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[Presentation of a survey scale for neuro-rehabilitation--with a general discussion of current rehabilitation scales].

Presented is a newly developed rehabilitation survey scale for the field of neuro-rehabilitation, in which levels of functioning relative to ten specific and four global functions are documented at set intervalls by means of a five-grade rating scale. Additionally, numerous symptoms or associated phenomena are recorded ungraded. Used in the clinical setting, this scale affords a quick overview of the rehabilitation profile, with relatively little time and effort being required. Scientific evaluation may uncover information on the impact the disorders of specific functions have on global functions, which is relevant primarily in the social context. Also, the scale may be applied in the framework of larger-scale comparative studies. Dealt with in an extensive discussion, our newly presented scale may be accorded a number of advantages over currently used scales, which warrant its introduction. It is the outcome of many years of developmental work and pertaining reliability verifications.

Activities of Daily Living↗

The preoccupation scale: its development and relationship with depression scales.

Self-focus has been thought to be an important factor in the development and maintenance of depression. The disposition to focus attention inward has been measured by the Private Self-Consciousness Scale (PSCS), which does not reflect the duration of self-focusing. Study 1 aimed to develop a Self-Preoccupation Scale (SPS) that would reflect both the degree and duration of self-focusing. In addition, a new concept, external-preoccupation-the maintenance of external-focus on a specific object-was proposed as a risk factor of depression. An External-Preoccupation Scale (EPS) was developed to measure this. Both the SPS and EPS showed excellent internal consistency and test-retest reliability. Study 2 aimed to examine the relationship between the SPS, EPS, and PSCS and depression. The EPS was not significantly correlated with depression scales. The moderate correlations of the SPS with the depression scales were significantly higher than the correlations of the PSCS with the depression scales.

Adult↗

The Brief Psychiatric Rating Scale (BPRS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE) in the evaluation of positive and negative symptoms.

Positive and negative a priori symptom scales were operationalized with the BPRS and the NOSIE. Acutely and consecutively admitted psychiatric patients (N = 247) were rated with these scales. Research questions dealt with the psychometric properties of the scales. It was found that the positive symptom scales had sufficient internal consistency; the negative scales did not. Diagnostic groups could be distinguished better with the positive symptom (PS) than with the negative symptom (NS) scales. The outcome of this research suggests that the positive and negative symptoms distinction is less meaningful in cross-sectional research, in which acute patients are rated, than in longitudinal research.

Adaptation, Psychological↗

The memorial anxiety scale for prostate cancer: validation of a new scale to measure anxiety in men with with prostate cancer.

BACKGROUND: The psychological difficulties facing men with prostate cancer are acknowledged widely, yet identifying men who may benefit from mental health treatment has proven to be a challenging task. The authors developed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) to facilitate the identification and assessment of men with prostate cancer-related anxiety. This scale consists of three subscales that measure general prostate cancer anxiety, anxiety related to prostate specific antigen (PSA) levels in particular, and fear of recurrence. METHODS: Ambulatory men with prostate cancer (n = 385 patients) were recruited from clinics throughout the United States. Prior to routine PSA tests, participants completed a baseline assessment packet that included the Hospital Anxiety and Depression Scale; the Distress Thermometer; the Functional Assessment of Cancer Therapy Scale, Prostate Module; and measures of role functioning, sleep, and urinary functioning. PSA values from the last three tests also were collected. Follow-up evaluation was completed within 2 weeks after patients learned of their PSA test result using a subset of these scales. RESULTS: Analysis of the MAX-PC revealed a high degree of internal consistency and test-retest reliability for the total score and for the three subscales, although reliability was somewhat weaker for the PSA Anxiety Scale. Concurrent validity was demonstrated by correlations between the MAX-PC and measures of anxiety. Overall changes in PSA levels were correlated only modestly with changes in MAX-PC scores (correlation coefficient, 0.13; P = 0.02). CONCLUSIONS: The MAX-PC appears to be a valid and reliable measure of anxiety in men with prostate cancer receiving ambulatory care.

Anxiety↗

Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale.

