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PubMed2003

Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department.

We propose an emergency department (ED) pulmonary embolism rule-out protocol based on pretest probability assessment coupled with either a negative D -dimer assay result or a negative D -dimer assay result plus a normal alveolar dead-space measurement. We examine the safety, efficiency, and feasibility of such a protocol, paying special attention to implicit and explicit strategies of pretest probability assessment among patients with suspected pulmonary embolism. Finally, we assess the potential effect of the proposed pulmonary embolism rule-out protocol on use of imaging resources and ED throughput.

Algorithms↗
PubMed2001

Safety, feasibility, and prognostic implications of pharmacologic stress echocardiography in 1482 patients evaluated in an ambulatory setting.

BACKGROUND: The outpatient prognostic assessment of coronary artery disease (CAD) by exercise electrocardiography has limitations, including the feasibility of the test and its low positive predictive value in several clinical conditions. In the current study we investigated the safety, feasibility, and prognostic value of pharmacologic stress echocardiography in a large cohort of ambulatory patients. METHODS: The study group was made of 1482 ambulatory patients (969 men, aged 60 +/- 10 years) who underwent stress echocardiography with either dipyridamole (n = 846) or dobutamine (n = 636) for evaluation of suspected or known stable CAD. The pretest likelihood of CAD was intermediate (<70%) in 709 patients and high (> or =70%) in 773 patients. RESULTS: There was no complication during the dipyridamole test, whereas 2 ischemia-dependent, sustained ventricular tachycardias occurred during the dobutamine test. Limiting side effects were observed in 2% of dipyridamole and in 3% of dobutamine stresses. The echocardiogram was positive in 459 patients. During a mean follow-up of 28 +/- 24 months, 58 patients died, 33 had a nonfatal myocardial infarction, and 158 underwent early (< or =3 months) and 64 late (>3 months) revascularization. Multivariate predictors of hard events (death, infarction) were positive echocardiographic results (hazard ratio [HR] 2.9) and resting wall motion score index (WMSI) (HR 2.3). In considering major events (death, infarction, late revascularization) as end points, positive echocardiographic result (HR 4.3), scar (HR 2.2), and resting WMSI (HR 1.7) were independent prognostic predictors. The 5-year survival rates for the ischemic and nonischemic groups were, respectively, 80% and 91% (HR 3.6, 95% confidence interval [CI] 3.8-8.4; P <.0001) considering hard cardiac events and 65% and 88% (HR 2.6, 95% CI 2.1-5.9; P <.0001) considering major events. Multivariate predictors of major events were positive echocardiographic results (HR 8.2) and male sex (HR 2.5) for the intermediate-risk group and positive echocardiographic results (HR 2.9), resting WMSI (HR 1.8), and prior Q-wave myocardial infarction (HR 1.8) for the high-risk group. CONCLUSIONS: Pharmacologic stress echocardiography is safe, highly feasible, and effective in prognostic assessment of ambulatory patients when both a general population and groups selected on the basis of pretest likelihood of CAD are analyzed. It represents a valid complementary tool to exercise electrocardiography for prognostic purposes in outpatients.

Ambulatory Care↗
PubMedDate not supplied

Effects of a 12-week cardiac rehabilitation exercise program on motivation and health-promoting lifestyle.

OBJECTIVE: The purpose of this study was to determine the effects of a 12-week cardiac rehabilitation exercise program on the motivation and lifestyle of persons recovering from a recent heart attack or cardiac-related procedures. DESIGN: The study design was a pretest and posttest quasi-experimental, nonrandom assignment. SETTING: The study was conducted at 4 cardiac rehabilitation centers in Northeast Ohio. SUBJECTS: The study included 57 participants in a cardiac rehabilitation exercise program (mean age = 64 years) and 57 comparisons (mean age = 64.6 years) who recently had a heart attack or underwent cardiac-related procedures. OUTCOME MEASURE: Motivation and health-promoting lifestyle were measured. INTERVENTION: A 12-week cardiac rehabilitation exercise program for small groups of participants (fewer than 12 persons) was conducted. The program provided arm and leg exercises 3 times a week for 30 to 60 minutes per session at an intensity of 60% to 90% of the maximum heart rate. RESULTS: Analysis of covariance was used to analyze the data. After controlling for education, income, and pretest scores, the exercise group scored significantly higher than the comparison group in most motivation-related variables. Regarding lifestyle, after adjusting for the control variables both groups showed positive changes during the 12-week period, but no significant difference was found between the 2 groups in overall lifestyle. CONCLUSION: The findings of the study confirmed that motivational variables were modifiable. Thus, when developing health promotion programs for initiating and maintaining a healthy lifestyle, the relative importance of different motivational variables should be considered.

