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PubMed1985

Administration of dexamethasone prior to training blocks ACTH-induced recovery of an extinguished avoidance response.

Pretest administration of ACTH has been shown to produce recovery of an extinguished avoidance response. Presumably this effect is found because endogenous ACTH is a component of the original training memory. However, another possible explanation of this finding is that administration of the peptide acts as a novel stimulus that "disinhibits" the extinguished response. In order to test this "disinhibitory" hypothesis of ACTH-induced recovery of an extinguished avoidance response, some subjects were given dexamethasone 2 hr prior to training and extinction. This synthetic glucocorticoid is effective in blocking endogenous release of ACTH. Thus, ACTH should not be a component of the training memory in subjects given dexamethasone prior to training and extinction but would be a relatively novel stimulus condition at testing. Pretest administration of ACTH was found to be effective in alleviating performance deficits induced by extinction only for subjects given saline prior to training and extinction. Administration of ACTH had no effect on the avoidance responding of subjects given dexamethasone. These findings suggest that pretest administration of ACTH affects retrieval processes rather than acts as a disinhibitor.

Adrenocorticotropic Hormone↗
PubMed1998

A test of the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury.

This study was designed to test the 1992 International Standards for Neurological and Functional Classification of Spinal Cord Injury. One hundred and six professionals in the field of spinal cord injury attending an instructional course at the 1994 ASIA Meeting participated in the test. Participants completed a pretest and posttest in which they classified two patients who had a spinal cord injury (one with complete tetraplegia and one with incomplete paraplegia) by sensory and motor levels, zone of partial preservation (ZPP), ASIA Impairment Scale and completeness of injury. Between tests, three members of the ASIA Standards Executive Committee gave presentations on the neurological assessment, scoring, scaling and classification of spinal cord injury and a video of the actual examinations of the two cases was viewed. Percent 'correct' (as defined by the ASIA Standards Committee) was calculated for sensory and motor levels, ZPP, ASIA Impairment and completeness. Overall, the analyses showed that participants had very little difficulty in correctly classifying the patient with complete tetraplegia. Pretests scores ranged from 72% (left motor level) to 96% (complete injury), posttest scores from 73% (left motor level) to 100% correct (complete injury). For the patient with incomplete paraplegia (Case 2), scores were considerably lower. Pretest scores ranged from 16% (right motor level) to 95% correct (incomplete injury); posttest scores from 21% (right motor level) to 97% correct (incomplete injury). The results showed that further revisions of the 1992 Standards and more training is needed to ensure accurate classification of spinal cord injury.

Chi-Square Distribution↗
PubMed2004

Input that contradicts young children's strategy for mapping novel words affects their phonological and semantic interpretation of other novel words.

Children tend to choose an entity they cannot already label, rather than one they can, as the likely referent of a novel noun. The effect of input that contradicts this strategy on the interpretation of other novel nouns was investigated. In pre- and posttests, 4-year-olds were asked to judge whether novel nouns referred to "name-similar" familiar objects or novel objects (e.g., whether japple referred to an apple or a binder clip). During an intervening treatment phase, they were asked to pick the referents of novel nouns from pairs of familiar objects (Experiments 1 and 3) or were taught subordinate names for familiar objects (Experiment 2). Most resisted the lure of phonological similarity in the pretest but increased selection of name-similar familiar objects over novel ones in the posttest. In Experiment 3, which involved monosyllables that differed in initial phoneme from the familiar words, treatment produced this effect only when accompanied by a rhyme-sensitization procedure. Experiment 2 included two other age groups: 2-year-olds, who were less resistant to phonological similarity in the pretest and responded to the treatment like the 4-year-olds; and adults, who nearly always selected the novel objects in the pretest and posttest. For children, the impact of treatment was positively associated with ability to detect phonological similarity and negatively associated with vocabulary size.

Adult↗
PubMed2000

Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy.

