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PubMed2003

[The Boratav Depression Screening Scale (Bordepta): a sensitive scale for recognizing depression in epidemiologic studies and primary health care].

OBJECTIVE: To develop a sensitive scale able to recognize depression in epidemiological surveys and primary health care. METHOD: The research was designed as an initial preliminary investigation followed by two subgroup studies. The preliminary study involved the selection of queries that would constitute the scale, based on the rule of brief reply. The first sub-study was intended to test the reliability and validity of the developed scale in a group of patients previously diagnosed with depressive disorder (n=60) and/or generalized anxiety disorder (n=61). The second sub-study aimed to determine the sensitivity, specificity and appropriate cut-off points of the scale, based on results obtained from non-psychiatric patients (n=96) and normal subjects (n=7). RESULTS: Item analysis showed a significant correlation varying from 0.501 to 0.729 between each item and total scale score. The Cronbach alpha value of the scale was 0.9005. Clinician-oriented vs. self report rating reliability correlation coefficient values were 0.534 to 0.850 (Kappa) and 0.856 (Pearson) for items and total scale score respectively. The concurrent validity of the scale as correlated with The Beck Depression Inventory and Trait Anxiety Scale were 0.812 and 0.763 respectively. The discriminant validity of items in terms of P values determined by chi-square testing was 0.021 to 0.0001. The sensitivity and specificity of the scale were 97.6% and 82% respectively at a cut-off point of 6.5, and 85.7% and 95.1% at 7.5. CONCLUSION: Boratav depression screening scale is valid and reliable, including optimal sensitivity and specificity for recognizing depression in epidemiologic studies and primary health care.

Adult↗
PubMed2002

The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module.

BACKGROUND: The Pediatric Quality of Life Inventory (PedsQL) is a modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents ages 2-18 years. The PedsQL 4.0 Generic Core Scales are multidimensional child self-report and parent proxy-report scales developed as the generic core measure to be integrated with the PedsQL disease specific modules. The PedsQL Multidimensional Fatigue Scale was designed to measure fatigue in pediatric patients. The PedsQL 3.0 Cancer Module was designed to measure pediatric cancer specific HRQOL. METHODS: The PedsQL Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module were administered to 339 families (220 child self-reports; 337 parent proxy-reports). RESULTS: Internal consistency reliability for the PedsQL Generic Core Total Scale Score (alpha = 0.88 child, 0.93 parent report), Multidimensional Fatigue Total Scale Score (alpha = 0.89 child, 0.92 parent report) and most Cancer Module Scales (average alpha = 0.72 child, 0.87 parent report) demonstrated reliability acceptable for group comparisons. Validity was demonstrated using the known-groups method. The PedsQL distinguished between healthy children and children with cancer as a group, and among children on-treatment versus off-treatment. The validity of the PedsQL Multidimensional Fatigue Scale was further demonstrated through hypothesized intercorrelations with dimensions of generic and cancer specific HRQOL. CONCLUSIONS: The results demonstrate the reliability and validity of the PedsQL Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module in pediatric cancer. The PedsQL may be utilized as an outcome measure in clinical trials, research, and clinical practice.

Activities of Daily Living↗
PubMed2006

Scale of interest versus scale of estimation: comparing alternative estimators for the incremental costs of a comorbidity.

We investigate how the scale of estimation in risk-adjustment models for health-care costs affects the covariate effect, where the scale of interest for the covariate effect may be different from the scale of estimation. As an illustrative example, we use claims data to estimate the incremental costs associated with heart failure within one year subsequent to myocardial infarction. Here, the scale of interest for the effect of heart failure on costs is additive. However, traditional methods for modeling costs use predetermined scale of estimation - for example, ordinary least squares (OLS) regression assumes an additive scale while log-transformed OLS and generalized linear models with log-link assume a multiplicative scale of estimation. We compare these models with a new flexible model that lets the data determine the appropriate scale of estimation. We use a variety of goodness-of-fit measures along with a modified Copas test to assess robustness, lack of fit, and over-fitting properties of the alternative estimators. Biases up to 19% in the scale of interest are observed due to the misrepresentation of the scale of estimation. The new flexible model is found to appropriately represent the scale of estimation and less susceptible to over-fitting despite estimating additional parameters in the link and the variance functions.