Adult↗
PubMed2002

Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness.

OBJECTIVE: To determine whether clinical and statistically significant changes in back pain, shoulder pain, spine stiffness, and quality of sleep may be documented after use of a prescribed bedding system. DESIGN: Quasi-experimental field study of single group pretest-posttest design with subjects serving as their own controls. SETTING: Two chiropractic clinics and the Oklahoma State University Program of Health and Human Performance. SUBJECTS: Convenience sample of 22 subjects (women, n = 13; men, n = 9) between the ages of 25 and 75 years with documented disturbed sleep, shoulder pain, low back pain, and spine stiffness of a chronic nature. OUTCOME MEASURES: Pretest and posttest 28-day Visual Analog Scales for pain, spine stiffness, and quality of sleep. MAIN RESULTS: The experimental bedding system reduced back pain by 57.21% (P =.000001), reduced shoulder pain by 60.83% (P =.000005), reduced back stiffness by 59.12% (P =.000004), and improved quality of sleep by 60.73% (P =.000001). CONCLUSIONS: Results suggest that subjects obtain significant improvement in shoulder and back pain, back stiffness, and quality of sleep after 28 days of prescribed bedding system use as compared with 28 days of personal bedding use. Female subjects and those with lower body weight were more likely to significantly improve than heavier and more obese subjects.

Adult↗
PubMed2002

The effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson's disease and rigidity.

OBJECTIVE: To quantify changes of evoked stretch responses (ESR) in the most rigid arm of patients with Parkinson's disease (PD) after Trager therapy. METHODS: Gentle rocking motion associated with this type of manual therapy was imparted to the upper limbs and body of 30 patients for 20 minutes. A pretest and 2 posttests (at 1 and 11 minutes after the treatment, respectively) were performed, consisting of electromyographic (EMG) recordings of the flexor carpi radialis and extensor digitorum communis while the patient's wrist was passively flexed and extended with an amplitude of 60 degrees and a frequency of 1 Hz. Patients received the treatment on the most rigid side of their bodies (ipsi-group) or on the contralateral side (contra-group). Half of patients in each group received the treatment while lying supine on a massage table (ipsi- and contra-supine) or sitting in a chair (ipsi- and contra-sitting). RESULTS: In general, the level of ESR were reduced by 36% immediately after treatment and remained 32% lower than pretest values 11 minutes after treatment (F = 41.45, P <.05). Patients who received the treatment lying supine benefited from a 42% reduction of ESR (F = 4.07, P <.05). The side on which the treatment was performed did not significantly influence the outcome of the treatment (F = 0.50, P >.05). However, post hoc analysis of the triple interaction (test x side x position) indicated that the sitting position was much less efficient for sustained contralateral effect (P >.05). CONCLUSIONS: Results from the present study strongly suggest that it is possible to modify the level of ESR by using Trager therapy. This stretch reflex inhibition may induce a reduction of the muscle rigidity seen in these patients. The present results may eventually lead to the development of a specific complementary therapy for patients with Parkinson's disease and rigidity.

Adult↗
PubMed2001

Developing the Vascular Quality of Life Questionnaire: a new disease-specific quality of life measure for use in lower limb ischemia.

