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PubMed1985

Attrition in prevention research.

Selective attrition can detract from the internal and external validity of longitudinal research. Four tests of selective attrition applicable to longitudinal prevention research were conducted on data bases from two recent studies. These tests assessed (1) differences between dropouts and stayers in terms of pretest indices of primary outcome variables (substance use), (2) differences in change scores for dropouts and stayers, (3) differences in rates of attrition among experimental conditions, and (4) differences in pretest indices for dropouts among conditions. Results of these analyses indicate that cigarette smokers, alcohol drinkers, and marijuana users are more likely to drop out than nonusers, limiting the external validity of both studies. For one project, differential rates of attrition among conditions suggested a possible attrition artifact which will interfere with interpretation of outcome results, possibly masking true program effectiveness. Recommendations for standardizing reports of attrition and for avoiding attrition through second efforts are made.

Adolescent↗

PubMed1979

Maladapting preschool children: identification, diagnosis, and remediation.

This article evaluates a preschool intervention program conducted as a part of the Wayne State University Preschool Project. The project's aim is (a) to provide early identification of preschool age children experiencing mental health problems, and (b) to reverse the diagnosed deficiencies, particularly among high risk children. The program was evaluated with children ranging in age from 3 to 4 years, within demographically comparable regions in the Detroit School System. Pretest and posttest measures were taken on the AML Scale and the Caldwell Preschool Inventory. Pretest scores were used to establish high risk children. A prescriptive intervention program was established within one region, aimed primarily at reducing adjustment problems among high risk children. The analysis of posttest data revealed more favorable scores among experimental children when compared to control children. In addition, evidence is provided of specific benefits for high risk children in the experimental program.

Acting Out↗

PubMed1980

Residual effects of lead poisoning on Denver Developmental Screening Test scores.

Subtest and Total scores on the Denver Developmental Screening Test were examined for a grop of 22 prechool-aged low-income children who had been lead-poisoned, then medically deleaded. Pretest scores were obtained before blood lead elevations occurred; posttest scores were obtained an average of 4.5 months after deleading. Pretest scores were comparable to those of matched Control group, but posttest scores on th Fine Motor-Adaptive subtest declined, indicating significant residual effecs of lead poisoning.

Adaptation, Physiological↗

PubMed1980

Electromyographic biofeedback for tension control during fine motor skill acquisition.

The presence of residual muscular tension has been implicated as a deterimental influence on the performance and learning of motor skills. A method for reducing muscular tension has been provided by the the advent of biofeedback training. This study investigated the effects of tension-control training by electromyographic (EMG) biofeedback on learning and performance of the pursuit-rotor backing task. Thirty young adult males were pretested for pursuit-rotor (PR) tracking skill, ranked by performance scores, and divided into identical triplicates to form two experimental groups and a control group. After a total of 3 hours of EMG biofeedback training for the experimental groups, all subjects were reevaluated on the PR test. One experimental group received biofeedback during the posttests. Analysis of variance of pretest-posttest difference means and t tests of scores representing performance and tension indicated that the EMG biofeedback training (1) significantly reduced tension induced by the novel motor skill and (2) significantly improved performance of the motor skill. Transfer of tension-control training was shown to facilitate learning and performance more than direct EMG biofeedback during performance. Residual tension reduction during learning was particularly facilitated by EMG biofeedback training, a profound implication for the management of stress in a variety of situations.

Adolescent↗

PubMed1993

Facilitated communication: a failure to replicate the phenomenon.

Twenty-one subjects participated in a study of Biklen's and Crossley's hypothesis that persons with autism show unexpected literacy and improved communication ability through the process of facilitated communication (FC). Repeated measures of literacy were conducted at (a) a baseline test of communicative ability before FC; (b) a pretest with facilitation; and (c) a posttest with facilitation after 20 hours of training. At both the pretest and posttest, the facilitators were screened from hearing or seeing the questions or pictorial stimuli. Although some facilitators reported newfound communicative abilities during training sessions, no client showed unexpected literacy or communicative abilities when tested via the facilitator screening procedure, even after 20 hours of training. Separate analyses indicated that some facilitators influenced the communicative output of their clients.

Adolescent↗

PubMed2001

A prospective evaluation of the value of anorectal physiology in the management of fecal incontinence.

