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At least 703 records · Page 39Linked to original sources
PubMed2000

The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling.

The SWAL-QOL outcomes tool was constructed for use in clinical research for patients with oropharyngeal dysphagia. The SWAL-QOL was constructed a priori to enable preliminary psychometric analyses of items and scales before its final validation. This article describes data analysis from a pretest of the SWAL-QOL. We evaluated the different domains of the SWAL-QOL for respondent burden, data quality, item variability, item convergent validity, internal consistency reliability as measured by Cronbach's alpha, and range and skewness of scale scores upon aggregation and floor and ceiling effects. The item reduction techniques outlined reduced the SWAL-QOL from 185 to 93 items. The pretest of the SWAL-QOL afforded us the opportunity to select items for the ongoing validation study which optimally met our a priori psychometric criteria of high data quality, normal item distributions, and robust evidence of item convergent validity.

Aged↗
PubMed2006

A randomized controlled trial of simulation-based teaching versus traditional instruction in medicine: a pilot study among clinical medical students.

OBJECTIVE: To compare simulator-based teaching with traditional instruction among clinical medical students. METHODS: Randomized controlled trial with written pre-post testing. Third-year medical students (n = 38) received either a myocardial infarction (MI) simulation followed by a reactive airways disease (RAD) lecture, or a RAD simulation followed by an MI lecture. RESULTS: Mean pre-post test score improvement was seen across teaching modalities (overall change score [simulation] = 8.8 [95% CI = 2.3-15.3], pretest [62.7]; change score [lecture] = 11.3 [95% CI = 5.7-16.9], pretest [59.7]). However, no significant differences were observed between simulator-based teaching and lecture, in either subject domain. CONCLUSIONS: After a single instructional session for clinical medical students, differences between simulator-based teaching and lecture could not be established by the written test protocols used in this pilot. Future studies should consider the effects of iterative exposure assessed by clinical performance measures across multiple centers.

Clinical Clerkship↗
PubMed2005

Methods to detect response shift in quality of life data: a convergent validity study.

When measuring changes in quality of life (QL) with a pretest-posttest design, response shift can affect results. We investigated the convergent validity of three approaches to detect response shift. (1) In the thentest approach, response shift is measured using a retrospective judgment of pretest QL-levels (thentest). (2) In the anchor-recalibration approach response shift is measured, assessing shifts in patients' individual definitions of the scale-anchors (worst and best imaginable QL) over time. (3) In the Structural Equation Modeling (SEM) approach response shift is indicated by mathematically defined changes in factor solutions and variance-covariance matrices over time. Prior to and three months after invasive surgery, 170 cancer patients completed the SF-36, the Multidimensional Fatigue Inventory (as pre-, post-, and thentest), and the anchor-recalibration task (as pre-, and posttest). Results showed agreement between the thentest and SEM approach on the absence (6 scales) and presence (2 scales) of response shift in 8 of the 9 scales. For the ninth scale both methods detected response shift, but in opposite directions. Possible explanations for this discrepancy are discussed. The anchor-recalibration task agreed with the other approaches on only the absence of response shift in 4 of the 7 scales. The convergent results of thentest and SEM support their validity, especially because they use statistically independent operationalizations of response shift. In this study, recall bias did not invalidate thentest results.

Activities of Daily Living↗
PubMed2005

Development and validation of a new health-related quality of life instrument for patients with sinusitis.