BACKGROUND: Skin surface microscopy (oil epiluminescence microscopy, dermoscopy, dermatoscopy) has been shown to increase the diagnostic accuracy of melanoma. However, all studies to date have been in an expert setting. OBJECTIVES: To determine whether primary care physicians (PCP) (general practitioners) could improve their melanoma diagnosis using surface microscopy after a short education intervention. METHODS: Seventy-four practising PCP completed a pretest of 50 melanomas and 50 atypical non-melanoma pigmented skin lesions (PSL) containing matched clinical and surface microscopy photographs. PCP were randomized between a surface microscopy education intervention or control group, followed by an identical post-test. RESULTS: Following training there was a significant improvement in the post-test vs. pretest in both clinical melanoma diagnosis (62.7% vs. 54.6%; P = 0.007) and surface microscopy melanoma diagnosis (75.9% vs. 57.8%; P = 0.000007). No difference was found in the control group between the post-test vs. pretest clinical melanoma diagnosis (53.7% vs. 50.6%; P = 0.21) or the surface microscopy melanoma diagnosis (54.8% vs. 52.9%; P = 0.56). Following training there was a significant improvement in the diagnosis of melanoma using surface microscopy vs. clinical diagnosis (75.9% vs. 62.7%; P = 0.000007), which was absent in the control group (54.8% vs. 53.7%; P = 0.59). No significant difference was found in clinical vs. surface microscopy post-test results for non-melanoma PSL in either the intervention group or control group. Improvement in the sensitivity for the diagnosis of melanoma with surface microscopy was seen without a decrease in specificity; this indicated that the effect should occur without increasing the number of needless excisions. CONCLUSIONS: All PCP in countries where melanoma leads to significant mortality should be trained in skin surface microscopy.

Clinical Competence↗
PubMed1993

The effects of comprehensive guidelines for the care of sickle-cell patients in crisis on the nurses' knowledge base and job satisfaction for care given.

The primary purpose of this study was to determine the effects of comprehensive nursing guidelines for sickle-cell patients in crisis on the nurses' knowledge base and job satisfaction for nursing care given. This study was carried out through the use of a single-group pretest-posttest design. A total of 18 subjects participated in the study. At the pretesting, each subject completed an Individual Information Questionnaire for the collection of background data, a Knowledge Base tool and a Job Satisfaction tool. Afterwards, all subjects attended 10.5 hours of educational programmes on sickle-cell disease, treatment, interventions and relaxation training. Following this, the comprehensive guidelines for the care of sickle-cell patients were instituted. At 3 months and 6 months after the guidelines had been in effect, subjects were again asked to complete the Knowledge Base and Job Satisfaction tools. The results of the tools were then measured comparing the three time intervals for any differences in knowledge and job satisfaction using independent measure t-tests. t-Tests were also performed for each question on the Job Satisfaction tool comparing the three time intervals. The results of the analyses demonstrated that there was a statistically significant increase in knowledge between the pretest and 6 month time interval. The findings also showed that there was no statistically significant increase in overall job satisfaction. However, the t-test results from the individual questions demonstrated a statistically significant increase in job satisfaction in the areas of nurse/physician collaboration and having a broad knowledge base of sickle-cell disease.

Acute Disease↗
PubMed2003

Exercise stress testing, myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty: a review of performance.

When chest symptoms recur in a patient who underwent percutaneous transluminal coronary angioplasty (PTCA), it is necessary to rule out restenosis (R). Three main noninvasive tests suggest the presence of R: exercise stress test (XT), myocardial perfusion imaging (MPI) and stress echocardiography (s-echo). The objectives of this review were: (1) to estimate the pretest probability of R as a function of time after PTCA in symptomatic patients and (2) to obtain an approximation of the diagnostic parameters of the XT, MPI and s-echo for detecting R. A MEDLINE search (English-language, years: 1980-2001) was conducted to identify studies examining post-PTCA functional testing for diagnosing R. Data from the studies were pooled. Comparing studies was often difficult due to varying methodology in the studies. Pretest probability of R in symptomatic patients increases in a nonlinear fashion from 20% or less at 1 month, to nearly 90% at 1-year postangioplasty. The approximated accuracy of the XT, MPI, and s-echo for detecting R was 62, 82 and 84%, respectively. During the first month after PTCA, none of the noninvasive modalities is able to accurately detect R. Late (7-9 months) after PTCA, the pretest probability of R is high and therefore the noninvasive measure may be spared. Our analysis suggests that MPI and s-echo should be preferred over the XT for diagnosing R.

