Errors in point-of-care testing (POCT) are particularly problematic because the test is conducted by clinical operators at the site of patient care and immediate medical action is taken on the results prior to review by the laboratory. The Performance Improvement Program at Baystate Health System, Springfield, Massachusetts, noted a number of identification errors occurring with glucose and blood gas POCT devices. Incorrect patient account numbers that were attached to POCT results prevented the results from being transmitted to the patient's medical record and appropriately billed. In the worst case, they could lead to results being transferred to the wrong patient's chart and inappropriate medical treatment. Our first action was to lock-out operators who repeatedly made identification errors (3-Strike Rule), requiring operators to be counseled and retrained after their third error. The 3-Strike Rule significantly decreased our glucose meter errors (p = 0.014) but did not have an impact on the rate of our blood gas errors (p = 0.378). Neither device approached our ultimate goal of zero tolerance. A Failure Mode and Effects Analysis (FMEA) was conducted to determine the various processes that could lead to an identification error. A primary source of system failure was the manual entry of 14 digits for each test, five numbers for operator and nine numbers for patient account identification. Patient barcoding was implemented to automate the data entry process, and after an initial familiarization period, resulted in significant improvements in error rates for both the glucose (p = 0.0007) and blood gas devices (p = 0.048). Despite the improvements, error rates with barcoding still did not achieve zero errors. Operators continued to utilize manual data entry when the barcode scan was unsuccessful or unavailable, and some patients were found to have incorrect patient account numbers due to hospital transfer, multiple wristbands on a single patient, and selection of expired account numbers from previous hospitalizations when printing the barcoded wristbands. Barcoding can thus improve the incidence of identification errors, but hospitals need to take additional steps to ensure successful barcode scanning and to verify that patient wristbands contain correct information. Implementation of patient barcoding was successful in significantly reducing identification errors with POCT, improving patient care, and enhancing interdisciplinary communication.

Delivery of Health Care, Integrated↗
PubMed1992

Implementing an infection control program for the community-based healthcare facility.

With the rampant increase in patients with communicable diseases, including AIDS and Hepatitis B, a sound infection control program is vital. Focusing on the needs of administrators in community healthcare agencies such as home health agencies, long-term care facilities, and public health departments, the authors discuss infection control concepts and the primary components of an infection control program.

Community Health Centers↗
PubMed1985

Manual actions of nine- to fifteen-week-old human infants during face-to-face interaction with their mothers.

This paper presents evidence that the manual actions of infants as young as 9 weeks of age may occur in relation to their facial expression, gaze direction, and vocalization. 28 full-term, healthy infants were observed during a 2-min spontaneous face-to-face interaction with their mothers. Videotapes were coded in real time using the following categories of manual action: POINT, SPREAD, CURL, and GRASP. Facial expressions, gaze direction, and vocalizations also were coded for each infant. All of the infants displayed CURL, 20 infants displayed SPREAD, 18 POINTED, and 11 showed GRASP. Right/left differences appeared for the categories CURL, SPREAD, and GRASP, but not for POINT. Hand action was systematically organized into sequences with other infant action. POINT occurred before or after mouthing and vocalization, CURL during vocalization, and SPREAD when the baby was looking away from the mother. The results are discussed in relation to their implications for the ontogeny of nonverbal communicative gestures.

Child Language↗
PubMedDate not supplied

Review of spiritual health: definition, role, and intervention strategies in health promotion.

PURPOSE OF THE REVIEW. Recognition of the spiritual dimension as a vital component of human wellness has led to an increased interest in spirituality education, yet very little progress has been made in identifying possible intervention methods for enhancing spirituality. The purpose of this article is to review current definitions of spiritual health; provide an overview of several successful intervention methods that may enhance spiritual health; and outline potential relationships between spiritual health interventions and behavioral, emotional, and physical health outcomes. SEARCH METHOD USED. Research and review articles were identified through a CD-ROM computer search of ERIC (1966 to 1994), PSYCHLIT (1974 to 1994), and MEDLINE (1991 to 1994) databases using appropriate key words. Cumulative indexes from Advances (1984 to 1993) were manually searched, and reference lists from identified studies and literature reviews were analyzed. A total of 71 articles were identified and considered. Model interventions were chosen for presentation on the basis of soundness of research design, peer-review publication, clear description of intervention method, and relationship to spiritual health components. SUMMARY OF IMPORTANT FINDINGS. Imagery, meditation, and group support activities may address various components of spiritual health such as meaning and purpose in life; self-awareness; and connectedness with self, others, and a larger reality. In turn, positive changes in health behaviors such as communication, diet activity, and treatment compliance were noted, and a variety of beneficial physical and emotional health outcomes such as heart disease reversal, decreased cancer mortality, reduced anxiety, and improved mood states were reported. MAJOR CONCLUSIONS. Health educators are in a position to develop, implement, and evaluate spiritual health interventions within the context of comprehensive programs. There is a need for training in the theoretical and methodologic foundations of interventions like meditation, imagery, and group support and a need for more evaluation research in the impact of such interventions.

