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ALTEX 2022New approach methodologies (NAMs) that do not use experimental animals are, in certain settings, entirely appropriate for assuring the safety of chemical ingredients,...
New approach methodologies (NAMs) that do not use experimental animals are, in certain settings, entirely appropriate for assuring the safety of chemical ingredients, although regulatory adoption has been slow. In this opinion article we discuss how scientific advances that utilize NAMs to certify systemic safety are available now and merit broader acceptance within the framework of next generation risk assessments (NGRA).
Topics: Animal Testing Alternatives; Animals; Chemical Safety; Risk Assessment
PubMed: 35796331
DOI: 10.14573/altex.2204281 -
Neuroradiology Jun 2016The Eustachian tube is a complex and inaccessible structure, which maintains middle ear ventilation to facilitate transmission of sound from the tympanic membrane to the... (Review)
Review
INTRODUCTION
The Eustachian tube is a complex and inaccessible structure, which maintains middle ear ventilation to facilitate transmission of sound from the tympanic membrane to the cochlea. A renewed interest in treatments for eustachian tube dysfunction has led to a demand for methods of imaging the Eustachian tube, and assessing tube opening non-invasively. This review aims to summarise the use of imaging in the anatomical assessment of the Eustachian tube, and to explore how radiological techniques can be used to assess tube function.
METHODS
A systematic review of the literature was performed with narrative data analysis.
RESULTS
With high-resolution images, the soft and bony anatomy of the Eustachian tube can be assessed in detail. CT and MRI are best suited to identifying features associated with obstructive or patulous Eustachian tube dysfunction, though true assessments of function have only been achieved with contrast enhanced radiographs and scintigraphy. A single modality has yet to provide a complete assessment. No test has entered routine clinical use, but further development and research is underway.
CONCLUSION
Significant information can be gained from imaging the Eustachian tube, and as faster acquisition techniques are developed, it is possible that dynamic imaging of tubal opening could play an important role in the assessment of patients with ET dysfunction.
Topics: Diagnosis, Differential; Ear Diseases; Eustachian Tube; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 26922743
DOI: 10.1007/s00234-016-1663-4 -
Cureus Nov 2023Hypospadias is a congenital malformation, which involves the displacement of the urethral orifice on the underside of the penis. The mainstay treatment of hypospadias is...
INTRODUCTION
Hypospadias is a congenital malformation, which involves the displacement of the urethral orifice on the underside of the penis. The mainstay treatment of hypospadias is surgery. Currently, there is no literature broadly assessing hypospadias repair outcomes in the Kingdom of Bahrain. This study aims to provide descriptive data on cosmetic, functional, and surgical outcomes of hypospadias repair at a single medical institute in the Kingdom of Bahrain.
METHOD
Data on patients who underwent hypospadias repair from January 2012 to December 2020 by a single surgeon were reviewed. Parents of patients were contacted via telephone for consent. All consenting participants returned for an outpatient assessment of functional and cosmetic outcomes using an original questionnaire and the Pediatric Penile Perception Score, respectively. All responses were recorded using a four-point Likert scale. Surgical outcomes were assessed by reviewing postoperative notes. All collected data were anonymized. The study was approved by the King Hamad University Hospital institutional review board.
RESULTS
Of the 29 patients who underwent surgical repair for hypospadias, 15 patients consented to participate. The mean age of the study population was 2.466 (SD = 0.496). Both parent and physician cosmetic assessments had similar results with the majority of participants very satisfied with all cosmetic parameters. Physician assessment reported higher satisfaction compared to parents. There were no reported cases of poor satisfaction. In terms of functional outcomes, there were no reported cases of straining on initiation, and a smooth and continuous urinary stream was reported in 80%. Only four patients reported post-void dribbling. When assessing surgical outcomes, 53.30% had coronally located urethra with no cases of postoperative complications. More than half of our patients were discharged after one day.
CONCLUSION
Our study noted overall high satisfaction in terms of surgical, cosmetic, and functional outcomes. Physicians reported better cosmetic outcomes when compared to parents. Further analysis with a larger sample size across various medical institutes will be required to better assess post-repair outcomes.
