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PubMed2003

Letters, numbers, symbols and words: how to communicate grades of evidence and recommendations.

The GRADE Working Group is developing and evaluating a common, sensible approach to grading quality of evidence and strength of recommendations in health care. In this article, we discuss the advantages and disadvantages of using letters, numbers, symbols or words to represent grades of evidence and recommendations. Using multiple strategies, we searched for comparative studies of alternative ways of representing ordered categories in any context. In addition, we contacted experts and reviewed theoretical work and qualitative research on how best to communicate grades of any kind quickly and clearly. We were unable to identify health care research that addressed, either directly or indirectly, the best way to present grades of evidence and recommendations. We found examples of symbols used by government, commercial and consumer organizations to communicate quality of evidence or strength of recommendations, but no comparative studies. Although a number of grading systems are used in health care and other fields, there is little or no evidence of how well various presentations are understood. Before promoting the use of specific symbols, numbers, letters or words, the extent to which the intended message is comprehended should be evaluated.

Communication↗
PubMed1992

Cholesterol consensus: a trans-Atlantic perspective. Amsterdam, The Netherlands, 31-October-1 November 1991.

This consensus document has been drawn up following the round-table conference 'Cholesterol Consensus: a Trans-Atlantic Perspective', Amsterdam, 31 October and 1 November 1991. Its recommendations are as follows. Elevated plasma cholesterol level should be viewed as one of a number of important risk factors that contribute to the high incidence of coronary heart disease in industrialized societies. Control of lipid abnormalities forms an essential part of an overall preventive strategy of risk factor reduction. Both population and individual strategies are required. To reduce the mean plasma cholesterol levels of populations, a multidisciplinary approach is needed, involving the health-care professions, government, food manufacturers and distributors, community and consumer organizations, and the media. While it is desirable for all individuals to know their plasma cholesterol level, universal screening is recommended only where resources for treatment and follow-up are sufficient to cope with the case load detected. As an interim measure, screening should be focused on individuals at special risk. The recommendations of the European Atherosclerosis Society and the U.S. National Cholesterol Education Program should be followed with regard to thresholds for treatment by dietary counselling and pharmacological methods, and targets for cholesterol reduction. These recommendations should be periodically reviewed as new research data becomes available. A number of key areas for research are listed.

Cholesterol↗
PubMed2004

[Influence of humic substance in solids on CODMn of the Yellow River].

Experiments were carried out to study the influence of humic substance in solids (Loess soil) on CODMn in the Yellow River. Several significant results were abtained from the study: (1) The total CODMn of water sample including liquid and solid phases increased significantly with the increase of solid content; The CODMn of liquid phase of water sample under pre-treatment with acid (LPWSPC) also increased significantly with the increase of solid content while that without pre-treatment did not increased significantly. (2) With the increasing of solid content, the total BOD5 of water sample increased much slower than the total CODMn and the CODMn of LPWSPC. (3) The humic substances with the content of 0.76% in solids (Loess soil) contributed greatly to the total CODMn of water sample. When the solid contents were 7.5 g/L and 15.0 g/L, the humic substances in solids accounted for 15.9% and 21.7% of the total CODMn of water sample, respectively. (4) When solid contents were 7.5 g/L and 15.0 g/L, fulvic acid,one of the main compositions of humic substance contributed to 23.6% and 50.6% of the CODMn of LPWSPC, respectively. Since the fulvic acid can hardly be biologically oxidized under natural conditions, the CODMn of LPWSPC in water quality monitoring exaggerates the oxygen-consuming organic contamination of the Yellow River.

China↗
PubMed2006

Rehabilitation Medicine Summit: Building Research Capacity--executive summary.

The general objective of the Rehabilitation Medicine Summit: Building Research Capacity was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were: (1) researchers, (2) research environment, infrastructure, and culture, (3) funding, (4) partnerships, and (5) metrics. The [approximately] 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small-group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.

Health Services Research↗
PubMedDate not supplied

Rehabilitation medicine summit: building research capacity.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called to pursue the agendas outlined in this article.

Biomedical Research↗
PubMed1987

The AIDS information crisis: confluence of the roles of information creator, seeker, and provider.

