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A list of 54 copepod species (Crustacea) in 23 families is presented for the Pacific coast of Costa Rica. Identifications are from zooplankton samples of the Victor Hensen Expedition during December 1993 and February 1994. Samples were taken with a Bongo net (0.60 m net opening, 2.50 m net length) with 200 microns mesh size. Oblique hauls were done from the surface to the ground at a towing speed of aprox. 1 knot. 37 species (68.5%) were found in the Gulf of Nicoya, 36 in Golfo Dulce (66.6%) and 17 (31.4%) species were common to both gulfs, while only twelve species (22.2%) were found in Coronado Bay. Four species (7.4%) were distributed along the coast and were common to the three regions: Paracalanus parvus, Euchaeta sp., Oithona plumifera and O. similis. Eleven species of calanoids found normally in the Costa Rica Dome show the influence of typical oceanic waters principally at the mouth of Gulf of Nicoya. Differences were observed in the composition and presence of the copepod species when the inner and outer (upper and lower) parts of both gulfs were compared. Gulf of Nicoya was dominated in its upper part by typical neritic estuarine species like Acartia lilljenborgii, Paracalanus parvus and, Hemyciclops thalassius as well as species of Pseudodiaptomus. On the other hand a more oceanic composition of copepods was observed in the lower part of the gulf. Both small species, like Oncaea venusta, as well as larger species, such as Pleuromamma robusta, Eucalanus attenuatus, E. elongatus and Rhincalanus nasutus, were typical of these waters. Oithona plumifera and O. similis were found in the lower part too; and both species are typical from oceanic water. Coronado Bay was characterized by the presence of typical oceanic species like Neocalanus gracilis, Euchaeta longicornis, Eucalanus attenuatus and Haloptilus ornatus with more transitional species like Clausocalanus pergens and C. furcatus near the coast. In the Golfo Dulce differences in copepod composition were also observed, but the separation of the species was not so evident. Outer stations were represented by oceanic species like Paracalanus aculeatus, Pleuromamma gracilis, Lucicutia ovalis, Candacia catula, Euchaeta wolfendeni and Oncaea mediterranea, while the inner station, located at the upper part of the Gulf, was more characterized by a mixed copepod group, with both neritic species like Pseudodiaptomus wrigthi, Acartia danae, A. clausi, Canthocalanus pauper as well as oceanic species like Scolicithricella marginata, Saphirina nicromaculata or Oncaea conifera. Two species of Coryceaus, C. flaccus and C. speciosus, were identified in the outer stations of Golfo Dulce, while C. brehmi was found in inner stations of Gulf of Nicoya. The majority of copepods found are typical of the east Pacific. This paper constitutes an additional work about the copepods in the Gulf of Nicoya and the first report of copepod species for Coronado Bay and Golfo Dulce.
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The society of physicians of Germany and the society of panel physicians laid down in the "assessment criteria for guidelines in medical care" what kind of demands the medical selfadministration makes on guidelines. This measure also had the goal to support and strengthen the efforts of the AWMF for guidelines of high value. On the basis of these assessment criteria, a tool was compiled for the systematic registration and documentation of quality criteria for good guidelines for the first time in areas of German language. This check list is guided by the structure and content of the "Criteria for Appraisal for National Guidelines" by the Scottish Intercollegiate Guidelines Network.
After a long period of discussions on the efficacy of psychotherapy, there is still a lack of conventions for measuring change after psychological treatment. This paper first describes the concept of statistical and clinical significance of change. Using the SCL-90-R as a commonly administered instrument we then propose conventions and cut-off points for its global severity score (GSI) and change after therapy. A German standard population and several psychotherapy samples were aggregated to determine cut-off points and confidence intervals (reliable change indices) for statistically and clinically significant changes. Tingey et al. (1996) proposed the use of multiple clinical groups (inpatients and outpatients) aiming at a more realistic determination of "stepwise" changes. We examined this procedure with our data. Results show that it is not applicable in the German samples collected so far. Initial SCL-90-R scores in these groups did not differentiate sufficiently between inpatients and outpatients. Therefore, according to Jacobson and Truax (1991), moving from a "functional" to a "dysfunctional" population is still the criterion for a clinically significant change.