Bias↗
PubMed1988

Avian scale development: XI. Immunoelectron microscopic localization of alpha and beta keratins in the scutate scale.

Epithelial-mesenchymal interactions play important roles in morphogenesis, histogenesis, and keratinization of the vertebrate integument. In the anterior metatarsal region of the chicken, morphogenesis results in the formation of distinct overlapping scutate scales. Recent studies have shown that the dermis of scutate scales is involved in the expression of the beta keratin gene products, which characterize terminal differentiation of the epidermis on the outer scale surface (Sawyer et al.: Dev. Biol. 101:8-18, '84; Shames and Sawyer: Dev. Biol. 116:15-22, '86; Shames and Sawyer: In A.A. Moscona and A. Monroy (eds), R.H. Sawyer (Vol. ed): Current Topics in Developmental Biology. Vol. 22: The Molecular and Developmental Biology of Keratins. New York: Academic Press, pp. 235-253, '87). Since alpha and beta keratins are both found in the scutate scale and are members of two different multigene families, it is important to know the precise location of these distinct keratins within the epidermis. In the present study, we have used protein A-gold immunoelectron microscopy with antisera made against avian alpha and beta keratins to specifically localize these keratins during development of the scutate scale to better understand the relationship between dermal cues and terminal differentiation. We find that the bundles of 3-nm filaments, characteristic of tissues known to produce beta keratins, react specifically with antiserum which recognizes beta keratin polypeptides and are found in the embryonic subperiderm that covers the entire scutate scale and in the stratum intermedium and stratum corneum making up the platelike beta stratum of the outer scale surface. Secondly, we find that 8-10-nm tonofilaments react specifically with antiserum that recognizes alpha keratin polypeptides and are located in the germinative basal cells and the lowermost cells of the stratum intermedium of the outer scale surface, as well as in the embryonic alpha stratum, which is lost from the outer surface of the scale at hatching. The alpha keratins are found throughout the epidermis of the inner surface of the scale and the hinge region. Thus, the present study further supports the hypothesis that the tissue interactions responsible for the formation of the beta stratum of scutate scales do not directly activate the synthesis of beta keratins in the germinative cells but influence these cells so that they or their progeny will activate specific beta keratin genes at the appropriate time and place.

Animals↗
PubMed2004

Validity study of a new diagnostic scale for drug-induced liver injury in Japan-comparison with two previous scales.

There are no specific diagnostic markers for drug-induced liver injury (DILI), a disease that is unpredictable and occasionally fatal. A new diagnostic scale, the DDW-J scale, was recently proposed in Japan, by modifying the International Consensus Meeting (ICM) scale in the items concerning chronologic criteria, concomitant drug(s), and extrahepatic manifestations. In order to determine the validity of the DDW-J scale, we assessed 127 patients (81 patients with DILI and 46 control patients) received a total of 423 drugs. When patients were assessed as 'highly probable' or 'probable', the DDW-J scale had higher sensitivity and slightly lowers specificity than the ICM scale (93.8% versus 77.8% and 89.1% versus 100%). The DDW-J scale was able to accurately diagnose DILI in some cases that were overlooked using the ICM scale. While the weighted statistical test indicated a poor correlation between the ICM and the DDW-J scales, receiver operating characteristic curves revealed that these two were superior to the Maria and Victorino scale. Future work still must be done using statistical evidence to refine the weights of individual parameters. However, the results from our study indicate that the DDW-J scale is a powerful tool with potentially important clinical applications in the diagnosis of DILI.

Journal Article↗
PubMed1999

A comparison of the Faces Pain Scale and the Facial Affective Scale for children's estimates of the intensity and unpleasantness of needle pain during blood sampling.