The dramatic increase in the number of cases and deaths from AIDS since 1981 has been accompanied by an information explosion on the topic. The government, health professionals, service organizations, consumers, and the media are each vital links in both formal and informal AIDS information networks. New information sources and systems have emerged from these five sectors, and their roles as information creators, seekers, and providers have come together. The need for integrative or synthesizing databases and systems which reflect the sectors' interdependence and acknowledge their roles in the information process is discussed. Databases and systems which reflect a multi-sector approach, such as the Computerized AIDS Information Network (CAIN), are suggested as potential solutions to the AIDS information problem.

Acquired Immunodeficiency Syndrome↗
PubMed1979

The Clearinghouse for Environmental Carcinogens of the National Cancer Institute, USA.

The NCI Clearinghouse for Environmental Carcinogens acts as an advisory body to the Carcinogenesis Testing Program of that Institute. It consists of 30 members, from academic institutions, labour organizations, consumer groups and industry. They are divided into three groups: the Chemical Selection group establishes priorities for compounds to be tested; the Experimental Design group decides on the test procedures and parameters to be used; and the Data Evaluation/Risk Assessment group review data from completed tests, for deficiencies in experimental design or conduct, the nature of the lesions produced and the statistical analysis of the results, and gives a critical opinion of the test.

Carcinogens, Environmental↗
PubMed1979

International efforts in independent living.

Several nations currently share a major concern for provision of services to severely disabled persons. The focus of this concern has been upon those services which promote maximum integration and independence of severely disabled individuals in the community. Recent efforts in this direction by governments, private citizens, and handicapped-consumer organizations in Sweden, The Netherlands, Denmark, England, Canada, and Australia are discussed. Developments in housing and environmental modification, transportation, and self-help training are reviewed for their potential interest to advocates and practitioners of rehabilitation for independent living.

Australia↗
PubMed1979

Children's car seat restraints: when top-tether straps are ignored, are these restraints safe?

Children's car seat restraints are impact sled-tested to evaluate their safety qualities. To determine whether these restraints can protect the child, it is necessary to test in two different ways those restraints that require a top-tether strap: (1) installed in accordance with the manufacturer's directions; and (2) installed in the manner they are actually used. In this study the five children's car seat restraints top-rated by a leading consumer organization were impact sled-tested with a top-tether strap in use. They were then tested without the top-tether strap--the way such restraints are often being used as indicated by an Insurance Institute for Highway Safety survey. In addition, two leading restraints not requiring a top-tether strap, but secured by the auto lap belt, were tested. This study shows that the five top-tethered restraints, when installed with top-tether and lap belt, and the two restraints not requiring a top-tether give good protection in a frontal crash. It also shows that, with one possible exception, the five restraints that require a top-tether strap do not provide adequate protection if the top-tether strap is not used.

Accident Prevention↗
PubMed1981

Extracorporeal perfusion of the whole human placenta--a new model.

An extracorporeal dual perfusion system of the whole human placenta was developed using a technique of multiple blunt cannulations of the intervillous space. The system was evaluated according to various perfusion-dynamic, metabolic and morphological criteria. Angiographic and dye distribution studies showed 80 to 100 per cent perfusion of the placenta. The perfused organ consumed oxygen, utilized glucose and produced HCG. The flow rates and acid-base values were within acceptable limits. However, problems with high fetoplacental vascular resistance, tendency to metabolic acidosis and fetomaternal fluid transfer were encountered. Ultrastructural studies showed variations in the syncytiotrophoblast and the microvilli.

Acid-Base Equilibrium↗
PubMed1980

Role of arterial O2 flow in peripheral chemoreceptor excitation.

Assurance of adequate oxygen flow is a fundamental issue for all oxygen-consuming organisms. In higher organisms, aortic and carotid body chemoreceptors are known to sense arterial hypoxia, but the factors that allow aortic and carotid body chemoreceptors to sense the level of O2 circulation deserve further clarification. Experiments in the cat are presented in which the activity of chemoreceptor afferents from aortic and carotid bodies was monitored while arterial O2 flow was manipulated by i) lowering PaO2, ii) carboxyhemoglobinemia, iii) anemia, and iv) lowering systemic blood pressure. All of the above alterations stimulated aortic body chemoreceptors, indicating that hemoglobin-bound O2 participated in the maintenance of the receptor PO2 level. In contrast, most carotid body chemoreceptors were not stimulated by moderate carboxyhemoglobinemia, anemia and/or hypotension, indicating that hemoglobin-bound O2 normally did not influence the receptor tissue PO2. However, hypotension at a low O2 capacity did stimulate the receptors. In aortic body circulation, O2 flow was already critical, and therefore the chemoreceptors were sensitive to O2 transport capacity whereas carotid body chemoreceptors were not, presumably because of a large blood flow. Accordingly, aortic body chemoreceptors are more suited for monitoring circulatory O2 flow and carotid chemoreceptors for respiratory O2 flow.

