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PubMedDate not supplied

Maintaining skin integrity: setting the standard in a rehabilitation facility.

Impaired skin integrity and a high risk for developing it are two of the more common nursing diagnoses made in the rehabilitation setting. Pressure sores and their consequences are directly related to increased length of stay for patients and can create higher costs for the institution. Most of the sequelae of pressure sores can be avoided, as the identification, prevention, and treatment of pressure sores have become more standardized. The rehabilitation facility discussed in this article developed a standard of care for the maintenance of skin integrity, a pressure sore protocol, and nursing care plans to provide a standardized format for nursing care. The standard was designed to ensure consistency among the nursing staff when they assess, plan, evaluate, and document care of patients who have pressure sores or are at risk of developing them. The standard also created a mechanism for evaluating the knowledge and skill of the nursing staff in preventing and treating pressure sores. This article describes the components of the standard of care and its supporting policies as well as its implementation and use.

Humans↗

PubMedDate not supplied

Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI?

The objective of this study was to assess the value of adding MR arthrography to standard MRI for patients with chronic wrist disorders. Thirty consecutive patients (age range, 19-73 years; mean, 36.2 years) were included in the investigation. The images were evaluated blindly and separately by two radiologists with regard to lesions of the scapholunate (SL) and lunotriquetral (LT) ligaments and the triangular fibrocartilage (TFC). Conventional two- or three-compartment arthrography was used as the standard of reference. For TFC lesions, standard MR images had a sensitivity of 92.3% (reader 1) and 84.6% (reader 2) and a specificity of 41.2% (reader 1) and 52.9% (reader 2). For MR arthrography, sensitivity was 84.6% (reader 1) and 84.6% (reader 2) and specificity was 88.2% (reader 1) and 100% (reader 2). For SL ligament tears, standard MRI had a sensitivity of 33.3% (reader 1) and 11.1% (reader 2) and a specificity of 47.6% (reader 1) and 57.1% (reader 2). For MR arthrography, sensitivity was 66.7% (reader 1) and 55.6% (reader 2) and specificity was 52.4% (reader 1) and 81.0% (reader 2). For LT ligament tears, standard MRI had a sensitivity of 28.6% (reader 1) and 35.7% (reader 2) and a specificity of 93.8% (reader 1) and 81.3% (reader 2). For MR arthrography, sensitivity was 35.7% (reader 1) and 23.1% (reader 2) and specificity was 93.8% (reader 1) and 94.1% (reader 2). In conclusion, the diagnostic performance of MRI in suspected lesions of the TFC and the SL and LT ligaments is improved by adding MR arthrography to the standard examination.

Adult↗

PubMed1992

External-standard high-performance liquid chromatographic method for quantitative determination of furosemide in plasma by using solid-phase extraction and on-line elution.

A rapid and simple external-standard high-performance liquid chromatographic (HPLC) method has been developed for the determination of the concentration of furosemide in plasma. The analyte is extracted with a C-2 ethyl sorbent. On-line elution of the analyte into the HPLC system is accomplished with an advanced automated sample processor (Varian). Furosemide is quantified by fluorescence detection within a linear range of 25 to 1000 ng/mL (average correlation coefficient, 0.9998), with a limit of detection of 1.8 ng/mL. Both internal- and external-standard procedures were evaluated, and the external-standard procedure demonstrated superior characteristics. The external-standard procedure was precise to within a relative standard deviation of 8% and accurate with less than 3% error throughout the concentration range studied. The external-standard HPLC method was used to analyze the concentration of furosemide in greater than 1000 plasma samples obtained from patients with either normal kidney function or renal failure who had received furosemide either orally or intravenously in an experimental setting.

Aged↗

PubMed1985

Contractile properties of standard and nerve-intact muscle grafts in the rat.

The contractile properties of standard and nerve-intact grafts of extensor digitorum longus muscles of rats were compared in vitro. Fourteen days after grafting, the time to peak tension and the half-relaxation times of nerve-intact grafts were shorter than those of standard grafts, but both were longer than control values. By 60 days, these variables attained normal values. At every sample period, the tetanic tensions of nerve-intact grafts were higher than those of standard grafts. Even at the early sampling periods, the twitch-tetanic tension ratios of nerve-intact grafts were close to normal values, whereas those of standard grafts were higher than normal. Stabilized nerve-intact grafts had a larger mass and greater maximum tetanic tension development than standard grafts, but were more fatigable. Compared with control EDL muscles, stable nerve-intact grafts show no differences except for lessened fatigability, whereas standard grafts demonstrate significant functional deficits.