AIMS: The purpose of this study was to develop and validate an easily used disease-specific quality of life (QOL) measure for patients with chronic lower limb ischemia and to design an evaluative instrument, responsive to within-subject change, that adds to clinical measures of outcome when comparing treatment options in the management of lower limb ischemia. METHODS: The first phase consisted of item generation, item reduction, formulating, and pretesting in patients with ischemia. The proportion of patients who selected an item as troublesome and the mean importance they attached to it were combined to give a clinical impact factor. Items with the highest clinical impact factor were used to formulate a new 25-item questionnaire that was then pretested in 20 patients with lower limb ischemia. In the second phase, reliability, validity, and responsiveness of the new questionnaire were assessed in 39 patients with lower limb ischemia who were tested at 0 and 4 weeks. The King's College Hospital's Vascular Quality of Life Questionnaire and the Short-Form 36 were administered at each visit, and treadmill walking distance and ankle/brachial pressure indices were recorded. The new questionnaire's reliability, internal consistency, responsiveness, and validity were determined. RESULTS: Areas of QOL impairment were consistent through the ranges of disease severity and age, with no apparent differences between the men and women. Therefore, a single questionnaire is applicable to all patients with chronic lower limb ischemia. In stable patients test-retest scores demonstrated a reliability of r more than 0.90. Each item had internal consistency (item-domain Cronbach alpha =.7-.9). The questionnaire was responsive to change, with correlation between change in the questionnaire's total score and both global and clinical indicators of change (P <.001). The questionnaire showed face and construct validity. CONCLUSIONS: This disease-specific questionnaire is reliable, responsive, valid, and ready for use as an outcome measure in clinical trials. It is sensitive to the concerns of patients with lower limb ischemia, offering a simple method to measure the effect of interventions on their QOL.

Adult↗
PubMed2003

Evaluation of a clinical skills orientation program for residents.

OBJECTIVE: Our purpose was to implement and evaluate an orientation program for residents, focusing on outpatient clinical skills. STUDY DESIGN: Eleven of 12 residents participated in a clinical skills orientation program immediately preceding the academic year. The skill stations included evaluation of abnormal uterine bleeding, intrauterine device insertion, basic infertility evaluation, endometrial and vulvar biopsies, pelvic organ prolapse quantification examination, hysterosalpingography and office hysteroscopy, ultrasound scanning, labor and delivery triage, and clinic administrative responsibilities. Before test, after test, and anonymous resident evaluations were used to evaluate the program. RESULTS: First-year residents demonstrated a statistically significant increase in posttest scores compared to pretest scores (42.5% vs 71.3%, P=.003). Only first-year resident posttest scores for the labor and delivery triage and basic infertility evaluation stations demonstrated statistically significant increases over pretest scores (14.3% vs 46.4%, P=.009; and 41.7% vs 83.3%, P=.049, respectively). Sixty-four percent of the residents rated the program as "very helpful." Most residents felt that the program was well organized and that the facilities were conducive to learning; all of the participants recommended an annual clinical orientation program. CONCLUSION: A clinical skills orientation program was well received and strongly desired by residents. First-year residents appeared to benefit the most from this orientation.

Clinical Competence↗
PubMed1985

What is the appropriate control for the tilt illusion?

Recently it has been suggested that when tilt illusions are measured by parallel matching to the test arm of an acute angle, the usual control condition involving a match to the test arm in the absence of the inducing arm is inappropriate. According to Hotopf et al this is so because the pretest contains a second, depth-based illusory effect which is not contained in the test conditions. Whereas Hotopf et al gave indirect evidence for this claim, direct evidence is presented here for their assertion. The results suggest that there is no single stimulus configuration which could serve as a pretest control for all tilt illusion stimuli. Rather, the condition in which the test and inducing lines intersect at 90 degrees probably is the appropriate control for all other inducing-test-line angle displays.

Depth Perception↗
PubMed1995

Temporal-signal detection and individual differences in timing.

Signal-detection procedures were used in three experiments to examine sensitivity and bias in time judgments and to evaluate individual differences in timing. The task required subjects to judge whether visual stimuli were presented for a certain target duration (the 'signal') or for a slightly longer duration. In experiment 1, subjects performed versions of the task involving both short (2 s) and long (12 s) target stimuli. Analyses of sensitivity and bias measures (d' and beta) provided evidence for consistency in timing performance within individuals. In experiment 2, subjects were tested on a detection task with 5, 10, or 15 s targets, followed by a temporal-reproduction task involving stimulus durations ranging from 3 to 17 s. Subjects with high temporal sensitivity showed less error in their reproductions than subjects with low temporal sensitivity. In experiment 3, subjects were pretested on a detection task with a 12 s target and then performed a temporal-production task where they attempted to generate a series of 12 s intervals under either control or informational feedback conditions. Feedback improved accuracy and reduced variability in temporal productions. However, the low-temporal-sensitivity subjects were more variable in their responses under both conditions than were the high-sensitivity subjects. The results point to the utility of a temporal-signal-detection task both as a means for studying individual differences in timing and as a pretesting technique for assigning subjects to high-sensitivity and low-sensitivity groups to reduce error in time-judgment data.