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OBJECTIVES: To identify existing guidelines and develop a synthesised guideline plus accompanying checklist. In addition to provide guidance on key theoretical, methodological and practical issues and consider the implications of this research for what might be expected of future decision-analytic models. DATA SOURCES: Electronic databases. REVIEW METHODS: A systematic review of existing good practice guidelines was undertaken to identify and summarise guidelines currently available for assessing the quality of decision-analytic models that have been undertaken for health technology assessment. A synthesised good practice guidance and accompanying checklist was developed. Two specific methods areas in decision modelling were considered. The first method's topic is the identification of parameter estimates from published literature. Parameter searches were developed and piloted using a case-study model. The second topic relates to bias in parameter estimates; that is, how to adjust estimates of treatment effect from observational studies where there are risks of selection bias. A systematic literature review was conducted to identify those studies looking at quantification of bias in parameter estimates and the implication of this bias. RESULTS: Fifteen studies met the inclusion criteria and were reviewed and consolidated into a single set of brief statements of good practice. From this, a checklist was developed and applied to three independent decision-analytic models. Although the checklist provided excellent guidance on some key issues for model evaluation, it was too general to pick up on the specific nuances of each model. The searches that were developed helped to identify important data for inclusion in the model. However, the quality of life searches proved to be problematic: the published search filters did not focus on those measures specific to cost-effectiveness analysis and although the strategies developed as part of this project were more successful few data were found. Of the 11 studies meeting the criteria on the effect of selection bias, five concluded that a non-randomised trial design is associated with bias and six studies found 'similar' estimates of treatment effects from observational studies or non-randomised clinical trials and randomised controlled trials (RCTs). One purpose of developing the synthesised guideline and checklist was to provide a framework for critical appraisal by the various parties involved in the health technology assessment process. First, the guideline and checklist can be used by groups that are reviewing other analysts' models and, secondly, the guideline and checklist could be used by the various analysts as they develop their models (to use it as a check on how they are developing and reporting their analyses). The Expert Advisory Group (EAG) that was convened to discuss the potential role of the guidance and checklist felt that, in general, the guidance and checklist would be a useful tool, although the checklist is not meant to be used exclusively to determine a model's quality, and so should not be used as a substitute for critical appraisal. CONCLUSIONS: The review of current guidelines showed that although authors may provide a consistent message regarding some aspects of modelling, in other areas conflicting attributes are presented in different guidelines. In general, the checklist appears to perform well, in terms of identifying those aspects of the model that should be of particular concern to the reader. The checklist cannot, however, provide answers to the appropriateness of the model structure and structural assumptions, as these may be seen as a general problem with generic checklists and do not reflect any shortcoming with the synthesised guidance and checklist developed here. The assessment of the checklist, as well as feedback from the EAG, indicated the importance of its use in conjunction with a more general checklist or guidelines on economic evaluation. Further methods research into the following areas would be valuable: the quantification of selection bias in non-controlled studies and in controlled observational studies; the level of bias in the different non-RCT study designs; a comparison of results from RCTs with those from other non-randomised studies; assessment of the strengths and weaknesses of alternative ways to adjust for bias in a decision model; and how to prioritise searching for parameter estimates.
Several commentators have identified the lack of generalisability and transferability of economic evaluation results. The aims of this study were: (a) to develop a checklist to assess the level of generalisability and transferability of economic evaluations; (b) to assess the generalisability and transferability of economic evaluations between the UK and France using the checklist; (c) to identify reasons for any lack of transferability and generalisability; (d) to assess how the transferability and generalisability of economic evaluations can be improved; and (e) to outline ways in which databases of economic evaluations and journals can assist in this area. The checklist was developed using previous work and the templates of the NHS EED and CODECS databases. A sub-checklist of essential items was then derived. Validation of the two checklists was undertaken with Health Economists participating in the EURONHEED project. Economic evaluations involving the UK and France were then located and assessed using the checklist. A summary score for each study was calculated based on the percentage of correctly reported (applicable) points, and the results in the empirical analysis compared to identify differences. The extended checklist includes 42 items, and the sub-checklist 16 items. Twenty-five economic evaluations met the inclusion criteria for the empirical analysis. In the extended checklist the mean score was 66.9+/-13.6%. The results for the sub-checklist were very similar. The analysis revealed that costing, assessments of generalisability by the author(s), assessment of data variability, discounting, study population, and the reporting of effectiveness are areas that need more attention. Differences in cost-effectiveness results are often accounted for by price or organisational differences. The developed checklists are useful in assessing the generalisability and transferability of economic evaluations. In order to improve the generalisability and transferability of economic evaluations authors need to be more explicit and detailed in describing and reporting their studies. If they are to provide added value to their users, international databases of economic evaluations should systematically assess the generalisability and transferability of studies. Further research is in progress on producing a weighted version of the checklist.
