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PubMed1989

Posttraining or pretest administration of nimodipine fails to affect retention of a simple learned association.

In previous experiments, the antagonist of voltage-sensitive calcium channels, nimodipine, given before training, enhanced the retention of an acquired preference for white-left relative to black-right in a two compartment apparatus. In the present experiments we attempted to determine if the retention effects produced by the drug could be attributed to effects occurring in the posttraining period. Various groups of rats received posttraining injections of nimodipine or its vehicle and two hours prior to testing received a second injection of nimodipine or its vehicle or no injection at all. All rats were tested for retention of the association twice, both 24 and 48 hr after acquisition. No posttraining or pretesting drug effects were found. This would support the view that the enhanced retention found after treatment with nimodipine found by ourselves and by others is due to a change in the animals at the time of acquisition.

Animals↗
PubMed1989

Pretest beta-endorphin and epinephrine, but not oxotremorine, reverse retrograde interference of a conditioned emotional response in mice.

CD-1 mice were trained in a classically conditioned emotional response paradigm and tested 24 hr later. Exposure to an open field 0 or 1, but not 3 hr after training retroactively interfered with retention of the conditioned emotional response. The retroactive interference was counteracted by the pretest IP administration of beta-endorphin (0.05 microgram/mouse) or epinephrine (1 microgram/mouse), but not by that of oxotremorine (5 micrograms/mouse). The three drugs were able to enhance retention test performance in animals not exposed to the open field after training. In view of evidence in the literature that beta-endorphin and epinephrine are released during training in an aversive task like this, it seems likely that these two agents were able to overcome the effect of retroactive interference by reinstating neurohumoral attributes of the conditioned emotional task at the time of testing.

Animals↗
PubMed2006

A new discrimination method for the Concealed Information Test using pretest data and within-individual comparisons.

A latent class discrimination method is proposed for analyzing autonomic responses on the concealed information test. Because there are significant individual differences in autonomic responses, individual response patterns are estimated on the pretest. Then an appropriate discriminant formula for the response pattern of each individual is applied to the CIT test results. The probability that the individual concealed information is calculated by comparing the discriminant formula value of the crime-related item to that of non-crime-related items. The discrimination performance of the latent class discrimination method was higher than those of the logistic regression method and the discriminant analysis method in an experimental demonstration applying the three methods to the same data set.

Adult↗
PubMed2006

Effects of a back-pain-reducing program during pregnancy for Korean women: a non-equivalent control-group pretest-posttest study.

BACKGROUND: Although many pregnant women experience back pain, it has not considered an important health problem. No study has investigated the effects of a back-pain-reducing program (BPRP) during pregnancy for Korean women. OBJECTIVE: The purpose of this study was to evaluate the effect of a program designed to reduce back pain in pregnant women. METHODS: A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended an antenatal clinic and experienced back pain during their pregnancy were included in an intervention group (n=29), and their intensity of back pain, functional limitation and anxiety were compared with women in a control group from another antenatal clinic (n=27). The data were collected at three time points: prior to intervention, and 6 and 12 weeks after intervention. RESULTS: At 12 weeks after intervention, the intensity of back pain experienced by the intervention group was significantly lower than that of the control group. However, there were no statistically significant differences between the groups with respect to functional limitations and anxiety. CONCLUSIONS: The findings show that the pain-reducing program developed for this study was effective in reducing the intensity of back pain experienced by pregnant women. Promoting good posture and regular exercise can be recommended as a method to relieve back pain in pregnancy women. Further studies are needed to confirm the effect of the BPRP during pregnancy.

Activities of Daily Living↗
PubMed2005

Clinical experience did not reduce the variance in physicians' estimates of pretest probability in a cross-sectional survey.

BACKGROUND AND OBJECTIVES: In light of the increasing popularity of the threshold approach in clinical decision-making, this study assesses the role of expertise in physicians' agreement in estimating the probability of disease in patients. METHODS: A cross-sectional survey of physicians of different specialties, attending weekly staff meetings in four teaching hospitals in Jerusalem, Israel. An anonymous questionnaire describing three case scenarios of patients with chest pain was administered and participants were asked to estimate pretest probabilities of disease. RESULTS: Eighty-six physicians (practicing cardiology, internal medicine, and family medicine, as well as general practitioners and internists) out of 125 approached (response rate 69%). The mean estimated probabilities were very similar for residents and specialists; however, the standard deviation was higher for specialists in all three cases: 20.7, 21.0, and 19.1 among specialists and 16.4, 20.5, and 14.9 among residents, respectively. CONCLUSION: This study, based on case scenarios, did not find that medical expertise improved agreement among doctors when estimating the probability of disease in patients-despite the common belief that senior physicians should have smaller interobserver differences in probability estimates. The wide variation observed calls into question the applicability of the threshold approach.