Angioplasty, Balloon, Coronary↗
PubMed2000

Eliciting patients' preferences for adjuvant chemotherapy in breast cancer: development and validation of a bedside decision-making instrument in a French Regional Cancer Centre.

In developed countries, the physician-patient relationship is moving from a paternalistic model to new decision-making models that take patient preferences into account. OBJECTIVES: Our aim was to develop a Decision Board (DB) and to test its acceptability in a French Regional Cancer Centre regarding the decision on whether or not to use chemotherapy after surgery in postmenopausal women with breast cancer. This paper presents the development process for this instrument and reports the pretesting phase, as well as the corresponding results. METHODS: A working group was created with oncologists, psychologists and economists. Following the first phase, i.e. the development process, a first version of the instrument was presented to health professionals. Their feedback led to important modifications of the instrument. The DB was then presented to experienced patients, which resulted in slight changes. The second phase consisted of pretesting the comprehension, internal and across-time consistency of the DB on healthy volunteers. RESULTS: The DB was pretested in a group of 40 healthy volunteers. Eighteen respondents chose chemotherapy and 22 chose not to have chemotherapy. Comprehension rates were very high (>/=87.5%). Internal consistency was assessed considering option attitudes based on outcomes and option attitudes based on process. Women shifted their choices in a predictable way. Across-time consistency was appraised using the test-retest method with Visual Analog Scales. The Intraclass Correlation Coefficient was 0.97. DISCUSSION-CONCLUSION: Due to cultural differences, the DB developed in our French Cancer Centre is quite different from the DBs previously developed elsewhere. Our instrument showed good comprehension and consistency properties, which are corroborated by the DB literature. Whether our DB is acceptable for patients with breast cancer must still be tested. Patients' reactions will tell us which type of decision-making model is at work. Further research is needed in order to explore the shared decision-making process and clarify the concept.

Journal Article↗
PubMed2002

What is the optimal approach for using a direct amplification test in the routine diagnosis of pulmonary tuberculosis? A preliminary assessment.

OBJECTIVE: The aim of this study was to determine the most appropriate strategy for the rapid diagnosis of pulmonary tuberculosis (PTB) using a nucleic acid amplification (NAA) test. METHODOLOGY: This was a prospective study of 128 adult patients in whom respiratory secretions were tested for Mycobacterium tuberculosis by the AMPLICOR assay. The basis for starting PTB treatment was noted for each patient. The optimal approach was determined by using Bayes' theorem to compare different combinations of pretest probability, smear results with the AMPLICOR test. RESULTS: The incidence of PTB was 15.6%. In only one patient was treatment for PTB commenced because of a positive AMPLICOR result. The rest were managed according to the conventional approach which relied upon clinical judgment and direct smear. The optimal approach was to treat patients with high or intermediate pretest risk for PTB who returned positive AMPLICOR tests. The overall accuracies of the conventional approach, AMPLICOR test and optimal approach were 89.8, 95.3 and 96.1%, respectively. CONCLUSION: This small study suggests that NAA testing be limited to patients with high or intermediate pretest risk of PTB. In this group, positive results demand treatment while the management of those with negative results still relies on clinical judgment.

Adult↗
PubMedDate not supplied

Impact of the Caring for Aging Relatives Group program: an evaluation.

