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Suggested standards for reports dealing with cerebrovascular disease. Subcommittee on Reporting Standards for Cerebrovascular Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery.

The evaluation of clinical reports on vascular disease is often made difficult by variations in descriptive terms, clinical classification, and outcome criteria. In 1983 the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery created the Ad Hoc Committee on Reporting Standards to address these problems and recommend solutions. Some general problems were addressed in the initial report dealing with lower extremity ischemia. This article concerns clinical standards for reports dealing with cerebrovascular disease, suggests a scheme for clinical classification, and recommends standardized reporting practices for grading risk factors, angiographic and other diagnostic findings, and the results and complications of therapeutic intervention.

Cerebrovascular Disorders

Self-report, peer-report, and teacher-report measures of childhood depression: an analysis by item.

We explored the low correlation among different types of childhood depression measures at the item level. The items from the Children's Depression Inventory (CDI), Peer Nomination Inventory of Depression (PNID), and the Child Behavior Checklist-Teacher Report Form (CBCL-T) were combined, and both first- and second-order factor analyses were conducted. Results indicate that self-report, peer-report, and teacher-report assessments of depression measure generally uncorrelated constructs. Second-order analysis suggests that depression as a global construct is being measured to some degree by items from all three instruments. Canonical analysis was employed to identify items that best predicted CDI, PNID, and CBL-T summary scores simultaneously. Also, the relationship between specific items with similar content was investigated. Results from these analyses generally supported a conclusion that the three types of measures yield scores that are primarily independent and that the use of summary scores is not masking stronger relationships within measures. These findings have implications for clinical practice and construct elaboration.

Achievement

Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery.

The literature on arterial aneurysms is subject to potential misinterpretation because of inconsistencies in reporting standards. The joint councils of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery appointed an ad hoc committee to address this issue. This communication, prepared in response to the need for standardized reporting, defines and classifies arterial aneurysms and recommends standards for describing the causes, manifestations, treatment, and outcome criteria that are important when publishing data on aneurysmal disease.

Aneurysm

Reporting standards in venous disease. Prepared by the Subcommittee on Reporting Standards in Venous Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery.

This report comprises suggested reporting standards for publications dealing with (1) acute lower extremity venous thrombosis, (2) chronic lower extremity venous insufficiency, (3) upper extremity venous thrombosis, and (4) pulmonary embolism. Attempts have been made to set forth numeric grading schemes for disease severity, risk factors, and outcome criteria. Some of the recommendations had to be arbitrary of necessity, but they were judged the most generally acceptable by members of the committee. They are offered not as binding rules but as guidelines whose observance will serve the clarity and precision of communication.

Adult

Anonymous reports of child physical abuse: are they as serious as reports from other sources?

Anonymous reports of child physical abuse were compared to reports made by professionals and by nonprofessionals on three characteristics: substantiation rate, seriousness of substantiated incidents, and severity of allegations. Data pertinent to the characteristics were abstracted from 1,207 reports made to the Baltimore City Department of Social Services during 1983. Results suggest that reports made by anonymous sources are more likely to be unfounded than reports made by the other two sources. However, despite the lower substantiation rate, those few anonymous reports (15.5%) that do get substantiated seem to represent equally as serious incidents of physical abuse as founded reports from the other two sources. An attempt to explain the lower substantiation rate of anonymous reports in terms of seriousness of allegations reveals that professional but not nonprofessional reporters make more serious allegations than anonymous reporters. Discussion focuses on drawing conclusions about anonymous reports from existing knowledge and recommendations for future research.

Child

Report decision-making patterns among mandated child abuse reporters.

