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PubMed2004

Agreement between scales in the measurement of breast cancer risk perceptions.

The objective of this article is to compare the accuracy and numeric responses of breast cancer risk perception as measured by a frequency scale and percentage scale. A cross-sectional survey was conducted. Perceptions of five-year and lifetime breast cancer risk were measured using a frequency and a percentage scale. Estimation error was calculated as the absolute difference between actual breast cancer risk as determined by the Gail model and perceived risk. Agreement between scales was determined by calculating the mean and standard deviation of the difference between numeric responses. The study was conducted among women enrolled in two primary care clinics associated with an academic medical center. Two-hundred-fifty-four participants were recruited from one of the two participating internal medicine clinics. Inclusion criteria included female gender and age 40-84 years. Exclusion criteria included a history of breast cancer, dementia, or a life expectancy of less than two years. The frequency scale was more accurate than the percentage scale in estimating lifetime risk (p= 0.05), but less accurate in estimating five-year risk (p < 0.02). Only 79 participants (31%) were considered consistent scale users, providing identical responses when using the frequency and percentage scale for a given risk estimate. Although the mean difference (percentage-frequency scale) for estimates of breast cancer lifetime risk was only 2.4, the empirically determined 90% limits of agreement between the frequency and percentage scale for lifetime risk were wide, from -30 to 40. Higher numeracy was associated with consistent use of scales (OR 1.61, 95% CI; 1.09-2.37). We report disagreement in breast cancer risk perceptions when measured by a frequency and a percentage scale. The accuracy and direction of bias associated with each scale varies according to the time frame of risk being assessed.

Adult↗
PubMed2006

Risk assessment scales for pressure ulcer prevention: a systematic review.

AIM: This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. BACKGROUND: Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. METHOD: A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. FINDINGS: Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). CONCLUSION: There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.

Aged↗
PubMed2002

Visual rating scales for age-related white matter changes (leukoaraiosis): can the heterogeneity be reduced?

BACKGROUND AND PURPOSE: It has been hypothesized that the use of different visual rating scales partly explains the discordant results of studies investigating risk factors and clinical correlates of age-related cerebral white matter changes (leukoaraiosis). We aimed to compare 6 widely used rating scales for leukoaraiosis and to calculate conversion coefficients of the score of 1 scale in the score of a second scale. METHODS: Two trained raters evaluated 80 pairs of CT and MRI scans using 2 CT and 4 MRI rating scales for white matter changes. Correlations among the scales were evaluated and regression lines were constructed with each of the CT and MRI scale scores as variables. RESULTS: A high correlation was observed in all the paired comparisons of the 6 scales (Spearman's rho ranging from 0.85 to 0.96, P<0.0001). Using regression analysis, we determined numeric parameters to transform the score of 1 scale to the corresponding score for each of the remaining scales and relative confidence intervals. The predictive values of these conversions expressed as R(2) ranged from 0.75 to 0.92. CONCLUSIONS: The present findings support the view that a good correlation exists among the considered visual rating scales for white matter changes. With the limitation that conversion parameters are calculated by applying a linear regression to partly nonlinear scales, their use allows comparison of the results of previous studies that used different scales and to pool data from past and ongoing clinical trials.

Aging↗
PubMed2006

The use of the SF-36 questionnaire in adult survivors of childhood cancer: evaluation of data quality, score reliability, and scaling assumptions.

BACKGROUND: The SF-36 has been used in a number of previous studies that have investigated the health status of childhood cancer survivors, but it never has been evaluated regarding data quality, scaling assumptions, and reliability in this population. As health status among childhood cancer survivors is being increasingly investigated, it is important that the measurement instruments are reliable, validated and appropriate for use in this population. The aim of this paper was to determine whether the SF-36 questionnaire is a valid and reliable instrument in assessing self-perceived health status of adult survivors of childhood cancer. METHODS: We examined the SF-36 to see how it performed with respect to (1) data completeness, (2) distribution of the scale scores, (3) item-internal consistency, (4) item-discriminant validity, (5) internal consistency, and (6) scaling assumptions. For this investigation we used SF-36 data from a population-based study of 10,189 adult survivors of childhood cancer. RESULTS: Overall, missing values ranged per item from 0.5 to 2.9 percent. Ceiling effects were found to be highest in the role limitation-physical (76.7%) and role limitation-emotional (76.5%) scales. All correlations between items and their hypothesised scales exceeded the suggested standard of 0.40 for satisfactory item-consistency. Across all scales, the Cronbach's alpha coefficient of reliability was found to be higher than the suggested value of 0.70. Consistent across all cancer groups, the physical health related scale scores correlated strongly with the Physical Component Summary (PCS) scale scores and weakly with the Mental Component Summary (MCS) scale scores. Also, the mental health and role limitation-emotional scales correlated strongly with the MCS scale score and weakly with the PCS scale score. Moderate to strong correlations with both summary scores were found for the general health perception, energy/vitality, and social functioning scales. CONCLUSION: The findings presented in this paper provide support for the validity and reliability of the SF-36 when used in long-term survivors of childhood cancer. These findings should encourage other researchers and health care practitioners to use the SF-36 when assessing health status in this population, although it should be recognised that ceiling effects can occur.