OBJECTIVE: To pilot-test a simple checklist designed to improve coding of acute myocardial infarction (AMI) in hospital discharge abstracts. BACKGROUND: Health records technologists review hospital charts to code discharge diagnoses according to the International Classification of Diseases, 9th revision (ICD-9). Many studies have suggested that there is a high false positive rate in coding AMI, ie, ICD-9 410, on hospital discharge abstracts. PATIENTS AND METHODS: The checklist required either at least two of suggestive symptoms, diagnostic electrocardiographic changes, or diagnostic rise in serum cardiac enzymes; or confirmation by autopsy. First case of use was confirmed-typical time to complete the checklist was 3 to 4 mins. Then 16 Ontario community hospitals were recruited to apply the checklist on a blinded basis to 1000 randomly drawn in-patient records-10% were audited for another study to confirm AMI; and 90% were originally coded with 'most responsible diagnosis' (MRD) of AMI, other cardiovascular diagnoses and various noncardiac conditions. Percentage agreement (95% CI) between the checklist and the confirmed or coded diagnosis was analyzed; coding of AMI as a secondary diagnosis was examined in further analyses. RESULTS: One hospital withdrew for logistical reasons; the final useable sample from 15 hospitals was 943 records. The checklist correctly identified 100% of AMIs independently confirmed for another study; usual coding identified 89.7% of cases (70 of 78; 95% CI 80.8 to 95.5). For cases not confirmed, but where the physician had nonetheless diagnosed AMI, six of 11 charts were miscoded as AMI in hospital records; none were miscoded by the checklist. For records with AMI as MRD, 11.6% (44 of 380; 95% CI 8.5 to 15.2) were classified as false positives by the checklist. Where an AMI was coded as a secondary diagnosis, 52.9% (36 of 68; 95% CI 40.5 to 65.2) met the checklist criteria for AMI. Finally, among records where the MRD was other than AMI, 6.8% (38 of 563; 95% CI 4.8 to 9.2) met checklist criteria for AMI during admission, but 94.7% had an ICD-9410 code as a secondary diagnosis. CONCLUSION: A simple checklist can be very easily applied, has extremely high sensitivity for confirming the presence of AMI, and identifies a clinically significant proportion of charts with false positive codes for AMI. Conversely, these findings support the high sensitivity (low false negative rates) of conventional coding practices for AMI in Canadian hospital records, be it as a primary or secondary diagnosis (eg, 95% detection rate). Usual coding, combined with the checklist for tentative ICD-9 410 diagnoses, would improve the accuracy of Canadian hospital records.
In this study we evaluated the practical performance of 70 general practitioners in cardiopulmonary resuscitation (CPR) before and after instruction and compared checklist-based scores to mechanical recording scores in order to investigate which scoring method is preferable. Both checklist and recording strip-based scores showed significant improvement after instruction, but only 37% were judged proficient according to the American Heart Association standards (checklist scoring), and 47% according to the recording print-based scoring system, while rates judged 97% as satisfactory by general impression. Interrater reliability was highest for the recording print (0.97) and lower for the checklist (0.79), especially for CPR performance (0.56). Comparison of checklist and recording print showed that the checklist was specific but not very sensitive in identifying poor performance for cardiac compression rate, since observers overestimated performance. The correlation for CPR performance between checklist score and recording strip score was low (0.45), indicating that candidates were ranked differently. The correlation between diagnosis and performance score was low for checklist as well as recording print (0.22), indicating that the score on diagnosis was a poor predictor for the score on performance of CPR. These results support the use of the recording manikin as compared with the use of a checklist for formative evaluation of basic life support skills. However, as proficiency in diagnosis and performance in CPR are poorly correlated, assessment of diagnosis using a checklist must be included. Therefore we strongly recommend the combination of assessment by observers using a checklist for diagnostic procedures and the recording strip of the manikin for performance of CPR, as employed in most evaluation schemes.
We evaluated a new guideline, in the form of a "checklist of considerations," to support end-of-life decision making in the treatment of demented patients with pneumonia. Questionnaires were sent to nursing home physicians (NHPs) in The Netherlands at three times: before implementation of the checklist (concerning 91 individual patients), during use of the checklist (concerning another 107 individual patients), and after data collection (concerning the targeted patient category of demented nursing home patients with pneumonia as a whole). In the last questionnaire, one NHP from each nursing home (n = 55 NHPs) gave his or her general opinion about the checklist. We measured the usefulness of the checklist in supporting decision making and its frequency of actual use. The NHPs accepted the contents of the checklist for use in the targeted patient category. It was used in 46% of the incident cases of pneumonia. The checklist was considered more useful in supporting decision making for the targeted patient category (85% of the NHPs) than for the individual patient (47%). Possible explanations for this discrepancy in "usefulness" include the difference in the nature of the outcome measures and the fact that the checklist was used more frequently for the "easier cases." Information on individual patient level, patient category level, and nursing home and NHP characteristics is used to suggest checklist improvements.