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PubMed1991

Consistency of evaluators assessing inhaler technique.

Since correct inhaler technique is vital for maximum efficacy, the evaluation of technique in patients or health care professionals involved in education programs or research projects is essential. Inconsistency could lead to confused patients and inaccurate research findings. This study is the first to determine interrater consistency with assessing recitation and demonstration of inhaler technique and, if needed, was designed to improve consistency until 95% agreement was achieved. A checklist for correct inhaler technique was constructed by consolidating information from the literature and package inserts. Initially three evaluators were used, however, a fourth evaluator was added for the last two trials to create teams to improve consistency. Percent agreement, probability and kappa scores were calculated. Six trials evaluating inhaler technique of 56 health care professionals at five different sites, revisions of the checklist, and evaluator teams were required to increase overall percent agreement from 81% to 98%. Agreement increased substantially on the verbal component because of specific changes made in the checklist and the objective nature. Demonstration steps consistently had lower agreement than verbal steps. Agreement on the demonstration component was more difficult because of subjectivity involved in observing a subject actuate the inhaler at the correct time, inhale or exhale slowly, and hold one's breath. The relative rankings of percent agreement and kappa scores were the same, however, kappa scores allowed differentiation of agreement due to chance and ability. To achieve interrater consistency, training and practice are required. Interrater consistency should be achieved to ensure accurate reporting of research results on inhaler technique and education of patients.

Clinical Trials as Topic↗
PubMed1991

Relationship between personality and premenstrual symptoms: a study in five general practices.

A large representative sample of women of child bearing age in five urban practices were asked to complete two measures to record premenstrual changes in their health. The first method was a daily health record which sought to disguise the fact that the focus of the study was premenstrual changes while the second method was a conventional, retrospective checklist. In addition, the women completed a personality inventory which allowed them to be allocated to one of two personality subtypes according to level of neuroticism--neurotic or stable. The results suggest that women in the neurotic subgroup are, in general, more likely to report premenstrual changes than stable women and particularly so on the retrospective checklist rather than the daily record of health changes. It was also shown that women in the stable subgroup were less likely to be inconsistent reporters of symptoms on the two questionnaires than neurotic women. Better understanding of the variable nature of the premenstrual syndrome may demand that more attention is paid to the method of collection of data and to how this interacts with the woman's basic personality. In particular, for research purposes, the traditional method of a retrospective checklist introduces an unacceptable level of response bias in favour of the identification of women with high neuroticism scores, and underrepresents more stable women who suffer from premenstrual complaints. Previous treatment trials which have used this method may therefore be invalid and their conclusions should be reappraised.

Adult↗
PubMed1990

Strategies for increasing house staff management of cholesterol with inpatients.

This study tested the effectiveness of two conceptually different chart audit-based approaches to modifying physicians' clinical practices to conform with quality-assurance standards. The objective was to increase intern utilization of cholesterol management opportunities in the inpatient setting. Using a clinical trial study design, 29 internal medicine interns were randomly assigned to four intervention groups identified by the intervention they received: control, reminder checklists (checklists), patient-specific feedback (feedback), or both interventions (combined). Over a nine-month period, intern management of high blood cholesterol levels in internal medicine inpatients (n = 459) was monitored by postdischarge chart audit. During both a baseline and subsequent intervention period, interns documented significantly more cholesterol management for inpatients with coronary artery disease (CAD) than without CAD. During baseline, 27.3%, 24.3%, 21.7%, 12.4%, 5.4%, and 2.7% of all inpatient charts had intern documentation concerning a low-fat hospital diet, cholesterol history, screening blood cholesterol level assessment, follow-up lipid profile, nutritionist consult, and preventive cardiology consult, respectively. The feedback intervention significantly increased overall intern-documented cholesterol management among inpatients with CAD. The checklists significantly decreased overall intern-documented cholesterol management. Feedback appears to be an effective approach to increasing intern cholesterol management in inpatients.

Adult↗
PubMed1987

[Assessment of risk before major gynecologic operations using a personal risk check list].

