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PubMed2002

Systematic evaluation of rating scales for impairment and disability in Parkinson's disease.

We assessed the clinometric characteristics of rating scales used for the evaluation of motor impairment and disability of patients with Parkinson's disease (PD), conducting a systematic review of PD rating scales published from 1960 to the present. Thirty studies describing clinometrics of 11 rating scales used for PD were identified. Outcome measures included validity (including factor structure), reliability (internal consistency, inter-rater, and intrarater) and responsiveness. We traced three impairment scales (Webster, Columbia University Rating Scale [CURS] and Parkinson's Disease Impairment Scale), four disability scales (Schwab and England, Northwestern University Disability Scale [NUDS], Intermediate Scale for Assessment of PD, and Extensive Disability Scale), and four scales evaluating both impairment and disability (New York University, University of California Los Angeles, Unified Parkinson's Disease Rating Scale [UPDRS], and Short Parkinson Evaluation Scale). The scales showed large differences in the extent of representation of items related to signs considered responsive to dopaminergic treatment or to those signs that appear late in the disease course and lack responsiveness to treatment. Regardless of the scale, there was a conspicuous lack of consistency concerning inter-rater reliability of bradykinesia, tremor, and rigidity. Overall disability items displayed moderate to good inter-rater reliability. The available evidence shows that CURS, NUDS, and UPDRS have moderate to good reliability and validity. In contrast to their widespread clinical use for assessment of impairment and disability in PD, the majority of the rating scales have either not been subjected to an extensive clinometric evaluation or have demonstrated clinometric shortcomings. The CURS, NUDS, and UPDRS are the most evaluated, valid, and reliable scales currently available.

Disability Evaluation↗
PubMed1991

The word-graphic rating scale as a measure of children's and adolescents' pain intensity.

A program of studies was designed to select and test a pain intensity scale for inclusion in a multidimensional pain assessment tool for children and adolescents. The focus was on determining each scale's validity, reliability, ease of use, preference, and the lack of age, gender, and ethnic biases. Five pain scales were evaluated in four separate studies: a word-graphic rating scale, a visual analogue scale, a graded-graphic rating scale, a magnitude estimation scale (0 to 10), and a color scale. Subjects (N = 1,223) were 8 to 17 years of age and, in three of the studies, were hospitalized and judged to be in pain. In Study 1, well children used the scales to assess pain in an analogue situation selecting the color scale easiest to use and best liked. Convergent validity for the five scales was supported. In Study 2, hospitalized children, who were experiencing pain, overwhelmingly selected the word-graphic rating scale as their choice. A pilot version of a multidimensional pain assessment tool incorporating the word-graphic rating scale was tested in Study 3 using a repeated measures design. The scale demonstrated sensitivity to changes in postoperative pain intensity over time. In Study 4, convergent validity of the five scales and test-retest reliability of the word-graphic rating scale were supported. The series of four studies provides strong evidence to support use of the word-graphic rating scale to measure pain intensity in pediatric populations.

Adolescent↗
PubMed2005

[Which sedation scale should be used in the paediatric intensive care unit? A comparative prospective study].

OBJECTIVES: To compare pain and sedation assessments by nurses undertaken with the Objective Pain Scale (OPS) and a Visual Analogue Scale (VAS) to the current reference scale for paediatric intensive care that is the COMFORT scale. To compare the unmodified COMFORT scale to a COMFORT "behaviour" scale which does not include physiologic items. To evaluate the ease of use of these scales. METHODS: This prospective observational comparative study was carried out in children aged 1 year or older who were admitted in an intensive care unit. At 2 to 3 time points within 24 hours, a pain sedation assessment was carried out by the nurse in charge of the child with COMFORT scale, OPS and VAS. Correlation tests were used to compare the scores of each scale. RESULTS: Nurses recorded 55 assessments in 20 children. Correlation studies showed a poor correlation between OPS, VAS and the COMFORT scale (Spearman's r=0.54 and 0.53 respectively) and a strong correlation between the COMFORT scale and the COMFORT "behaviour" scale (Spearman's r=0.96). The COMFORT behaviour scale was the most frequently fully completed scale. CONCLUSION: Among the 3 scales compared to the COMFORT scale in this study, the COMFORT "behaviour" scale was the only one to show a strong correlation and it also seemed to be the easiest to use.