STUDY OBJECTIVE: We determine how the alert/verbal/painful/unresponsive (AVPU) responsiveness scale (alert, responsive to verbal stimulation, responsive to painful stimulation, and unresponsive) corresponds to the Glasgow Coma Scale (GCS) when assessing consciousness level in the poisoned patient. METHODS: Consciousness level was assessed using the AVPU responsiveness scale and the GCS in all patients admitted to the hospital during a 6-month period with deliberate or accidental poisoning. An AVPU responsiveness scale algorithm and details of the individual components of the GCS were provided. Data were recorded prospectively on admission to the toxicology ward by nursing staff in the majority of cases and from case records for the small number of patients admitted directly to the ICU. Nursing staff also recorded any difficulty assessing consciousness level using either scoring system. RESULTS: Of the 1,384 patients studied, 1,138 patients were alert, 114 patients responded to a verbal stimulus, 87 patients responded to a painful stimulus, and 15 patients were unresponsive. The median GCS scores with interquartile ranges (IQR) for each AVPU responsiveness category were 15 (IQR 15), 13 (IQR 12 to 14), 8 (IQR 7 to 9), and 3 (IQR 3), respectively. There was a degree of overlap between the range of GCS scores for each category. Nursing staff recorded more difficulty using the GCS than the AVPU responsiveness scale. Alcohol-intoxicated patients proved to be the most difficult to assess. All patients who were unresponsive required intubation. No patient with a GCS score greater than 6 was intubated. CONCLUSION: Each AVPU category can be shown to correspond to a range of GCS scores. The AVPU responsiveness scale appears to provide a rapid simple method of assessing consciousness level in most poisoned patients, but difficulty was still observed in assessing alcohol-intoxicated patients.

Cohort Studies↗

The Subjective Rating Scales for Measurement of Mental Workload-Thurstonian Scaling.

Subjective rating scales for measuring work demands and individual capabilities to cope with work requirements were developed using the Thurstonian procedure. The scales measure six dimensions of mental workload: mental difficulties, feeling of responsibility, awareness of risk, interpersonal conflicts, monotony, and time pressure. Individual scale results make it possible to assess the level of mental workload understood as a relation between the subjective rating of work demands and individual capabilities in each of the six dimensions. Two versions of scales were prepared: classic and modified ones. To assess the level of reliability of the particular scales, 481 participants were examined twice at a 1-month interval. A procedure to prepare scales for the measurement of other dimensions of mental workload is also presented.

Thurstonian scaling↗

The Challenging Behaviour Scale (CBS): development of a scale for staff caring for older people in residential and nursing homes.

OBJECTIVES: A review of behavioural rating scales identified the need for a measure of resident behaviours that staff in care homes for older people find difficult to manage. A 25-item, broad-based rating scale, the Challenging Behaviour Scale (CBS), was developed to meet this need and its psychometric properties were examined. DESIGN: Cross-sectional surveys. METHODS: Ratings of 484 residents, living in 16 homes across England, were used to examine four methods of collecting inter-rater reliability data. Ratings of 382 residents living in 13 homes were used to evaluate criterion validity and to establish norms. Six further homes were used to explore qualitatively the validity of the suggested norms. Ratings of 98 residents living in four further homes were used to examine concurrent validity. The predictive validity of the CBS 'challenge' score was evaluated, using time-sampled direct observation of challenging behaviour in 237 residents, living in 11 homes. RESULTS: The scale records staff reports of the incidence, frequency and 'management difficulty' of resident behaviour and it can also identify 'challenging residents' through a computed score. It has good internal consistency, good test-retest reliability and adequate validity. Inter-rater reliability is good when staff receive training or when staff groups of at least three, of mixed qualifications, complete the scale. Norms are suggested for prospective studies of the prevalence of challenging behaviour. CONCLUSIONS: The CBS is quick to complete and may have potential for the evaluation of psychosocial interventions in care settings. It is, as far as we know, the first staff observational rating scale that is based on the reports of care staff, who constitute the backbone of residential care provision. Suggestions for improvements in criterion and content validity are outlined.

Aged↗

[Evaluation of subjective happiness in the elderly using a visual analogue scale of happiness in correlation with depression scale].

A Visual analogue scale of happiness (VAS-H) was applied to elderly population in a community to evaluate their subjective quality of life. The study population consisted of 313 elderly people aged over 75. Using a 20 cm visual analogue scale (VAS), VAS-H was measured by asking subjects to place a single vertical mark on a horizontal line at a point corresponding to their current subjective degree of happiness judged from health condition and psycho-social background as a whole; The VAS-H was anchored on the left and with the words "-100%; unhappiest" and on the right end with the words "+100%; happiest". The scores of VAS-H (%) were obtained by multiplying the distance (cm) from the zero point to the vertical line by 10. To determine the characteristics of VAS from the standpoint of the quality of life, we compared VAS with scores of two kinds of established depression scale, because the mood which was assessed by these scale was supposed to be an important factor of the quality of life. The results of the simultaneously assessed Geriatric Depression Scale (GDS), and Zung's depression scale (SDS) which was obtained 1 year before for the same subjects were compared with that of VAS-H. The score of VAS-H had a significantly negative correlation with both GDS and SDS. In conclusion, VAS-H was a simple and useful method to evaluate degree of subjective happiness which was one factor of quality of life in the elderly people.