Anaesthesia and operation risk is determined by many factors. State of physical health and main disease of the patient are predominant ones. In many countries attempts have been carried out to systematize the preoperative findings by a classification and to estimate the preoperative risk by objective parameters. The anaesthesia-checklist of Lutz, introduced in 1972, more and more finds a consent in different modifications and is widely used. After approval of specialists, of internal medicine, anaesthesiology and gynaecology an own checklist has been elaborated taking the pattern of principles from Lutz. The scheme considered patient selection, diagnostic possibilities and spectrum of operations in the women's hospital of Humboldt-University of Berlin/GDR. After having tested our checklist in a retrospective (n = 2290 patients) and a prospective study (n = 100 patients) its application in clinical practice can be recommended.

Adult↗
PubMed1978

Macro-monitoring: a step toward rational psychopharmacotherapy.

A 15-item checklist was used to monitor the drug therapy of 516 patients in five clinical settings. The primary purpose of this study was to determine the extent of irrational drug use in these several settings. After gathering baseline data, two similar clinical units were selected for a six-month follow-up to determine the impact of drug consultation by an expert clinical psychopharmacologist. In the unit where drug consultation was provided, there was a significnat reduction in extended antiparkinsonian agent use (p less than 0.001), multiple daily dosage (p less than 0.001), inappropriate anxiolytic use (p less than 0.01), polypharmacy (p less than 0.001) and too rapid change in medication (p less than 0.01). The unit that did not have drug consultation continued to have a high percentage of patients receiving drugs in an inappropriate manner. Although the consultant had a significant impact on drug use, it was recognized that such consultation is not feasible for most psychiatric facilities. The checklist itself is a systematic tool that can be used to identify prescribing practices of questionable appropriateness. If used properly by the pharmacist, the checklist can serve as a supportive system to assist the physician in providing better patient care.

Drug Information Services↗
PubMed1982

Identifying the reasons for low immunization coverage. A case study of Yaounde (United Republic of Cameroon).

Among the problems encountered today in Expanded Programmes on Immunization (EPI) is the failure to reach an acceptable level of immunization coverage in rapidly growing urban areas. This paper describes a checklist to identify the reasons for such low coverage. The checklist was first used in Yaounde, United Republic of Cameroon. There the low coverage is found to be associated with certain neighborhoods, one ethnic group, low socio-economic status, and newly-arrived families. Publicity about immunizations is not reaching Yaounde residents in those categories. Furthermore, health lessons (given only in French) seem to be confusing the parents rather than educating them. Finally, previous ineffective immunization programmes have made Yaounde residents mistrustful of the current programme. The authors recommend solutions to each of these Yaounde problems. The checklist, and the methods used for answering it in Yaounde, should prove useful to other immunization programmes.

Attitude to Health↗
PubMed1995

The Icelandic child mental health study.

The purpose of this study was to test the applicability of a standardized procedure for assessing Icelandic children's behavior/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist by Achenbach to estimate the self-reported prevalence by parents and adolescents of emotional and behavior problems in children from 2-16 years of age and self-reported prevalence of adolescents from 11-18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing lists with a letter to parents of children 2-10 years of age. The lists for adolescents 11-18 years of age were distributed by teachers in school. Those adolescents who were not in school received the lists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2-3 year old children; 943 parents of 4-16 year old children, and 546 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group (47%), but increasing to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons are presented with the Child Behavior Checklist for this study with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries in behavior/emotional problems reported. The present study prevalence data behavior/emotional problems in Icelandic children from the general population from 4-16 year olds for 943 children is 17.5 (boys 19.1; girls 15.).

Adolescent↗
PubMed1995

[DSM IV and research. The problem of clinical trials].