Anemia↗
PubMed1976

Use of automated, on-line pyruvate analysis.

Normothermic blood perfusions of isolated canine liver were undertaken to determine the most sensitive and reliable indicators of viability. Perfusate flow rates and arterial and portal venous pressures were monitored. Arterial and venous concentrations of potassium, pyruvate, serum glutamic oxaloacetic transaminase, and oxygen were monitored and the values stored on magnetic tape for computerized calculation of outputs. Continuous evaluation of taurocholate concentration in the perfusate allowed adjustment of infusion rate to provide a constant flow of bile across the hapatocytes. Pyruvate output, portal venous resistance, serum glutamic oxaloacetic transaminase output and potassium output provided the earliest indices of deterioration. Bile flow and oxygen consumption remained constant until irreversible outflow block had occured. The earliest and most constant parameter signaling deteoration of the ex vivo liver was pyruvate output. The deteriorating liver released pyruvate into the perfusate, while the functioning organ consumed or maintained the available substrate. Since pyruvate output occurs before the onset of irreversible damage, measures can be enacted to reverse the deterioration. Restoration of the preparation can be evaluated through the cessation of pyruvate output.

Animals↗
PubMed1988

Sampling and analysis techniques for trace volatile organic emissions from consumer products.

Comparisons are made of two techniques for the trace analysis of volatile organic compound (VOC) emissions from consumer products: direct on-line sampling and analysis and on-line solid sorbent collection followed by off-line analysis. Two types of direct analyses are examined. The first consists of direct injection of emissions from a sample loaded environmental chamber into a gas chromatograph equipped with a flame ionization detector (FID) for compound identification. Direct injection of headspace collected emissions into a gas chromatograph equipped with a mass selective detector is the second direct method scrutinized. The more traditional technique of solid sorbent collection of the volatile organic emissions followed by thermal desorption (TD)/gas chromatographic (GC)/mass spectrometric (MS) analysis is compared to both direct on-line methods.

Deodorants↗
PubMed2006

National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services.

The authors report on a 2002 national survey of mental health mutual support groups (MSG) and self-help organizations (SHO) run by and for mental health consumers and/or family members, and consumer-operated services (COS). They found 7,467 of these groups and organizations-3,315 MSGs, 3,019 SHOs, and 1,133 COSs-greatly eclipsing the number of traditional mental health organizations (4,546). MSGs reported that 41,363 people attended their last meetings. SHOs reported a total of 1,005,400 members. COSs reported serving 534,551 clients/members in 1 year. The array of services and supports provided within each of these types (MSG, SHO, COS) is reported, and implications for the President's New Freedom Commission on Mental Health recommendations are explicated.

Health Care Surveys↗
PubMed1997

Consumer empowerment in mental health organizations: concept, benefits, and impediments.

This article proposes a framework for promoting consumer empowerment in mental health organizations. Consumer empowerment involves consumer participation in organizational decision-making, program development and evaluation, access to resources, and opportunities for consumers to develop and run services as well as to maintain personal dignity and integrity. The benefits include increased service innovation, responsiveness to changes in the market place, accountability, as well as the enhancement of quality of care, the protection of consumer rights, among others.

Community Participation↗
PubMed2006

A new method using a health index (HI) to screen low level toxic organic substances in consumer products.

To ensure selection of appropriate materials for industrial use in terms of toxicity, a procedure to estimate a health index (HI) that can be used for prioritizing less hazardous components of consumer products is described. The HI is based on the occupational exposure limits (OELs) of organic substances that compose the products. To calculate the HI of a product, it is often necessary to predict OEL values for the substances for which an OEL value has not yet been promulgated. We developed a method to estimate the OEL values from median lethal dose (LD50) data of rodent. A good correlation between known OEL values and the LD50 data was obtained by a multivariate regression analysis by introducing organic compensation coefficients, which were caluculated as 10 to the Bth power where B is the regression coefficient of dummy variables denoting the characteristics of the organic compounds such as functional groups, molecular structures, and so on. We believe that the use of the present method should be limited to predicting unknown OEL values for the HI and used for material prioritization. It should not be extended to determinations of regulatory OELs.

Consumer Product Safety↗