BACKGROUND AND OBJECTIVE: There are few validated measures of sinusitis-specific health-related quality of life (HRQL). This study used patient focus and pretesting groups followed by a prospective cohort study to develop and validate a HRQL instrument for patients with sinusitis. METHODS: Instrument development involved a systematic literature review, use of expert input, and patient focus and pretesting groups. Patients were recruited from the practices of primary care providers and otolaryngologists. The derived survey instrument then underwent prospective testing in patients with acute sinusitis, chronic sinusitis, allergic rhinitis, and asymptomatic controls. Reduced item scales of the original instrument were developed for symptom frequency and bothersomeness. The psychometric properties of the survey instrument were evaluated for reliability, construct validity, responsiveness, and interpretability. RESULTS: In the prospective study, 47 patients with acute sinusitis and 50 patients with chronic sinusitis were compared to 18 patients with allergic rhinitis and 60 patients without nasal symptoms. Forty-three (91.5%) patients with acute sinusitis completed the questionnaire at baseline and at 1-month follow-up. Internal consistency was high for the symptom impact scale for acute and chronic sinusitis patients. The symptom frequency and especially bothersomeness scales had lower internal consistency particularly for acute sinusitis patients. Reproducibility among surgical patients retested prior to their procedure was good for each scale. A high degree of disciminant validity was demonstrated when comparing sinusitis patients to other groups, and a high degree of convergent validity was seen when the new measures were compared to other HRQL measures at baseline. Among patients with acute sinusitis, the responsiveness and interpretability of the symptom frequency, bothersomeness and impact scales were excellent. CONCLUSIONS: This study developed and validated a new sinusitis-specific HRQL instrument. The instrument included symptom frequency, bothersomeness and impact scales. It was shown to be valid in patients with acute and chronic sinusitis, and highly responsive and interpretable in acute sinusitis patients managed in the primary care setting.

Acute Disease↗
PubMed2005

Sleep problems and the risk for sleep disorders in an outpatient veteran population.

We used a self-report questionnaire to identify outpatients with chronic symptoms of sleep disorders and/or high pretest probability for sleep apnea as well as for restless legs syndrome (RLS), insomnia, and narcolepsy. Surveys were presented to patients waiting for an appointment in Veterans Administration (VA) Medical Center clinics in Northeast Ohio, USA. Items addressed the frequency of snoring behavior; wake time sleepiness or fatigue and history of obesity/hypertension for high risk for sleep apnea (Netzer et al. 1999), along with other symptoms, were scored as positive vs negative risk for insomnia, narcolepsy, and RLS. Of the patients offered the surveys, 886 (59.2%) provided timely responses to the questionnaire. Mean age was 62.5 years (range, 19 to 85 years); 95% were males; mean body mass index was 29.3 kg/cm(2) (range, 15.1 to 57.5 kg/cm(2)); and mean Epworth Sleepiness Scale score was 8.3 (range, 1 to 22) with 4.6% having a score >17. Of the respondents, 47.4% met high-risk criteria for sleep apnea, 41.7% for insomnia, 19% for restless leg syndrome, and 4.7% for narcolepsy. Twenty-four percent reported use of sleeping pills or bedtime alcohol. Drowsy driving >3-4 days a week or every day was reported in 5.7%. VA primary care patients have high prevalence for pretest probability for sleep apnea. This population also reports chronic symptoms for other sleep disorders and for drowsy driving.

Adult↗
PubMed2005

Sleep symptoms and clinical markers of illness in patients with heart failure.

The purpose of this study was to survey patients with heart failure (HF) for sleep symptoms using a standardized questionnaire and correlate symptoms with conventional markers of clinical status. A self-report paper questionnaire was offered to patients presenting to a tertiary care HF clinic. Symptoms were grouped according to "risk" categories and correlated with routine clinical information. One hundred six (52.7% of 201 with all data) respondents had a high pretest probability for sleep apnea syndrome. Sixty three (31.3%) reported symptoms suggesting the presence of chronic insomnia; seven (3.5%) and eight (4%) reported symptoms of narcolepsy and restless legs syndrome, respectively. High-risk respondents for sleep apnea had a higher body mass index (p<0.001), were younger (p<0.05), and had a higher ejection fraction (p<0.05). The odds ratio (confidence interval) for paroxysmal nocturnal dyspnea (PND) to a complaint of sleepiness was 1.99 (1.1-3.6) and to a complaint of insomnia was 3.5 (1.8-6.5). In men, complaints of sleepiness in patients with PND were correlated, 4.47 (1.9-10.3), as was a correlation to high pretest probability for sleep apnea, 2.47 (1.1-5.5). There were no correlation of New York Heart Association status classification to high risk for sleep apnea, but a complaint of insomnia tended to occur with worsening functional status (p<0.05). There was only modest correlation of self-reported symptoms as elicited by a questionnaire and risk for sleep disorders with common clinical assessments for HF. Such collection of symptoms might be useful in establishing guidelines for routine sleep testing or as an adjunct to clinical trials.