Caregiver support programs have been developed with the goal of alleviating the stress associated with the demanding role of caring for an older person. The majority of these programs, however, have not been formally evaluated. This study is a formal program evaluation which assessed the impact of a caregiver support program on its participants. Both the intervention and matched comparison groups included a convenience sample of 23 female caregivers. A quasi-experimental pretest-posttest design was used to measure morale, social support, and information. Findings showed there was a positive relationship between morale and social support. In the comparison group only, there was a positive relationship between morale and information in both the pretest and posttest. Within the intervention group, there was a significant increase (t = 2.79, p = 0.01) in the information scores between the pretest and posttest. Caregivers in the intervention group reported that the Caring for Aging Relatives Group (CARG) provided them with social support. The results of this study partially supported the usefulness of a caregiver support program; that is, information was gained, morale was maintained, and caregivers perceived the support program as helpful. Future research is needed to address what factors lead caregivers to attend a support program and what type of social support they receive from attending such a program.

Adult↗
PubMed2002

Colposcopy quality control for clinical trials: the positive effects from brief, intensive educational intervention.

OBJECTIVE: To determine whether a brief, intensive colposcopy course improves the cognitive skills of colposcopists participating in clinical trials. MATERIALS AND METHODS: Twenty-two colposcopists involved in a multicenter clinical trial attended an intensive colposcopy course designed to improve diagnostic skills. Participants completed a pretest and posttest of 10 case-based studies and the ASCCP Colposcopy Recognition Award (CRA) examination. Pre- and posttest exam and CRA results were compared for each individual and the group. RESULTS: The group mean pre- and posttest total scores were 67% and 73%, respectively. There was a significant improvement in posttest colposcopic impression mean scores compared with the pretest (56% and 44%, respectively). The greatest improvement in colposcopic impression mean scores was for low-grade, high-grade, and cancer cases; 25%, 23%, and 20%, respectively. CRA scores did correlate positively with pretest scores. CONCLUSION: A brief, intensive colposcopic educational program improved the cognitive skills of the colposcopists.

Journal Article↗
PubMed1999

Tension-type headache: pain, fatigue, tension, and EMG responses to mental activation.

Twenty patients with tension-type headache (14 chronic and 6 episodic) and 20 group-matched controls were selected for this study. They participated in a 1-hour, complex, two-choice, reaction-time test, as well as 5-minute pretest and 20-minute posttest periods. Subjects reported any pain in the forehead, temples, neck, and shoulders, as well as any feelings of fatigue and tension during the pretest, and every 10 minutes during the test and posttest by visual analog scales. Superficial electromyography was recorded simultaneously from positions representing the frontal and temporal muscles, neck (mostly splenius), and trapezius muscles. The location of pain corresponded to the position of the electrodes, but extended over a larger area. The test provoked pain in the forehead, neck, and shoulders of patients, i.e., pain scores from these regions increased significantly during the test. The pain scores continued to increase posttest. In patients, the EMG response of the trapezius (first 10 minutes of the test) was elevated relative to pretest. In controls, only the frontal muscles showed an EMG test response. Patients showed significantly higher EMG responses than controls in the neck (whole test period) and trapezius (first 10 minutes of the test period). There were significant differences in pain and fatigue scoring between patients and controls in all three periods and in tension scoring posttest. Fatigue correlated with pain, with increasing significance for all locations examined, while tension was mainly associated with the neck pain. The meaning of the variables "tension" and "fatigue" in headache, and their association with recorded muscle activity in various regions is discussed. The EMG response of the trapezius muscle to the test is discussed in comparison with similar responses observed in patients with other pain syndromes.

Adult↗
PubMed2001

Three quantitative approaches to the diagnosis of abdominal pain in children: practical applications of decision theory.

BACKGROUND/PURPOSE: The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints. METHODS: The records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression. RESULTS: In all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58. CONCLUSIONS: Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer.