Adolescent↗
PubMed2001

Measuring the impact of multiple sclerosis on psychosocial functioning: the development of a new self-efficacy scale.

OBJECTIVE: To develop a scale to measure self-efficacy in neurologically impaired patients with multiple sclerosis and to assess the scale's psychometric properties. DESIGN: Cross-sectional questionnaire study in a clinical setting, the retest questionnaire returned by mail after completion at home. SETTING: Regional multiple sclerosis (MS) outpatient clinic or the Clinical Trials Unit (CTU) at a large neuroscience centre in the UK. SUBJECTS: One hundred persons with MS attending the Walton Centre for Neurology and Neurosurgery and Clatterbridge Hospital, Wirral, as outpatients. METHODS: Cognitively impaired patients were excluded at an initial clinic assessment. Patients were asked to provide demographic data and complete the self-efficacy scale along with the following validated scales: Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, Impact, Stigma and Mastery and Rankin Scales. The Rankin Scale and Barthel Index were also assessed by the physician. RESULTS: A new 11-item self-efficacy scale was constructed consisting of two domains of control and personal agency. The validity of the scale was confirmed using Cronbach's alpha analysis of internal consistency (alpha = 0.81). The test-retest reliability of the scale over two weeks was acceptable with an intraclass correlation coefficient of 0.79. Construct validity was investigated using Pearson's product moment correlation coefficient resulting in significant correlations with depression (r= -0.52) anxiety (r =-0.50) and mastery (r= 0.73). Multiple regression analysis demonstrated that these factors accounted for 70% of the variance of scores on the self-efficacy scale, with scores on mastery, anxiety and perceived disability being independently significant. CONCLUSION: Assessment of the psychometric properties of this new self-efficacy scale suggest that it possesses good validity and reliability in patients with multiple sclerosis.

Adult↗
PubMed2001

Defining populations: a key step in identifying spatial and temporal scales.

The scale at which ecological risk assessors frame their analyses can be driven by a number of considerations. In many cases, the selection of the scale is among the most important decisions within the 'problem-formulation' phase of the ecological risk characterization. The scale of a risk characterization is often defined based on ownership boundaries, ecological, or habitat boundaries and/or physical and hydrogeological boundaries (e.g., watersheds). With increasing value being placed on consideration of spatial scales in risk characterization, the need to define a scale that balances analytical and ecological realities is imperative. Defining the spatial scale based on the scale of a population offers the risk assessor the opportunity to improve the ecological relevance of the risk characterization. Arriving at a single operational definition of a population would be difficult and not appropriate because of the variability in sites, issues, and management goals; however, we can begin to review operational definitions and establish analytical frameworks by which to select the appropriate, site-specific scale within the problem-formulation phase. Defining a scale based on a combination of ecological and site ownership considerations and the inclusion of habitat quality in the assessment of scale can improve the power and relevance of the problem formulation and risk characterization. In this analysis, we assess methods for incorporating spatial considerations into risk analyses, beginning with developing an understanding of the context of a site within the larger landscape. Clearly defining the scale of an assessment including the operational definition of populations is an important step in the problem formulation. Within a site or landscape, the scale may be refined further based on the percentage of the land within the scale of the analysis that provides habitat for a given species.

