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PubMed2005

Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review.

BACKGROUND: The literature was systematically reviewed to determine whether a prolonged prothrombin time or elevated international normalized ratio predicts bleeding during invasive diagnostic procedures. STUDY DESIGN AND METHODS: MEDLINE and CENTRAL were searched through August 2004, with no language restriction, and reference lists were reviewed. For inclusion, articles must have reported on bleeding in more than five patients with abnormal test results undergoing diagnostic procedures. RESULTS: One trial and 24 observational studies were included. In 2 studies of bronchoscopy, the bleeding rates were similar among those with normal and abnormal tests, with wide confidence intervals (CIs) around the risk differences. During central vein cannulation (3 studies), bleeding rates among those with abnormal tests was unlikely to exceed 2.3 percent. The largest of 3 studies of arteriography found equivalent bleeding rates in patients with and without abnormal tests (risk difference, 0%; 95% CI, -3% to 2%). In the 3 studies of liver biopsy with plugging, bleeding rates were 0, 4, and 5 percent with the upper bounds of the CI as high as 17 percent. In the largest study of transjugular biopsy, the bleeding rate was 1.5 percent (95% CI, 0.3%-4%) in patients with abnormal tests. The highest bleeding rate in the 3 studies of percutaneous liver biopsy was 5.3 percent (95% CI, 1%-13%), similar to the rate in patients with normal test results. CONCLUSION: There is insufficient evidence to conclude that abnormal test results predict bleeding. Randomized controlled trials should be performed to provide stronger evidence for clinical decision making regarding preprocedure transfusion.

Blood Coagulation Tests↗
PubMed1987

Evaluation of a temperate environment test to predict heat tolerance.

A temperate environment heat tolerance test (HTT) was formerly reported (Shvartz et al. 1977b) to distinguish heat acclimatized humans from former heat stroke patients. The purpose of this investigation was to evaluate the ability of HTT to measure acute individual changes in the HR and Tre responses of normal subjects, induced by classical heat acclimation procedures, thereby assessing the utility and sensitivity of HTT as a heat tolerance screening procedure. On day 1, 14 healthy males performed HTT (23.2 +/- 0.5 degrees C db, 14.9 +/- 0.5 degrees C wb) by bench stepping (30 cm high, 27 steps x min-1) for 15 min at 67 +/- 3% VO2max. On days 2-9, all subjects underwent heat acclimation (41.2 +/- 0.3 degrees C db, 28.4 +/- 0.3 degrees C wb) via treadmill exercise. Heat acclimation trials (identical on days 2 and 9) resulted in significant decreases in HR (170 +/- 3 vs 144 +/- 5 beats x min-1), Tre (39.21 +/- 0.09 vs 38.56 +/- 0.17 degrees C), and ratings of perceived exertion; plasma volume expanded 5.2 +/- 1.7%. On day 10, subjects repeated HTT; day 1 vs day 10 HR were statistically similar (143 +/- 6 vs 137 +/- 6 beats x min-1, p greater than 0.05) but Tre decreased significantly (37.7 +/- 0.1 vs 37.5 +/- 0.1 degrees C, p less than 0.05). Group mean HTT composite score (day 1 vs day 10) was unchanged (63 +/- 5 vs 72 +/- 6, p greater than 0.05), and individual composite scores indicated that HTT did not accurately measure HR and Tre trends at 41.2 +/- degrees C in 6 out of 14 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Acclimatization↗
PubMed1989

Cavitation induced by asymmetric, distorted pulses of ultrasound: a biological test.

Prediction of the response of gaseous microbubbles to ultrasonic waves is complicated by the finite-amplitude distortion associated with large amplitude acoustic fields. Typical finite-amplitude pulses in medical applications consist of a sharp positive spike followed by a smaller, slowly varying negative pressure. In previous theoretical studies it was found that: (a) the peak-positive pressure is a very poor index of bubble response; (b) the peak-negative pressure typically underestimates the bubble response; (c) a better predictor of bubble response is the pressure amplitude of the fundamental in a Fourier series expansion of the distorted pulse. It is reported here that the killing of Drosophila larvae exposed to pulsed, symmetric, sinusoidal fields and to pulsed, asymmetric, distorted fields is consistent with these predictions.

