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PubMed2004

Patient satisfaction with preoperative assessment in a preoperative assessment testing clinic.

UNLABELLED: Preoperative Assessment Testing Clinics (PATCs) coordinate preoperative surgical, anesthesia, nursing, and laboratory care. Although such clinics have been noted to lead to efficiencies in perioperative care, patient experience and satisfaction with PATCs has not been evaluated. We distributed a one-page questionnaire consisting of satisfaction with clinical and nonclinical providers to patients presenting to our PATC over three different time periods. Eighteen different questions had five Likert scale options that ranged from excellent (5) to poor (1). We achieved a 71.4% collection rate. The average for the subscale that indicated overall satisfaction was 4.48 +/- 0.67 and the average for the total instrument was 4.46 +/- 0.55. Although the highest scores were given for subscales describing the anesthesia, nurse, and lab, only the anesthesia subscale improved with time (P = 0.007). The subscale that involved information and communication had the highest correlation with the overall satisfaction subscale (r = 0.76; P < 0.0001). The satisfaction with the total duration of the clinic visit (3.71 +/- 1.26) was significantly less (P < 0.0001) than the satisfaction to the other items. The authors conclude that the practitioner and functional aspects of the preoperative visit have a significant impact on patient satisfaction, with information and communication versus the total amount of time spent being the most positive and negative components, respectively. IMPLICATIONS: Patient satisfaction can serve as an important indicator of the quality of preoperative care delivered in Preoperative Assessment Testing Clinics (PATC). Information and communication, both from clinical and nonclinical service providers, remain the most important positive components, and the total duration of the clinic visit represents the most negative component, of patient satisfaction in a PATC.

Anesthesia↗

PubMed2007

Distribution of virulence-associated genes in Yersinia enterocolitica biovar 1A correlates with clonal groups and not the source of isolation.

Yersinia enterocolitica, an important food- and water-borne enteric pathogen, is represented by six biovars viz. 1A, 1B and 2-5. Some biovar 1A strains, despite lacking virulence plasmid (pYV) and chromosomal virulence genes, have been reported to cause symptoms similar to that produced by isolates belonging to known pathogenic biovars. Virulence-associated genes viz. ail, virF, inv, myfA, ystA, ystB, ystC, tccC, hreP, fepA, fepD, fes, ymoA and sat were studied in 81 clinical and nonclinical strains of Y. enterocolitica biovar 1A by PCR amplification. All strains lacked ail, virF, ystA and ystC genes. The distribution of other genes with respect to clonal groups revealed that four genes viz. ystB, hreP, myfA and sat were associated exclusively with strains belonging to clonal group A. The clonal groups A and B were differentiated previously based on rep (REP-/ERIC) - PCR genomic fingerprinting. The distribution of virulence-associated genes, however, did not differ significantly between clinical and nonclinical strains. In strains of Y. enterocolitica biovar 1A, clonal groups seem to reflect virulence potential better than the source (clinical vs. nonclinical) of isolation.

Chromosomes, Bacterial↗

PubMed1986

Normative data on intermanual differences on three tests of motor performance.

A study was conducted to examine the actual frequency and distribution of intermanual differences on several motor tasks. In addition, the relationships of age, sex, and education were examined in a sample of 365 nonclinical subjects. There was no consistent relationship between age, educational level, and the difference scores and there were small but significant effects for sex. The distribution of scores essentially confirmed generally used guidelines for evaluation of intermanual differences, but most importantly revealed that a significant proportion of cases exhibited "atypical" patterns of performance. These findings are discussed in regard to previous studies and the implications for interpretation of intermanual differences in motor performance.

Adolescent↗

PubMed1998

Lack of an association between insulin-like growth factor-I and body composition, muscle strength, physical performance or self-reported mobility among older persons with functional limitations.

