Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Scoring framework”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,333 records · Page 74Linked to original sources

Exact and approximate graph matching using random walks.

In this paper, we propose a general framework for graph matching which is suitable for different problems of pattern recognition. The pattern representation we assume is at the same time highly structured, like for classic syntactic and structural approaches, and of subsymbolic nature with real-valued features, like for connectionist and statistic approaches. We show that random walk based models, inspired by Google's PageRank, give rise to a spectral theory that nicely enhances the graph topological features at node level. As a straightforward consequence, we derive a polynomial algorithm for the classic graph isomorphism problem, under the restriction of dealing with Markovian spectrally distinguishable graphs (MSD), a class of graphs that does not seem to be easily reducible to others proposed in the literature. The experimental results that we found on different test-beds of the TC-15 graph database show that the defined MSD class "almost always" covers the database, and that the proposed algorithm is significantly more efficient than top scoring VF algorithm on the same data. Most interestingly, the proposed approach is very well-suited for dealing with partial and approximate graph matching problems, derived for instance from image retrieval tasks. We consider the objects of the COIL-100 visual collection and provide a graph-based representation, whose node's labels contain appropriate visual features. We show that the adoption of classic bipartite graph matching algorithms offers a straightforward generalization of the algorithm given for graph isomorphism and, finally, we report very promising experimental results on the COIL-100 visual collection.

Algorithms↗

Integrative multi-omics profiling of insomnia-related molecular features reveals microbiome, immune, and therapy-relevant heterogeneity in colorectal cancer.

Emerging evidence implicates insomnia as a potential risk factor in carcinogenesis, potentially involving systemic inflammation, circadian disruption, and microbiome alterations. However, the molecular associations linking insomnia-related features to colorectal cancer (CRC), particularly with respect to tumor biology, immune microenvironmental states, and therapy-relevant phenotypes, remain largely unexplored. Multi-omics integration of genomic, transcriptomic, and microbiome data from 3,026 CRC patients across seven independent cohorts, including a large, well-annotated Clinical Omics study of Colorectal Cancer in China (COCC) cohort, enabled insomnia-based molecular classification through unsupervised non-negative matrix factorization (NMF) clustering. The insomnia subtype (IS) was biologically characterized via pathway enrichment, immune deconvolution, microbial profiling, and single-cell transcriptomics. Furthermore, an insomnia score (ISscore) was developed and validated in multiple cohorts for risk stratification and assessment of treatment-response-related indicators in CRC. Unsupervised clustering revealed two distinct molecular subtypes (IS1/IS2), with IS2 demonstrating significantly poorer survival. IS2 exhibited marked activation of EMT/angiogenesis pathways versus cell cycle activation in IS1. The IS2 microenvironment showed increased immunosuppression-related infiltration and exhausted T cell signatures, together with intratumoral microbiome variation characterized by depletion of Ruminococcaceae UCG-002 and enrichment of Hungatella/Selenomonas. The ISscore system stratified survival risk and was associated with computational indicators of immunotherapy response. Single-cell analysis nominated PPIA-BSG as a potential cell-cell communication signal involving high-ISscore tumor cells, CXCL12+ endothelial cells, and CLEC9A+ dendritic cell subsets. This multi-omics characterization of insomnia-CRC interplay suggests that insomnia-related molecular features are associated with an immunologically distinct and microbiome-altered tumor ecosystem. The ISscore provides a reproducible framework for capturing insomnia-related molecular heterogeneity, supporting risk stratification and future evaluation of therapy-relevant phenotypes.IMPORTANCEChronic insomnia affects millions, but it is not typically considered a cancer risk factor. Our study, analyzing vast biological data from over 3,000 colorectal cancer patients, uncovers a potential link between a person's predisposition to insomnia and their risk of developing this disease. This suggests that the biological pathways related to sleep may play a role in cancer development. Understanding this connection opens up new avenues for identifying individuals at higher risk and developing novel prevention strategies for colorectal cancer.

colorectal cancer↗

Optimal selection of SNP markers for disease association studies.