Animals↗
PubMed1984

Serial dexamethasone tests for predicting relapse in depressive disorder.

The dexamethasone suppression test (DST) was given to 86 patients with unipolar depression at the time of admission to the hospital. Thirty-three patients (38%) had abnormal DST responses. There was no difference in treatment response or outcome between patients with normal or abnormal DST responses on admission. Of the 33 patients who had abnormal DST responses on admission, 25 (76%) showed normal responses by the time of discharge. Five of the eight patients (63%) with "persistent" nonsuppression despite symptomatic improvement and discharge had relapse within six months, while only four of 25 patients (16%) whose DST response became normal (P less than .05) and ten of 53 patients (19%) who had normal DSTs at the time of admission (P less than .05) had relapse. These findings suggest that persistence of abnormal DST responses may provide a useful prognostic marker of risk for early relapse in depressive disorder.

Acute Disease↗
PubMed2004

Testing a predictive model of the use of HIV/AIDS symptom self-care strategies.

Several types of self-care strategies have been reported by patients with HIV/AIDS to manage their HIV/AIDS related symptoms. However, little research has examined the factors influencing the use of different HIV symptom self-care strategies. This paper presents the results of testing a predictive model of the use of eight types of symptom self-care strategies: medications, complementary treatments, self-comforting, daily thoughts/activities, changing diet, help-seeking, exercise, and spiritual care. Logistic regression tests were used to examine the likelihood of using the eight types of symptom self-care strategies that were summarized and categorized from the questionnaires reported by patients with HIV/AIDS (n = 359). Sociodemographic variables (age, gender, race, education, injection drug use, insurance status, income status) and disease-related variables (taking antiretroviral medications, symptom intensity, symptom bothersomeness, impact of symptom on daily life) were selected as predictive variables. Logistic regression analysis demonstrated that race (white vs. non-white) was a significant predictor for the use of medications (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.33-0.92), self-comforting (OR = 2.17, 95% CI = 1.24-3.79), help seeking (OR = 5.71, 95% CI = 2.57-12.70), and spiritual care (OR = 5.09, 95% CI = 1.81-14.30). In addition, symptom intensity significantly predicted the use of medications (OR = 1.22, 95% CI = 1.05-1.40) and gender significantly predicted the use of spiritual care (OR = 3.76, 95% CI = 1.71-8.25). Racial difference is the predominant predictor for the use of symptom self-care strategies. The cultural differences in the use of symptom self-care strategies should be considered in symptom management.

Adolescent↗
PubMed2001

Use of situational judgment tests to predict job performance: a clarification of the literature.

Although situational judgment tests have a long history in the psychological assessment literature and continue to be frequently used in employment contexts, there has been virtually no summarization of this literature. The purpose of this article is to review the history of such tests and present the results of a meta-analysis on criterion-related and construct validity. On the basis of 102 coefficients and 10,640 people, situational judgment tests showed useful levels of validity (rho = .34) that were generalizable. A review of 79 correlations between situational judgment tests and general cognitive ability involving 16,984 people indicated that situational judgment tests typically evidence relationships with cognitive ability (rho = .46). On the basis of the literature review and meta-analytic findings, implications for the continued use of situational judgment tests are discussed, particularly in terms of recent investigations into tacit knowledge.

Employee Performance Appraisal↗
PubMed1977

Validity of the W170 test for predicting maximal oxygen intake.