PURPOSE: This study was designed to determine whether anorectal physiology testing significantly altered patient management in the setting of fecal incontinence. METHODS: Patients referred to the anorectal physiology laboratory for evaluation of fecal incontinence were prospectively interviewed and examined by a colon and rectal surgeon. A decision to treat either medically or surgically was reached. The patients underwent physiologic testing with transanal ultrasound, pudendal nerve terminal motor latency, and anorectal manometry. A panel of board-certified colon and rectal surgeons then reviewed the history and physical examination, as well as the anorectal physiology tests, of each patient and reached a consensus on management. Management plans before and after physiologic evaluation were compared. RESULTS: Ninety patients (6 males) were entered into the study. The patients were divided in two groups: those with pretest medical management plans (n = 45) and those with pretest surgical management plans (n = 45). A change in management was noted in nine patients (10 percent). In the medical management group, the management changed from medical to surgical therapy in five patients. Transanal ultrasound detected anal sphincter defects in all patients who changed from medical to surgical management but in only 10 percent of those who remained under medical management (P = 0.0001). In the surgical management group, three patients (7 percent) changed from surgical to medical therapy and one patient (2 percent) changed from sphincteroplasty to neosphincter. Transanal ultrasound detected a limited anal sphincter defect in one patient (33 percent) who changed from surgical to medical management and a significant defect in all 41 patients (100 percent) who remained under surgical management (P = 0.003). CONCLUSIONS: Anorectal physiology testing is useful in the evaluation of patients with fecal incontinence. Without the information obtained from physiologic testing, 11 percent of patients who may have benefited from surgery would not have been given this option, and 7 percent of patients could have potentially undergone unnecessary surgery. Transanal ultrasound is the study most likely to change a patient's management plan.

Adult↗

PubMed1995

Effect of SB 200646A, a 5-HT2C/5-HT2B receptor antagonist, in two conflict models of anxiety.

SB 200646A is the first selective 5-HT2C/5-HT2B receptor antagonist and has previously been observed to have anxiolytic-like properties in the rat social interaction test. In the present study the effects of the compound in two conflict models of anxiety, the rat Geller-Seifter and marmoset conflict test, were examined. In the rat Geller-Seifter test, suppressed responding was increased by all doses of SB 200646A between 5 and 40 mg/kg PO when given 1 h pretest. Unsuppressed responding was slightly increased only at 10 mg/kg PO. Suppressed responding was also increased by the benzodiazepine anxiolytic, chlordiazepoxide, at 1, 2.5 and 5 mg/kg PO 1 h pretest. Unsuppressed responding was modestly increased by chlordiazepoxide only at 5 mg/kg PO. In the marmoset conflict test marmosets were trained to lever press for a palatable food reward. Lever pressing was subsequently suppressed by air puffs. In this procedure suppressed responding was increased by both the benzodiazepine anxiolytic diazepam at 2 and 5 mg/kg PO and SB 200646A after 10 and 20 mg/kg PO. Both treatments caused small increases in unsuppressed responding at 2 and 20 mg/kg PO respectively. Taken together with the previous effects of SB 200646A in the rat social interaction test, this is compelling evidence that 5-HT2C/2B receptor antagonists may possess anxiolytic properties.

Animals↗

PubMed1996

Loss of tolerance to morphine after a change in route of administration: control of within-session tolerance by interoceptive conditioned stimuli.

Tolerance to morphine analgesia (tail-immersion test) was examined after manipulation of two aspects of a tolerance test: 1) the route of drug administration and 2) the time interval between the test dosing and the tolerance test. The intravenous (IV) and intraperitoneal (IP) routes were used, together with a novel test for tolerance in which the test morphine was infused IV just 2 min before measuring the opiate effect. The first experiment validated this test as an assay for tolerance by examining the log dose-response (LDR) curve changes produced by daily IP injection with 0, 20 or 200 mg/kg morphine; the IV test confirmed the expected parallel shift to the right and flattening of the LDR curve. In the second experiment, all rats of two groups were injected once daily for 3 weeks with 20 mg/kg morphine and with saline except that one group received the morphine IV (and saline IP), the other morphine IP (saline IV). The results indicated route-specific tolerance. On a test using 20 mg/kg given IV morphine, tolerance was significantly greater in rats treated with IV morphine than in those treated IP. However, a larger effect on tolerance was produced by a pretest application of 5 mg/kg morphine 30 min before the actual tolerance test. This manipulation was designed to "prime" short-term, adaptive processes hypothesized to occur within a normal tolerance test session as morphine is taking effect. The tolerance on the test increased (equivalent to 2 to 3 fold shift in the LDR curve) when the pretest morphine was given with the same route as the chronic morphine, regardless of treatment group. It was concluded that opiate tolerance may be modulated by conditioned stimuli produced by morphine acting through different routes. These interoceptive cues appear to modulate rapidly acquired and short-lived adaptive processes taking place within a given test session.