OBJECTIVE: The hypothesis that decreased growth hormone (GH) secretion contributes to the functional decline that occurs with aging is far from substantiated. There have been few studies addressing the distribution and correlates of IGF-I, an indicator of GH activity, in nonclinical populations. As part of a growth hormone intervention trial, we examined the cross-sectional relations between IGF-I levels and multiple measures of physical function, body composition, and strength in a group of older men and women exhibiting mild to moderate reductions in measured physical performance. METHODS: Using a variety of advertising techniques, 155 older subjects were recruited from a metropolitan area to participate in a growth hormone and exercise intervention study. At baseline, all subjects had blood drawn for IGF-I and underwent testing of body composition using dual X-ray absorptiometry, muscle strength using isokinetic dynamometry, and functional assessment using timed performance measures and self-report. Associations between levels of IGF-I, body composition, strength, and physical function were assessed after dividing men and women separately into tertiles of IGF-I as well as treating IGF-I as a continuous variable. RESULTS: Men had higher IGF-I levels than women, and a significant inverse correlation was observed between age and IGF-I in men (r=-0.29, P=.009). There were no clear trends for associations between tertiles of IGF-I, and any of the variables tested. Linear regression models with IGF-I treated as a continuous measure were not associated significantly with any of the measures of physical function, body composition, or strength (all P > 0.05). CONCLUSIONS: In conclusion, although IGF-I levels declined with age in men, these data did not demonstrate an association between IGF-I and measures of muscle strength, body composition, or physical functioning. These findings support the growing body of evidence that IGF-I levels may not be an indicator of growth hormone activity in older persons.

Aged↗

PubMed1987

The relationship between family functioning and demographic characteristics in an epidemiological study.

This paper reports on the characteristics of two dimensions (behavior control and communication) of the McMaster Model of Family Functioning (MMFF) as assessed through the MMFF semi-structured interview in families of the normal nonclinical population of Quebec City (N = 118). Interrater reliability as well as scores distribution are reported. Particular attention is given to the absence of association found between family functioning and socioeconomic status. Exploratory data about the relationship between parental conflict and family functioning are also discussed in terms of future inquiries in child psychiatric epidemiology.

Child Behavior Disorders↗

PubMed1994

Behavior problems in 5- to 11-year-old children from low-income families.

OBJECTIVE: The aims of the present study were to survey the Child Behavior Checklist (CBCL) scores (behavioral section) in a nonclinical population of US urban children from low-income families and to compare the distribution and pattern of scores with the normative data in the CBCL manual (1991). METHOD: The sample consisted of 890 low-income children and a mother or female guardian selected randomly from among Seattle public school students aged 5 to 11 years. RESULTS: In this sample the total CBCL score as well as all subscale scores were significantly higher than the norms. The proportion of children who scored in the clinical/borderline range was also higher than the norm. CONCLUSIONS: These findings support previous work showing that poverty is a risk factor for mental distress in children. They also raise questions about the validity of the CBCL norms for screening or research purpose for low-income families.

Child↗

PubMed2003

Randomly amplified polymorphic DNA as a valuable tool for epidemiological studies of Paracoccidioides brasiliensis.

Randomly amplified polymorphic DNA (RAPD) has been successfully used to detect genetic variations among isolates of Paracoccidioides brasiliensis. However, the usefulness of this technique for assessing important parasitic properties is still unconfirmed. In the present work we further investigated the applicability of RAPD in revealing important intrinsic and extrinsic features of this fungus associated with geographical origin, time of isolation, source of clinical specimen, clinical forms of human disease and also in vitro and in vivo susceptibility to antimicrobial and antifungal drugs. The RAPD patterns allowed us to distinguish all of the analyzed strains, which included 26 clinical isolates, 2 animal isolates, and 1 environmental isolate of P. brasiliensis obtained from different geographic regions, confirming the strong discriminating power of this technique. A phenetic tree, build from the RAPD data, showed that although the two nonclinical Brazilian strains were set together the majority of the clinical Brazilian strains were randomly distributed through different sub-branches of a major cluster without any correlation to any of the parameters analyzed. A second major cluster, however, has grouped isolates from Mato Grosso and Roraima (Brazil) that not only were susceptible in vitro to trimethoprim-sulfamethoxazole but also produced a good in vivo response. These results open new vistas for epidemiological and clinical studies of P. brasiliensis.

Amphotericin B↗

PubMed1999

Latent class analysis of Child Behavior Checklist attention problems.

OBJECTIVE: To test whether attention problems in children are continuously distributed or categorically discrete, the authors performed latent class analyses (LCA) of items from the Attention Problems scale of the Child Behavior Checklist (CBCL) using data from the clinical and nonclinical samples used in the derivation of the CBCL syndromes. METHOD: A CBCL was completed by a parent or guardian of each of 2,100 nonreferred children selected to be representative of U.S. nonreferred children and a demographically matched sample of 2,100 clinically referred children. Attention problems symptoms were subjected to LCA. RESULTS: LCAs were consistent with the presence of 3 levels of symptom presentation in both samples. Children in the nonclinical sample were classified as having no symptoms, mild symptoms, or moderate symptoms. Children in the clinical group had mild, moderate, or severe symptoms. CONCLUSIONS: These results suggest that child and adolescent psychiatric symptoms such as attention problems can be thought of as continuously distributed phenomena rather than discrete disease entities, lending support for an empirical approach to both clinical work and research. In addition, high prevalence rates of attention problems in both clinical and nonclinical samples suggest the need for careful screening of attention problems in clinic and academic settings.