Genetic association studies with population samples hold the promise of uncovering the susceptibility genes underlying the heritability of complex or common disease. Most association studies rely on the use of surrogate markers, single-nucleotide polymorphism (SNP) being the most suitable due to their abundance and ease of scoring. SNP marker selection is aimed to increase the chances that at least one typed SNP would be in linkage disequilibrium (LD) with the disease causative variant, while at the same time controlling the cost of the study in terms of the number of markers genotyped and samples. Empirical studies reporting block-like segments in the genome with high LD and low haplotype diversity have motivated a marker selection strategy whereby subsets of SNPs that 'tag' the common haplotypes of a region are picked for genotyping, avoiding typing redundant SNPs. Based on these initial observations, a plethora of 'tagging' algorithms for selecting minimum informative subsets of SNPs has recently appeared in the literature. These differ mostly in two major aspects: the quality or correlation measure used to define tagging and the algorithm used for the minimization of the final number of tagging SNPs. In this review we describe the available tagging algorithms utilizing a 3-step unifying framework, point out their methodological and conceptual differences, and make an assessment of their assumptions, performance, and scalability.

Algorithms↗

The Research Quality Framework and its implications for health and medical research: time to take stock?

As the Australian university sector awaits final decisions about the introduction and stipulations of a research quality framework (RQF), to assess the quality and impact of research, we have studied international commentary on the value of such exercises. This suggests there is little hard evidence to recommend the proposed RQF. The UK government led the field in 1986 with its research assessment exercise (RAE), which is widely believed to have compromised clinical academic medicine by failing to satisfactorily acknowledge the contribution of clinical academics, not only to research but also to teaching and clinical practice. After the 2008 RAE, the UK government will move to a simpler, metrics-based system for assessing research quality and allocating funding. The New Zealand Performance Based Review Fund (PBRF), introduced in 2003, is based on a combination of peer review and performance indicators. Several concerns have been raised; among them is the real cost-benefit ratio of participation, with reports that many universities have spent more on the exercise than they will gain in funding increases. The scoring system has received the most criticism and, after the partial round assessment scheduled for this year, the controversial unit of assessment will be reviewed. It might be more cost-effective for Australia to modify existing research assessment processes than to undertake a potentially costly and arduous exercise.

Advisory Committees↗

Assessment of cognitive coping styles: a closer look at situation-response inventories.

Cognitive coping style approaches establish two concepts central to the understanding of people's responses to a stressful situation: "attention" and "avoidance". Theoretical frameworks corresponding to these conceptions are Sensitization-Repression (Byrne, 1961), Monitoring-Blunting (Miller, 1980), and Vigilance-Cognitive Avoidance (Krohne, 1986). Such types of cognitive coping styles are usually measured by means of situation-response inventories. In the present article, we take a closer look at this kind of coping assessment by considering the scenarios, the coping options and response formats, the dimensionality of the constructs, and published data on the reliability and the validity of seven situation-response inventories. Three important points deserve to be highlighted: (a) it probably makes little sense to assess coping style using scenarios that diverge maximally with respect to controllability and predictability since coping is not assumed to show such complete cross-situational stability; (b) similarly named inventories rely on largely different operationalizations and can hardly be considered as measuring similar constructs; and (c) monitoring/vigilance and blunting/avoidance generally emerge as independent constructs, which argues against use of summary scores.

Adaptation, Psychological↗

[Reliability of quantifying vascular white matter brain lesions -- a contribution to reproducible quantitative diagnosis].

PURPOSE: Microangiopathic lesions of the brain tissue correlate with the clinical diagnosis of vascular subcortical dementia. The "experience-based" evaluation is insufficient. Rating scales may contribute to reproducible quantification. MATERIALS AND METHODS: In MRI studies of 10 patients, 9 neuroradiologists quantified vascular white matter lesions (WMLs) at two different points in time for 12 anatomically defined regions with respect to number, size and localization (score). For 9 observers and 10 studies, 90 intra-observer differences were obtained for each of the 12 WML scores. To calculate the inter-observer reliability, rating pairs were formed. Furthermore, 360 differences were computed for each score and rating for 12 anatomically defined WML scores, and the intraclass correlation (ICC) was calculated as a measure of agreement (reliability). RESULTS: As to the intra-observer reliability, the median of the differences was 1.5 for the entire brain as opposed to 0 for defined brain regions. The corresponding values for the inter-observer reliability were 3 and 1, respectively. The mean intra-class correlation coefficient for the 10 studies was 0.88, whereas the mean interclass correlation concerning the inter-observer reliability was 0.70, with the first and second rating being averaged. The rating of each study took about 6 minutes. CONCLUSION: The rating scale with high intra- and inter-observer reliability can dependably quantify WMLs and correlates with the clinical diagnosis of vascular dementia. Using a reliable rating scale, the diagnostic distinction of age-associated physiological vs. pathological size of the WML can make a contribution to the reproducible quantifiable diagnostic evaluation of vascular brain tissue lesions within the framework of dementia diagnostics.