Analgesics, Opioid↗

PubMedDate not supplied

Predicting cardiac complications in patients undergoing non-cardiac surgery.

The authors prospectively studied 455 consecutive patients referred to the general medical consultation service for cardiac risk assessment prior to non-cardiac surgery, in order to validate a previously derived multifactorial index in their clinical setting. They also tested a version of the index that they had modified to reflect factors they believed to be important. For patients undergoing major surgery, the original index performed less well in the validation data set than in the original derivation set (p less than 0.05), but still added predictive information to a statistically significant degree (p less than 0.05). The modified index also added predictive information for patients undergoing both major and minor surgery, demonstrating an area under the Receiver Operating Characteristic curve of 0.75 (95% confidence interval of 0.70 to 0.80). A simple nomogram is presented which will enable conversion of pretest probabilities into posttest probabilities using the likelihood ratios associated with each risk score. It is recommended that clinicians estimate local overall complication rates (pretest probabilities) for the clinically relevant populations in their settings before they apply the predictive properties (likelihood ratios) demonstrated in this study in order to calculate cardiac risks for individual patients (posttest probabilities).

Aged↗

PubMed1996

Effects of an inpatient geriatrics rotation on internal medicine residents' knowledge and attitudes.

OBJECTIVE: The purpose of this study is to assess the effect of a geriatrics-focused acute medicine inpatient rotation and the presence or absence of a geriatrician as attending physician on knowledge about and attitudes toward older patients and the field of geriatrics. DESIGN: Randomized trial. INTERVENTION: A 4-week acute care inpatient internal medicine rotation at a university-affiliated Veterans Affairs Medical Center; experiences included caring for acutely ill, older medical patients, interdisciplinary team meetings, geriatrics-based noon conferences, interaction with geriatrics-trained nurse practitioners, and a syllabus of readings on geriatric medicine. PARTICIPANTS: Postgraduate year 1, 2, and 3 internal medicine residents were randomly assigned to one of three groups: (1) the intervention with a geriatrics-trained internist attending (n = 44); (2) the intervention with a non-geriatrics-trained internist attending (n = 25); or (3) no exposure to the intervention (n = 24). INSTRUMENTS: Knowledge was assessed using a 35-item test. Attitudes were evaluated using a 24-item questionnaire. RESULTS: There were no differences among the three groups of residents in pretest knowledge (p = .971, analysis of variance). There was a significant difference in the changes in scores from the pretest baseline among the three groups (group 1 = .030, group 2 = .051, group 3 = -.009; p = .039). Both groups assigned to the intervention showed significant improvement in knowledge (p = .011); the presence or absence of a geriatrics-trained attending physician did not alter the results. Resident attitude scores were generally positive and did not change after the intervention. CONCLUSIONS: An intensive integrated acute medicine rotation in geriatrics improved residents' knowledge of geriatric medicine. The presence of a geriatrics-trained attending physician was not necessary for this improvement. Residents' attitudes toward geriatric medicine and their geriatrics education were generally positive and were not influenced by this experience.

Adult↗

PubMedDate not supplied

Detection of bovine viruses in fetal bovine serum used in cell culture.

This investigation employed a viral screening method detect endogenous bovine virus contaminants in commercially supplied fetal bovine serum. Fifty-one lots of fetal bovine serum from 14 suppliers were examined. Over 30% of the lots tested were found to contain bovine viruses; they included bovine virus diarrhea virus, parainfluenza type3-like virus, bovine herpesvirus-1, bovine enterovirus type 4, and an unidentified cytopathogenic agent. Of the 51 lots, 20 had been pretested by the suppliers and were considered to be free of known viral contaminants. Our viral screening methods revealed that five of these pretested lots, or 25%, contained endogenous bovine viruses.

Animals↗

PubMedDate not supplied

A model of standardized training in basic life support skills of emergency medicine residents.