Cardiology↗
PubMed2005

Estimating the pretest probability threshold to justify empiric administration of heparin prior to pulmonary vascular imaging for pulmonary embolism.

Expertly interpreted pulmonary vascular imaging (either ventilation-perfusion scan or computed tomography chest angiography) is not uniformly available at most hospitals, including those in the US. When evaluating a patient with suspected pulmonary embolism during times when pulmonary vascular imaging is not available, clinicians frequently face the decision of whether to administer heparin while awaiting availability of imaging. In this report, we analyze published data to quantitate the probability of death or disability from untreated pulmonary embolism versus the probability of serious bleeding for one, two and seven days of heparin therapy. For these three time points, we estimate the pretest probability of pulmonary embolism to justify the empiric administration of heparin.

Data Interpretation, Statistical↗
PubMed1998

Determination of pretest probability for detection of a cardiovascular source of emboli by transesophageal echocardiography using clinical and transthoracic echocardiographic data.

Transesophageal echocardiographic findings and their effect on disease management were evaluated in 216 patients with suspected cardiovascular source of emboli. Clinical and transesophageal echocardiographic findings were useful in defining pretest probability for finding a probable cardiovascular source of emboli on transesophageal echocardiography.

Adult↗
PubMed2000

Accuracy of a pretest questionnaire in exercise test protocol selection.

Proper exercise test protocol selection is essential to allow adequate time for observation of subjective and physiologic responses to exercise, as well as provider-patient interaction and patient comfort. This study evaluates the accuracy of a pretest questionnaire in predicting exercise capacity for exercise test protocol selection and compares the accuracy of this questionnaire when ramp versus step protocols are used.

Activities of Daily Living↗
PubMed2001

Assessment of pretest risk for venous thromboembolic disease.

The news, therefore, is somewhat pessimistic. Empiric estimate appears to be fairly good in stratifying risk groups for PE but suffers from a lack of standardization, as well as poor sensitivity and specificity. Multiple attempts to standardize pretest risk have used several different but usually overlapping variables, and none appears yet to be much better than simple clinical estimate--the very scale they were trying to replace. The clinician therefore must assess whether, on the basis of what has been published so far, there is any convincing reason to move from an empiric to a score-based prediction system. Apart from the clear advantage of standardization, the score-based systems are varied, not agreed on, and usually clumsy to use in a busy ED. Until one prediction system has been shown to be both easy to remember and use in clinical practice, and to be more accurate than an empiric score, emergency physicians should continue to use their own practice-based empiric system. DVT can be safely, quickly, and accurately diagnosed in the ED, and for most cases there is no need to use a prediction rule. Suspected PE continues to be a complex entity to evaluate and diagnose in the ED, and none of the objective prediction rules have yet been able to improve the difficult task of the ED evaluation of the patient with suspected PE.

Humans↗
PubMed1999

Pretesting Spanish-language educational radio messages to promote timely and complete infant immunization in California.

California's Hispanic infants have lower immunization levels than non-Latino white infants, 53.7% versus 65.2%, respectively. Spanish-language radio is an effective mass media venue for imparting information to Latino populations. It has been demonstrated that lack of parental knowledge of infant immunization timing is associated with delayed immunization coverage. In an effort to improve Latino parent knowledge of immunization timing, two Spanish-language radio commercials were developed to be used in conjunction with community-based educational efforts. In order to gage the potential educational impact of the two commercials, they were pretested with a group of low-income Spanish-speaking Latino parents who represented members of the target population for whom the commercials were created. Both commercials were rated favorably by parents, and elicited immunization-specific responses. Although correct recall of the simplified, basic immunization schedule was low, the level of immunization response consistency and overall approval of both commercials appear to support their use as part of Latino infant immunization educational outreach in California.

Adult↗
PubMed2003

The utility of pretest probability assessment in patients with clinically suspected venous thromboembolism.

The assessment of pretest probability (PTP), with stratification into low-, intermediate- and high-risk groups is an essential initial step in the current diagnostic management of patients with suspected venous thromboembolism (VTE). In combination with additional information, it reduces the need for initial and supplementary imaging, and allows considerable refinement of the posterior probability of VTE following non-invasive imaging. PTP may be assessed either empirically or by using various decision rules or scoring systems, the best known of which are the simplified Wells scores for suspected deep vein thrombosis (DVT) and pulmonary embolism (PE), and the Geneva score for suspected PE. Each of these approaches shows similar directional and categorical accuracy, and has been validated as facilitating clinically useful classification of the PTP, although an overview of data suggests that fewer patients tend to be classified as low PTP when assessed empirically. This group is the most important to identify, as several outcome studies have shown that imaging and treatment are safely obviated in outpatients with suspected DVT or PE who have a low PTP in combination with negative d-dimer testing, a subgroup accounting for up to half of all patients studied. Hence, while probably not of critical importance, the explicit approach offered by scoring systems might be preferred over empirical assessment, particularly when used by more junior staff.