Aged↗

Detection of disease genes by use of family data. I. Likelihood-based theory.

We present a class of likelihood-based score statistics that accommodate genotypes of both unrelated individuals and families, thereby combining the advantages of case-control and family-based designs. The likelihood extends the one proposed by Schaid and colleagues (Schaid and Sommer 1993, 1994; Schaid 1996; Schaid and Li 1997) to arbitrary family structures with arbitrary patterns of missing data and to dense sets of multiple markers. The score statistic comprises two component test statistics. The first component statistic, the nonfounder statistic, evaluates disequilibrium in the transmission of marker alleles from parents to offspring. This statistic, when applied to nuclear families, generalizes the transmission/disequilibrium test to arbitrary numbers of affected and unaffected siblings, with or without typed parents. The second component statistic, the founder statistic, compares observed or inferred marker genotypes in the family founders with those of controls or those of some reference population. The founder statistic generalizes the statistics commonly used for case-control data. The strengths of the approach include both the ability to assess, by comparison of nonfounder and founder statistics, the potential bias resulting from population stratification and the ability to accommodate arbitrary family structures, thus eliminating the need for many different ad hoc tests. A limitation of the approach is the potential power loss and/or bias resulting from inappropriate assumptions on the distribution of founder genotypes. The systematic likelihood-based framework provided here should be useful in the evaluation of both the relative merits of case-control and various family-based designs and the relative merits of different tests applied to the same design. It should also be useful for genotype-disease association studies done with the use of a dense set of multiple markers.

Alleles↗

Anxiety in a cohort of Swiss women participating in a mammographic screening programme.

OBJECTIVES: To follow up anxiety in a cohort of women screened for breast cancer. METHODS: Within the framework of a pilot screening programme for breast cancer in the Canton of Vaud (Switzerland), a cohort of 924 participants aged 50-70 years were invited to answer questions on anxiety related to mammography screening. Anxiety was measured using a specific tool, the psychological consequences questionnaire (PCQ), and a new single item, direct question, breast cancer anxiety indicator (BCA). Participants were asked to fill in the questionnaire at four different phases: at screening, before the result, and 2 and 8 weeks after the result. The final response rate was 93.7%. Predictors of anxiety at each phase were assessed using multiple regression. RESULTS: Among those screening negative (94.7%), anxiety at screening was very low and remained so during the screening process. Among those screening false positive, anxiety was significantly higher 8 weeks after having received a negative diagnosis. Predictors of anxiety before screening were lower education and higher age, with a strong exogenous anxiety component. For subsequent phases, the initial anxiety score and education were the main determinants. Furthermore, a false positive result at screening was the most important predictor of anxiety 2 months after negative diagnosis. Anxiety measured with the BCA was strongly correlated with the PCQ. CONCLUSION: Anxiety was very low at screening and remained so during the process for negative women. Initial anxiety level was a strong predictor of anxiety during the entire process, up to 8 weeks after a negative result, and could be easily assessed using the BCA. The sustained higher anxiety level among those screening false positive is an undesirable side effect of the programme.

Aged↗

Knowledge, attitude and practice of Nigerian women towards breast cancer: a cross-sectional study.

BACKGROUND: Late presentation of patients at advanced stages when little or no benefit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women. Recent global cancer statistics indicate rising global incidence of breast cancer and the increase is occurring at a faster rate in populations of the developing countries that hitherto enjoyed low incidence of the disease. Worried by this prevailing situation and with recent data suggesting that health behavior may be influenced by level of awareness about breast cancer, a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Nigeria towards breast cancer. METHODS: One thousand community-dwelling women from a semi-urban neighborhood in Nigeria were recruited for the study in January and February 2000 using interviewer-administered questionnaires designed to elicit sociodemographic information and knowledge, attitude and practices of these women towards breast cancer. Data analysis was carried out using Statistical Analysis Software (SAS) version 8.2. RESULTS: Study participants had poor knowledge of breast cancer. Mean knowledge score was 42.3% and only 214 participants (21.4%) knew that breast cancer presents commonly as a painless breast lump. Practice of breast self examination (BSE) was low; only 432 participants (43.2%) admitted to carrying out the procedure in the past year. Only 91 study participants (9.1%) had clinical breast examination (CBE) in the past year. Women with higher level of education (X2 = 80.66, p < 0.0001) and those employed in professional jobs (X2 = 47.11, p < 0.0001) were significantly more knowledgeable about breast cancer. Participants with higher level of education were 3.6 times more likely to practice BSE (Odds ratio [OR] = 3.56, 95% Confidence interval [CI] 2.58-4.92). CONCLUSION: The results of this study suggest that community-dwelling women in Nigeria have poor knowledge of breast cancer and minority practice BSE and CBE. In addition, education appears to be the major determinant of level of knowledge and health behavior among the study participants. We recommend the establishment and sustenance of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer to all women in Nigeria.