Adolescent↗
PubMed2001

Scales of mussel bed complexity: structure, associated biota and recruitment.

Hierarchically scaled surveys were carried out on beds of the brown mussel Perna perna (Linnaeus) on the South coast of South Africa. The object was to assess spatial and temporal variations in the complexity of mussel beds and to investigate relationships between mussel bed complexity and mussel recruitment. Complexity was divided into three components: physical complexity; demographic complexity; associated biota. A series of variables within each component were recorded at two different scales (10 and 50 cm) within nested quadrats on three separate occasions. The nested ANOVA design explicitly incorporated spatial scale as levels of the ANOVA. These scales were: shores (areas 1 km in length separated by 25 km); transects (areas 20 m in length separated by 100s of meters); 50x50-cm quadrats separated by meters and 10x10-cm quadrats separated by cm) This approach was intended to generate hypotheses concerning direct associations between recruitment and complexity versus co-variation due external processes. Three main questions were addressed: (1) At what scale does each variable of complexity exhibit greatest significant variation? (2) At these scales is there similar ranking of variables of complexity and recruitment? (3) Within this/these scales, is there any significant relationship between the variables measured and mussel recruitment? On two occasions (Nov. 97 and Mar. 98) the majority of variables showed greatest significant variation at the transect-scale. On a third occasion (Oct. 97) most variables showed greatest significant variation at the quadrat-scale and the site-scale. On all occasions a markedly high percentage of the variation encountered also occurred at the smallest scale of the study, i.e., the residual scale of the ANOVA analyses. Some similarity in the ranking of variables occurred at the transect scale. Within the transect-scale, there was little indication of any relationship between variables of complexity and recruitment. Relationships were inconsistent either among transects or among sampling occasions. Overall, the results suggest that a high degree of variation in mussel bed complexity consistently occurs at very small scales. High components of variance generally also occur at one or more larger scales; however, these scales vary with season. Mussel recruitment does not appear to be directly affected by complexity of mussel beds. Instead it appears external factors may influence both complexity and recruitment independently. In addition recruitment may influence complexity rather than vice versa.

Journal Article↗
PubMed1997

Scale development in zebrafish (Danio rerio).

In the course of an extensive comparative, structural and developmental study of the cranial and postcranial dermal skeleton (teeth and scales) in osteichthyan fishes, we have undertaken investigations on scale development in zebrafish (Danio (Brachydanio) rerio) using alizarin red staining, and light and transmission electron microscopy. The main goal was to know whether zebrafish scales can be used as a model for further research on the processes controlling the development of the dermal skeleton in general, especially epithelial-mesenchymal interactions. Growth series of laboratory bred specimens were used to study in detail: (1) the relationship of scale appearance with size and age; (2) the squamation pattern; and (3) the events taking place in the epidermis and in the dermis, before and during scale initiation and formation, with the aim of searching for morphological indications of epithelial-mesenchymal interactions. Scales form late in ontogeny, generally when zebrafish are more than 8.0 mm in standard length. Within a population of zebrafish of the same age scale appearance is related to standard length, but when comparing populations of different age the size of the fish at scale appearance is also related to age. Scales always appear first in the posterior region of the body and the squamation then extends anteriorly. Scales develop in the dermis but closely apposed to the epidermal-dermal boundary. Cellular modifications occurring in the basal layer of the epidermis and in the dermis before scale formation clearly indicate that the basal epidermal cells differentiate first, before any evidence of differentiation of the progenitors of the scale-forming cells in the dermis. This strongly suggests that scale differentiation could be initiated by the epidermal basal layer cells which probably produce a molecular signal towards the dermis below. Subsequently dermal cells accumulate close to the epidermis, and differentiate to form scale papillae. The late formation of the scales during ontogeny is due to a late colonisation of the dermis by the progenitors of the scale-forming cells. Because of their late formation during ontogeny and of their regular pattern of development, scales in zebrafish represent a good model for further investigations on the general mechanisms of epithelial-mesenchymal interactions during dermal skeleton development, and in particular for the study of the gene expression patterns.