Aged↗

How should a subarachnoid hemorrhage grading scale be determined? A combinatorial approach based solely on the Glasgow Coma Scale.

OBJECT: The purpose of this study was to present a combinatorial approach used to develop a subarachnoid hemorrhage (SAH) grading scale based on the patient's preoperative Glasgow Coma Scale (GCS) score. METHODS: There are 4094 different combinations that can be used to compress the 13 scores of the GCS into two to 12 grades. Break points, the positions in the scale in which two adjacent scores connote a significantly different outcome, are obtained by a direct comparison of the GCS and the Glasgow Outcome Scale (GOS). Guided by the break points, the number of combinations to be considered can be limited. All possible combinations are statistically analyzed with respect to intergrade differences in outcome. Single combinations, with the maximum number of grades having maximum intergrade outcome differences for each corresponding set of adjacent grades, must be selected. The authors verified the validity of this combinatorial approach by retrospectively analyzing 1398 consecutive patients with aneurysmal SAH who underwent surgery within 7 days of the last hemorrhage episode. The patients' GCS scores were assessed just before surgery and their GOS scores were estimated 6 months post-SAH. The combinatorial approach yields only one acceptable grading scale: I (GCS Score 15); II (GCS Scores 11-14); III (GCS Scores 8-10); IV (GCS Scores 4-7); and V (GCS Score 3). CONCLUSIONS: The combinatorial approach, guided by the break points, is so simple and systematic that it can be used again in the future when revision of the grading scale becomes necessary after development of new and effective treatment modalities that improve patients' overall outcome.

Age Factors↗

Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR Score.

The Glasgow Coma Scale (GCS) has been the gold standard for assessing the level of consciousness in patients with significant brain injury. Prior efforts to modify or replace this scale have been unsuccessful because no scale could improve on its simplicity and practical usefulness. This review provides a historical perspective on coma scales and introduces a new and simple, but more comprehensive, scale: the Full Outline of UnResponsiveness (FOUR) Score, which has been recently validated. The FOUR Score has 4 components with "4" as a maximal score for each item. The individual components are eye responses (eye opening and eye tracking), motor responses (responses to pain and following simple hand commands), brainstem reflexes (pupil, cornea, and cough reflexes), and respiration (breathing rhythm and respiratory drive in ventilated patients). The FOUR Score is a further improvement on previous scales for classifying and communicating impaired consciousness.

Brain Injuries↗

Tavern patrons and the MacAndrew Alcoholism Scale: self-reported drinking behavior in relation to the MMPI L and K scales.

This study investigated the ability of the MacAndrew Alcoholism (MAC) Scale to distinguish between alcoholics and nonalcoholics using self-ratings from patrons of taverns (N = 128); while only about 14% of the variance in the MAC Scale was accounted for by the self-rating (alcoholic/nonalcoholic) scale, the MAC Scale correctly identified 70% of those who reported alcohol use to levels consistent with alcoholic dependency after variance in the alcohol use scale attributable to the L and K scales of the MMPI was accounted for.

Adult↗

Modeling the performance of pilot-scale countercurrent chromatography: scale-up predictions and experimental verification of erythromycin separation.

Biosynthesis of polyketide antibiotics, such as erythromycin A (EA), can result in the formation of analogues of the main compound that are chemically and structurally extremely similar. The large-scale purification of these antibiotics by conventional high-performance liquid chromatography (HPLC) can be prohibitively expensive due to the large volume of both solvent and adsorbent required. This study examines the feasibility of using a novel pilot-scale countercurrent chromatography (CCC) machine as an alternative to HPLC. CCC is a low-pressure (typically <4000 kN m(-2)) liquid-liquid chromatographic technique that allows the separation of solutes on the basis of their partitioning between two immiscible liquid phases. The effects of mobile phase flow rate, column rotational speed, and sample injection volume on the attainable yield and purity of EA were investigated. Our results show that, at a mobile phase flow rate of 40 mL min(-1), a rotational speed of 1200 rpm, and an injection volume of 100 mL (10 g total erythromycin), EA could be satisfactorily fractionated with a purity of approximately 92% (w/w) and a recovery yield of approximately 100% (w/w). The total solute throughput was estimated to be 0.41 kg day(-1). More importantly, we demonstrated simple and predictive linear scale-up of the CCC separation based on data obtained from a single laboratory-scale CCC chromatogram, and verified this experimentally. The retention time and peak width of the target compound at the pilot scale could be predicted to within 4% for operation at a range of mobile-phase flow rates and injection volumes. This predictable nature of CCC separations, unlike HPLC methods, can greatly reduce process development times and enable a complete process-scale operating scenario to be planned.

Chromatography, Liquid↗