Age Factors↗

PubMed2002

Compliance with recommendations of the urodynamic society for standards of efficacy for evaluation of treatment outcomes in urinary incontinence.

The Urodynamic Society (US) published (1997) minimal standards to assess the efficacy of therapy for urinary incontinence (UI). The standards were developed by a US committee and were approved by the American Urological Society. The objective of our study was to evaluate compliance with these standards in recent UI research studies. A MEDLINE search was conducted for all articles in which outcomes of treatment for UI were reported (November, 1997-October, 1999). Reported data were compared with the recommended minimum standards including pre- and posttreatment data. Compliance rates for each data field were calculated by percentages for (1) the individual article and (2) overall compliance rate among all articles. A total of 39 articles that reported treatment for UI were selected. The treatments included various surgical procedures, injectables, pharmacologic treatments, and mechanical valves. Overall compliance for each article varied between 0% and 100%. Only one article met all 100% of the recommendations and one met none. The overall mean compliance rate for each article was 29%. We conclude that there is far less than optimal reporting of outcomes for treatment of UI per the recommendations of the Urodynamic Society. This low compliance makes standardized evaluation of treatment outcomes of UI difficult if not impossible. We suggest that initiation of funded cooperative clinical trials may improve the standardization in UI.

Guideline Adherence↗

PubMed1996

International collaborative study by in vitro bioassays and immunoassays of the First International Standard for Inhibin, Human Recombinant.

The First International Standard for Inhibin, Human Recombinant, (ISI), a lyophilized preparation of rDNA-derived human 32 kDa Inhibin A in ampoules coded 91/624, was evaluated by international collaborative study for its suitability to serve as an International Standard. This study, which involved 15 laboratories in nine countries, included a variety of in vitro bioassays and immunoassays. The ISI was compared with two other lyophilized preparations of human recombinant inhibin, the International Standard for Porcine inhibin (ISP) and preparations of human follicular fluid inhibin. Predicted loss of activity based on estimates of potency of contents of ampoules which had been stored under conditions of accelerated thermal degradation indicated that the ISI has satisfactory stability. On the basis of the results of this study, the ISI was deemed suitable to serve as a standard for in vitro bioassays and immunoassays and was established by the Expert Committee on Biological Standardization of the World Health Organization as the First International Standard for inhibin, recombinant human, with an assigned unitage of 150,000 International Units per ampoule. This unitage maintains an approximate continuity of units with the ISP.

Animals↗

PubMedDate not supplied

Prospective randomized double-blind trial of branched chain amino acid enriched versus standard parenteral nutrition solutions in traumatized and septic patients.

The addition of branched chain amino acids (BCAA) to total parenteral nutrition (TPN) solutions of balanced aminoacid composition has been reported to result in improved nitrogen balance, preservation of plasma protein levels, and improved immune function; however, only a few large clinical studies have been performed, yielding conflicting results. We, therefore, studied in a prospective, randomized double blind trial, the effects of BCAA enrichment of an otherwise isonitrogenous and isocaloric TPN solution on plasma protein levels in 101 traumatized and septic patients. TPN-derived nitrogen intake was similar in both study groups. Nitrogen balances in the BCAA group (n = 49) were not different from those in the standard group (n = 52). Plasma total protein levels increased significantly in the standard group resulting in a significant difference between study groups on day 7. Pre-albumin levels increased significantly in the BCAA group and in the standard group. The number of neutrophils (rods) was significantly lower in the standard group compared to the BCAA group on day 7. Lymphocytes increased significantly in the standard group as did the number of platelets, resulting in a significant difference between study groups on day 7. We conclude that BCAA enrichment of standard TPN solutions does not result in more efficient nitrogen metabolism in septic or traumatized patients.

Amino Acids, Branched-Chain↗

PubMed1989

The ACR-NEMA Digital Imaging and communications Standard: a nontechnical description.