Complementary Therapies↗
PubMed1980

Computerized information system for ICU patient management.

To solve the problem of data management, a digital computer was introduced in this ICU in 1977. Data are manually entered at the bedside alpha-numeric keyboards; two beds are directly connected to the computer. The system was especially designed to work in the 11-bed ICU; its functions are: (1) admission, discharge, and transfer data of patients; (2) management of doctors' and nurses' notes in a free text form; (3) management of the problem-oriented record; (4) management of physical and bio chemical variables, medical disorders, and fluid balance; and (5) diagnostic and therapeutic decision-making. Since 1977, the authors have computerized over 2600 patients and now conclude: (1) data management and communication have improved, thus, allowing nurses more time for direct patient care; (2) teaching of the residents and nurses has been facilitated and minimizes disparities from their diverse experience; (3) it has contributed to the development of protocols for many of the procedures; and (4) it has led to a more systematic approach to patient care. The assistance of a professional computer programmer and continuous maintenance of the software are essential.

Computers↗
PubMed2000

How to maintain blood supply during computer network breakdown: a manual backup system.

Electronic data management systems using computer network systems and client/server architecture are increasingly used in laboratories and transfusion services. Severe problems arise if there is no network access to the database server and critical functions are not available. We describe a manual backup system (MBS) developed to maintain the delivery of blood products to patients in a hospital transfusion service in case of a computer network breakdown. All data are kept on a central SQL database connected to peripheral workstations in a local area network (LAN). Request entry from wards is performed via machine-readable request forms containing self-adhesive specimen labels with barcodes for test tubes. Data entry occurs on-line by bidirectional automated systems or off-line manually. One of the workstations in the laboratory contains a second SQL database which is frequently and incrementally updated. This workstation is run as a stand-alone, read-only database if the central SQL database is not available. In case of a network breakdown, the time-graded MBS is launched. Patient data, requesting ward and ordered tests/requests, are photocopied through a template from the request forms on special MBS worksheets serving as laboratory journal for manual processing and result report (a copy is left in the laboratory). As soon as the network is running again the data from the off-line period are entered into the primary SQL server. The MBS was successfully used at several occasions. The documentation of a 90-min breakdown period is presented in detail. Additional work resulted from the copy work and the belated manual data entry after restoration of the system. There was no delay in issue of blood products or result reporting. The backup system described has been proven to be simple, quick and safe to maintain urgent blood supply and distribution of laboratory results in case of unexpected network breakdown.

Blood Transfusion↗
PubMed1980

Who needs change? Moving from research to clinical studies.

Classification in psychiatry serves as a basis for communication within science, as a basis of information retrieval, as a descriptive system, as a source for the construction of theories, and finally as a basis for making predictions. Not only has research diagnostic criteria had significant importance to research, but they can now serve the clinician equally well as exemplified by DSM III.

Bipolar Disorder↗
PubMed1996

Short communication: use of the output video signal for dynamic range, brightness control and image memory assessment in X-ray fluoroscopy.

The output video signal from three X-ray fluoroscopy machines was recorded with a storage oscilloscope to calculate the dynamic range of their image intensifier television camera chains. The two MERATE MTH90 and MGR50hf machines employed the same imaging chain but the response of the former to exposure was significantly lower because of a three channel light distribution optical system which was installed but not used. The CGR Stenoscope machine was found to have a very narrow dynamic range to the extent that it was not usable. Additional measurements on the CGR machine showed that the image intensifier brightness control mechanism would produce stabilized brightness in less than 0.4 s and it proved to be faster than the manual selection of exposure parameters. The quality of the image stored in the memory device on the same system was compared with the original by subtracting the two video signals on the oscilloscope and thus acquiring a quantitative measure of their difference.

Fluoroscopy↗
PubMed1989

Data protection in health information systems (HIS).

Information and communication systems in a health (care) environment are risky systems as the data processed, transmitted, stored and retrieved are person-related. An unjustified disclosure may compromise the individual's personal or social life. Therefore these systems must be subject to carefully designed and implemented protection procedures guaranteeing the correct use of those data, corresponding in the medical sphere with the ancient Oath of Hippokrates, as well as the preservation of their correctness, completeness etc., as requested by legal regulations valid for the location of the respective computer-aided information system. The same is true for the manual handling of person-related health data by conventional methods. In any case, the data subject's right of informational self determination must be taken into account.

Confidentiality↗
PubMed2005

A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder.