Adolescent↗
PubMed1994

A food-safety curriculum for second- and third-grade elementary students.

OBJECTIVE: To create and implement a food-safety curriculum for second- and third-grade elementary students. DESIGN/SUBJECTS: One pilot study and one expanded study were conducted in two elementary schools (106 students) and nine elementary schools (455 students), respectively. In both studies the subjects selected were determined by their enrollment in the classes. The expanded program targeted third-grade students and fourth-grade students in the English as a Second Language program in ethnically and racially diverse areas. INTERVENTION: An educational curriculum entitled "Discovering Food Safety--Detective Mike Robe's Fantastic Journey" was administered to the target audiences. OUTCOME MEASURES: A pretest and a posttest containing the same questions were delivered to the students before and after curriculum administration. Students were not given the answers to the questions, that is, the graded tests were not returned. Different evaluation sheets were designed for students and teachers and the program was rated using a hedonic scale. STATISTICAL ANALYSES: Results were analyzed using the Student's t test. RESULTS: Pretests and posttests were administered in each study. Test scores increased significantly in the expanded study and the pilot study after the programs were implemented. Student and teacher evaluations indicated that they were extremely satisfied with the curriculum. APPLICATIONS/CONCLUSIONS: A food-safety curriculum was designed that met the needs of the target audience and had successful results. The program appeared to be effective for populations of diverse backgrounds.

Child↗
PubMed1995

Prognostic value of predischarge dipyridamole technetium 99m sestamibi myocardial tomography in medically treated patients with unstable angina.

Recently developed unstable angina clinical practice guidelines have recommended risk stratification with dipyridamole thallium-201 myocardial imaging in patients at "intermediate" pretest clinical risk who cannot exercise maximally. The prognostic value of predischarge dipyridamole technetium 99m sestamibi (MIBI) tomography has not been assessed in this clinical setting. To this end, 128 medically treated patients with unstable angina at intermediate pretest clinical risk underwent follow-up for 16 +/- 11 (mean +/- SD) months after predischarge intravenous dipyridamole MIBI tomography. An abnormal MIBI scan result was present in 99 patients (77%), of whom 47 had one or more reversible and 76 had one or more fixed perfusion defects. Cardiac events occurred in 68 (53%) patients after dipyridamole testing: recurrent unstable angina (n = 36), nonfatal acute myocardial infarction (n = 6), or death (n = 26). A cardiac event occurred in 10% of patients with normal MIBI tomography results compared with 69% of those with abnormal results (p < 0.01). Event rates associated with specific perfusion defects were similar (reversible = 68%; fixed = 71%) and were greater than rates in patients without defects (both p < 0.05). Clinical variables associated with increased risk of cardiac events by univariate analysis included a history of congestive heart failure, prior myocardial infarction, and diabetes mellitus (all p < 0.05). Independent multivariable predictors (Cox proportional hazards model) of any cardiac event were an abnormal result of MIBI scan (relative risk [RR] = 4.3, 95% confidence interval [CI] 1.5 to 12.0) and a reversible (RR = 1.8, 95% CI 1.1 to 2.9) or a fixed perfusion defect (RR = 2.9, 95% CI 1.6 to 5.4).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1984

Bayesian analysis using Fourier transforms of thallium-201 scintiscans to predict the presence of coronary artery disease.

Bayes' theorem of conditional probability was applied to the diagnosis of coronary artery disease (CAD) using thallium-201 scintigraphy as the testing procedure. Thallium-201 scintiscans were evaluated with a discriminant function previously developed using the amplitude coefficients of the Fourier transforms of the scans. The technique was applied prospectively to a population of 100 patients undergoing diagnostic coronary arteriography and thallium-201 scintigraphy, including 83 patients with CAD (70% or greater stenosis of luminal diameter) and 17 control subjects. A pretest probability of CAD was determined for each patient from the patient's age, sex and anginal symptoms. The pretest probability was combined with the patient's discriminant score to determine a posttest probability for CAD. For patients with CAD, the mean posttest probability was 0.85. Moreover, 57 of 83 patients (69%) had posttest probabilities exceeding 90%, including 40 patients (48%) with posttest probabilities exceeding 99%. For control subjects, the mean posttest probability was 0.19, with 11 of 17 (65%) having a posttest probability of less than 10%. Overall, 68 subjects had a posttest probability either less than 10% or more than 90% of which 63 were correctly classified (93%). Using a 50% posttest probability as a cutoff for classification, the technique has an 89% sensitivity, an 82% specificity and an overall accuracy of 88%. Therefore, this method objectively distinguishes patients with CAD from control subjects and provides a measure of the certainty of diagnosis. In addition, the discriminant function avoids the problem of inter- and intraobserver variability in visually interpreting thallium-201 scans.