Abdominal Pain↗
PubMedDate not supplied

The effect of talocrural joint manipulation on range of motion at the ankle.

OBJECTIVE: To determine whether a single high-velocity, low-amplitude thrust manipulation to the talocrural joint altered ankle range of motion. DESIGN: A randomized, controlled and blinded study. SUBJECTS: Asymptomatic male and female volunteers (N = 41). METHODS: Subjects were randomly assigned into either an experimental group (n = 20) or a control group (n = 21). Both ankles of subjects in the experimental group were manipulated by using a single high-velocity, low-amplitude thrust to the talocrural joint. Pretest and posttest measurements of passive dorsiflexion range of motion were taken. RESULTS: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects. A significantly greater pretest dorsiflexion range of motion existed in those ankles in which manipulation produced an audible cavitation. CONCLUSION: Manipulation of the ankle does not increase dorsiflexion range of motion in asymptomatic subjects. Ankles that displayed a greater pretest range of dorsiflexion were more likely to cavitate, raising the possibility that ligament laxity may be associated with the tendency for ankles to cavitate.

Adult↗
PubMed2003

A comprehensive pelvic dissection course improves obstetrics and gynecology resident proficiency in surgical anatomy.

OBJECTIVE: This study was undertaken to evaluate the impact of a pelvic dissection course on resident proficiency in surgical anatomy. STUDY DESIGN: Over a 1-year period, residents attended a course consisting of pretesting and posttesting, lectures, and pelvic dissection. Tests results were analyzed using paired Student t test, analysis of variance, and Kruskal-Wallis statistics. RESULTS: Of 42 residents, 24 completed all testing (study cohort). On written and practical examinations, resident scores improved a median of 42% and 29% (both P<.0001). Postgraduate year (PGY) 2 demonstrated the greatest improvement on the practical and PGY-3s demonstrated the greatest improvement on the written. Baseline written and practical results discriminated PGY level (construct validity): PGY-2=PGY-3<PGY-4 on written pretest, PGY-2<PGY-3=PGY-4 on practical pretest. No difference between resident cohorts was seen in either posttest. CONCLUSION: Resident surgical anatomy proficiency is measurably improved by a comprehensive course.

Anatomy↗
PubMed1993

Overestimation of test effects in clinical judgment.

The purpose of this study was to assess the ability of health care professionals to evaluate the effect of test results on disease risk. Fifty health care professionals, including 29 physicians and 21 nonphysicians, associated with a university hospital were studied. Subjects were presented with two hypothetical scenarios involving a common clinical situation to assess the effect of test results on the estimation of disease risk. Estimates of the pretest and posttest probability of breast cancer and mammography sensitivity and specificity were elicited for hypothetical 30- and 70-year-old patients presenting with a breast lump. There was no significant difference between physician and nonphysician probability and sensitivity estimates, although physicians provided higher specificity estimates which were more consistent with literature-derived values. Both physicians and nonphysicians consistently overestimated the risk associated with a positive test result compared to probabilities derived from Bayes' theorem based on the subject's pretest probability and sensitivity and specificity estimates, as well as standard test performance estimates. There was no significant difference between posttest probability estimates for negative test results and those derived from Bayes' theorem utilizing the subject's pretest probability and sensitivity and specificity estimates. Physicians and nonphysicians both estimate test performance characteristics accurately but consistently overestimate the effect of positive test results on the probability of disease. In addition to experience with specific clinical problems, decision making by clinicians could be enhanced by training in the formal methods of decision analysis.

Adult↗
PubMed1998

Teaching oncology and cancer care to general practice trainees in Sweden: a two-year prospective, randomized study.