Animals↗
PubMed2001

An evaluation of the usefulness of the MMPI-2 F(p) scale.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F(p) scale was developed by Arbisi and Ben-Porath (1995) by identification of 27 items endorsed by fewer than 20% of individuals in both normal and psychiatric samples. The F(p) scale was designed for applications in settings characterized by high base rates of serious psychopathology, such as psychiatric inpatient units, and is proposed as a useful scale in discriminating overreported protocols from those produced by patients with serious psychopathology. In this study we investigated the characteristics of this scale in a sample of 617 psychiatric inpatients who responded to the MMPI-2 under standard conditions, and 203 overreported protocols derived in research studies conducted with normal adult participants instructed to simulate various forms of serious psychopathology. Results of this study are consistent with prior reports of a relatively low frequency of item endorsement for F(p) scale items in psychiatric samples, and intercorrelations between the F(p) scale and the MMPI-2 basic clinical scales in clinical samples that are generally lower than those produced between either F or Fb and the basic clinical scales. However, this intercorrelational pattern between F(p) and the MMPI-2 basic scales was not as consistent for the overreported sample. Additionally, the F(p) scale appears to be effective in discriminating overreported from accurate MMPI-2 protocols, with some evidence that the optimal cutting scores for this and other MMPI-2 infrequency scales may differ as a function of gender. Finally, these findings do not show clear evidence of improved group prediction derived from the use of the F(p) scale in contrast to results obtainable through the use of the MMPI-2 F scale.

Adolescent↗
PubMed2006

The deconstruction of the Hy Scale of MMPI-2: failure of RC3 in measuring somatic symptom expression.

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Clinical Scales have a long history in psychological assessment. Recently, Tellegen et al. (2003) conducted a series of analyses to restructure the scales to reduce what they considered to be problems that limit scale functioning. In a critique of the Restructured Clinical (RC) Scales published in this issue, Nichols (2006/this issue) questions a number of aspects of the approach Tellegen et al. took including their theoretical assumptions, methods of analysis, and failures to report important information needed for scale evaluation such as relationships with existing scales. We concur with many points raised by Nichols. In our analysis of the performance of the RC3 scale, we found that it has "drifted" so far from the original Hy scale as to be a completely different measure- a scale of cynical attitudes that is already well represented in existing MMPI-2 measures. In this article, we take these concerns a step further and examine the history and construct validity of the Hy scale in evaluating the somatic expression of problems that the original authors (McKinley & Hathaway, 1944) intended. We also include new information from a medical setting, an application not represented in Tellegen et al.'s RC Scale monograph. In agreement with Rogers et al. (2006/this issue), it is our conclusion that some RC Scales do not represent the measurement domain of the original scales and should not be relied on for or used to refine traditional interpretation, particularly in medical or forensic situations (such as personal injury cases) because of their confusing and conflicting results.

Female↗
PubMed1979

Studies on scale morphogenesis in the Golgi apparatus of Pyramimonas tetrarhynchus (Prasinophyceae).

Ultrastructural investigations of scale formation in the cisternae of the Golgi apparatus have been carried out on the prasinophycean flagellate Pyramimonas tetrarhynchus, whose cell surfaces are covered with 6 different scale types, 3 on the flagella and 3 on the cell body. Our results suggest that at least 4 and probably all 6 scale types can be formed together within the same cisterna and that there is some degree of intracisternal differentiation, since the formation of 2 scale types (the small underlayer scales on cell body and flagella) is restricted to the cisternal peripheries, whereas the remaining scale types are formed in the more central portions. Detailed studies of morphogenesis of the larger body scales reveal the earliest identifiable stages as 8-armed figures, with 8 thin arms in the intermediate body scales (IBS), and 4 thick and 4 thin arms in the outer body scales (OBS). From these incipients structures that bear little resemblance to the finished products, the complex, 3-dimensional mature body scales are elaborated in each of the cell's 4 distyosomes, and maintain throughout their different developmental sequences a close relationship to the inner surfaces of the cisternal membranes, as well as a particular orientation within the dictyosomes. Preliminary calculations of total numbers of scales that cover cell and flagellar surfaces are included. The small, underlayer scales, which on the flagella are shown to be arranged in 24 rows, number about 350000; larger scales of more complex construction number about 20 000.

Animals↗
PubMed2004

A hierarchical analysis of the scaling of force and power production by dragonfly flight motors.