PubMed: 38098936
DOI: 10.7759/cureus.48808 -
Biomedical Engineering Online Feb 2023Social isolation (SI) is a state of low social interaction with peers associated with various adverse health consequences in older adults living in the community. SI is... (Review)
Review
Social isolation (SI) is a state of low social interaction with peers associated with various adverse health consequences in older adults living in the community. SI is most often assessed through retrospective self-reports, which can be prone to recall or self-report biases and influenced by stigma. Ambient and wearable sensors have been explored to objectively assess SI based on interactions of a person within the environment and physiological data. However, because this field is in its infancy, there is a lack of clarity regarding the application of sensors and their data in assessing SI and the methods to develop these assessments. To understand the current state of research in sensor-based assessment of SI in older adults living in the community and to make recommendations for the field moving forward, we conducted a scoping review. The aims of the scoping review were to (i) map the types of sensors (and their associated data) that have been used for objective SI assessment, and (ii) identify the methodological approaches used to develop the SI assessment. Using an established scoping review methodology, we identified eight relevant articles. Data from motion sensors and actigraph were commonly applied and compared and correlated with self-report measures in developing objective SI assessments. Variability exists in defining SI, feature extraction and the use of sensors and self-report assessments. Inconsistent definitions and use of various self-report scales for measuring SI create barriers to studying the concept and extracting features to build predictive models. Recommendations include establishing a consistent definition of SI for sensor-based assessment research and development and consider capturing its complexity through innovative domain-specific features.
Topics: Humans; Aged; Independent Living; Retrospective Studies; Social Isolation; Motion
PubMed: 36849963
DOI: 10.1186/s12938-023-01080-4 -
The Cochrane Database of Systematic... Dec 2010Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews... (Review)
Review
BACKGROUND
Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.
OBJECTIVES
To systematically review methods to assess effects on health equity in systematic reviews of effectiveness.
SEARCH STRATEGY
We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010.
SELECTION CRITERIA
We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities.
DATA COLLECTION AND ANALYSIS
Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.
MAIN RESULTS
Thirty-four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility.
AUTHORS' CONCLUSIONS
There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.
Topics: Age Factors; Developing Countries; Ethnology; Health Status Disparities; Humans; Racial Groups; Research Design; Review Literature as Topic; Sex Factors; Socioeconomic Factors
PubMed: 21154402
DOI: 10.1002/14651858.MR000028.pub2 -
Age and Ageing May 2018Diagnostic Test Accuracy (DTA) describes a field of research that aims to assess how well a test is able to detect or exclude a condition of interest. Although geriatric... (Review)
Review
Diagnostic Test Accuracy (DTA) describes a field of research that aims to assess how well a test is able to detect or exclude a condition of interest. Although geriatric medicine is not as reliant on investigations as other medical disciplines, almost all patient encounters with older adults will involve some form of diagnostic assessment. Thus, understanding the terminology and methods of DTA is essential for any clinician. In this review we use examples based around the diagnosis of dementia to highlight issues in DTA research. Some of these are generic to any DTA research and some are particularly pertinent to older adults. One can apply a test accuracy framework to a clinical question by defining four key components: the condition of interest; the index test(s) (i.e. the assessment(s) of interest); the reference standard (the best available method for assessing the condition of interest) and the population or healthcare setting in which testing takes place. Test accuracy is often described using complementary measures of sensitivity and specificity. However, many other metrics to describe test accuracy are available; in clinical practice predictive values may have greater utility. These and other descriptive statistics can be derived from a two by two table that cross-classifies the index test results with the reference standard results. Test performance and utility is not only determined by accuracy, other measures such as feasibility and acceptability should be considered and may be of particular importance when describing test performance in older adults with physical and cognitive impairments.
Topics: Age Factors; Biomedical Research; Cognition; Dementia; Humans; Mental Status and Dementia Tests; Patient Selection; Predictive Value of Tests; Reference Standards; Reproducibility of Results; Research Subjects; Terminology as Topic
PubMed: 29528366
DOI: 10.1093/ageing/afy023 -
International Journal of Law and... 2024To systematically review the literature on methods for the standardized and objective assessment of Testamentary Capacity (TC), to identify the best evidence-based and... (Review)
Review
OBJECTIVE
To systematically review the literature on methods for the standardized and objective assessment of Testamentary Capacity (TC), to identify the best evidence-based and clinically pragmatic method to assess TC. Doubts concerning TC can have far-reaching legal and financial implications.