This intervention study was designed to determine the current level of basic life support knowledge and skills of residents in a university-based emergency medicine residency program, and to investigate the potential benefit derived by these residents from a standardized theoretical and practical training session. All residents underwent tests before and after the training session. The residents were asked to perform basic life support on a recording cardiopulmonary resuscitation mannequin. Assessments were made using a 10-item checklist, with the highest score being 17. Each step performed by the resident was scored by an emergency physician for accuracy and effectiveness. Twenty-eight residents participated in the study. According to the modified Berden scale, the pretest and posttest scores were 11.2 +/- 2.9 and 15.6 +/- 1.0, respectively, and the mean difference was 4.36 +/- 2.9 (t test, P<.001). Only 11 residents (39.3%) were rated as "good" or "very good" in the pretest, whereas the corresponding figure in the posttest was 27 (96.4%) (P<.001). Skills, such as checking the airway patency (P<.001), checking breathing (P<.001), appropriate compression rate (P<.003), and delivering 2 effective breaths (P<.001), improved significantly. Depth of chest compression (P<.023) was improved significantly only in residents with fewer than 2 years of experience. The training process should comprise standardized courses to facilitate acquisition of the desired skills.

Adult↗

PubMed2003

[Questions about questions: cognitive survey of questionnaire development].

OBJECTIVES: Traditional pretests are used in the development of survey items to identify technical and comprehension problems. Cognitive processes involved in answering survey questions are not the object of this kind of test. METHODS: Cognitive survey methods were used here to test a questionnaire screening for rehabilitation needs in people suffering from back pain. Essential techniques of cognitive testing (think-aloud, probing, confidence ratings) are outlined. We applied these techniques to 20 patients suffering from either acute or chronic back pain in order to test the survey. RESULTS: The main goal, i.e., identifying problems in item formulation by means of cognitive testing, was achieved. Almost one third of the survey questions were rephrased according to the results of the study. Some of the improvements of the questionnaire are illustrated. CONCLUSIONS: The increased effort required to perform cognitive testing as compared to traditional pretesting pays off. The two methods have specific pros and cons and cannot replace one another.

Adult↗

PubMed2006

[Chronic stable angina pectoris. A comparison of diagnostic pathways].

Against the background of a variety of international guidelines and a national disease management program for patients with coronary heart disease, a national health-care guideline for the management of patients with chronic ischemic heart disease ("Nationale VersorgungsLeitlinie Chronische KHK [NVL KHK]") was first published in Germany in 2006. This guideline is an interdisciplinary initiative of several German health-care authorities and medical societies. Because of the limited diagnostic sensitivity of about 70% only, and a high percentage of patients, who are unable to exercise, a negative stress ECG can definitely not exclude hemodynamically significant coronary heart disease. Therefore, the well-known evidence-based algorithms of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for noninvasive stress testing and complementary stress imaging were newly adopted by the NVL KHK. In flow charts for patients with suspected or already known chronic ischemic heart disease, the essential importance of stress imaging is depicted on different levels of decision. Stress imaging methods considered comparable and interchangeable are: stress echocardiography combined with physical or pharmacological stress testing, myocardial perfusion imaging with physical or pharmacological stress testing, dobutamine stress magnetic resonance imaging (DSMR), or myocardial perfusion magnetic resonance tomography (MRT). Basically, no stress imaging method is definitely superior to the others, each method has its own advantages and disadvantages that should be considered and adjusted to the individual patient. Moreover, the NVL KHK gives the recommendation that with the decision for one method also the local availability and institutional expertise of diagnostic centers should be taken into account. However, according to the Bayes theorem, stress imaging combined with physical or pharmacological stress testing is only indicated in patients with an intermediate pretest probability for chronic ischemic heart disease between 10% and 90%. However, the assessment of the pretest probability is difficult or impossible in totally asymptomatic patients with suspected chronic ischemic heart disease. This is exemplified by a typical case report.

Angina Pectoris↗

PubMed2004

Impaired quality of life in patients commencing radiotherapy for cancer.

BACKGROUND: This study tested a three-item questionnaire to measure global quality of life (QOL) and pain in patients commencing radiotherapy, based on items from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 instrument. PATIENTS AND METHODS: In a pretest, the EORTC QLQ-C30 and the three-item short questionnaire were administered to 100 patients, yielding similar global QOL and pain scores. After the pretest, the three-item questionnaire was administered to 1,837 patients prior to first radiotherapy treatment. RESULTS: 254 (13.8%) patients with impaired QOL were identified. These patients had a mean global QOL score of 32.6 compared to 72.4 (p < 0.001) found in patients with satisfactory QOL. Patients with impaired QOL were also more likely < 60 years and treated for lung, gastrointestinal or head and neck cancer or advanced, metastatic cancer. CONCLUSION: This brief questionnaire addresses important aspects of QOL, is feasible to use in a clinical setting and therefore represents a potentially useful tool for detecting those patients who may benefit from further evaluation and/or psychosocial support.