Maximum isometric force output by single muscles has long been known to be proportional to muscle mass(0.67), i.e to muscle cross-sectional area. However, locomotion often requires a different muscle contraction regime than that used under isometric conditions. Moreover, lever mechanisms generally affect the force outputs of muscle-limb linkages, which is one reason why the scaling of net force output by intact musculoskeletal systems can differ from mass(0.67). Indeed, several studies have demonstrated that force output by intact musculoskeletal systems and non-biological systems is proportional to motor mass(1.0). Here we trace the mechanisms that cause dragonflies to achieve a change from muscle mass(0.67) scaling of maximum force output by single flight muscles to mass(1.0) scaling of dynamic force output by the intact dragonfly flight motor. In eight species of dragonflies, tetanic force output by the basalar muscle during isometric contraction scaled as muscle mass(0.67). Mean force output by the basalar muscle under dynamic conditions (workloops) that simulated in vivo maximum musculoskeletal performance was proportional to muscle mass(0.83), a significant increase in the scaling exponent over that of maximum isometric force output. The dynamic performance of the basalar muscle and the anatomy of its lever, consisting of the second moment of area of the forewing (d(2)) and the distance between the muscle apodeme and the wing fulcrum (d(1)), were used to analyze net force output by the integrated muscle-lever system (F(ind)). The scaling of d(2) conformed closely to the expected value from geometic similarity (proportional to muscle mass(0.31)), whereas d(1) scaled as muscle mass(0.54), a significant increase over the expected value from geometric similarity. F(ind) scaled as muscle mass(1.036), and this scaling exponent was not significantly different from unity or from the scaling exponent relating maximum load-lifting by flying dragonflies to their thorax mass. Thus, the combined effect of a change in the scaling of force output by the muscle during dynamic contraction compared to that during isometric contraction and the departure from geometric similarity of one of the two lever arm lengths provides an explanation for how mass(1.0) scaling of force output by the intact musculoskeletal system is accomplished. We also show that maximum muscle mass-specific net work and power output available scale as mass(0.43) and mass(0.24), respectively.

Animals↗
PubMed1994

SCALING MODULUS AS A DEGREE OF FREEDOM IN THE DESIGN OF LOCUST LEGS

Previous work has shown that the scaling of mechanical behaviour in bending of the metathoracic tibiae of the African desert locust (Schistocerca gregaria) is not predicted by the scaling of external dimensions. The flexural stiffness of the tibia scales to (body mass)1.53, which is similar to the predictions of the elastic similarity model of scaling. The external dimensions, however, scale in a manner that produces relatively more elongate limb segments &shy; an observation that differs from the predictions of any existing scaling model. In this paper, we examined two alternative hypotheses to explain this uncoupling of morphology and mechanics: (1) that the load-bearing cuticular material is distributed in the legs in a manner that is not indicated by changes in external dimensions, or (2) that the stiffness of the cuticular material is altered to produce the observed scaling of flexural stiffness. The second moment of area (I) scaled to (body mass)1.19, which was similar to scaling I to (tibial radius)4. This indicates that the relationship between the external dimensions of the tibiae and the specific distribution of load-bearing material is conserved independently of scale. Therefore, the locust achieves the observed scaling of flexural stiffness by altering the modulus of the load-bearing cuticular material. In fact, the time-dependent modulus (E') scales to (body mass)0.311. In essence, the scaled material stiffness provides a degree of freedom in design in addition to external morphological dimensions in accommodating the changing demands placed on a skeletal structure with increases in body size.

Journal Article↗
PubMed2004

[Development of a brief communication ability scale for Japanese demented elderly].

We developed a brief scale to evaluate communication ability of the demented elderly. This scale assesses not only abilities related to overall communication such as verbal function, judgment and emotional function, but also non-verbal communication such as eye-contact, nodding and smiling. The scale places little burden on the demented elderly subject and takes only a few minutes to perform, even if the dementia is severe. We evaluated 106 demented elderly residents of nursing homes using this brief communication ability scale, and the following results were obtained. The validity of this scale was confirmed by the high correlation coefficient between this scale and the formal caregiver questionnaire scores concerning communication ability, and the high-correlation coefficient between this scale and intellectual functions (r = -0.904), emotional functions (r = -0.841) and motor functions (r = -0.679) of dementia syndromes rating scale (Gottfries, Bråne, Steen scale; GBS scale), Hasegawa's Dementia Scale-Revised (HDS-R) (r = 0.625) and the Mini-Mental State Examination (MMS) (r = 0.733). The reliability of this scale was confirmed by the high interrater reliability coefficient of 0.828, test-retest reliability coefficient of 0.940 and Cronbach alpha coefficient of 0.938. These results indicate that the new scale is useful in the assessment of communication ability among the demented elderly.