Analysis of Variance↗
PubMed2003

Central coherence and cognitive shifting in relation to social improvement in high-functioning young adults with autism.

The objective of this prospective study was to evaluate the possible role of two cognitive styles--weak central coherence and poor cognitive shifting--in predicting social improvement in patients with autistic disorder. Thirty patients, largely similar in age (young adults), intelligence (high-functioning) and living conditions (residential treatment in the same unit) were assessed at two separate time points with a 3-year interval between pretest and posttest. At pretest central coherence, cognitive shifting and several aspects of social functioning--symptom severity, social intelligence and social competence--were measured. At posttest social functioning was reassessed. Unlike central coherence, cognitive shifting was identified as a significant prognostic marker. This differential outcome might be an indication that patients with poor cognitive shifting and patients with weak central coherence have different prognoses with the current, highly structured treatment milieu; it is unknown whether patients with poor cognitive flexibility might benefit more from treatments specifically designed to address this problem.

Adolescent↗
PubMed2002

Age differences in perceived workload across a short vigil.

The main objective of this research was to investigate age differences in the perceived workload associated with the performance of a demanding, high event rate, vigilance task. Younger participants (n=26) aged 16 to 35 years (M=27.8) and older participants (n=24) aged 45 to 65 years (M=52.2) completed perceived workload scales (NASA-TLX) following a brief practice session (pretest) on the vigilance task, and then again following a test session (posttest) lasting nine minutes. In relation to the vigilance task, a statistically significant performance decrement was identified, but there was no evidence that performance differed according to age in respect to that decrement. However, a dissociation was found in relation to the perceived workload ratings: while no age differences were found in vigilance performance, the workload ratings revealed older participants to perceive a significantly greater increase in workload from pretest to posttest. These findings are considered theoretically in relation to the demands placed upon attentional resources, and their implications for both laboratory-based vigilance research, and workplace systems monitoring situations, are discussed.

Adolescent↗
PubMed2002

Improving children's mental rotation accuracy with computer game playing.

The authors investigated the relation between mental rotation (MR) and computer game-playing experience. Third grade boys (n = 24) and girls (n = 23) completed a 2-dimensional MR test before and after playing computer games (during 11 separate 30-min sessions), which either involved the use of MR skills (the experimental group) or did not involve the use of MR skills (the control group). The experimental group outperformed the control group on the MR posttest but not on the pretest. Boys outperformed girls on the pretest but not on the posttest. Children whose initial MR performance was low improved after playing computer games that entailed MR skills. The findings imply that computer-based instructional activities can be used in schools to enhance children's spatial abilities.

Analysis of Variance↗
PubMed2002

Narrative discourse and theory of mind development.

The authors examined experimentally whether exposure to social discourse about concepts related to mental states could promote changes in children's theory of mind understanding. In 2 studies, 3- to 4-year-old children were assigned to either a training or a no training control condition. All children were administered several theory of mind measures at pretest and 2 posttests. Training was not effective in improving performance in Study 1 (n = 37); but in Study 2 (n = 54), modifications of the training procedure led to significant improvements on measures of false belief and deception from pretest to 1st posttest. The findings support the influence of social discourse on children's theory of mind development.

Analysis of Variance↗
PubMed1995

Gender difference in horizontality performance before and after training.

To investigate why some individuals, especially females, fail Piaget's horizontality task, the author administered Piaget's horizontality task, the rod and frame field-dependence task, Bem's Sex Role Inventory, and a history of spatial activities questionnaire to 122 undergraduates. Individuals who failed the horizontality task were trained on this task, and after 1 month all participants were administered a horizontality posttest. Hierarchical regression analysis revealed that field dependence was related significantly to both pretest and posttest scores. Sex and masculine sex role concept were related to pretest but not to posttest scores. The implications of these findings for group differences in horizontality performance are discussed.