Adolescent↗

PubMed2005

Effects of morphine on the plus-maze discriminative avoidance task: role of state-dependent learning.

RATIONALE: The amnesic effects of morphine may be related to its action on nociception, anxiety, or locomotion. This effect is also suggested to be related to state dependency. OBJECTIVES: The aims of this study were to verify the effects of morphine on mice tested in the plus-maze discriminative avoidance task (DAT) that uses light and noise as aversive stimuli and allows the concomitant evaluation of learning, memory, anxiety, and locomotion and also to verify the possible role of state-dependent learning in the effects of morphine. METHODS AND RESULTS: The DAT was conducted in a modified elevated plus-maze. In the training, the aversive stimuli were applied when mice entered in one of the enclosed arms, whereas in the test, no stimuli were applied. The main results showed that (1) pretraining morphine (5-20 mg/kg i.p.) induced retrieval deficits (evaluated by the time spent in the aversive arm in the test) but not acquisition deficits (evaluated by the decrease in aversive arm exploration along the training); (2) pretest morphine (5-10 but not 20 mg/kg) counteracted this deficit; (3) morphine induced hypolocomotion (decreased number of entries in the arms), irrespective of memory alterations; and (4) morphine did not alter anxiety-like behavior (evaluated by the time spent in the open arms) during the training. CONCLUSIONS: Morphine given before training induces retrieval deficits in mice tested in the DAT, and these deficits could be related to morphine-induced state-dependent learning. Neither the memory deficit induced by pretraining morphine nor the reversal of this deficit by pretest morphine seems to be related to anxiety levels or locomotor alterations.

Animals↗

PubMed2006

Cognitive predictors of skill acquisition on social problem solving in patients with schizophrenia.

The aim of the study was to evaluate the relationship between social problem solving ability, clinical features and cognitive functions, and determine the predictors of benefit from social problem solving training in 63 patients with schizophrenia. We administered Brief Psychiatric Rating Scale (BPRS), Wisconsin Card Sorting Test (WCST), Digit Span Test, Continuous Performance Test (CPT) and the Assessment of Interpersonal Problem Solving Skills (AIPSS). Only BPRS-positive symptoms subscale was negatively related to AIPSS on linear regression analysis. After the completion of the pretest, the patients were randomized to either problem solving training (n = 32) or control groups (n = 31). Patients in training group received 6 weeks problem solving training in-group modality, and those in control group were treated as usual. We readministered AIPSS at the end of 6 weeks. There were significant changes from pretest to posttest on AIPSS-total, AIPSS-receiving skills, and AIPSS-processing skills score in training group but not in control group. The number of correct answers in WCST and CPT hit rate were the predictors of post-training AIPSS scores in training group. Our findings suggest that skill acquisition on social problem solving is related with cognitive flexibility and sustained attention.

Adolescent↗

PubMed2002

The role of practice and automaticity in temporal and nontemporal dual-task performance.

Research on time and attention shows that a nontemporal task may interfere with a concurrent timing task by making time judgments shorter, more variable, and/or more inaccurate compared to timing-only conditions. Brown (1998, Psychological Research, 61, 71-81) counteracted the interference effect by giving subjects automaticity training on a nontemporal task to reduce the amount of processing resources the task required. Such practice attenuated interference in timing. Two new experiments were designed to replicate and extend the previous findings. Subjects generated a series of 5-s temporal productions under single-task (timing only) and dual-task (timing plus nontemporal task) conditions. The nontemporal tasks were pursuit rotor tracking (Experiment 1), and mirror-reversed reading (Experiment 2). We employed a pretest-practice-posttest paradigm, with the practice sessions devoted to performance of the nontemporal task. Pretest-posttest comparisons showed that practice reduced interference in timing in both experiments. Dual-task probe trials were given during the practice sessions to trace the time course of the improvement in timing. The results showed that interference in timing was reduced with even small amounts of practice. The findings support the idea that timing is very sensitive to changes in the allocation of attentional resources.

Adolescent↗