Bayes Theorem↗
PubMed2003

Does assessment of pretest probability of disease improve the utility of echocardiography in suspected endocarditis in children?

OBJECTIVE: To compare the yield rate (YR) of echocardiography when evaluating children with suspected infectious endocarditis (IE) in both the actual clinical setting and in the hypothetic setting where strict clinical criteria are applied. Study design Medical records of 101 children undergoing echocardiography for suspected IE were reviewed. Echocardiograms with positive findings were identified and the actual diagnostic YR was calculated. With the use of clinical criteria proposed by von Reyn (VR), the probability of IE was retrospectively classified as (1) rejected, (2) possible, or (3) probable. Theoretic YR of echocardiography was calculated for each classification. RESULTS: The actual YR of echocardiography was 12% (12/101). The YR of echocardiography by VR class was 0% in rejected, 20% in possible, and 80% in probable cases (chi(2) = 55.1, P <.0001). Echocardiography did not change the probability of IE in any patient classified as rejected, but allowed reassignment of disease probability in a significant proportion of patients with possible or probable IE. CONCLUSIONS: The YR of echocardiography was significant when clinical probability of IE was intermediate-to-high, and low, with marginal clinical utility, when clinical probability was low. Strict pretest assessment of disease probability may lead to more effective utilization of echocardiography in this population.

Bacteria↗
PubMed1992

In the eye of the beholder: pretesting the effectiveness of health education materials.

Health educators at the University of Massachusetts evaluated five posters to determine whether students comprehended, identified with, and were motivated by the messages, which dealt with aspects of safer sex, alcohol use, and stress management. Pretesting, they suggest, provides an opportunity for remedying design flaws before distributing materials, improving effectiveness, and saving money by assuring that the target audience receives the intended message. Six suggestions for improving effectiveness and acceptability of printed health education materials are offered.

Attitude to Health↗
PubMed2006

Understanding interrelationships among HIV-related stigma, concern about HIV infection, and intent to disclose HIV serostatus: a pretest-posttest study in a rural area of eastern China.

The objective of the study was to examine the interrelationships among HIV-related public and felt stigma, worry of HIV infection, HIV/AIDS knowledge and intention to disclose HIV testing results in a rural area of China, where HIV spread among former commercial blood donors. A one-group pretest-posttest study was conducted among 605 marriage license applicants. The following relationships showed statistical significance in path analysis: (1) HIV/AIDS knowledge --> worry [beta (Standardized coefficient) = -0.39]; (2) worry --> public stigma (beta = 0.27); (3) public stigma --> felt stigma (beta = 0.22); and (4) felt stigma --> intention to disclosure (beta = -0.20). Separate path analyses for males and females generated similar association patterns. HIV counseling reduced perceived worry but exerted little impact on HIV-related stigma and the intention. The pathway from a lack of HIV/AIDS knowledge to increased stigma and to decreased intention to disclose one's serostatus is particularly policy relevant as decreased intention to disclosure may be related to continuing practice of HIV risk behaviors. The findings demonstrate interventions aiming at the reduction of stigma should be targeted at both the individual and community levels.

Adult↗
PubMed1997

Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing.

BACKGROUND: In response to the isolation of the BRCA1 gene, a breast-ovarian cancer-susceptibility gene, biotechnology companies are already marketing genetic tests to health care providers and to the public. Initial studies indicate interest in BRCA1 testing in the general public and in populations at high risk. However, the optimal strategies for educating and counseling individuals have yet to be determined. PURPOSE: Our goal was to evaluate the impact of alternate strategies for pretest education and counseling on decision-making regarding BRCA1 testing among women at low to moderate risk who have a family history of breast and/or ovarian cancer. METHODS: A randomized trial design was used to evaluate the effects of education only (educational approach) and education plus counseling (counseling approach), as compared with a waiting-list (control) condition (n = 400 for all groups combined). The educational approach reviewed information about personal risk factors, inheritance of cancer susceptibility, the benefits, limitations, and risks of BRCA1 testing, and cancer screening and prevention options. The counseling approach included this information, as well as a personalized discussion of experiences with cancer in the family and the potential psychological and social impact of testing. Data on knowledge of inherited cancer and BRCA1 test characteristics, perceived risk, perceived benefits, limitations and risks of BRCA1 testing, and testing intentions were collected by use of structured telephone interviews at baseline and at 1-month follow-up. Provision of a blood sample for future testing served as a proxy measure of intention to be tested (in the education and counseling arms of the study). The effects of intervention group on study outcomes were evaluated by use of hierarchical linear regression modeling and logistic regression modeling (for the blood sample outcome). All P values are for two-sided tests. RESULTS: The educational and counseling approaches both led to significant increases in knowledge, relative to the control condition (P < .001 for both). The counseling approach, but not the educational approach, was superior to the control condition in producing significant increases in perceived limitations and risks of BRCA1 testing (P < .01) and decreases in perceived benefits (P < .05). However, neither approach produced changes in intentions to have BRCA1 testing. Prior to and following both education only and education plus counseling, approximately one half of the participants stated that they intended to be tested; after the session, 52% provided a blood sample. CONCLUSIONS: Standard educational approaches may be equally effective as expanded counseling approaches in enhancing knowledge. Since knowledge is a key aspect of medical decision-making, standard education may be adequate in situations where genetic testing must be streamlined. On the other hand, it has been argued that optimal decision-making requires not only knowledge, but also a reasoned evaluation of the positive and negative consequences of alternate decisions. Although the counseling approach is more likely to achieve this goal, it may not diminish interest in testing, even among women at low to moderate risk. Future research should focus on the merits of these alternate approaches for subgroups of individuals with different backgrounds who are being counseled in the variety of settings where BRCA1 testing is likely to be offered.