METHOD
A systematic search of the literature was conducted, using PRISMA guidelines, to identify studies which describe methods or tools for the assessment of TC.
RESULTS
The Testamentary Definition Scale (TDS); the Testamentary Capacity Assessment Tool (TCAT); and the Testamentary Capacity Instrument (TCI) all have good psychometric properties, but TDS only partially assesses TC, and the TCI is designed for research rather than day-to-day clinical practice.
CONCLUSION
The TCAT could usefully supplement the clinical assessment of TC, coupled with a standardized examination of cognition. There is room to develop an all-encompassing TC assessment tool. Currently, the clinical judgement of a medical professional, taking account of the medical, legal, ethical issues informing a capacity or competency decision, remains the gold standard for assessing TC.
Topics: Humans; Expert Testimony; Mental Competency; Wills; Cognition; Emotions
PubMed: 38422563
DOI: 10.1016/j.ijlp.2024.101969 -
Frontiers in Neurology 2022Approximately 20% of people with epilepsy (PWE) suffer from anxiety. These fears are quite diverse and may manifest periictally or interictally, be part of the seizure's... (Review)
Review
OBJECTIVE
Approximately 20% of people with epilepsy (PWE) suffer from anxiety. These fears are quite diverse and may manifest periictally or interictally, be part of the seizure's semiology, or an expression of reactive psychological distress from seizures themselves. Our review addresses the question of what screening tools are used in clinical care and epileptological research to capture the complexity of epilepsy-specific anxieties.
METHOD
On 2021/11/11, we entered a search string in PubMed that covered our research interest as completely as possible. We also screened the bibliographies of our findings and followed PubMed's recommendations. From the assessments we found in the included studies, we extracted domains that represent the range of manifestations of anxiety, in order to compare the tools and to discuss to what extent they are suitable for assessing epilepsy-specific anxieties.
RESULTS
We screened 1,621 abstracts. In total, we identified 24 different anxiety assessments. In addition to the psychiatric assessments in use, we found 7 tools that were designed to assess epilepsy-specific anxieties. The latter focus on different aspects of epilepsy-specific anxieties. In some cases, the conceptual frameworks are not sufficiently transparent or divergent.
CONCLUSION
Because a diagnosis of epilepsy can result in, or seizures may appear as, anxiety, it is important to better understand this psychological burden and address it therapeutically, if necessary. There is a need for screening tools that integrate specific points of a variety of assessments, so as to cover the broad range of epilepsy-specific fears. None of the assessments we found meets this integrative perspective. At the same time, the appropriate design of such a required tool presupposes a conceptual framework of what should be considered as epilepsy-specific anxiety.
PubMed: 35547374
DOI: 10.3389/fneur.2022.836321 -
American Journal of Pharmaceutical... Oct 2022The objective of this review is to maximize the benefit of peer assessments in teamwork settings in professional pharmacy curricula. Best practices do not exist for... (Review)
Review
The objective of this review is to maximize the benefit of peer assessments in teamwork settings in professional pharmacy curricula. Best practices do not exist for using peer assessments in academic settings. The studies on peer assessments that we reviewed applied various conditions: Some studies used peer assessments of teams for formative assessments, while others used them for summative assessments; some assessed teamwork at a limited number of time points, while some assessed multiple time points; some attached student names to the assessments, while some were anonymous; and some explained why the tool was being used, while others offered no explanation. To use peer assessments most beneficially, instructors must define the purpose for their use, explain the purpose of teamwork, orient students to the tool being used, assess teamwork over time, provide feedback, minimize grades associated with the assessment, and use partial anonymity when collecting feedback.
Topics: Curriculum; Education, Pharmacy; Feedback; Humans; Peer Group; Peer Review
PubMed: 34697020
DOI: 10.5688/ajpe8795