There remain large discrepancies between pediatricians' practice patterns and the American Academy of Pediatrics (AAP) guidelines for the assessment and treatment of children with attention-deficit/hyperactivity disorder (ADHD). Several studies raise additional concerns about access to ADHD treatment for girls, blacks, and poorer individuals. Barriers may occur at multiple levels, including identification and referral by school personnel, parents' help-seeking behavior, diagnosis by the medical provider, treatment decisions, and acceptance of treatment. Such findings confirm the importance of establishing appropriate mechanisms to ensure that children of both genders and all socioeconomic, racial, and ethnic groups receive appropriate assessment and treatment. Publication of the AAP ADHD toolkit provides resources to assist with implementing the ADHD guidelines in clinical practice. These resources address a number of the barriers to office implementation, including unfamiliarity with Diagnostic and Statistical Manual of Mental Disorders criteria, difficulty identifying comorbidities, and inadequate knowledge of effective coding practices. Also crucial to the success of improved processes within clinical practice is community collaboration in care, particularly collaboration with the educational system. Such collaboration addresses other barriers to good care, such as pressures from parents and schools to prescribe stimulants, cultural biases that may prevent schools from assessing children for ADHD or may prevent families from seeking health care, and inconsistencies in recognition and referral among schools in the same system. Collaboration may also create efficiencies in collection of data and school-physician communications, thereby decreasing physicians' non-face-to-face (and thus nonreimbursable) elements of care. This article describes a process used in Guilford County, North Carolina, to develop a consensus among health care providers, educators, and child advocates regarding the assessment and treatment of children with symptoms of ADHD. The outcome, ie, a community protocol followed by school personnel and community physicians for >10 years, ensures communication and collaboration between educators and physicians in the assessment and treatment of children with symptoms of ADHD. This protocol has the potential to increase practice efficiency, improve practice standards for children with ADHD, and enhance identification of children in schools. Perhaps most importantly, the community process through which the protocol was developed and implemented has an educational component that increases the knowledge of school personnel about ADHD and its treatment, increasing the likelihood that referrals will be appropriate and increasing the likelihood that children will benefit from coordination of interventions among school personnel, physicians, and parents. The protocol reflects a consensus of school personnel and community health care providers regarding the following: (1) ideal ADHD assessment and management principles; (2) a common entry point (a team) at schools for children needing assessment because of inattention and classroom behavior problems, whether the problems present first to a medical provider, the behavioral health system, or the school; (3) a protocol followed by the school system, recognizing the schools' resource limitations but meeting the needs of community health care providers for classroom observations, psychoeducational testing, parent and teacher behavior rating scales, and functional assessment; (4) a packet of information about each child who is determined to need medical assessment; (5) a contact person or team at each physician's office to receive the packet from the school and direct it to the appropriate clinician; (6) an assessment process that investigates comorbidities and applies appropriate diagnostic criteria; (7) evidence-based interventions; (8) processes for follow-up monitoring of children after establishment of a treatment plan; (9) roles for central participants (school personnel, physicians, school nurses, and mental health professionals) in assessment, management, and follow-up monitoring of children with attention problems; (10) forms for collecting and exchanging information at every step; (11) processes and key contacts for flow of communication at every step; and (12) a plan for educating school and health care professionals about the new processes. A replication of the community process, initiated in Forsyth County, North Carolina, in 2001, offers insights into the role of the AAP ADHD guidelines in facilitating development of a community consensus protocol. This replication also draws attention to identification and referral barriers at the school level. The following recommendations, drawn from the 2 community processes, describe a role for physicians in the collaborative community care of children with symptoms of ADHD. (1) Achieve consensus with the school system regarding the role of school personnel in collecting data for children with learning and behavior problems; components to consider include (a) vision and hearing screening, (b) school/academic histories, (c) classroom observation by a counselor, (d) parent and teacher behavior rating scales (eg, Vanderbilt, Conner, or Achenbach scales), (e) consideration of speech/language evaluation, (f) screening intelligence testing, (g) screening achievement testing, (h) full intelligence and achievement testing if discrepancies are apparent in abbreviated tests, and (i) trials of classroom interventions. (2) Use pediatric office visits to identify children with academic or behavior problems and symptoms of inattention (history or questionnaire). (3) Refer identified children to the contact person at each child's school, requesting information in accordance with community consensus. (4) Designate a contact person to receive school materials for the practice. (5) Review the packet from the school and incorporate school data into the clinical assessment. (6) Reinforce with the parents and the school the need for multimodal intervention, including academic and study strategies for the classroom and home, in-depth psychologic testing of children whose discrepancies between cognitive level and achievement suggest learning or language disabilities and the need for an individualized educational plan (special education), consideration of the "other health impaired" designation as an alternate route to an individualized educational plan or 504 plan (classroom accommodations), behavior-modification techniques for targeted behavior problems, and medication trials, as indicated. (7) Refer the patient to a mental health professional if the assessment suggests coexisting conditions. (8) Use communication forms to share diagnostic and medication information, recommended interventions, and follow-up plans with the school and the family. (9) Receive requested teacher and parent follow-up reports and make adjustments in therapy as indicated by the child's functioning in targeted areas. (10) Maintain communication with the school and the parents, especially at times of transition (eg, beginning and end of the school year, change of schools, times of family stress, times of change in management, adolescence, and entry into college or the workforce).