The purpose of this report is to present, in nontechnical terms, the purpose and history of the American College of Radiology and National Electrical Manufacturers Association (ACR-NEMA) Digital Imaging and Communications Standard (ACR-NEMA Standards Publication no. 300-1985), an explanation of what the standard is, the characteristics of the standard, possible applications of the standard, and ongoing standardization efforts. It is assumed that the reader has at least a basic understanding of the concepts and technologies described collectively as picture archiving and communication systems (PACS). For information on PACS, please refer to the NEMA PACS Primer and the list of suggested reading contained therein (for copies, write or call NEMA, 2101 L St, Suite 300, Washington, DC 20037, ATTN: Ms Cindy Fuscoe; telephone 202-457-1965).

Computer Communication Networks↗

PubMed1997

Perspectives on development of IEEE 1073: the Medical Information Bus (MIB) standard.

Automated data capture from bedside patient medical devices is now possible using a new Institute of Electrical and Electronic Engineering (IEEE) and American National Standards Institute (ANSI) Medical Information Bus (MIB) data communications standard (IEEE 1073). The first two standard documents, IEEE 1073.3.1 (Transportation Profile) and IEEE 1073.4.1 (Physical Layer), define the hardware protocol for bedside device communications. With the above noted IEEE MIB standards in place, hospitals can now start designing customized applications for acquiring data from bedside devices such as bedside monitors, i.v. pumps, ventilators, etc. for multiple purposes. The hardware 'plug and play' features of the MIB will enable nurses and physicians to establish communications with these devices simply and conveniently by plugging them into a bedside data connector. No other action will be necessary to establish identification of the device or communications with the device. Presently to connect bedside devices, technical help from hardware and software experts are required to establish such communications links. As a result of standardization of communications, it will be easy to establish a highly mobile network of bedside devices and more promptly and efficiently collect patient related data. Collection of data automatically should lead to the design of new medical computing applications that will tie in directly with the emerging mission and operations of hospitals. The MIB will permit acquisition of patient data more efficiently with greater accuracy, more completeness and more promptly. The above noted features are all essential to the development of computerized treatment protocols and should lead to improved quality of patient care. This manuscript provides the rational and historical overview of the development of the MIB standard.

Computer Communication Networks↗

PubMed2006

[The Gini coefficient. A numerical grading for the degree of standardization of surgical subspecialities].

BACKGROUND AND GOAL: General hospitals are under pressure especially under payment by DRGs (diagnosis related groups), therefore, a general trend for specialized surgical centers is obvious. For this reason knowledge of the level of standardization is important and allows strategical management of surgical subspecialties. MATERIALS AND METHODS: The Gini coefficient (GC, range: 0-1) is a measurement of the level of standardization when an economical ABC analysis is performed. Low GC values are typical for low levels of standardization. All surgical cases coded by ICD-9-CM in 1 of the 8 central operation rooms in a Swiss general teaching hospital over a period of 30 months were included. The database was analyzed by the ABC method. Due to the ABC analysis the GC for each speciality was specified. RESULTS AND DISCUSSIONS: In data period 1 a total of 11,573 and in data period 2 3,449 operations done by 7 specialities were evaluated. The GC for the Pareto distribution was 0.86. Neurosurgery had a value of only 0.34, which means that nearly every operation was unique. The highest level of standardization was reached by vascular surgery with a GC of 0.68. Compared with other industries the degree of standardization in our general hospital is low as measured by the GC. CONCLUSIONS: The GC is a valuable and objective measurement of the different procedures and standardization of surgery of given surgical subspecialties. It can be calculated from the operation room management (ORM) database and allows an objective analysis of the variety of surgical procedures per subspecialty. In this study the GC was implicated in an ORM setting for the first time.

Algorithms↗

PubMed2002

[Standardized sectional planes of the locomotor apparatus].

Comparable to the standardized ultrasound screening of newborns and infants according to Graf's method, the standardized ultrasound examination of the locomotor apparatus has become an important feature in the evaluation of many acute and chronic diseases. The standardized ultrasound examination technique according to the guidelines of DEGUM and DGOOC helps the experienced and inexperienced user to avoid diagnostic mistakes by reproducibly displaying anatomical landmarks. Specific individual planes can be necessary in certain indications. The main advantage in comparison to other diagnostic means (i.e., computed tomography and magnetic resonance imaging) lies in the possibility of dynamic examination, which allows excellent imaging especially in rotator cuff affections. In cases without pathological findings, two standardized planes have to be documented. Otherwise, the pathological finding has to be documented in two standardized planes. The standardized procedure is a useful means for assuring and improving the quality of sonographic examinations of articular and periarticular structures.

Ankle Joint↗

PubMed2006

Feasibility of preparing and analyzing gas standards containing heavy hydrocarbons (C10-C16).