To what degree can facial expression scales help children differentiate between the sensory and emotional aspects of the pain experience? This study examined the relationship between children's ratings on the Faces Pain Scale (an intensity measure), the Facial Affective Scale (an affective measure), and a paired mechanical visual analogue (MVAS) method for measuring the intensity and unpleasantness of pain. It was predicted that ratings on the Faces Pain Scale should correlate best with the MVAS measure of pain intensity rather than unpleasantness. Likewise, ratings on the Facial Affective Scale should correlate best with the MVAS measure of pain unpleasantness (assumed to reflect an emotional dimension) rather than intensity. Eighty children scheduled for blood sampling were selected in two age groups: 4 to 6, and 7 to 10 years. Children rated needle pain using each pain scale. As hypothesized, ratings on the Faces Pain Scale correlated more highly with the MVAS ratings for intensity (r =0.77) than for unpleasantness (r =0.52). A smaller reverse finding was confirmed for the Facial Affective Scale which correlated more highly with the MVAS for unpleasantness (r =0.64) than for intensity (r =0.51). Factor analysis indicated that 'pain dimension' (intensity vs affect) was a relatively weak factor as compared with shared instrument variance (two MVAS vs two face scales). No systematic age effects were observed. In conclusion, the Faces Pain Scale and the Facial Affective Scale may partly measure different aspects of the pain experience in children, although it remains to be determined to what degree the obtained differences are clinically meaningful. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Journal Article↗
PubMed2004

Can results of the Aging Males' Symptoms (AMS) scale predict those of screening scales for androgen deficiency?

INTRODUCTION: The Aging Male Symptoms' (AMS) scale was designed as a health-related quality of life (QoL) scale and standardized as a self-administered scale, first, to assess symptoms of aging (independent from those which are disease-related) between groups of males under different conditions, second, to evaluate the severity of symptoms/QoL over time, and, third, to measure changes pre- and post-androgen replacement therapy. The scale is in widespread use (17 languages currently available) and a recent review of methodological data documented good psychometric characteristics and ability as a clinical utility. This paper describes test characteristics of the AMS (positive and negative predictive values), taking two internationally established and published screening scales for androgen deficiency as the available standard. METHOD: A sample of 150 German males aged 40-69 years completed the AMS scale and two screening scales for androgen deficiency: the ADAM scale of Morley and colleagues and the screener of Smith and colleagues. The technique of a computer-assisted telephone interview was applied. RESULT: The comparison of the AMS with the two screening instruments for androgen deficiency showed sufficiently good compatibility despite conceptual differences. The AMS scale sufficiently predicted the results of the two screening instruments. A positive predictive value of 92% and a negative predictive value of 50% were found regarding the ADAM scale. The respective figures regarding Smith's screener were 65% and 49% for positive and negative predictive values, respectively. CONCLUSION: The AMS scale obviously measures a similar phenomenon as the two established and widely used screeners for androgen deficiency, although it was not developed as a screening instrument.

Adult↗
PubMed2005

Feasibility and reliability of four pain self-assessment scales and correlation with an observational rating scale in hospitalized elderly demented patients.

BACKGROUND: Acute and chronic pain is common in hospitalized demented elderly people, yet there are limited data about the performance of pain assessment tools in this population. The aim of this study was to evaluate the feasibility and reliability of four pain self-assessment scales in this population and compare their performance to an observational pain rating scale. METHODS: Our prospective clinical study was conducted in an acute-care and intermediate-care geriatric hospital on 160 consecutive inpatient referrals to the dementia consultation who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for dementia. Exclusion criteria were delirium, terminal care, and severe sensory impairment. Four unidimensional self-assessment tools--the verbal, horizontal visual, vertical visual, and faces pain scales--were administered in randomized order to mild, moderate, and severely demented patients. An observational pain rating scale was independently completed by the nursing team. RESULTS: Only 12% of the 160 patients (mean age 85 years, 71% women) understood no scale. Respectively, 97%, 90%, and 40% of patients with mild, moderate, and severe dementia understood at least one scale (p <.05). There was a nonsignificant trend toward poorer comprehension of the faces scale. Test-retest reliability was high for all four self-assessment scales, and the correlation between these scales was very strong (Spearman's r(s) = 0.81-0.95; p <.001). Observational rating correlated moderately with self-assessment and tended to underestimate pain intensity (r(s) = 0.31-0.40; p <.05). CONCLUSIONS: Self-assessment pain scales can be used reliably in the vast majority of older hospitalized patients with mild to moderate dementia and in nearly half of those with severe dementia. Observational pain rating scales correlate only moderately with self-assessment and should be reserved for those few patients who have demonstrated that they cannot complete a self-assessment.