Animals↗
PubMed2000

Geometry of river networks. I. Scaling, fluctuations, and deviations.

This paper is the first in a series of three papers investigating the detailed geometry of river networks. Branching networks are a universal structure employed in the distribution and collection of material. Large-scale river networks mark an important class of two-dimensional branching networks, being not only of intrinsic interest but also a pervasive natural phenomenon. In the description of river network structure, scaling laws are uniformly observed. Reported values of scaling exponents vary, suggesting that no unique set of scaling exponents exists. To improve this current understanding of scaling in river networks and to provide a fuller description of branching network structure, here we report a theoretical and empirical study of fluctuations about and deviations from scaling. We examine data for continent-scale river networks such as the Mississippi and the Amazon and draw inspiration from a simple model of directed, random networks. We center our investigations on the scaling of the length of a subbasin's dominant stream with its area, a characterization of basin shape known as Hack's law. We generalize this relationship to a joint probability density, and provide observations and explanations of deviations from scaling. We show that fluctuations about scaling are substantial, and grow with system size. We find strong deviations from scaling at small scales which can be explained by the existence of a linear network structure. At intermediate scales, we find slow drifts in exponent values, indicating that scaling is only approximately obeyed and that universality remains indeterminate. At large scales, we observe a breakdown in scaling due to decreasing sample space and correlations with overall basin shape. The extent of approximate scaling is significantly restricted by these deviations, and will not be improved by increases in network resolution.

Ecosystem↗
PubMed1993

A comparison of five stroke scales with measures of disability, handicap, and quality of life.

BACKGROUND AND PURPOSE: Recently much debate has arisen on the appropriateness of assessing stroke outcomes with stroke impairment scales. Our purpose was to study the relationship between long-term impairments and functional outcomes in terms of disability, handicap, and quality of life. METHODS: We studied 87 patients who had a stroke 6 months earlier. Impairments were scored on five stroke scales: the Orgogozo Scale, the National Institutes of Health scale, the Canadian Neurological Scale, the Mathew scale, and the Scandinavian Stroke Scale. Disability was assessed with the Barthel Index, handicap with the Rankin scale, and quality of life with the Sickness Impact Profile. The linear relationship between stroke scales and functional scales was assessed with correlation coefficients. We used regression analyses to explain functional health. RESULTS: The stroke scales were highly related to one another (range, r = -.85 to .92). The correlation between stroke scales and functional scales was < .70 and decreased from Barthel (mean r2 = 47.5%) to Rankin (mean r2 = 36.5%) to Sickness Impact Profile (mean r2 = 33%). Stroke scales were rather poorly correlated with patients' psychosocial conditions (mean r2 = 11.5%). Functional health status was mainly related to leg power and orientation. The standardized stroke scale weights of the explanatory items were lower than their standardized regression weights. CONCLUSIONS: Stroke scales only partly explain functional health. The impact of impairments on functional outcomes seems to be underestimated by the stroke scale weights. The correlation patterns give empirical support to the hierarchical structure of the International Classification of Impairments, Disabilities and Handicaps.

Aged↗
PubMed2005

Development and pilot testing of four desired health outcomes scales.