The goal of this investigation was to examine whether reporting decisions could be described by a coherent process that was consistent across incidents of suspected abuse. Using case vignettes imbedded in a national mail survey of mandated reporters, we examined the relationship between a series of judgments about the cases described in the vignettes and reporting intentions. These judgments included seriousness of the incident; whether the incident should be labeled "abuse" or "neglect"; whether the law would require a report; and whether the child and, separately, the rest of the family would benefit from a report. These five abuse-relevant judgments were strongly related to each other and together accounted for a substantial amount of the variance in reporting intentions. The law's demands most closely related to reporting intentions; benefits of reports were least closely related. Varimax rotation of a factor analysis revealed two factors: The first included seriousness, the abuse label, and the law's requirements, along with reporting intentions. The two benefit judgments loaded on the second factor. There were small differences in reporting judgments and patterns as a function of type of abuse. The implications of these findings for mandated reporter behavior are discussed.

Adolescent

The validity of self-reported and surrogate-reported cataract and age-related macular degeneration in the Beaver Dam Eye Study.

The validity of reported ocular disease was investigated in a population-based epidemiologic study of persons aged 43-86 years residing in Beaver Dam, Wisconsin. In a telephone survey conducted from September 1987 through May 1988, histories of cataract and age-related macular degeneration were obtained from the subject for 2,155 cases and from a surrogate for 1,433 cases. Within 2 years, these persons underwent a complete ocular examination. At that time, an "in-person" self-reported history of eye disease was obtained and disease presence was determined based on ocular photographs. The reporting methods, telephone versus in-person and surrogate versus subject, were compared and the validity of each assessed. Reporting methods were in agreement in better than 90% of all cases. Reporting of cataract showed a sensitivity of 20.4 for surrogate by telephone, 30.2 for self-report by telephone, and 37.8 for self-report at the examination. Sensitivity of reported age-related macular degeneration was poorer, with the highest rate of 17.9 for the "in-person" self-report. Specificity was better than 90.0 for all reporting methods for both cataract and age-related macular degeneration. These data suggest that estimates of prevalence of ocular disease should not be based solely on reported histories, and that clinical determinations are necessary.

Adult

Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System.

Between October 1982 and June 1985 the Adverse Drug Reaction Reporting System received reports of 104 suspected adverse reactions occurring in 93 patients who took isotretinoin. Adverse reactions involving the skin and mucous membranes (29 reports), central nervous system (23), musculoskeletal system (12), pregnancy (11), and eyes (8) were most commonly reported. Severe headache was the most frequently reported adverse reaction (15 reports). In four cases headaches were attributed to pseudotumor cerebri. Some of the reported reactions, for example, a disulfiram (Antabuse)-like reaction and oculogyric crisis, have not been described previously in the literature. Other reports, such as congenital malformations, serve to emphasize some of the serious reactions that are known to occur. These spontaneous reports of adverse reactions associated with isotretinoin use, together with the literature we review, may help alert physicians to the diverse spectrum of adverse reactions that may develop in patients taking isotretinoin.

Abnormalities, Drug-Induced

Severity-indexed, incident report-based medication error-reporting program.

A medication error-reporting program is described. Medication errors at a large teaching hospital are reported through traditional incident reports. Specific information on the errors is documented on an additional form; data captured include the type of error, system breakdown point, and class of drug involved. A severity ranking that reflects patient outcome is also assigned to each medication error. The data are entered into a relational database and analyzed. Reports are generated that show the overall error rate, the distribution of errors by severity ranking and drug class, and the error types, system breakdown points, and drug classes associated with errors of the highest severity rankings. Between January and December 1990, the number of medication error reports received per month ranged from 73 to 141, and the number of errors reported per month increased during the year. Although the incident report-based method underestimates the actual number of medication errors, the program has been effective in identifying problem areas and trends so that quality assurance and medical committees can implement measures to improve drug use. The use of a severity-indexed medication error-reporting program based on incident reports and managed through a relational database has revealed problems that are then addressed by other quality assurance measures.

Documentation

Physician reporting of adverse drug reactions. Results of the Rhode Island Adverse Drug Reaction Reporting Project.