Like its predecessors, DSM IV allows the prospective study population for clinical trials to be defined as accurately possible. The inclusion and exclusion criteria allow clear definition of the diagnostic category to which patients belong, and the simplest way of allowing the clinician to find his way through the criteria under consideration is to place the latter in a "checklist". The clinician then checks whether or not a given criterion is present, and after completing the checklist calculates whether the checked criteria are sufficient to warrant inclusion of a given patient. This approach, though methodical nevertheless, contains a significant drawback. The diagnostic criteria of DSM IV are at once "positive" (symptoms which a patient must present to qualify for inclusion in a diagnostic category) and "negative" (symptoms which the patient must not present in order to qualify for inclusion). In some cases it is relatively simple to establish the existence of such negative criteria (e.g. cases in which it must be ascertained that symptoms are due neither to ingestion of a toxic substance nor to recent bereavement). However, very often these negative symptoms are not presented one by one in the list of criteria, but are instead grouped together in an allusive phrase such as: "the symptoms must not be due to any associated disorder", or, "the symptoms must not occur exclusively during episodes of an associated disorder", or again, "the criteria of such and such a disorder are not met". Thus, in theory, each time a negative criterion of this type is encountered, the investigator must refer to the disorder for which diagnosis constitutes an exclusion criterion and verify that the conditions of this disorder are not met. For example, criterion B for major depressive episodes states that "the symptoms do not meet criteria for a mixed episode". It is therefore necessary to verify that the exclusion criteria are indeed absent. This type of "Chinese box" procedure thus implies that checklists should not only contain the diagnostic criteria for the particular disorder being sought, but that they should include a complete list of diagnostic criteria for all other disorders requiring exclusion. Since such an awkward procedure would make it impossible to draw up reasonable case report forms, a selection of exclusion criteria is generally made, often on a somewhat arbitrary basis. It might in fact prove more useful to adopt diagnostic algorithms.

Arousal↗
PubMed1996

[Evaluation of the training of the anesthesiologist].

In order to evaluate both the knowledge and the degree of competence acquired by anesthesiology trainees, we constructed a checklist and began using it in January 1994. Twenty-one trainees participated in a 3-month program ending in February 1995. By means of the checklist, we attempted to evaluate the extent of their individual attainment. The total number of anesthesia administered was 50.9 +/- 7.8 cases. The total anesthesia time was 212.0 +/- 32.8 hours, and 76.2 % of the anesthesia methods applied involved either nitrous oxide-sevoflurane or nitrous oxide-isoflurane. Using a 5-level rating scale, the self-assessment by the supervising doctor tended to be one point higher than the assessment by the trainees. We plan to improve this checklist to improve the results of training.

Anesthesia, Inhalation↗
PubMed1997

Patterns of symptom complaints in methadone maintenance patients.

AIM: Not all maintenance patients respond to methadone in the same manner, and many complain of withdrawal symptoms during the 24-hour inter-dosing interval (i.e. the dose does not 'hold'). The persistence of these complaints are a source of concern as they may signal unsanctioned drug use and poor treatment outcome. This study examined the prevalence and profile of symptom complaints in methadone maintenance patients who report that their methadone dose does not 'hold'. DESIGN: In the first phase, a cross-sectional survey of 114 methadone patients examined a range of symptoms including direct opioid effects and withdrawal. Phase 2 involved a comparison of the temporal pattern of symptom complaints between patients who reported the oral dose not 'holding' and those who did not. SETTING: Participants in this study were enrolled in the South Australian Public Methadone Maintenance Program. MEASUREMENTS: In Phase 1, a checklist of 21 commonly reported symptom complaints associated with methadone maintenance treatment was administered. In Phase 2, this checklist was modified to include only those symptoms that changed in the 24-hour inter-dosing interval. The checklist was administered eight times over this period. Further data were collected using the Morphine Benzedrine Group Scale of the Addiction Research Centre Inventory, a measure of positive opioid effect. FINDINGS: In Phase 1, it was found that approximately one-third of the sample reported that the methadone dose was consistently inadequate in preventing withdrawal symptoms for the entire inter-dosing interval. They could not be differentiated by demographic, health, other drug use or treatment characteristics. In Phase 2, despite having a higher oral methadone dose, patients reporting that their daily dose did not 'hold' experienced a smaller degree of opioid effect, and a greater intensity of opioid withdrawal, during the 24-hour period. CONCLUSION: These data demonstrate that there is a change in pharmacodynamic response over the 24-hour period for all methadone patients, but the degree of change is greater in a subgroup of patients. Charting symptom presentation throughout the inter-dosing interval can aid in identifying those patients who are experiencing difficulties with their treatment regime.