PURPOSE/OBJECTIVES: To develop and pilot test scales to measure desired health outcomes hypothesized to result from high-quality cancer nursing care: Fortitude Scale, Trust in Nurses Scale, Cancer Patient Optimism Scale, and Authentic Self-Representation Scale. DESIGN: Instrument development. SETTING: Community cancer support organization. SAMPLE: 66 recently treated patients with cancer who attended a cancer support organization workshop. The sample was predominately white, middle-aged, well-educated females. METHODS: Items for each scale were generated from qualitative data and the literature. The scales properties were evaluated using expert panel assessment of content validity, cognitive interviews of patients with cancer, and reliability and validity testing of each scale with the Multitrait/Multi-Item Analysis Program Revised (MAP-R) statistical program. FINDINGS: Participant responses to the four scales did not include the lowest possible score. Responses yielded evidence of adequate Cronbachs alpha internal consistency reliability for each scale: 0.81 for the Fortitude Scale; 0.81 for Trust in Nurses Scale, 0.75 for Cancer Patient Optimism Scale, and 0.71 for Authentic Self-Representation Scale. The MAP-R statistics yielded evidence of acceptable convergent validity and discriminant validity. CONCLUSIONS: The data provided preliminary evidence of acceptable psychometric properties for four scales designed to measure desired outcomes of cancer nursing care. Support was found for careful use of scales. Further psychometric testing with large samples is recommended. IMPLICATIONS FOR NURSING: These scales represent an initial effort toward providing measures of the desired health outcomes that patients with cancer attributed to high-quality cancer nursing care.

Female↗
PubMed2005

Routine scale and polish for periodontal health in adults.

BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided. OBJECTIVES: The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapist or dental hygienist) on periodontal health. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 9th April 2003. SELECTION CRITERIA: Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals ; outcomes- tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two reviewers. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and weighted mean differences were calculated as appropriate using random-effects models. MAIN RESULTS: Eight studies were included in this review and all studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis). There were no studies comparing the effects of scaling and polishing provided by dentists or Professionals Complementary to Dentistry. AUTHORS' CONCLUSIONS: The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.

Adult↗
PubMed2004

Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations.

The Movement Disorder Society Task Force for Rating Scales for Parkinson's disease (PD) prepared a critique of the Hoehn and Yahr scale (HY). Strengths of the HY scale include its wide utilization and acceptance. Progressively higher stages correlate with neuroimaging studies of dopaminergic loss, and high correlations exist between the HY scale and some standardized scales of motor impairment, disability, and quality of life. Weaknesses include the scale's mixing of impairment and disability and its non-linearity. Because the HY scale is weighted heavily toward postural instability as the primary index of disease severity, it does not capture completely impairments or disability from other motor features of PD and gives no information on nonmotor problems. Direct clinimetric testing of the HY scale has been very limited, but the scale fulfills at least some criteria for reliability and validity, especially for the midranges of the scale (Stages 2-4). Although a "modified HY scale" that includes 0.5 increments has been adopted widely, no clinimetric data are available on this adaptation. The Task Force recommends that: (1) the HY scale be used in its original form for demographic presentation of patient groups; (2) when the HY scale is used for group description, medians and ranges should be reported and analysis of changes should use nonparametric methods; (3) in research settings, the HY scale is useful primarily for defining inclusion/exclusion criteria; (4) to retain simplicity, clinicians should "rate what you see" and therefore incorporate comorbidities when assigning a HY stage; and (5) because of the wide usage of the modified HY scale with 0.5 increments, this adaptation warrants clinimetric testing. Without such testing, however, the original five-point scales should be maintained.

Feasibility Studies↗
PubMed2005

Scaling up population dynamics: integrating theory and data.

How to scale up from local-scale interactions to regional-scale dynamics is a critical issue in field ecology. We show how to implement a systematic approach to the problem of scaling up, using scale transition theory. Scale transition theory shows that dynamics on larger spatial scales differ from predictions based on the local dynamics alone because of an interaction between local-scale nonlinear dynamics and spatial variation in density or the environment. Based on this theory, a systematic approach to scaling up has four steps: (1) derive a model to translate the effects of local dynamics to the regional scale, and to identify key interactions between nonlinearity and spatial variation, (2) measure local-scale model parameters to determine nonlinearities at local scales, (3) measure spatial variation, and (4) combine nonlinearity and variation measures to obtain the scale transition. We illustrate the approach, with an example from benthic stream ecology of caddisflies living in riffles. By sampling from a simulated system, we show how collecting the appropriate data at local (riffle) scales to measure nonlinearities, combined with measures of spatial variation, leads to the correct inference for dynamics at the larger scale of the stream. The approach provides a way to investigate the mechanisms and consequences of changes in population dynamics with spatial scale using a relatively small amount of field data.