Journal Article↗

A test for children's goal-directed behavior: a pilot study.

A test for children's goal-directed behavior was developed, based on neuropsychological executive function research of Vilkki and Holst and on the framework of Lewin's level-of-aspiration research. 46 12-yr.-old children were participants. Fluid Intelligence was expected to be linked to goal-directed behavior and a commonly used executive function task, the Wisconsin Card-sorting Test. A child was asked to set personal goals in a short-term memory task without prior knowledge about performance. Four different task versions were developed employing both verbal (memorizing series of words) and visuospatial (memorizing block sequences) material. The child set an individual goal for each memory trial. Goal-setting after successful and failed trials was investigated. Usually, the children lowered their goals after failures and set their goals higher or did not change them after successful trials. Compared to goal on a previous trial, Inadequate Responses included setting a goal higher after a failed trial and setting it lower after success. Fluid Intelligence was related to goal-directed behavior, viz., Inadequate Responses. It also correlated with scores on the Wisconsin Card-sorting Test. The results are in concordance with previous research. In addition to experimental executive function research, the novel test might be useful in research concerning children's motivation, self-efficacy, and self-regulated learning.

Child↗

Regression models for multiple outcomes in large epidemiologic studies.

In situations in which one cannot specify a single primary outcome, epidemiologic analyses often examine multiple associations between outcomes and explanatory covariates or risk factors. To compare alternative approaches to the analysis of multiple outcomes in regression models, I used generalized estimating equations (GEE) models, a multivariate extension of generalized linear models, to incorporate the dependence among the outcomes from the same subject and to provide robust variance estimates of the regression coefficients. I applied the methods in a hospital-population-based study of complications of surgical anaesthesia, using GEE model fitting and quasi-likelihood score and Wald tests. In one GEE model specification, I allowed the associations between each of the outcomes and a covariate to differ, yielding a regression coefficient for each of the outcome and covariate combinations; I obtained the covariances among the set of outcome-specific regression coefficients for each covariate from the robust 'sandwich' variance estimator. To address the problem of multiple inference, I used simultaneous methods that make adjustments to the test statistic p-values and the confidence interval widths, to control type I error and simultaneous coverage, respectively. In a second model specification, for each of the covariates I assumed a common association between the outcomes and the covariate, which eliminates the problem of multiplicity by use of a global test of association. In an alternative approach to multiplicity, I used empirical Bayes methods to shrink the outcome-specific coefficients toward a pooled mean that is similar to the common effect coefficient. GEE regression models can provide a flexible framework for estimation and testing of multiple outcomes.

Anesthesia↗

Functional impact of breast cancer by age at diagnosis.

PURPOSE: To explore changes in physical and psychosocial function before and after breast cancer by age at diagnosis. PATIENTS AND METHODS: A total of 122,969 women from the Nurses' Health Study (NHS) and NHS 2, ages 29 to 71 years, who responded to pre- and postfunctional status assessments were included; 1,082 women were diagnosed with breast cancer between 1992 and 1997. Functional status was measured using the Medical Outcomes Study Short Form 36 (SF-36). Mean change in health-related quality of life (HRQoL) scores was computed across categories representing the combination of incident breast cancer (yes or no) and age at diagnosis (< or = 40, 41 to 64, or 65+ years). RESULTS: Compared with women < or = 40 years without breast cancer, women with breast cancer experienced significant functional declines. Young (age < or = 40) women who developed breast cancer experienced the largest relative declines in HRQoL (as compared with middle-aged and elderly women) in multiple domains including physical roles (-18.8 v -11.5 and -7.5 points, respectively), bodily pain (-9.0 v -2.7 and -2.7 points), social functioning (-11.3 v -4.3 and -4.4 points) and mental health (-3.1 v 0.0 and +0.4 points). Much of the decline in HRQoL among elderly (age > or = 65) women with breast cancer was age related. CONCLUSION: Young women may fare worse than middle-aged or elderly women in both physical and psychosocial dimensions after breast cancer diagnosis. The needs of women facing breast cancer may be better understood within a life stage framework.