Adult↗
PubMed1996

Improvement of Tsukiji free fish market in Tokyo ("Kaizen" of work environment).

"TSUKIJI" is one of the biggest and most famous Free Fish Markets in the world, but there are many problems on the working condition because it was built about 60 years ago. Our investigation was held 1991 to 1993 to give some improvements regarding layout of buildings, working time, heat condition at refrigerator, working posture, and so on. We used a questionnaire on daily life and health care of workers, time study with measurement of heartbeats, and checklist (using Checklist for Improvement of Safety-Health and Working Conditions,' made by ILO). The main occupations in TSUKIJI were seller, buyer, delivery worker, and refrigerator maintenance worker. Their starting time was early in the morning, usually between 2:00 a.m. and 5:00 a.m., but the hardest one was delivery workers starting at 9:00 p.m. They used auto cargo car for carrying to shops from refrigerator or from auction places many times. Sellers had two different types of work. First, the seller set up the auction, numbering the fish (or cases of seafood), arranging them in order, and so on. The rest of the work was transaction of invoices, sometimes using VDU with almost sitting. These works did not look well balanced. Buyer of tuna cut if like lumber by electric saws did not have guard for protection and there were more than 200 machines. Overlooking the market by checklist, some problems were clarified, and suggestions for improvement include restructuring the whole layout of the market or reforming buildings, standardization of the cases, adjustment of health facilities, safety protection on tools and machines, management of working system, working posture, health care, and so on.

Adult↗
PubMed1998

[A standard method for reporting ramdomized medical scientific research; the 'Consolidation of the standards of reporting trials' (CONSORT)].

The 'Consolidation of the standards of reporting trials' (CONSORT) statement was published in 1996. From that time on all manuscripts reporting randomized controlled trials (RCTs) submitted to JAMA, The Lancet or the British Medical Journal, must include a flow diagram and all the information in the CONSORT checklist. The Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) will follow suit. The manuscripts must be accompanied by this checklist together with the page numbers where each item may be found. The completed checklist will be sent to the editors and the reviewers but will not be published. This method of publication is also applicable to longitudinal or cross-sectional studies. By making the process of publishing trials controllable it is hoped that the quality of these manuscripts will improve and with it their use and the quality of scientific research.

Clinical Trials as Topic↗
PubMed1998

Behaviours caregivers use to determine pain in non-verbal, cognitively impaired individuals.

To create a checklist of behaviours that caregivers could use to determine pain in non-verbal individuals with mental retardation, primary caregivers were recruited by the Division of Neurology and interviewed using a semistructured interview. Caregivers of 20 individuals were asked to recall two instances of short, sharp pain and two of longer-lasting pain and describe the individual's behaviour. Transcribed interviews were reviewed by two of the authors and sets of non-overlapping items were developed. Average age of the 20 individuals was 14.5 years (range 6 to 29 years) and language level averaged 10 months as scored by the MacArthur Communicative Development Inventory. All had mental retardation and 18 had epilepsy and spastic quadriplegia or hemiparesis. Thirty-one behaviours were extracted from the interviews. The specific behaviours were often different from one child to another but the classes of behaviours (Vocal, Eating/Sleeping, Social/Personality, Facial expression of pain, Activity, Body and limbs, and Physiological) were common to almost all children. Reliability of using the checklist on interviews was very good (kappa=0.77). The checklist has excellent content validity and will be useful for caregivers of cognitively-impaired, non-verbal individuals to report on pain behaviours. Further research is needed to additionally assess its validity and sensitivity.

Adolescent↗
PubMedDate not supplied

Screening for nutritional risk among community-dwelling elderly on Prince Edward Island.

The purpose of this survey was to estimate the prevalence of nutritional risk among a group of community-dwelling older persons on Prince Edward Island, aged 70 years and over, and to examine the relationships between health-related factors and nutritional risk. Subjects (n = 215) were interviewed as part of the 1996 Canadian Study of Health and Aging. The prevalence of nutritional risk, as measured by the DETERMINE checklist, in PEI seniors was 37.1% (95% CI = 36.3, 37.9). The prevalence was estimated at 47% after adjusting for the sensitivity and specificity of the checklist. Only pain was a significant predictor of the presence or absence of nutritional risk (logistic regression, p = 0.05). The only predictor to discriminate between the three categories of no nutritional risk, moderate risk, and high risk was depression (Kruskal-Wallis, p = 0.035). Several limitations were identified with the use of the DETERMINE checklist.