Aged↗
PubMedDate not supplied

[Validation of a scale for responsibility (Salkovskis Responsibility Scale)].

Appraisal of inflated responsibility for harm is the cornerstone of Salkovskis's cognitive theory for obsessive compulsive disorder. The aim of our study is to present the validation study of the French translation of the R scale. The present study compared 50 subjects with obsessive compulsive disorder, 37 patients suffering from social phobia and 183 control subjects on a responsibility questionnaire (R scale). The cognitive hypothesis of Obsessive Compulsive Disorder (OCD) specifies two levels of responsibility-related cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations). The R scale evaluates the responsibility assumptions. Such attitudes should reflect the more generalized tendency to assume responsibility in a given situation, particularly situations involving intrusions and doubts. It is possible that such assumptions may be less specific to OCD. The inclusion of social phobia subjects in the present study allows evaluation of the specificity of any findings to OCD. Patients were diagnosed and classified according DSM IV criteria. The control subjects were taken in the general population. No formal interview was conducted. The three groups were compared for sex, age and educational level. Before treatment, all the participants filled in the Responsibility Scale of Salkovskis (27 items), the Beck Depression Inventory (21 items), the Beck Anxiety Inventory and the Bouvard's Obsessive Compulsive Thoughts Checklist. The results indicate that the two anxious groups scored significantly higher than the control group on Beck Depression and Anxiety Inventories but no significant difference was observed between the two anxious groups. OCD patients scored significantly higher than both social phobic patients and control subjects on the Obsessive Compulsive Thoughts Checklist (OCTC). The social phobic group scored this checklist significantly higher than the control group. In sum, the three groups were different on obsessive compulsive thoughts. On the washing subscale of the Obsessive Compulsive Thoughts Checklist, the OCD patients differed significantly from the control group and the social phobia patients. No difference was observed between the social phobia subjects and the control group. On the two other subscales of the OCTC, the checking and the responsibility scales, the three groups were different: OCD patients scored significantly higher than both social phobic patients and control subjects; the social phobic patients scored higher than the control group. Results support the reliability (test retest) and the internal consistency of the questionnaire. Patients with obsessive compulsive disorder (OCD) and social phobia subjects had significantly elevated score on the total scale compared to control subjects. However social phobia patients did not differ from patients with OCD. So, the responsibility for harm, evaluated by the R-scale seems not to be specific of OCD. This finding does not support the results of two studies (28, 30). But these two studies compared OCD patients with an anxious group including panic disorder with agoraphobia, generalized anxiety disorder and social phobia. The correlations with a measure of OCD symptoms were higher than the correlations with anxiety and depression. Finally, the factor structure was only studied on the control group. The exploratory factor analysis indicates that the R scale is a two-dimensional scale, reflecting a need to prevent risks and the belief that one has power to harm. The first dimension is less specific to the pathology than the second. Only patients with OCD had significantly elevated score on the "need to prevent risks" compared to the non-clinical group. The two anxious groups differed on "the belief that one has power to harm" from the non-clinical group but social phobia patients did not differ from patients with OCD. In sum, the two subscales of the R scale did not discriminate OCD patients and social phobic subjects. Further research is needed to replicate the present findings and to confirm the two dimensions of the R scale. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems. However, responsibility assumptions such as the belief that one has the power to harm are shared with social phobia.

Adult↗
PubMed2003

Ten-year review of rating scales. VI: scales assessing externalizing behaviors.