Animals↗
PubMed2004

Re-scaling social preference data: implications for modelling.

As applied in cost-utility analysis, generic health status indexes require that full health and dead are valued as 1 and 0, respectively. When social preference weights for health states are obtained using a visual analogue scale (VAS), their raw scores often lie on a scale with different endpoints (such as "best" and "worst" health). Re-scaling individual raw scores to a 0-1 scale leads to the exclusion of respondents who fail to value dead or full health. This study examined alternative approaches that do not impose such strict exclusion criteria. The impact of a different timing of re-scaling (before or after aggregation) and a different measure of central tendency (median or mean) is measured. Data from a postal valuation survey (n=722) conducted in Belgium are used. The following models are considered: (a) re-scaling values for EQ-5D health states on a within-respondent basis and using mean re-scaled values as proxies for social preference values, (b) using median re-scaled values as proxies for social preference values, (c) computing the median raw VAS values and then re-scale, and (e) re-scaling mean raw VAS values. Exclusion rates, health state rankings and valuations and incremental value differences between pairs of states are computed for each model. Models that use a different timing of re-scaling, are compared ceteris paribus to evaluate the importance of timing of re-scaling and models that use a different measure of central tendency are compared ceteris paribus to evaluate the importance of the measure of central tendency. The exclusion rates are above 20% in the models that re-scale valuations before aggregation and less than 5% in the models that re-scale after aggregation. Health state valuations are found to be different in all two by two comparisons. Although in some comparisons the incremental values are statistically significantly different between models, they are never clinically significantly different. Differences in health state rankings were larger between the models that use a different measure of central tendency than between the models that re-scale at a different time. This study shows that, for the data sample used, the choice of the measure of central tendency is more important for the social health status preference values than the timing of re-scaling. Using median original valuations in the analysis of EQ-5D valuation data is theoretically appealing because it builds on the "median voter" model and has the advantage of a lower respondent exclusion rate. Further analysis, on other data samples, will have to confirm the current findings.

Adult↗
PubMedDate not supplied

Correlations between scale structure and pigmentation in butterfly wings.

We examined the correlation between color and structure of wing scales in the nymphalid butterflies Bicyclus anynana and Heliconius melpomene. All scales in B. anynana are rather similar in comparison to the clear structural differences of differently pigmented scales in H. melpomene. Where scale structural differences in H. melpomene are qualitative, they seem to be quantitative in B. anynana. There is a "gradient" in the density of some structural elements, the cross ribs, in the scales of B. anynana: black, gold, and brown scales show progressively lower cross rib density within an individual. There is, however, high individual variation in the absolute cross rib densities (i.e., scales with a particular color and cross rib density in one individual may have a different color but similar density in another individual). By ectopically inducing color pattern during early pupal development, we examined whether a scale's color and its microstructure could be uncoupled. The effect of these manipulations appears to be different in B. anynana and H. melpomene. In Bicyclus, "black" scales induced by wing damage at an ectopic location normally containing brown scales acquire both an intermediate structure and color between that of brown and normal black scales. In Heliconius, however, intermediate colors or scale structure were never observed, and scales with an altered color (due to damage) always have the same structure as normal scales with that color. The results are discussed on the basis of gene expression patterns, variability in rates of scale development and pigment, and scale sclerotization pathways.

Analysis of Variance↗
PubMed1998

A simultaneous comparison of three neonatal pain scales during common NICU procedures.