Adult↗
PubMed2004

A questionnaire study of women's views regarding the effectiveness of serum Down screening in north west Wales.

Questionnaires were circulated to 300 women awaiting mid-trimester anomaly scanning in north west Wales to determine women's views of the adequacy of counselling, availability of pretest scanning, method of receiving test results and whether the Down screening process in general was acceptable. Seventy-five per cent of respondents had serum Down screening; 80.3% of women agreed or strongly agreed that counselling prior to antenatal testing for Down syndrome was adequate; 80.7% of women agreed or strongly agreed that the consequences of a high risk result were explained before testing; 88.7% of women agreed or strongly agreed that they had a choice as to whether screening was accepted or not; 81.7% of women agreed or strongly agreed that they were involved in the decision process; and 40.0% of women having Down testing did not have previous ultrasound biometry. Routine pretest ultrasound scanning remains a resource priority.

Adult↗
PubMed2000

Memory improvement in assisted living elders.

Part of the Cognitive Behavioral Model of Everyday Memory (CBMEM), an eight session cognitive enhancement program, entitled "Memories, Memories, Can We Improve Ours?" was tested with older adults living in an assisted living facility in the midwest. The aims of this quasi-experimental study were: to improve everyday memory, memory self-efficacy, and meta-memory. A total of 19 older adults (14 female, 5 male) with an average age of 83 years participated. For the pretest there were 16 individuals in the experimental group. The experimental group was post-tested one week after completing the intervention. At posttest memory self-efficacy scores significantly increased in the experimental group (M1 = 52.13, M2 = 68.50, where M1 represents pretest and M2 represents posttest). Total memory performance scores were not significantly different at posttest; however the prospective memory items of asking for an appointment (M1 = .56, M2 = 1.25), asking for a belonging (M1 = .62, M2 = .88), and delivering a message (M1 = 1.00, M2 = 1.19) significantly improved.

Activities of Daily Living↗
PubMed1991

The validity of academic learning time-physical education (ALT-PE) as a process measure of achievement.

The purpose of this study was to determine whether the ALT-PE system (Version 2) is valid as a process approach to estimate student achievement. Students (N = 60) were randomly selected from a data base that includes pretest and posttest scores for two volleyball skills and seven sessions of videotaped instruction. Videotapes were collected using two cameras with a split-screen generator so most instruction and practice could be seen. ALT-PE data were coded from the videotapes. In addition to normal ALT-PE coding conventions, coders recorded the skill that was the focus of instruction. Combinations of context and learner involvement categories were summed for each skill across the seven class sessions and to form other logical categories (e.g., total motor appropriate intervals). Achievement scores were calculated by posttest on pretest regression for each skill with the residual score used for subsequent analysis. Residual achievement scores were correlated with summed ALT-PE categories. The results indicate for the serve both total motor appropriate and practice-motor appropriate intervals were related to student achievement. For the pass, practice-motor appropriate intervals were related to achievement and the total motor appropriate-achievement correlation failed significance. These results demonstrate the validity of the ALT-PE system as a process measure of achievement can be partially substantiated.

Achievement↗
PubMed2005

Part and whole practice: chunking and online control in the acquisition of a serial motor task.

A four-component aiming movement was used to examine the relative effectiveness of part and whole practice. Following a pretest, participants were assigned to one of three practice groups. Participants in a "Whole" group practiced the four components together as a unit. A "No Overlap" group practiced the first two and last two components of the task, alternating every fifth trial. An "Overlap" group practiced the transition between the second and third components on every trial by alternating practice of the first three and last three components every five trials. Participants in all groups improved significantly from pretest to immediate posttest and maintained their performance over a 24-hr delay. Contrary to the "chunking hypothesis," participants in the No Overlap group improved as much as those in the other two groups. Kinematic data indicated that participants in all three groups learned to use response-produced feedback earlier in the individual movement trajectories. Moreover, participants appeared to acquire a general ability to make transitions between movement components rather than specific transitions. The results suggest that segmented or segmented "overlap" practice regimes may benefit learning movement sequences of short duration.

Adult↗