Adult↗
PubMed2002

Pretest prediction of BRCA1 or BRCA2 mutation by risk counselors and the computer model BRCAPRO.

BACKGROUND: Because BRCA gene mutation testing is costly, occasionally uninformative, and frequently associated with ethical and legal issues, careful patient selection is required prior to testing. Estimation of BRCA gene mutation probability is an important component of pretest counseling, but the accuracy of these estimates is currently unknown. We measured the performance of eight cancer risk counselors and of a computer model, BRCAPRO, at identifying families likely to carry a BRCA gene mutation. METHODS: Eight cancer risk counselors and the computer model BRCAPRO estimated BRCA gene mutation probabilities for 148 pedigrees selected from an initial sample of 272 pedigrees. The final sample was limited to pedigrees with a proband affected by breast or ovarian cancer and BRCA1 and BRCA2 gene sequencing results unequivocally reported as negative or positive for a deleterious mutation. Sensitivity, specificity, negative predictive value, positive predictive value, and areas under receiver operator characteristics (ROC) curves were calculated for each risk counselor and for BRCAPRO. All statistical tests were two sided. RESULTS: Using a greater-than-10% BRCA gene mutation probability threshold, the median sensitivity for identifying mutation carriers was 94% (range = 81% to 98%) for the eight risk counselors and 92% (range = 91% to 92%) for BRCAPRO. Median specificity at this threshold was 16% (range = 6% to 34%) for the risk counselors and 32% (range = 30% to 34%) for BRCAPRO (P =.04). Median area under the ROC curves was 0.671 for the risk counselors (range = 0.620 to 0.717) and 0.712 (range = 0.706 to 0.720) for BRCAPRO (P =.04). There was a slight, but not statistically significant, improvement in all counselor performance measures when BRCAPRO-assigned gene mutation probability information was included with the pedigrees. CONCLUSIONS: Sensitivity for identifying BRCA gene mutation carriers is similar for experienced risk counselors and the computer model BRCAPRO. Because the computer model consistently demonstrated superior specificity, overall discrimination between BRCA gene mutation carriers and BRCA gene mutation noncarriers was slightly better for BRCAPRO.

Breast Neoplasms↗
PubMed2003

Semiparametric estimation of treatment effect in a pretest-posttest study.

Inference on treatment effects in a pretest-posttest study is a routine objective in medicine, public health, and other fields. A number of approaches have been advocated. We take a semiparametric perspective, making no assumptions about the distributions of baseline and posttest responses. By representing the situation in terms of counterfactual random variables, we exploit recent developments in the literature on missing data and causal inference, to derive the class of all consistent treatment effect estimators, identify the most efficient such estimator, and outline strategies for implementation of estimators that may improve on popular methods. We demonstrate the methods and their properties via simulation and by application to a data set from an HIV clinical trial.

Antiviral Agents↗
PubMed1990

Pretesting a childbirth handbook.

The development of health education materials for pregnant women involves the work of knowledgeable and experienced health professionals, writers, editors, and artists. Frequently, these materials are also extensively reviewed by various experts and organizations prior to publication. Even with all this expert input and review, however, they can miss the mark if they are not deemed appropriate and acceptable by the audience for whom they were created. In developing a new booklet on childbirth, the New York State Department of Health wanted to ensure that the material would be read and used by pregnant women from various income and educational levels and racial and ethnic groups. Research was conducted by the department to pretest the booklet for its appropriateness for and acceptance by the target audience. Based on the reactions and suggestions from 89 women in eight focus groups, the booklet was revised extensively before being made available to the general public.

Adult↗