State and federal agencies are beginning to monitor ambient air for compounds related to diesel exhaust. The National Institute of Standards and Technology (NIST) was asked to develop standards containing heavy (C10-C16) alkanes which could then be used in air monitoring and exhaust studies. Several primary gravimetric standards, containing heavy (C10-C16) alkanes in nitrogen, were developed and analyzed by gas chromatography (GC) with flame-ionization detection (FID). The results of this research indicate that accurate gas standards containing these hydrocarbons can be prepared. However, the analytical results show that the temperature of the transfer system from the gas cylinder to the GC column (including the gas-sample valve) must be heated in order to prevent adsorption of these compounds within the analytical system. The results indicate that even at elevated temperatures these compounds are being absorbed within the system. The results show that quantitative results cannot be obtained by using one compound such as hexane, as an internal standard to determine the concentration of other hydrocarbons. Quantitative and accurate results are best obtained if standards for each hydrocarbon of interest are used to determine concentrations of unknowns for the respective hydrocarbon.

Journal Article↗

PubMed2001

Development of perfluorocarbon (PFC) primary standards for monitoring of emissions from aluminum production.

An EPA Voluntary Aluminum Industrial Partnership (VAIP) program has been formed to help US primary producers focus on reducing the emissions of two perfluorocarbons (PFCs), tetrafluoromethane (CF4) and hexafluoroethane (C2F6), during the production of aluminum. To ensure comparability of measurements over space and time, traceability to national sources was desirable. Hence, the EPA approached the NIST to develop a suite of primary standards to cover a mole fraction (concentration) range of 0.1 to 1400 micromol mol(-1) for CF4 and 0.01 to 150 micromol mol(-1) of C2F6. A total of eight gravimetric PFC gas standards were prepared with relative expanded uncertainties of < or = 0.52% (approximately 95% confidence level). These primary standards were ultimately used to assign values to a series of secondary gas standards at three mole-fraction levels with relative expanded uncertainties ranging from +/- 0.7% to 5.3% (approximately 95% confidence level). This series of secondary standards was used within the aluminum industry to calibrate instruments used to make emission measurements. Assignment of values to the secondary standards was performed by use of gas chromatography with flame-ionization detection (GC-FID) and Fourier transform infrared spectrometry (FTIR). Real time pot-line and stack samples from a local aluminum plant were also obtained and sub-samples sent to each participating facility for analysis. The data generated from each facility were sent to NIST for analysis. The maximum difference between the NIST and individual facilities' values for the same sub-sample was +/- 26%.

Journal Article↗

PubMed2005

Towards standardization of dual X-ray absorptiometry (DXA) at the forearm: a common region of interest (ROI) improves the comparability among DXA devices.

Manufacturer-implemented regions of interest (ROIs) to determine the bone mineral density (BMD) at the forearm are currently not standardized across dual X-ray absorptiometry (DXA) devices. We hypothesized that their differences introduce considerable variation in measurement results for forearm BMD when taken on different devices, and that a ROIs common to all devices with standardized placement and size significantly improve device comparability. The common ROI was defined to have a fixed length of 2 cm and to extend proximally from the location where the ulna and radius bones superimpose on the DXA image. The effects of universal standardization of forearm BMD were combined with and compared to those of the common ROI. They were drawn on 91 female study participants (ages 20-80 years, 10 per decade) who were scanned on Hologic QDR-4500, Aloka DCS-600EX, GE Lunar PIXI and Norland pDEXA DXA scanners. For all device combinations, manufacturer-implemented ROI root mean-square errors were significantly higher than for the common ROI, suggesting that implementing an ROI with common design on all scanners is a good way to reduce interdevice variability. When manufacturer-implemented ROIs were universally standardized root mean-square error (RMSE) values were less different from that of the nonstandardized Common ROI, suggesting that universal standardization can further improve interdevice comparability even when a common ROI such as the one implemented here is used. ROI standardization dramatically improves interdevice comparability.

Absorptiometry, Photon↗

PubMed1996

Comparison of dose standard units for drug utilisation studies.