OBJECTIVE: This is the sixth article in a series of 10-year reviews of rating scales. The current article reviews scales that assess externalizing behaviors such as disruptive behavior disorders and aggression. METHOD: Relevant scales were found by searching popular electronic databases. The search was then broadened by a review of the references in selected articles. Due to the paucity of well-established scales, any such scales with potential utility for elucidating the functioning of youths with externalizing behaviors were selected. RESULTS: None of these scales is diagnosis-based, although some correlate with DSM-IV-defined disruptive behavior disorders. Most scales assessing disruptive behavior disorders have a solid normative base, good psychometric functioning, and high clinical utility. Scales assessing aggression comprise a bimodal group. Several have been adapted from the adult literature and are widely used in clinical practice, while others address theoretical aspects of aggression and are used predominantly in research. Empirical support for all of the scales assessing aggression varies widely, although several show potential for routine clinical practice. CONCLUSIONS: Overall, these scales measure a variety of constructs with considerable utility for assessing youths' externalizing behaviors, predicting outcome, and evaluating treatment effects. Many need further validation with youth.

Aggression↗
PubMed1980

The WHO Depression Scale. Relationship to the Newcastle Scales.

The WHO (World Health Organization) Depression Scale is a new rating scale developed to evaluate the complete clinical history and description of depression. Items of the WHO scale were transformed to cover the items of the two Newcastle scales that are designed to differentiate between endogenous and non-endogenous depressions. In 98 depressed inpatients examined prior to antidepressive therapy only moderate agreement between scores transformed to the two Newcastle scales was found. Also the distribution patterns of the scores on the two scales were different. In patients classified as endogenous on one or both scales a significant relationship between plasma levels of imipramine or clomipramine and antidepressive effect was found. In patients classified on both scales as doubtful - or non-endogenous depressions - no such correlation could be identified. The initial severity of depression, as defined by the Hamilton Depression Scale, was the same in endogenous, doubtful and non-endogenous depression according to the scores transformed to the two Newcastle scales.

Adult↗
PubMed1997

[Use of the Glasgow Coma Scale and the Jouvet Coma Scale to evaluate the level of consciousness].

The Glasgow Coma Scale (GCS) and the Jouvet Coma Scale (JCS) have been evolved for assessing the depth and duration of impaired consciousness and coma. The analysis and the utilization of these scales have showed that they are complementary. The GCS is more sensitive when there is a more intense loss of consciousness, whereas the JCS shows its sensitivity better in the states close to normal. This study was aimed to compare the results obtained from the evaluation of the consciousness level by the utilization of the two scales. The comparison was done within a prospective study with 48 patients, all of them over 18 years old, interned in three intensive care units of different hospitals in the city of São Paulo. The evaluations were done daily by the researchers and the scales applied in sequence totaling 5 minutes. Each scale was applied in 106 evaluations, and the results showed a statistically meaningful difference between the GCS and the JCS as to the indication of alteration in the consciousness levels. In 37.74% of the evaluations done with the JCS there was an indication of alteration in the consciousness level, whereas with the GCS the alteration was present in only 23.58% of the evaluations. Another important observation about the utilization of both scales was that people whose scores were between 9 and 10 in the GCS had had an stronger indication of alteration of consciousness level by the same scale, while those with scores between 12 and 15 had a stronger indication of alteration in the consciousness level by JCS. When using GCS there has been the application of the non-testable (NT) in 20% of the evaluations. This did not occur when using the JCS. However it is believed that specific conditions of that particular group might have led to that result as well as specific characteristics of groups of patients might favor the utilization of different scales to evaluate the consciousness level. Therefore the final choice between such scales should consider the conditions and the peculiar characteristics of the clientele to be evaluated and not individual or health department services preferences.

Adolescent↗
PubMed2007

Scale up of a viscous fungal fermentation: application of scale-up criteria with regime analysis and operating boundary conditions.