Recent research has related pedalling frequency to perceived exertion, indicating that subjects pedalling at higher frequencies tend to perceive lower levels of exertion. If tests administered at higher pedalling speeds are valid, then more accurate data on extremely low fit individuals might be possible. The purpose of this study was to determine the validity of the Wahlund-Sjostrand W170 test administered at 50 and 80 rpm. Maximal oxygen intake was determined for thirty male volunteer college students using standard open-circuit techniques. W170 tests were administered at 50 and 80 rpm using standard test protocol. The results indicated a differential effect of pedalling speed upon the validity of the W170 tests. Validity coefficients of rxy = 0.73 and rxy = 0.64 were found for the 50 and 80 rpm tests, respectively. Maximal oxygen intake predicted from the W170 test administered at 80 rpm was significantly different from both the criterion maximal oxygen intake and the W170 prediction at 50 rpm. This difference was attributed to a significantly higher heart rate response to 80 rpm tests at the lower workload of 600 kpm/min. It was concluded that more valid W170 tests are attained at the conventional pedalling speed of 50 rpm.

Adult↗
PubMed2000

Neuropsychological testing may predict early progression of asymptomatic adrenoleukodystrophy.

OBJECTIVES: To investigate the correlation between neuropsychological and MRI findings in children with the childhood cerebral (CCALD) and asymptomatic forms of X-linked adrenoleukodystrophy (ALD) and to identify early cognitive markers that may predict disease progression in asymptomatic children with ALD. BACKGROUND: The few published neuropsychological studies on CCALD suggest a correlation between the pattern of cognitive deficit and lesion site; however, neuropsychological performance in asymptomatic children with ALD has not been investigated. METHODS: The authors assessed cognitive function and cerebral MRI findings in seven CCALD and eight asymptomatic ALD children. RESULTS: The CCALD children's cognitive skills were severely compromised, especially Wechsler and executive functions. Visual perception, short-term memory, and language were generally preserved, except that naming was severely impaired. All had extensive posterior white matter deterioration. The asymptomatic children had relatively intact neuropsychological performance, but their verbal fluency was compromised and naming severely impaired. All except one had mild white matter alterations. For all the children, the majority of neuropsychological test performance correlated significantly with extent of white matter lesions. CONCLUSIONS: The pattern of cognitive deterioration in children with CCALD and the significant correlation of neuropsychological test performance with extent of white matter lesions indicate a white matter dementia similar to that observed in adults with demyelinating diseases. The deficits found in asymptomatic children, despite their normal intelligence, suggest that careful neuropsychological investigation can identify early signs of malfunction. These may be markers of disease progression useful for selecting children for bone marrow transplant, although this will require confirmation by prospective longitudinal studies.

Adolescent↗
PubMed2002

Sensitivity and specificity of the functional hallux limitus test to predict foot function.

Functional hallux limitus is an underrecognized entity that generally does not produce symptoms but can result in a variety of compensatory mechanisms that can produce symptoms. Clinically, hallux limitus can be determined by assessing the range of motion available at the first metatarsophalangeal joint while the first ray is prevented from plantarflexing. The aim of this study was to determine the sensitivity and specificity of this clinical test to predict abnormal excessive midtarsal joint function during gait. A total of 86 feet were examined for functional hallux limitus and abnormal pronation of the midtarsal joint during late midstance. The test had a sensitivity of 0.72 and a specificity of 0.66, suggesting that clinicians should consider functional hallux limitus when there is late midstance pronation of the midtarsal joint during gait.

Adult↗
PubMed2001

Predictive drug allergy testing: an alternative viewpoint.

T- and B-cells recognise drugs when bound as haptens to carrier molecules. Recent studies suggest that drugs might also bind in a non-covalent form to MHC-peptide complexes and T cell receptors, and are thereby able to stimulate T cells. This has, however, only been shown for drug-specific T cell clones. Functional analysis revealed that drug-reactive T cells secrete high amounts of IL-5 and are cytotoxic. Cytotoxicity is mediated by drug-specific CD4(+) and CD8(+) cells and, as revealed by the immunohistochemical analysis of drug-induced exanthems, might be involved in the killing of keratinocytes thus explaining the drug-induced exanthem. Further work is needed to clarify the type and exact location of the rather labile drug binding to MHC and T cell receptors, and to evaluate what drug allergies might be caused by such an unusual presentation and immune stimulation. This new model as well as findings from the analysis of clinical drug allergies may have major implications on how to test and predict the allergenic potential of drugs. A change and expansion of currently performed test procedures is required to predict the allergenic potential of drugs.