OBJECTIVE: This study evaluated neonatal pain scales during procedures commonly performed in a neonatal intensive care unit. DESIGN: Evaluated were the Neonatal Infant Pain Scale (NIPS), the Comfort scale, and a new scale known as the Scale for Use in Newborns (SUN). Four procedures were scored: intubation, intravenous catheter insertion, endotracheal tube suctioning, and diaper changes. Scoring was done before, during, and after each procedure. Thirty-three patients were tested during 68 procedures with 1,428 scale scores. RESULTS: All scales demonstrated significant changes. In before-versus-during for each procedure, the increase in pain scale score was significant for the NIPS, Comfort scale, and SUN. All three scales also demonstrated a return to baseline (before-vs.-after) for the four procedures, except for the Comfort scale, which remained elevated (p < .05) following diaper change. The NIPS had a significantly larger coefficient of variation (CV, 188% +/- 99%), whereas the Comfort scale and SUN had small CVs (27% +/- 5% and 33% +/- 8%, respectively). In evaluating potential confounding influences, it was found that infants > 2.5 kg on sedative or analgesic medications appeared to have procedure-related accentuation and sustained elevation in scale scores, whereas swaddling seemed to provide little added benefit. CONCLUSIONS: The pain scale scores identify changes in an infant's behavior/physiologic state. It is unclear whether these changes are totally "pain specific." In comparing the three scales, the SUN overall was a preferable tool because of its ease of use, scale symmetry, and scoring consistency.

Birth Weight↗
PubMedDate not supplied

Faces scales for the measurement of postoperative pain intensity in children following minor surgery.

OBJECTIVES: Faces scales are commonly used to obtain self-reports of pain intensity from children. Previous research using hypothetical vignettes and pain following venepuncture has found differences in children's pain ratings as a function of the type of faces scale used. The purpose of the present study was to determine whether scales beginning with a smiling rather than neutral "no pain" face would produce higher ratings in the assessment of postoperative pain intensity in children and to compare ratings using different faces scales to those reported with an additional independent measure of pain intensity. METHODS: Participants were 78 children between the ages of 5 and 13 years undergoing surgery, one of their parents, and their postoperative care nurse. Following surgery, children were asked to provide a rating of their current pain intensity using a set of 5 successively administered faces scales and the Colored Analog Scale (CAS). Parents and nurses provided independent ratings using the same measures. RESULTS: Results showed that parents and nurses rated significantly more pain when using scales with a smiling rather than a neutral "no pain" face. This pattern was not as clear for the children's ratings, although their highest ratings were provided when using a smiling "no pain" faces scale. Children's and nurses' ratings on the CAS were generally more similar to their ratings using scales with neutral "no pain" faces, whereas parents' CAS ratings tended to fall in between ratings provided on the smiling and neutral "no pain" faces scales. Scale preference, age and sex differences in pain ratings, and child-parent-nurse agreement in pain ratings are also examined. DISCUSSION: Children's and parents' ratings of postoperative pain intensity are influenced by the presence of a smiling "no pain" face at the beginning of faces scales, with such scales producing significantly higher ratings than scales with neutral "no pain" faces. Ratings on the independent CAS measure were more comparable to those provided on faces scales with neutral "no pain" faces. Nurses are also susceptible to the influencing effect of a smiling face at the beginning of a faces scale.

Adolescent↗
PubMed2005

The Newcastle Satisfaction with Nursing Scales: a valid measure of maternal satisfaction with inpatient postpartum nursing care.

AIM: To test the validity of The Newcastle Satisfaction with Nursing Scales as measures of patient satisfaction with nursing care in an inpatient postpartum unit. BACKGROUND: The Newcastle Satisfaction with Nursing Scales (Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale) were developed to measure the satisfaction of medical-surgical inpatients with nursing care. METHODS: The Newcastle Satisfaction with Nursing Scales were administered by interviewers to 189 postpartum women prior to hospital discharge. We tested the construct validity of the scales by making five a priori predictions: mothers who were more satisfied would be more likely to have one nurse caring for them and to recommend the postpartum unit to a friend. We also predicted that the Experience of Nursing Care and Satisfaction with Nursing Care Scales would be positively correlated with each other, with a global question about satisfaction with nursing care, and with a global question about satisfaction with overall postpartum stay. RESULTS: Four of the five a priori predictions were supported by the data. The mean Newcastle Satisfaction with Nursing Scale scores of mothers who would recommend the unit to a friend were higher (more satisfied) than those who would not (P < 0.001). The Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale were positively and significantly correlated with each other (r = 0.9, P < 0.001). There was a positive and significant correlation between the scales and global ratings of nursing care (Experience Scale r = 0.79, P < 0.001; Satisfaction Scale r = 0.82, P < 0.001) and overall postpartum stay (Experience Scale r = 0.64, P < 0.001; Satisfaction Scale r = 0.68, P < 0.001). CONCLUSION: The Newcastle Satisfaction with Nursing Scales are valid measures of maternal satisfaction with inpatient postpartum nursing care.