The scale up of the novel, pharmaceutically important pneumocandin (B(0)), from the filamentous fungus Glarea lozoyensis was successfully completed from pilot scale (0.07, 0.8, and 19 m(3)) to production scale (57 m(3)). This was accomplished, despite dissimilar reactor geometry, employing a combination of scale-up criteria, process sensitivity studies, and regime analysis using characteristic time constants for both oxygen mass transfer and bulk mixing. Dissolved oxygen tension, separated from the influence of agitation by gas blending at the 0.07 m(3)-scale, had a marked influence on the concentrations of pneumocandin analogs with different levels of hydroxylation, and these concentrations were used as an indicator of bulk mixing upon scale up. The profound impact of dissolved oxygen tension (DOT) (low and high levels) on analog formation dictated the use of constant DOT, at 80% air saturation, as a scale-up criterion. As a result k(L)a, Oxygen uptake rate (OUR) and hence the OTR were held constant, which were effectively conserved across the scales, while the use of other criterion such as P(g)/V(L), or mixing time were less effective. Production scale (57 m(3)) mixing times were found to be faster than those at 19 m(3) due to a difference in liquid height/tank diameter ratio (H(L)/D(T)). Regime analysis at 19 and 57 m(3) for bulk mixing (t(c)) and oxygen transfer (1/k(L)a) showed that oxygen transfer was the rate-limiting step for this highly shear thinning fermentation, providing additional support for the choice of scale-up criterion.

Ascomycota↗
PubMed1990

Consistencies and discrepancies in self- and observer-rated anxiety scales. A comparison between the self- and observer-rated Marks-Sheehan scales.

The Marks-Sheehan anxiety scales are the only scales where self-ratings and observer ratings are perfectly matched by the number, the content and the scaling of the items. Therefore these scales are an excellent tool to investigate the compatibility and to study different structures in self- and observer ratings. This was done by using the data material on the Marks-Sheehan scales of the Cross National Collaborative Panic Study. In this study 1168 outpatients who met the DSM-III criteria for panic disorder were randomly allocated either to alprazolam, imipramine or placebo treatment. Our results show that the Marks-Sheehan scales are highly comparable to other established rating scales. Both scales have a similar stable and consistent factor pattern for somatic symptoms but not for psychic symptoms of anxiety. Our results provide empirical evidence that the low consistencies between self- and observer ratings reported so far can be improved by using a rating scale which matches up item for self- and observer ratings. However, other sources of disagreement can only be solved by more elaborated item descriptions and training of patients as well as raters to obtain a better compatibility between self- and observer rating scales.

Adult↗
PubMed2005

The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature.

OBJECTIVE: To systematically compare the PEDro scale and the Jadad scale when applied to the stroke rehabilitation literature. STUDY DESIGN AND SETTING: A literature search of multiple databases was used to identify all trials from 1968 through 2002. Each article was reviewed and assigned quality scores according to PEDro and Jadad criteria. Quality scores for both scales were compared using descriptive statistics. The correlation between the scales was estimated using the Pearson product moment correlation coefficient. RESULTS: 272 randomized controlled trials were retrieved and subjected to quality scoring to both the PEDro scale and the Jadad scale. Mean scores (with standard deviation) for the PEDro and Jadad scales were 5.78 (1.4) and 2.46 (1.1), respectively. The Pearson coefficient determined the PEDro and Jadad scales to be significantly correlated (r = .59, P < .01). Although significant, the correlation was not deemed to be very strong. When applied to physical or rehabilitation therapy studies only, the scales were slightly less correlated (r = .49, P < .01) than among drug-based studies (r = .52, P < .01). CONCLUSION: In the stroke rehabilitation literature, where double-blinding studies are often not possible due to the nature of the interventions, breaking down the levels of blinding and accounting for concealed allocation, intention-to-treat, and attrition is important. Accordingly, the PEDro scale provides a more comprehensive measure of methodological quality of the stroke literature.

Evidence-Based Medicine↗
PubMed2002

The Universal Standard Scale: proposed improvements to the American National Standards Institute (ANSI) scale for corneal topography.