Aged↗
PubMed2005

[Randomized clinical trials (CONSORT)].

It has been repeatedly shown that the information supplied in publications of clinical trials is frequently insufficient or inaccurate and that some methodologic problems are associated with exaggerated estimates of the effect of healthcare interventions. To improve the quality of reports of clinical trials, a group of scientists and editors developed the CONSORT statement (Consolidated Standards of Reporting Trials), a 22-item checklist (plus flow diagram), that can be used by authors, editors, reviewers, and readers. After publication in 1996, CONSORT was adopted by several journals and editorial groups. In 1999, a second version was drawn up, which was published in 2001. This article presents the Spanish translation of the two elements integrating the revised CONSORT, the flow diagram and the 22-item checklist, and provides a short comment on each of them. Previous publications of the CONSORT statement and other useful resources such as examples of what are considered good communications may be obtained from the CONSORT web site (http://www.consort-statement.org).

Authorship↗
PubMed2005

[Meta-analyses (QUOROM)].

The increase in the number of published systematic reviews and meta-analyses over the last few years has highlighted the need to establish guidelines for their publication, in order to facilitate their interpretation and use. The Quality of Reporting of Meta-analyses Conference, which took place in 1996, resulted in the QUOROM statement, consisting of a checklist and flow diagram. The checklist is composed of 18 items to encourage authors to provide essential information to readers about the methods and results of the meta-analysis. The flow diagram of randomized clinical trials (RCT) helps to provide information about the number of RCTs identified, included and excluded in the meta-analysis and the reasons for excluding them. Both tools provide standards for improving the quality of reporting of meta-analyses to make them rigorous, useful and reliable.

Authorship↗
PubMed2005

[Observational studies in epidemiology (STROBE)].

Although there are many texts on the quality of epidemiological studies, little effort has been made to evaluate the publication of epidemiological studies and their results (the articles). Concern to improve the reporting of epidemiological studies prompted a working group to launch the STROBE (Strengthening the Reporting of observational studies in Epidemiology Statement). The STROBE checklist contains 22 items organized according to the Title and Abstract, Introduction, Methods, Results, and Discussion structure that can be used for the main epidemiological designs (cohort studies, case-control studies, and cross-sectional studies). It is a checklist to improve the reporting quality of epidemiological studies (generally original articles) and, therefore, to evaluate the quality of this type of publication and facilitate critical reading.

Authorship↗
PubMed2005

Limitations of dermoscopy in the recognition of melanoma.

OBJECTIVE: To compare dermoscopic features of melanocytic nevi with those of early melanomas that were not excised initially because of their uncharacteristic clinical and dermoscopic appearance. DESIGN: Retrospective study of the baseline images of 325 melanocytic skin lesions that were observed by digital dermoscopy and finally excised because of changes over time. SETTING: A dermatologic clinic and a dermatologic department at a university hospital. MAIN OUTCOME MEASURES: Comparison of baseline images of melanomas and melanocytic nevi by pattern analysis, the ABCD rule of dermoscopy, and the 7-point checklist. RESULTS: Baseline dermoscopic images of 262 melanocytic nevi and 63 melanomas from 315 patients were included in the analysis. The patterns of dermoscopic features observed in the baseline images of melanocytic lesions finally diagnosed as melanomas during follow-up did not differ substantially from the patterns observed in the baseline images of melanocytic nevi. Pattern analysis, the ABCD rule of dermoscopy, and the 7-point checklist failed to achieve adequate diagnostic accuracy for melanoma. In retrospect, no dermoscopic feature or pattern of features could be identified that reliably differentiated between melanomas and melanocytic nevi at the time of the first presentation. CONCLUSION: Dermoscopy depends on the appearance of classic dermoscopic features and is therefore limited in the diagnosis of very early and mainly featureless melanomas.

Biopsy, Needle↗