Animal Testing Alternatives↗
PubMed1996

Predicting radon testing among university employees.

To determine covariates of radon testing behavior, we surveyed by mail a random sample of all Boston University employees (N = 915) six to nine months after they had been informed of the availability of radon testing services through the University's medical center. The response rate was 58%. Analysis suggests blue collar workers were underrepresented within the response rate. Slightly more than half of the respondents (51%) were men. The majority (69%) were under the age of 45. Twenty-seven percent of the respondents (N = 143) had tested their homes for radon. Bivariate analysis revealed important differences between radon testers and nontesters. Testers were 12 times more likely to be home owners than renters (p = 0.00), and were more knowledgeable about radon's characteristics and testing procedures (p = 0.00). Testers were more likely to view radon as a serious problem (p = 0.00), to consider radon testing efficacious (p = 0.00), and to consider themselves susceptible to exposure (p = 0.00). Testers were also less likely to perceive barriers to radon testing. We used logistic regression to compare the usefulness of the Health Belief Model and the Diffusion of Innovations Model in predicting radon testing. We concluded that the knowledge deficits and barriers to radon testing identified in this study should be targeted in radon educational interventions.

Behavior↗
PubMed1991

Usefulness of severity of myocardial ischemia on exercise testing in predicting the severity of myocardial ischemia during daily activities.

To determine the relation between myocardial ischemic indexes on exercise testing and on ambulatory Holter recording, 60 patients with stable coronary artery disease who exhibited an ischemic response to both testing procedures were studied. All patients performed a Bruce protocol exercise test and underwent 24-hour Holter recording within 2 weeks without antianginal medications. Mean exercise duration was 7.4 +/- 2.8 minutes, mean heart rate at 1-mm ST depression was 118 +/- 20 beats/min and mean maximal ST depression during exercise was 2.2 +/- 1 mm. During Holter recording the average number of ischemic episodes was 4.7 +/- 2.6 per patient, mean duration of daily ischemia was 62 +/- 54 minutes, mean maximal ST depression was 3.2 +/- 1.3 mm and average heart rate at 1-mm ST depression was 93 +/- 17 beats/min. Overall, the correlations between ischemic indexes on both testing procedures were very weak (mean r2 = 0.054). The only exercise variable that had a significant correlation (p less than 0.05) with all Holter variables was heart rate at 1-mm ST depression, yet it correlated very weakly (0.064 less than or equal to r2 less than or equal to 0.125) with most Holter covariates and had a better correlation (r2 = 0.256) only with average heart rate at 1-mm ST depression during Holter. Thus, ischemic indexes on exercise testing cannot accurately predict ischemic indexes on ambulatory Holter recording in patients with stable coronary artery disease who exhibit ischemic changes on both tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1975

Cleaning hydrophilic contact lenses: an overview.

The composition of the major, critical component of the amorphous deposits forming on hydrophilic lenses during wear was identified and reported by Karageozian as basically proteinaceous in nature. The research surrounding the identification has produced animal and laboratory models for testing the parameteres involved in the protein deposition, as well as in its removal. A standardized system for classifying the protein deposits during and after formation, along with the experimental animal and laboratory models allows a relatively complete development of the predictive tests required for a compound or a product intended for use as a cleaner of hydrophilic lenses. These predictive tests have been run on several available cleaning systems as well as on a new one; the results indicate clearly that, unlike the available systems, the new system will safely remove deposits from hydrophilic lenses. The laboratory predictive test results have been borne out by clinical trial; the clinical results indicate the suitability of the new formulation and the predictive capability of the test models developed.

Animals↗
PubMed1983

Value of the ajmaline-procainamide test to predict the effect of long-term oral amiodarone on the anterograde effective refractory period of the accessory pathway in the Wolff-Parkinson-White syndrome.