Adult↗
PubMed1992

Prognostic implications of a negative dipyridamole-thallium scan: results in 360 patients.

PATIENTS AND METHODS: A total of 360 patients with either normal perfusion (314) or fixed defects (46) on dipyridamole-thallium scans were followed over an average period of 16 months. Of the 360 patients, 194 subsequently underwent major noncardiac surgery. RESULTS: There were a total of eight cardiac events including two postoperative complications (one fatal and one nonfatal myocardial infarction) and six cardiac events during long-term follow-up (one sudden death and five nonfatal infarctions). During the follow-up period, three patients underwent coronary artery bypass surgery. The low cardiac event rate could not be explained by a low pretest likelihood of coronary artery disease: 77% of the 360 patients had either typical angina pectoris, a previous myocardial infarction, or peripheral vascular disease, which is associated with a high prevalence of coronary artery disease. CONCLUSIONS: In patients with a high pretest likelihood of coronary artery disease, the absence of thallium redistribution on a dipyridamole-thallium scan denotes a very low (1%) cardiac risk for major noncardiac surgery as well as low long-term cardiac mortality (0.3%) and morbidity (1.4%) rates. The coronary death rate is comparable to that of patients with minimal (less than 50%) coronary stenoses.

Clinical Protocols↗
PubMed1980

Evaluation of student performance in a multi-site clinical clerkship.

A method for examining the equivalency of student performance in multi-site clinical clerkships is presented. Six student performance variables within the clerkship are explored: pretest, posttest, oral examination, presentation of a subject review, general clinical performance, and patient write-ups. Student achievement on two external examinations (a University of Washington School of Medicine third-year comprehensive examination and the Part II examination of the National Board of Medical Examiners) is reviewed and compared. This method applied to an obstetrics and gynecology clerkship at the University of Washington reveals no significant differences in student performance among sites on the pretest, oral examination, and both external examinations, but there were differences on four internal measures (posttest, presentations, write-ups, and clinical ratings). The use of this information for clerkship improvement and faculty development is described.

Clinical Competence↗
PubMed1985

Strength training effect in young and aged women.

The purpose of this study was to compare the effects of isometric strength training of the nondominant left abductor digiti minimi muscles of young and aged women. The ten young subjects, mean age 22.6 years, were all nursing students. The ten older subjects, mean age 69.2 years, did not constitute a similar homogeneous group, although they all lived in the metropolitan area of Richmond, VA. All subjects were volunteers. Training consisted of each subject performing 20 maximal isometric contractions of the left abductor digiti minimi three times weekly for six weeks. A pretest and six weekly measurements of strength were made on a strain gauge. Significant strength increases were found for the pretest-posttest measurements within each group at the same p less than 0.0001 level. When both groups were compared on the initial strength measurement and on the six weekly measurements, no statistically significant differences were found. Therefore, the null hypothesis was accepted.

Adult↗
PubMed1992

Exercise testing and training of persons with dysvascular amputation: safety and efficacy of arm ergometry.