Adult↗

The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of stroke.

The aim of this study was to reach consensus about the prognostic factors when deciding the discharge destination from a hospital stroke unit, and to construct a prognostic conceptual framework. To realise an optimal integration of knowledge from research findings and from clinical experience by expert opinions we used a 'modified Delphi Technique', which is the most commonly used method for the production of clinical guidelines. The process yielded 26 prognostic factors, which were arranged in clinical and social sub-domains. The sub-domains and the factors within each sub-domain were prioritised according to their assumed predictive value for the decision process. The order of importance of the prognostic factors in the clinical domain was: (1) disabilities, (2) pre-morbid disabilities, (3) impairments and (4) disease/biology; and the order of importance of the factors in the social domain was: (1) home front, (2) social situation and (3) residence. The Delphi procedure is an excellent instrument to determine and prioritise prognostic factors. With this procedure research-based and consensus-based knowledge can be combined. For a valid procedure it is mandatory to state explicitly in advance how the scores will be judged, and to explain the scientific level of the evidence during the whole procedure.

Activities of Daily Living↗

Quality improvement in an outpatient department for subacute low back pain patients: prospective surveillance by outcome and performance measures in a health technology assessment perspective.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To develop clinical indicators and standards in an outpatients' department for sub acute low back pain patients. SUMMARY OF BACKGROUND DATA: A systematic quantitative surveillance to assess quality of care was implemented using outcome and performance measures. These measures were developed within the framework of Health Technology Assessment, which comprises the areas of healthcare technology, patient, organization, and economy. METHODS: A multidisciplinary project group defined 1) clinical indicators in terms of outcome and performance measures and 2) the corresponding standards using the available evidence from literature. Observed outcomes were compared with the standards. Associations between process and outcome measures were investigated. RESULTS: A total of 300 patients were included consecutively. In relation to technology, the standards for the field of application were fulfilled (e.g., not too many patients were x-rayed). With respect to effectiveness, the observed rate of patients reaching a 50% cutoff point of improvement of pain and function did not fulfill the standards. In relation to patient aspects, the standards of, for example, proper understanding of patient education and satisfaction, were fulfilled. In relation to organization, nearly one third of the patients were referred later to the department than the recommended 24 weeks. This refer variable showed an association to a reduced chance of scoring "better" or "much better" in "patients global assessment." The chance was reduced by 50% if patients were referred later than 12 weeks after onset of pain. In relation to economy, the cost of gaining a quality adjusted life-year by a course in the department was considerably lower than by comparison with total hip arthroplasty. CONCLUSIONS: Surveillance by clinical indicators in relation to the four areas of health technology assessment provides quantitative information that is meaningful for various stakeholders on important aspects of the quality of care (including consumers), provides a basis for quality improvement, and provides data for analysis of possible important relationships between structure, process, and outcome.

Acute Disease↗

Quality of training in public health in the UK: results of the first national training audit.

OBJECTIVES: Since 1997, UK public health training has undergone major changes, including the creation of specialist registrars (SpRs), introduction of a competency framework, admission of non-medical (specialist) trainees and National Health Service organizational change. It was therefore considered timely to audit the quality of this training. STUDY DESIGN: Cross-sectional survey of all UK public health trainees, conducted in April 2003. METHODS: The survey questions were based on 75 previously identified standards, with three sections: induction (30 standards), health protection (13 standards) and general training (32 standards). Results were calculated for the UK. Deaneries were compared on 10 key standards, as was the training of SpRs and specialist trainees. RESULTS: Two hundred and ninety responses were received (62% response rate). Only 16 (21%) of 75 standards were met by at least 80% of respondents, with problems in induction, health protection, secretarial facilities and examination support. Across 10 key standards (including initial welcome, trainer support, breadth/relevance of work and facilities), 59% indicated that their training had met at least eight standards. Results for individual deaneries were significantly different (P = 0.02), although 13 of 16 had median scores of eight out of 10, or over. Deaneries with specialists scored lower than those without (median scores eight vs nine, P = 0.003). Median specialist and SpR scores on the 10 key standards were seven and eight, respectively (P<0.001). In addition, SpRs were more likely to be 'on-call' [odds ratio (OR) = 66.8, 95% confidence interval (CI) 17.2-259.4, P<0.001] and to feel prepared for this role (OR = 10.7, 95% CI 1.4-79.8) than specialists. CONCLUSION: This was the first UK National Audit of Public Health Training. Few standards were achieved amongst respondents, although the levels set may be considered to be high and the response rate (62%) was less than optimal, potentially biasing results. Despite these caveats, recent organizational change in England appears to have led to significant training disruption among respondents. Nevertheless, repeating such an audit annually within deaneries could help to improve public health training throughout the UK.