PURPOSE: To evaluate the American National Standards Institute (ANSI) corneal topography scale (ANSI Z-80.23-1999) and to develop a Universal Standard Scale (USS) based on scientific principles and clinical usefulness. DESIGN: Retrospective data analysis and computer modeling of frequency of corneal power distributions. METHODS: Four variations of corneal topography color scales were constructed using the ANSI standard description. The scales used 21 contour intervals with step sizes of 0.5, 1.0, or 1.5 diopters (D). In example 1, hue was varied, whereas saturation and brightness were held constant. In example 2, hue was varied systematically, whereas luminance was varied to compensate for spectral sensitivity. In example 3, hue was varied, whereas luminance was adjusted to improve color contrast at the center of the scale. In example 4, the palette was generated by varying the red, green, and blue color intensity levels. In the USS, colors were defined by hue, brightness, and saturation, and appearance was optimized by using contrast. The contour interval was determined from the standard deviation of keratometry for 27 normal corneas. The scale range was based on corneal powers found in 388 topography maps of 12 different corneal conditions. RESULTS: ANSI-derived maps were difficult to interpret because of poor color contrast and the inability to associate contours with specific colors in the scale. The 0.5 D interval slightly improved the appearance of some patterns but reduced the useful clinical range of the scale. ANSI colors did not match the user's expectations; abnormal patterns appeared in shades of green, which is associated with normality. The standard deviation of keratometry readings for the normal population was 1.59 D. Hence, the contour interval for the USS was set to 1.5 D. More than 99.9% of the corneal powers in 388 clinical maps were within the range of 30 to 67.5 D, which was chosen as the range for the USS. CONCLUSIONS: The ANSI scale for corneal topography is a series of scales that lead to clinical misinterpretations. The alternative USS would provide uniform presentation, unambiguous interpretation, and greater ease of comparison among maps produced by different topographers.

Color↗
PubMed1999

Assessing the consistency of psychometric properties of the HRQoL scales within the EORTC QLQ-C30 across populations by means of the Mokken Scaling Model.

This paper demonstrates how the Mokken Scaling Model and other statistical tools may be useful in assessing the consistency of psychometric properties of health-related quality of life (HRQoL) scales across various populations. The main focus is the psychometric performance of the scales proposed for the EORTC QLQ-C30 in seven patient groups totalling more than 2,000 cancer patients. All scales performed satisfactorily in the total sample with the exception of the role functioning and cognitive functioning scales, which failed in terms of reliability and item discriminant validity. The descriptive statistics for the scales show that several of them, particularly those that build upon only two items, have discrimination problems at the extremes, visible in the high percentages at the maximum or the minimum observed values. The scalability analysis in the subsamples showed that the essential assumption in the Mokken Scaling Model of equal item step order does not hold for the cognitive functioning, emotional functioning and physical functioning scales. We conclude that the Mokken Scaling Model is well suited to the purpose of examining the generalizability of HRQoL scales across subpopulations although a global statistical test of the fit of the measurement model is not available.

Activities of Daily Living↗
PubMedDate not supplied

Pain evaluation in the intensive care unit: observer-reported faces scale compared with self-reported visual analog scale.

BACKGROUND AND OBJECTIVES: The visual analog scale (VAS) is a simple and sensitive mean of pain assessment. The faces scale is also a simple, self-reporting method for children. Facial signs of pain have not been used to assess pain in postoperative adult patients in the intensive care unit (ICU). METHODS: Fifty patients undergoing esophageal cancer surgery by a thoracoabdominal procedure were studied. Epidural opioids, such as morphine or buprenorphine, combined with bupivacaine were administered during and after surgery. Pain measurement was performed by a physician in the ICU using the self-reported VAS 0.5, 1, 2, 4, and 6 hours after tracheal extubation and thereafter every 4 hours during the stay in the ICU. A nurse who was unaware of the patients' VAS scores assessed facial expression as a measure of pain intensity using a five-grade faces scale immediately before pain evaluation by VAS. The VAS was rescaled into five discrete units that would match the five faces scale scores. Weighted kappa statistics were used to establish a relative level of agreement between the five-grade VAS and faces scale. RESULTS: Good agreement was found between the five-grade VAS and the faces scale 30 minutes and 1 hour after tracheal extubation (weighted kappa values .67 and .62, respectively). The VAS and faces scales were measured 7-13 times per patient during the stay in the ICU, and 518 observations were collected. Although moderate agreement was found between the five-graded VAS and faces scale for all pairs of observation (weighted kappa values .54), less agreement was found between them in patients with moderate pain. In addition, the calculated mean differences between the five-graded VAS and faces scale differed significantly between patients. CONCLUSION: The faces scale may be useful for pain evaluation in the ICU.

Adult↗