Recent studies indicate that most persons with dysvascular amputation also have moderate to severe cardiovascular disease with impairment in functional capacity. This may limit the ability to achieve optimal function with their prosthesis because of inadequate conditioning. We developed an exercise testing and training program using arm ergometry in conjunction with standard rehabilitation for persons with acute dysvascular amputation who were profoundly deconditioned after complicated perioperative courses. The program consisted of daily arm ergometry, performed on an interval basis, at an intensity individually optimized through exercise testing. Twenty-five patients, with a mean age of 63 years, completed the inpatient program with pretest and discharge work performance assessment. There was no significant difference between pretest and discharge assessment of baseline or peak heart rate, systolic blood pressure, diastolic blood pressure, or Borg rating of perceived exertion. Peak systolic blood pressure was elevated at discharge compared to admission testing (p less than .04). Heart rate responses were decreased during the early stages of testing when comparing discharge telemetry to admission findings. The duration of exercise increased from 12.6 minutes to 16.3 minutes (p less than .0004), and the maximum work output increased from 17.1 watts to 23.5 watts (p less than .0004). There was no significant morbidity associated with either arm ergometry testing or the exercise program. We conclude that arm ergometry testing and training is a safe and effective method for improving the efficiency of arm work in the patient with acute dysvascular amputation.

Aged↗
PubMedDate not supplied

Treatment of generalized social phobia: results at long-term follow-up.

This study investigated the long-term follow-up effectiveness of (cognitive-) behavioural group and individual treatments for generalized social phobia. Patients were reassessed 18 months after they had finished one of the following treatment packages: (1) exposure in vivo; (2) cognitive therapy followed by exposure in vivo; or (3) a cognitive-behavioural treatment in which both strategies were integrated from the start. Half of the patients were individually treated, the other half in a group. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs on the patients who completed the long-term follow-up (n = 50) demonstrated significant time effects, indicating lasting improvement compared with the pretest. Between the posttest and the 18-month follow-up no significant changes were observed. ANCOVAs either with the pretest or the posttest as covariate showed a significant interaction at 18-month follow-up between treatment package and treatment modality on three of the four compound outcome variables. The group treatment with exposure in vivo alone had been the most effective in the longer term, the integrated group treatment the least effective, while the individual treatments had given improvements in-between. Results are qualified in view of numbers of dropouts, additional treatments in the respective treatment conditions, and clinical relevance.

Cognitive Behavioral Therapy↗
PubMed1995

Effects of scopolamine infusions into the anterior and posterior cingulate on passive avoidance and water maze navigation.

We examined the role of anterior and posterior cingulate cortical muscarinic receptors in water maze spatial learning and passive avoidance. Pretraining and posttraining trial scopolamine (a mixed a muscarinic acetylcholine antagonist) infusions into the anterior cingulate cortex dose dependently (3 no effect; 10 and 30 micrograms impaired) impaired passive avoidance performance. Pretesting infusion into the anterior cingulate had no effect on passive avoidance. Scopolamine infusion into the anterior cingulate did not impair spatial navigation. On the contrary, scopolamine (3 micrograms no effect, 10 and 30 micrograms impaired) infusions into the posterior cingulate before daily training trials impaired water maze navigation to a hidden platform, but did not affect navigation to a visible escape platform or passive avoidance. Posttraining and pretesting infusion into the posterior cingulate did not impair WM spatial navigation. The present results indicate that muscarinic acetylcholine receptor antagonist may modulate passive avoidance performance via cholinergic receptors located in anterior cingulate cortex and the ability to develop a spatial navigation strategy via muscarinic receptors located in posterior cingulate.

Analysis of Variance↗
PubMed1995

Involvement of benzodiazepine/GABA-A receptor complex in ethanol-induced state-dependent learning in rats.

State-dependent learning (SDL) induced by ethanol (EtOH) was investigated on the step-through passive avoidance task in rats. Pretraining injection of EtOH dose-dependently reduced step-through latency in the test session 24 h after the training. Injection of EtOH (1.0 g/kg) before both the training and test sessions, however, failed to reduce the latency. These results show that EtOH produces SDL. The failure of learning performance in SDL (dissociation in SDL) induced by EtOH was blocked by bicuculline, Ro15-4513 and picrotoxin injected before the training session. The success of learning performance in SDL (non-dissociation in SDL) induced by EtOH was also blocked by bicuculline, Ro15-4513 and picrotoxin injected before the test session. The antagonism of Ro15-4513 against EtOH was blocked by flumazenil. In the substitution test, pretest injection of EtOH produced non-dissociation in SDL in the both of pretraining diazepam-and muscimol-treated rats. On the other hand, neither pretest injection of diazepam nor muscimol produced non-dissociation in the pretraining EtOH-treated rats: asymmetrical cross-substitution between EtOH and diazepam and between EtOH and muscimol was observed. These results suggest that the EtOH-induced SDL is partially mediated by the benzodiazepine (BDZ)/GABA-A receptor complex.