In patients with the Wolff-Parkinson-White syndrome, intravenous ajmaline (50 mg administered over 3 minutes) or procainamide (10 mg/kg body weight administered over 10 minutes) is helpful in defining the duration of the anterograde effective refractory period of the accessory pathway. In this study the value of the ajmaline-procainamide test to predict the effects on the anterograde effective refractory period of the accessory pathway of long-term oral amiodarone were assessed. Thirty-six patients with the Wolff-Parkinson-White syndrome were studied. Twenty-four (Group A) had a negative result of the ajmaline-procainamide test and a mean duration of the anterograde effective refractory period of the accessory pathway of 237 +/- 24 ms. Twelve (Group B) had a positive result in the ajmaline-procainamide test (disappearance of preexcitation during sinus rhythm after administration of ajmaline and procainamide) and a duration of the anterograde effective refractory period of the accessory pathway of 284 +/- 25 ms (p less than 0.05 versus values in Group A). Amiodarone prolonged the anterograde effective refractory period of the accessory pathway by 53 +/- 35 ms in patients in Group A to 290 +/- 37 ms (p less than 0.001) and by 100 +/- 85 ms in patients in Group B to 384 +/- 94 ms (p less than 0.001). The difference in mean increase between both groups was not significant. In most patients (83%) in Group A amiodarone prolonged the anterograde effective refractory period of the accessory pathway to 260 to 330 ms. However, in most patients (83%) in Group B, amiodarone prolonged the anterograde effective refractory period of the accessory pathway to greater than or equal to 330 ms (p less than 0.01). Thus, an ajmaline-procainamide test is of value in predicting the results of oral amiodarone on the anterograde effective refractory period of the accessory pathway.

Adolescent↗
PubMed1992

Isolation and characterization of new highly polymorphic DNA markers from the Huntington disease region.

The defect causing Huntington disease (HD) has been mapped to 4p16.3, distal to the DNA marker D4S10. Subsequently, additional polymorphic markers closer to the HD gene have been isolated, which has led to the establishment of predictive testing programs for individuals at risk for HD. Approximately 17% of persons presenting to the Canadian collaborative study for predictive testing for HD have not received any modification of risk, in part because of limited informativeness of currently available DNA markers. Therefore, more highly polymorphic DNA markers are needed, which will further increase the accuracy and availability of predictive testing, specifically for families with complex or incomplete pedigree structures. In addition, new markers are urgently needed in order to refine the breakpoints in the few known recombinant HD chromosomes, which could allow a more accurate localization of the HD gene within 4p16.3 and, therefore, accelerate the cloning of the disease gene. In this study we present the identification and characterization of nine new polymorphic DNA markers, including three markers which detect highly informative multiallelic VNTR-like polymorphisms with PIC values of up to .84. These markers have been isolated from a cloned region of DNA which has been previously mapped approximately 1,000 kb from the 4p telomere.

Chromosomes, Human, Pair 4↗
PubMed1998

The ability of the chemiluminescence test to predict clinical outcome and the necessity for amniocenteses in pregnancies at risk of haemolytic disease of the newborn.

The chemiluminescence test measures the ability of anti-D to sensitise red cells for recognition by monocytes. It predicts clinical outcome in haemolytic disease of the newborn with greater precision than quantification of anti-D levels by AutoAnalyzer. However, whether or not the chemiluminescence test can, or should, affect clinical management is not clear. Of 56 alloimmunised women referred to a single fetal medicine unit, 30 underwent a total 63 amniocenteses to establish the extent of fetal haemolysis. Overall, chemiluminescence test results were a better predictor of amniocenteses with elevated bilirubin levels than the AutoAnalyzer (P < 0.01). Chemiluminescence results > 30% were always associated with elevated bilirubin levels. The chemiluminescence test might be used to prompt the direct evaluation of fetal haemolysis in patients with borderline levels of anti-D (5-15 IU/mL). However, the ability of the test to predict amniocenteses with normal bilirubin levels was less clear.

Amniocentesis↗