Adolescent↗
PubMed1994

Interconversion of stroke scales. Implications for therapeutic trials.

BACKGROUND AND PURPOSE: Stroke scales are intended to measure stroke severity for the purpose of clinical trials. Scores have been used to determine trial entry, to compare patient groups within or between trials, or as a secondary end point. The use of scores as an end point in meta-analysis has not been validated, but such analyses have nevertheless been performed when equivocal results have been obtained using the main outcome measure. The different scale designs suggest that conversion of scores may not be possible. We sought to determine whether scores on different scales could be interconverted. METHODS: A single observer scored 433 consecutive admissions to an acute stroke unit on the Canadian Neurological Scale, the middle cerebral artery Neurological Score (or Orgogozo scale), and the National Institutes of Health stroke scale. Data were separated into training and test sets, and linear regression was used to model conversion between scales. Prediction errors were calculated. Strokes were subdivided according to the Oxfordshire Community Stroke Project classification, and coefficients of determination were calculated for different subtypes. RESULTS: Conversion between Canadian and middle cerebral artery Neurological scales was satisfactory (R2 = 94.7%), and prediction errors were acceptable (absolute prediction error, 5.0 +/- 5). Conversion from the National Institutes of Health scale was worse (R2 = 87.5% to Canadian and 89.0% to Neurological Score), and prediction errors were significantly greater (Neurological Score error, 8.7 +/- 7; Canadian Neurological Scale error, 8.5 +/- 7.3; P < .005 for both). Coefficients of determination for interconversion were significantly worse for dysphasic patients with total anterior circulation strokes than for other stroke types (P < .01). Reweighting the motor component of the National Institutes of Health scale improved coefficients of determination and reduced prediction errors, but prediction error for conversion to the Canadian scale remained significantly greater than other conversions (P = .001). CONCLUSIONS: The Canadian Neurological Scale and the middle cerebral artery Neurological Score may reliably be converted. The National Institutes of Health scale cannot be used to predict these scores reliably, even with reweighting of the motor score. Interconversion is poorest for patients with dysphasia and total anterior circulation strokes. These results suggest that there will be more general difficulty in interconverting scales that use different test items and weighting. Meta-analysis using sequential changes in averaged scores from various stroke scales is not valid.

Adult↗
PubMed2000

Criterion-validity-based assessment of four scale constructs.

BACKGROUND: The aim of this study was to discuss, in general, selected crucial aspects of the appropriate methodology for the development and validation of scales indicating health status, and to illustrate this empirically by within-material comparison of the accuracy of four different scale constructs based on identical raw data. METHODS: The empirical example was based on information from the parents of 99 refugee children, aged 3-15 years, from the Middle East, who participated in a structured interview on their children's mental health. Following this, they were exposed to a blinded semi-structured psychological interview. Four anxiety scales were constructed based on answers to 12 anxiety symptom questions in the structured interview: Scale 1, by cumulation of original item scores, each ranging from 0 to 3; Scale 2, by counting the number of symptoms being present; Scale 3, by counting the number of frequent or intense anxiety symptoms; Scale 4, by estimation of the multivariate probability of the child being anxious, as assessed by the psychological interview. The scales were compared for their accuracy in the identification of children assessed as anxious by psychological interview. RESULTS: The four scales correlated mutually, and each of them was significantly associated with anxiety, as assessed by psychological interview. The weighted scale, however, performed significantly better than the unweighted scales for sensitivity but not for specificity. In the present data set the overall amount of misclassification was, however, significantly less than in the unweighted scales. CONCLUSION: As expected from theory, the weighted scale was found to be superior to the unweighted scales, in identifying the anxious children of the empirical example. In the presence of a blinded criterion measurement, empirical regression-based weighting of scale items thus constitutes an accessible and valid alternative to traditional methods of health and social scaling.

Adolescent↗