Consumer Behavior↗

Development of a preference-weighted health status classification system in France: the Health Utilities Index 3.

The Health Utilities Index is a generic multiattribute preference-based system for assessing health-related quality of life, devised by Torrance et al. It is being used in cost-effectiveness evaluations in North America and in international multicentre studies but was not available in France. Following adaptation of the HUI3 classification in France, the purpose of the reported investigation was to derive French preference weights. This article provides a reminder of the theoretical foundations used to model the multiattribute utility function. Within this framework, a multiattribute multiplicative aggregate utility function was constructed in accordance with the explicitly decomposed approach. The study took place in June 1999 over a sample of 365 persons from the French general population, aged between 20 and 65, and not suffering from any chronic or incapacitating illness. The recruitment procedure was based upon a random selection of individuals, using the phone book. Interviews took place in the homes of the interviewees. The methods of revelation (VAS and SG) were applied by setting the value of the best possible state of the HUI3 a priori at 1, and leaving a choice between two states (worst possible state, death) for 0. The aggregated individuals (person-mean and median) were calculated and the multiplicative utility functions constructed. A comparison of the calculated utilities with the observed ones provides a primary indicator of the validity of the person-mean or median functions constructed. The slight absolute differences obtained between observed and calculated utilities and the low RMSE scores lead us towards a favourable conclusion.

Adult↗

Toward a multidimensional assessment of picture archiving and communication system success.

OBJECTIVES: Based on a prevalent framework in the information systems field, this study proposes and describes an integrated model for evaluating picture archiving and communication system (PACS) success from multiple users' perspectives. METHODS: Our study details the validation process of the proposed model at a large tertiary-care teaching hospital in Canada. Both qualitative and quantitative data were collected to assess the psychometric properties of the measurement instrument and test the research hypotheses. RESULTS: Our findings clearly reveal that radiologists, technologists, and clinicians have different views regarding the factors influencing PACS success. For instance, the results for radiologists show that their concern with efficiency and productivity is best guaranteed by a system that is reliable and easy to use. Furthermore, that only perceived system usefulness influenced clinicians' satisfaction with PACS is a reflection of the primary impact that technology has on their work, namely, the ability to have instant access to images from any point in the hospital. Even though, overall, all three groups view the adoption of PACS positively, the mean scores indicate that radiologists and technologists seem to be more satisfied and their expectations to be met at a higher level than clinicians. CONCLUSIONS: We believe the measurement instruments developed in this study can be used as a diagnostic tool by project managers interested in better understanding the extent to which different groups of stakeholders perceive the deployment of PACS as being successful and how factors influencing perceptions of PACS success vary across user types.

Data Collection↗

Tumor marker utility grading system: a framework to evaluate clinical utility of tumor markers.

Introduction of tumor markers into routine clinical practice has been poorly controlled, with few criteria or guidelines as to how such markers should be used. We propose a Tumor Marker Utility Grading System (TMUGS) to evaluate the clinical utility of tumor markers and to establish an investigational agenda for evaluation of new tumor markers. A Tumor Marker Utility Grading Worksheet has been designed. The initial portion of this worksheet is used to clarify the precise characteristics of the marker in question. These characteristics include the marker designation, the molecule and/or substance and the relevant alteration from normalcy, the assay format and reagents, the specimen type, and the neoplastic disease for which the marker is being evaluated. To determine the clinical utility of each marker, one of several potential uses must be designated, including risk assessment, screening, differential diagnosis, prognosis, and monitoring clinical course. For each of these uses, associations between marker assay results and expected biologic process and end points must be determined. However, knowledge of tumor marker data should contribute to a decision in practice that results in a more favorable clinical outcome for the patient, including increased overall survival, increased disease-free survival, improvement in quality of life, or reduction in cost of care. Semiquantitative utility scales have been developed for each end point. The only markers recommended for use in routine clinical practice are those that are assigned utility scores of "++" or " " on a 6-point scale (ranging from 0 to ) in the categories relative to more favorable clinical outcomes. Each utility score assignment should be supported by documentation of the level of evidence used to evaluate the marker. TMUGS will establish a standardized analytic technique to evaluate clinical utility of known and future tumor markers. It should result in improved patient outcomes and more cost-efficient investigation and application of tumor markers.

Biomarkers, Tumor↗