OBJECTIVE: To improve general practice (GP) trainees' knowledge of and attitudes towards oncology and their management of cancer patients. METHOD: A prospective study of 33 GP trainees who, after a first assessment, were randomized either to attend a two-year cancer course (n = 17) or to a control group (n = 16). Both groups were tested at the beginning (pretest) and end (post-test) of the two years. The maximum possible score was 76. All tests were corrected blindly by an oncologist and a general practitioner. RESULTS: The intervention group showed significant post-test-pretest improvements in the domains "knowledge" (mean difference 2.6, 95% CI 1.3-3.8) and "attitudes" (mean difference 2.9, 95% CI 0.8-5.0), but not in "patient management" (mean difference 0.3, 95% CI -0.6-1.2). There was no significant change in the test scores of the controls. The total mean (post-test-pretest) differences were 8.3 (95% CI 4.9-11.6 for the intervention group and -1.4 (95% CI -4.1-1.3) for the controls. CONCLUSION: A low-intensity two-year cancer course improved the knowledge and attitudes of GP trainees. Patient management, however, was not improved and may be more suited for hospital training. The current five-year specific training in general practice in Sweden seemed to be of limited value in the field of oncology. Thus, there is a need for further development of educational tools for cancer training of GP trainees, at least in Sweden.

Clinical Competence↗
PubMedDate not supplied

Prosodic problems in Swedish children with language impairment: towards a classification of subgroups.

BACKGROUND: Symptoms of prosodic problems have been found in Swedish children with language impairment at word and phrase level and possibly also at discourse level. AIMS: The aim was twofold. First, to characterize a group of children with prosodic problems compared with children with normal language development. Second, to investigate the possibilities to classify subgroups of prosodic problems. METHODS & PROCEDURES: A new Swedish assessment procedure for prosody that captures prosodic features at word, phrase and discourse level was used. Twenty-five children with prosodic problems and 25 children with typically developing language matched by age, gender and regional dialect participated in the study. Pretesting included tests of language comprehension, grammatical skills and oral motor skills. OUTCOMES & RESULTS: The difference between the experimental and control groups was highly significant in all parts of the procedure. The total score of the procedure significantly correlated with grammatical abilities measured in the pretesting procedure, but there was no correlation with the other linguistic abilities measured in the pretesting procedure. CONCLUSIONS: The results indicate a possible differentiation into two different subgroups, one with primarily phonetic and/or linguistic problems, the other with prosodic problems at discourse level possibly related to pragmatic problems.

Case-Control Studies↗
PubMed2006

Impact of a volunteer companion program on nursing students' knowledge and concerns related to palliative care.

BACKGROUND: Deficiencies in end-of-life education may explain nursing students' reports of feeling anxious and unqualified to care for dying patients. A volunteer Palliative Care Companion program was developed to provide undergraduate nursing students with an experiential learning opportunity by spending time with dying patients and their families. OBJECTIVE: To evaluate the impact of the Palliative Care Companion program on nursing students' knowledge, attitudes, and concerns about providing palliative care, and to describe companion students' volunteer activities. DESIGN: Quasiexperimental controlled pretest-posttest design. SETTING/SUBJECTS: Fifty-two undergraduate nursing students (32 companion students, 20 controls) at a midwestern U.S. university with an affiliated hospital-based palliative care service. MEASUREMENTS: All participants completed the Palliative Care Quiz for Nurses, Attitudes Toward Palliative Care, and Concern About Caring for Dying Patients questionnaires at the beginning and end of the semester. Companion subjects also kept a journal describing their palliative care experiences. RESULTS: Attitude scores were not analyzed because of poor internal consistency of the questionnaire. Changes in scores on knowledge items did not reach significance. Concern scores decreased significantly from pretest to posttest in the companion group. After adjusting for pretest concern score, there was a trend toward lower concern score in the companion group compared to controls (p=0.07). Companion students' journals described activities including visiting patients, viewing end-of-life videos, attending educational and public lectures, independent reading, and making bereavement phone calls to family members. CONCLUSIONS: The Palliative Care Companion program did not produce significant improvements in knowledge and concerns compared to controls, but companion students described their participation as a meaningful learning experience.

Adult↗