OBJECTIVE: As employment of different dose standards would be impractical and confusing, the aim of this article is to compare the define daily dose (DDD) with some more recently proposed standards, namely, the minimum marketed dose (MMD), the equipotential dose (ED), the average daily dose (ADD), and the non-standard prescribed daily dose (PDD). METHODS: Literature review, critical comparative analysis. RESULTS: The DDD, defined by an independent scientific committee assisting the WHO Collaborating Centre for Drugs Statistics Methodology, has been employed in a large number of national and international comparative studies at the population level, usually as number of DDDs per 1000 inhabitants per day. However, the DDD can also be used at the individual level. The PDD, not being a standard unit, can be appropriately used in a second step to explain differences detected by the DDD methodology. CONCLUSIONS: A globally accepted dose standard unit is important in drug utilisation studies, particularly if different investigations are to be compared. None of the alternatives seemed to offer any advantage over the DDD. Hence there is reason to advocate use of the DDD as the sole standard dose unit in all pharmacoepidemiologic studies.

Drug Utilization↗

PubMed2002

A new low-dose CT examination compared with standard-dose CT in the diagnosis of acute sinusitis.

A low-dose CT of the paranasal sinuses was designed with few, thin sections, non-uniform intersection gaps, low milliampere settings and avoidance of direct radiation to the eye lens. The low-dose CT was prospectively compared with standard-dose CT in patients with suspicion of acute sinusitis. Forty-seven patients were examined with low-dose CT immediately after standard-dose CT. The effective dose and the lens dose were calculated and compared. Using standard-dose CT as a gold standard the sensitivity and specificity of low-dose CT was calculated for each sinus group. The effective dose and the lens dose of the low-dose CT were reduced to, respectively, 3 and 2% of the standard-dose CT. The diagnostic yield of the low-dose CT with regard to acute sinusitis was good with a high specificity (> or =96%) for all sinus groups. The sensitivity was also high (> or =95%) except for the frontal sinus where the sensitivity was 83%. Low-dose CT offers considerable dose reduction and should be the standard for imaging patients with suspected acute inflammatory paranasal disease.

Acute Disease↗

PubMed2001

Standardized axillary lymphadenectomy improves local control but not survival in patients with palpable lymph node metastases of cutaneous malignant melanoma.

BACKGROUND: The aim of the present study was to investigate whether consistent application of standard surgical techniques contributes to improved local control or improved survival in melanoma patients with palpable lymph node metastases to the axilla. METHOD: Using Kaplan-Meier estimations and the Cox proportional hazards model, 120 axillary dissections were assessed. The data from 63 patients who had received standardized axillary lymphadenectomy were compared to those of 57 patients operated on before the introduction of standardized lymphadenectomy. RESULTS: The introduction of standardized axillary lymphadenectomy led to a significant decrease in 5-year local recurrence probability from 43.1% to 13.1% ( P=0.0008). Using multifactorial analysis, the standardized operative procedure resulted in a significantly lower risk of recurrence in the dissected axilla ( P=0.009). The development of intransit metastases was also related to recurrence in the nodal basin ( P=0.03). No significance was accorded to the number of metastatic lymph nodes, tumor thickness, epidermal ulceration, site of primary melanoma, age, sex, or adjuvant chemotherapy. Notably, no differences in the survival rates were observed between the two treatment groups. CONCLUSION: In patients with palpably enlarged axillary lymph node metastases, the introduction of a complete lymphadenectomy, standardized according to the currently acknowledged principles of oncological surgery, improves local disease control without improving overall survival.

Axilla↗

PubMed2002

Standards for renal biopsies: comparison of inpatient and day care procedures.

There are no national standards for the adequacy and complications of percutaneous renal biopsies. We developed local standards that have been used in a prospective audit of biopsies undertaken in a tertiary pediatric nephrology unit between January 1997 and December 2000. We compared outcomes of biopsies performed on inpatients with day care procedures. A total of 251 biopsies (113 transplant) were undertaken, 114 (46%) as day care procedures. Adequate tissue for diagnosis was obtained in 245 (97.6%), with a standard set at >95%. This was also achieved for a mean number of passes in native (<3 in 80%) and transplanted (<2 in 80%) kidneys. Eleven patients (4%) developed macroscopic hematuria (standard <5%) and none required transfusion. Delay in discharge occurred in 4 patients, and a further 4 returned to the ward post discharge. There was no significant difference in complication rates between inpatient and day care patients. Our local biopsy standards were met in this audit. Such standards could provide useful comparisons between units in national audit programs, as well as permitting the monitoring of individual performance as part of clinical governance. Day care procedures benefit the patient and family, as well as significantly reducing costs.

Adolescent↗