Adolescent↗

PubMed1998

Pharmaceutical practice management.

BACKGROUND: Being accomplished in the short span of 21 years the number of states granting therapeutic optometric privileges has now reached 50. Since health care reform is also expanding, optometrists' prescribing responsibilities will probably increase in proportion to their clinical demands. PURPOSE: In addition to clinical expertise, optometrists should possess practical knowledge about pharmaceutical industry practices and the effects of managed care. This article addresses issues such as drug pricing and distribution, reimbursement, and patient costs, which can affect pharmaceutical dispensing. CONCLUSION: Optometrists should become aware of "nonclinical" prescribing influences that can affect patients. By doing so, they can make informed decisions about the products they prescribe, to ensure optimum patient care and compliance.

Drug Costs↗

PubMed1998

Patterns of adaptation to conflict in bulimia and temporo-mandibular joint disorder.

Two age- and education-matched groups of 45 women, respectively, with the diagnoses of Bulimia and of Temporo-mandibular Joint Disorder, were administered the Serial Color-Word Test, to assess differences in the pattern of adaptation to conflict (the latter being represented by the Stroop task). Three types of norms (clinical, nonclinical and based on reading times) and the functions derived from a previous cluster analysis were employed. Comparisons utilizing clinical norms and cluster analytical functions did not significantly differentiate between groups. According to both nonclinical norms and norms based on reading times, the two clinical groups were significantly different concerning the distribution of adaptation patterns. Bulimic patients resorted more often to the Dissociative pattern (high nonlinear change of reading times), while temporomandibular patients were characterized by the Cumulative pattern (high linear change) and, secondarily, by the Cumulative-Dissociative pattern (high linear and nonlinear change). Intergroup differences were more marked when employing the new norms based on reading times.

Adult↗

PubMed2004

Mindfulness-based stress reduction and health benefits. A meta-analysis.

OBJECTIVE: Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic and psychiatric disorders. The program, nonreligious and nonesoteric, is based upon a systematic procedure to develop enhanced awareness of moment-to-moment experience of perceptible mental processes. The approach assumes that greater awareness will provide more veridical perception, reduce negative affect and improve vitality and coping. In the last two decades, a number of research reports appeared that seem to support many of these claims. We performed a comprehensive review and meta-analysis of published and unpublished studies of health-related studies related to MBSR. METHODS: Sixty-four empirical studies were found, but only 20 reports met criteria of acceptable quality or relevance to be included in the meta-analysis. Reports were excluded due to (1) insufficient information about interventions, (2) poor quantitative health evaluation, (3) inadequate statistical analysis, (4) mindfulness not being the central component of intervention, or (5) the setting of intervention or sample composition deviating too widely from the health-related MBSR program. Acceptable studies covered a wide spectrum of clinical populations (e.g., pain, cancer, heart disease, depression, and anxiety), as well as stressed nonclinical groups. Both controlled and observational investigations were included. Standardized measures of physical and mental well-being constituted the dependent variables of the analysis. RESULTS: Overall, both controlled and uncontrolled studies showed similar effect sizes of approximately 0.5 (P<.0001) with homogeneity of distribution. CONCLUSION: Although derived from a relatively small number of studies, these results suggest that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems.

Adaptation, Psychological↗

PubMed2001

Symptom cluster associated with mild traumatic brain injury in university students.

There is growing recognition that even a minor blow to the head can have serious consequences on physical, cognitive, behavioral, and social well-being. Previous studies have indicated that such changes may in turn have a dramatic effect on the ability of university students to carry out their studies. This survey measured the prevalence of mild traumatic brain injury in a nonclinical population of 1,075 university students from all disciplines. In addition to surveying the nature, cause, and sex distribution, it further investigated the relationships between the physical, cognitive, behavioral, and social repercussions of the incidents. Results replicated earlier findings and indicated a prevalence rate of mild traumatic brain injury of 34.9% (n = 375). Moreover, significant correlations were found among the physical, cognitive, behavioral, and social changes reported by the students, suggesting a cluster of symptoms associated with such incidents. Altogether, these results suggest that even currently enrolled and active university students may face unique and subtle challenges related to a mild traumatic brain injury.

Adult↗

PubMed1991

A nonclinical model for predicting scaling and root planing case difficulty.