The Food and Drug Administration, Rockville, Md, contracted with the Rhode Island Department of Health, Providence, to conduct a project to increase reporting of suspected adverse drug reactions through physician education. Voluntary reporting, an important part of postmarketing surveillance that signals potential problems with marketed drugs, historically has been underused by physicians. After 2 years, there was a more than 17-fold increase in reports submitted directly from Rhode Island compared with the yearly average before initiation of the project. Increases in the total numbers of reports were paralleled by significant increases in the numbers of reports of severe reactions. Similar increases were not experienced nationally. Physicians in Rhode Island were surveyed before and 2 years after interventions began to determine changes in knowledge and attitudes about reporting of adverse drug reactions. Significant gains in knowledge and positive attitudes toward the reporting system occurred. We conclude that physicians can be stimulated to increase their reporting of suspected reactions, thereby improving the viability of the federal reporting system.

Attitude of Health Personnel

Psycho-social variables of female rapees not reporting and reporting the first incidence of rape.

Rape statistics are difficult to assess due to differential definitions of the crime, the ratio of arrests resulting from reported complaints, and the extent of the numbers of unreported rapes, especially those regarding the first incidence of the crime. The present research was conducted to determine: 1. specific psycho-social variables associated with female rapees not reporting and reporting the first incidence of rape, and 2. a comparison of the similarities and/or differences of each, as well as 3. their influences on the women leading them to develop not reporting and reporting positions. Results suggested sixteen different variables important to female rapees not reporting and reporting the first incidence of rape. There were significant differences regarding which of these tended to be associated with either the women not reporting or reporting the rape act.

Attitude

Differences in attention control between 'clinic-observable' and 'reported' hyperactivity: a preliminary report.

A series of attention tests were administered to two groups of hyperactive children and a control group of normal children. The first group of hyperactive children had both 'reported' hyperactivity (defined as having hyperactive behaviour reported at school and home) and 'clinic-observable' hyperactivity (defined as having hyperactive behaviour readily observable in a clinic interview). The second group had only 'reported' hyperactivity. The results of attention testing indicated that the children with both 'reported' and 'clinic-observable' hyperactivity had significant attentional difficulties in comparison with children with 'reported' hyperactivity as well as with the normal controls. On the other hand, the children with 'reported' hyperactivity had less evidence of attentional problems when compared to the normal children. Hence; the differentiation into 'reported' and 'clinic-observable' hyperactivity was of theoretical importance as clinic behaviour was a significant diagnostic marker in predicting performance in attention tests. The results of this study suggest the presence of different types of attention deficits in 'reported' and 'clinic-observable' hyperactivity respectively as well as heterogeneity in hyperactive children.

Attention

The impact of mandatory reporting legislation on reporting behavior.

In New South Wales Australia, in July 1987, the category of professionals required to report suspected cases of child sexual assault to the Department of Family and Community Services was extended to include teachers and other school professionals. This paper reports on the impact of the process associated with the enactment of the new mandatory reporting requirements on the reporting behavior of the new mandatory notifiers. There was a significant increase in the number and proportion of reports of suspected sexual assault received from teachers. At the same time there has been no change in the quality of teachers' reports, as measured by the percentage of reports which are verified on assessment.

Australia

Methodological note: corroboration of self-reported smoking status using significant other reports.

Significant other reports (SORs) are commonly used in smoking cessation studies to verify self-reports of smoking status. This report focuses on factors related to the smoker and significant other, which can affect self-reported classification of smoking status when using SORs. Data used in this analysis were collected from a cohort of 107 smokers who participated in a smoking cessation program. Participants were contacted at 1, 3, and 6 months after quitting to obtain self-reports of smoking status. SORs also were obtained at each assessment period. The highest discrepancy rate between self-report and SOR was observed among slippers, followed by relapsers, and abstainers, respectively. In addition, corroboration of smoking status was influenced by the social context in which the significant other was likely to see the smoker.

Adult