Animals↗
PubMed1996

Effects of combined block of alpha 1-adrenoceptors and NMDA receptors on spatial and passive avoidance behavior in rats.

The present study was designed to investigate the interactions between alpha 1-adrenoceptors and NMDA receptors in modulating spatial navigation and passive avoidance behavior in rats. Pretraining treatment with prazosin, and alpha 1-adrenoceptor antagonist, at 2 mg/kg i.p., impaired acquisition performance in a water maze navigation test and had no effect on passive avoidance behavior. Posttraining and pretest injections of prazosin had no effect on water maze or passive avoidance behavior. Pretraining treatment with ((+/-))-3-(2-carboxypiperazin-4-yl)-propyl-1-phosphonic acid (CPP), a competitive NMDA receptor antagonist, does dependently (3 and 10 mg/kg) impaired passive avoidance and water maze behavior. Posttraining treatment with CPP had no effect on water maze and passive avoidance behavior. A pretraining combination of subthreshold doses of CPP (1 mg/kg) and prazosin (1 mg/kg) impaired water maze behavior. A combination of subthreshold doses of CPP (3 mg/kg) and prazosin (1 mg/kg) injected posttraining or pretest had no marked effect on water maze or passive avoidance performance. A control experiment showed that CPP 3 mg/kg or CPP 1 mg/kg and prazosin 1 mg/kg injected pretraining had no effect on cue navigation to a clearly visible platform, but CPP 10 mg/kg markedly impaired performance. The present results indicate that alpha 1-adrenoceptors and NMDA receptors may synergistically regulate acquisition of spatial navigation performance. Therefore, it would be interesting to study the effects of combined stimulation of alpha 1-adrenoceptors and NMDA receptors on age-related memory defects.

Adrenergic alpha-Antagonists↗
PubMed1994

Effect of chronic administration of selective 5-hydroxytryptamine and noradrenaline uptake inhibitors on a putative index of 5-HT2C/2B receptor function.

Chronic treatment with selective 5-HT reuptake inhibitors (SSRI) are therapeutic in obsessive compulsive disorder, depression, anxiety, bulimia nervosa and migraine. In the present study the possibility that SSRI's act by desensitizing 5-HT2C/5-HT2B receptors was assessed using a putative in vivo model of 5-HT2C/5-HT2B receptor function, mCPP-induced hypolocomotion. mCPP (2, 4 and 6 mg/kg i.p. 20 min pretest) reduced locomotion and rears in rats treated acutely or chronically with saline. Acute oral administration of the SSRI's fluoxetine (10 mg/kg), paroxetine (10 mg/kg), or clomipramine (70 mg/kg) or the noradrenaline reuptake inhibitor, desipramine (10 mg/kg), all 1 hr pretest, did not prevent mCPP-induced hypolocomotion. In contrast, chronic treatment with the SSRI's paroxetine and fluoxetine (both 10 mg/kg p.o. daily x 21 days), significantly attenuated the effect of mCPP (4 and 6 mg/kg i.p.) on locomotion and rears 24 hr after the last pretreatment dose. Chronic clomipramine (70 mg/kg p.o. daily x 21 days) also significantly attenuated the effect of mCPP (4 mg/kg i.p.) on rears and tended to reduce the hypolocomotor response. However, chronic treatment with desipramine, (10 mg/kg p.o. daily x 21) had no effect on any of the parameters measured. As chronic fluoxetine and paroxetine did not reduce brain mCPP levels (determined by HPLC 30 min after 4 mg/kg i.p.) the results suggest that chronic SSRI's, but not desipramine, reduce 5-HT2C/5-HT2B receptor responsivity. If this occurs in man, it may mediate or contribute to their reported therapeutic efficacy in depression, anxiety, bulimia, migraine and alcoholism. It may also be of particular relevance to their unique efficacy in OCD.

Animals↗