Adolescent↗
PubMed1986

Image transmission and data compression. Two key elements of an electronic imaging department.

Growing numbers of diagnostic images are being produced electronically and filmed only for storage, or sometimes also for interpretation. However, in most imaging centers, transmission of images from one location to another is still being accomplished manually. Almost 40 years ago, x-rays were first transmitted over telephone lines, and this form of "teleradiology" has been increasingly used to link isolated hospitals and clinics to larger facilities so that radiologists can interpret the images. Continuing improvement of the various electronic image-processing technologies has produced faster means of transmission, and increasingly sophisticated computer algorithms for "compressing" the image data have further improved both transmission speed and the quality of the transmitted images. To date, only a few imaging research centers and teaching hospitals have integrated these techniques into a comprehensive picture archiving and communications system (PACS) or digital image management system (DIMS), and a number of factors are restraining these systems' spread. However, electronic transmission of images for interpretation by specialists at a central facility is likely to increase, and truly "filmless" radiology may someday become a reality, if image transmission and data compression techniques are eventually determined to create images of acceptable quality in all imaging modalities.

Computer Communication Networks↗
PubMed1994

Cell cycle remodeling requires cell-cell interactions in developing Xenopus embryos.

Flow cytometric analysis has revealed a general remodeling of the cell cycle in developing Xenopus embryos. During early gastrulation the cell cycle is dominated by S phase, with 82% of all interphase nuclei in the S phase fraction. As development proceeds over the next 60 hours, a gradual decline in S phase cells is proportional to an increase in the number of cells in G1. By the late tailbud stage, 85% of all nuclei are found in the G1 fraction, approximating the cell cycle profile of adult somatic cells. Cell cycle remodeling occurs on schedule even in embryos that have been dissociated into a loose mound of cells which remain in close proximity to one another. However, cells that have been widely separated by manual dispersion do not undergo remodeling. These dispersed cells maintain an S phase-dominated cell cycle and continue to show patterns of blastula and gastrula gene expression at least 30 hours beyond gastrulation. We conclude that cell cycle remodeling occurs in the absence of an intact embryo but requires the inductive influences associated with a community of cells.

Animals↗
PubMed2005

Development of a Chinese medicine assessment measure: an interdisciplinary approach using the delphi method.

BACKGROUND: The diagnostic framework and clinical reasoning process in Chinese medicine emphasizes the contextual and qualitative nature of a patient's illness. Chinese medicine assessment data may help interpret clinical outcomes. OBJECTIVES: As part of a study aimed at assessing the validity and improving the inter-rater reliability of the Chinese diagnostic process, a structured assessment instrument was developed for use in clinical trials of acupuncture and other Chinese medical therapies. STUDY DESIGN: To foster collaboration and maximize resources and information, an interdisciplinary advisory team was assembled. Under the guidance of two group process facilitators, and in order to establish whether the assessment instrument was consistent with accepted Chinese medicine diagnostic categories (face validity) and included the full range of each concept's meaning (content validity), a panel of Traditional Chinese Medicine (TCM) expert clinicians was convened and their responses were organized using the Delphi process, an iterative, anonymous, idea-generating and consensus-building process. An aggregate rating measure was obtained by taking the mean of mean ratings for each question across all 10 experts. RESULTS: Over three rounds, the overall rating increased from 7.4 (SD = 1.3) in Round 1 to 9.1 (SD = 0.5) in Round 3. The level of agreement among clinicians was measured by a decrease in SD. CONCLUSIONS: The final instrument TEAMSI-TCM (Traditional East Asian Medicine Structured Interview, TCM version) uses the pattern differentiation model characteristic of TCM. This modular, dynamic version was specifically designed to assess women, with a focus on gynecologic conditions; with modifications it can be adapted for use with other populations and conditions. TEAMSI-TCM is a prescriptive instrument that guides clinicians to use the proper indicators, combine them in a systematic manner, and generate conclusions. In conjunction with treatment manualization and training it may serve to increase inter-rater reliability and inter-trial reproducibility in Chinese medicine clinical trials. Testing of the validity and reliability of this instrument currently is underway.

Data Interpretation, Statistical↗