As students progress through their clinical education, the integration of patient types challenging the development of scaling and root planing skills is necessary. A clinical screening to determine case type is ideal; however, some programs do not have the time or resources for a clinical screening, and some patients do not want to take the time for the additional screening appointment. The intent of the screening process is to determine case type and/or treatment needs. In some cases, this information is used to match student educational requirements with patient needs. Even though an institution or program may have a clinical screening process, patient assignment can still be haphazard, resulting in an inequitable distribution of patient case types to students. It seems the problem is due, in part, to the absence of a mechanism for early identification and distribution of case types. The purpose of this study was to develop a model for initially predicting patient scaling and root planing case difficulty from nonclinical, patient variables obtained during a telephone interview. Dental hygiene student evaluation forms (n = 1,356) at the University of North Carolina at Chapel Hill School of Dentistry were gathered and categorized by patient case difficulty. A sample of charts was selected from each scaling classification. The scaling classifications were then subdivided into two samples for developing and testing the model. Variables selected from the patient charts as possible predictors were smoking status, race, age, gender, date of last prophylaxis, periodontal classification, and oral hygiene habits (brushing and flossing).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

Is adoption a risk factor for the development of adjustment problems?

The extent to which being adopted increases a child's risk for the development of adjustment problems has been debated for decades. Results from studies examining prevalence of adopted children and adolescents in outpatient and inpatient mental health treatment suggest that the risk associated with adoption is modest or nonexistent. This body of research is reviewed and critiqued. Two possible explanations for the apparent disparate findings of the clinically based and nonclinically based studies are explored: biases in referral for mental health treatment and the influence of the shape of the distribution of adjustment problems in the adopted and nonadopted populations. Implications for clinical practice and future research are explored.

Adaptation, Psychological↗

PubMed1992

Nonclinical testing of formulas containing hydrolyzed milk protein.

The allergenic potential of cow milk-based infant formula can be reduced by protein hydrolysis. Controlled clinical studies are necessary to demonstrate conclusively the biologic efficacy of these formulations in human beings. Nonclinical testing programs provide manufacturers with the opportunity to characterize various molecular and immunologic properties of these hydrolysates and their corresponding final product forms. Physicochemical analyses provide data relating to the extent of protein hydrolysis and peptide molecular weight distribution. Immunochemical analyses can semiquantitatively estimate hydrolysate reactivity with preformed antibody. The ability of hydrolysate-based products to induce an immune response can be evaluated by using animal models. It is the responsibility of the manufacturer to choose the appropriate combination of nonclinical tests and use them to document product consistency, thus helping to ensure consistent clinical performance.

Animals↗

PubMed1996

Patterns of dissociation in clinical and nonclinical samples.

Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.

Adolescent↗

PubMed1989

Developmental perspectives in child and adolescent depressive symptoms in a community sample.

This developmental study provides some normative data on the distribution of depressive symptoms in 210 children and adolescents in three different age groups (8, 12, and 17 years) from a nonclinically referred sample. The Child Assessment Schedule and other instruments were used. Studying depression from a dimensional point of view, the authors found withdrawal, pessimism, horrible dreams, and suicidal ideation and tendency in the different age groups to be closely related to depressive symptoms.

Adolescent↗

PubMed1988

Excellence in the management of clinical pharmacy services.

Differences in the management of clinical versus nonclinical pharmaceutical services, unique aspects of managing clinical services, and management challenges for the 1990s are described. In nonclinical practice, pharmacists are located in the central pharmacy and have limited contact with physicians and nurses; managers focus on drug procurement, distribution, and accountability. A clinical program takes pharmacists to the patient's bedside and into more inter-professional contact; the management of a clinical pharmacy service is measured by the benefits received by patients, physicians, and nurses and by the job satisfaction of the pharmacists. Management of a clinical program requires (1) recognition of the potential for drugs to cause harm and commitment to pharmacists' responsibility for ensuring appropriate clinical outcomes, (2) analysis of the hospital and how clinical services can best be provided there, (3) obtaining resources to establish or gain access to a drug information service, (4) developing resources and support for a pharmacokinetics service, (5) for a pharmacokinetics service, (5) designing efficient distribution systems supported by automated applications and an adequate technician staff, (6) developing a pharmacist staff that will gain physicians' and nurses' support for clinical programs, (7) developing an organized approach to keeping staff members up to date on new drugs and technology and assisting them in sharing this knowledge with physicians and nurses, (8) demanding and ensuring the quality of the clinical performance of each pharmacist, (9) documenting and evaluating the cost-effectiveness of services provided, and (10) recruiting and retaining good pharmacists and technicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