Aged↗
PubMed1998

Psychometric assessment of four fatigue scales with a sample of rural cancer patients.

There are differences between rural and urban persons experiencing cancer that may make the experience of fatigue more difficult for rural cancer patients. There were no scale to measure fatigue that had been validated with rural cancer patients. The purpose of the present research was to study the psychometric properties of four fatigue scales for use with rural cancer patients. The four scales were the Multidimensional Assessment of Fatigue Scale, the Fatigue Severity Scale, the Visual Analogue Scale for Fatigue, and the Rhoten Fatigue Scale. The four scales were mailed to 270 rural cancer patients, with 131 usable scales returned (48% return rate). Interitem correlations, Cronbach's alpha reliability, and factor analyses were performed on the four scales. Based on these analyses, the Multidimensional Assessment of Fatigue Scale, the Fatigue Severity Scale, and the Visual Analogue Scale for Fatigue were judged to be adequate for use with rural cancer patients.

Adult↗
PubMed2000

Assessing radiographic status of rheumatoid arthritis: introduction of a short erosion scale.

OBJECTIVE: Although radiographs are an important marker of rheumatoid arthritis severity, no valid simple scoring method exists. Current scoring systems are cumbersome, difficult to learn, time consuming, and suitable only for experts. In addition, there is no "gold standard" for radiographic severity, so that it is impossible for the clinician, trialist, or researcher to place patients' scores along a continuum of radiographic severity. We investigated the scoring and scaling properties of radiographs read by the Larsen method, and we developed a shortened scale that can be placed in the perspective of a linear severity continuum. METHODS: A total of 3,538 paired hand radiographs obtained over a 24 year period were read by Larsen method and evaluated by Rasch analysis. By iterative methods the number of joints was reduced so that proper fitting, scaling, and dimensionality were obtained. The shortened scale was then tested against the full Larsen scale to determine its ability to detect radiographic progression. RESULTS: A scale consisting of 6 joints on each hand (3 wrist areas and 3 metacarpophalangeal joints) performed as well as the full 28 joint Larsen score, and had improved fit and scaling properties. This Short Erosion Scale (SES) also performed as well as the Larsen score in measuring radiographic progression as measured by comparative effect sizes. In addition, a nomogram was developed to translate SES scores into radiographic severity scores according to a Rasch logit scale. CONCLUSION: We developed a Short Erosion Scale by reducing the number of joints evaluated in the Larsen method from 28 to 12. The scale is at least as sensitive in detecting change as the full Larsen scale. SES fits the Rasch model and is hierarchical and generally well spaced. Graphs and nomograms are available so that intrinsic radiographic severity can be documented. This scale is suitable for use in clinical practice and observational studies, and may be appropriate for clinical trials as well.

Arthritis, Rheumatoid↗
PubMed2001

[Evaluation of theoretical accuracy, reliability, discriminative power and difficulty for physical, mental and social well-being scales in adolescents].

The purpose of this study was to develop and validate the questionnaire used to measure adolescents' wellbeing and its physical, mental and social dimensions. The questionnaire was composed of two parts: the first part contained wellbeing indicators and the second part contained criterion indicators (health disorders and harmful behaviours). Physical wellbeing scale contained the most common complaints due to psychosocial and life style factors, and was measured by three indicators: headache, abdominal pain and backache. Mental wellbeing scale contained emotional and moral dimensions that were recognised as closely connected with the physical disorders from one hands and the process of socialisation from the other hands. There were eight indicators: fatigue, stress, fear, depression, loneliness, helplessness, feeling of guilt, and low self-complacency. Five indicators: perceived social support, relationship with mother, father, friends and teacher measured social wellbeing scale. Each indicator of wellbeing is scored in three scales: dichotomise scale, five-point Likert scale and visual analogue scale. The cluster sample of 445 schoolchildren aged 14-15 years, randomly selected from the last grade of elementary schools of Warsaw was surveyed in October-November 1999. The physical, mental, social and total wellbeing scales were found to be reliable, but differing in internal consistency. The total and mental scales of wellbeing demonstrated high reliability, while the physical and social scales demonstrated moderate reliability. Analysis of correlation between criterion and tested variables showed acceptable discriminative power of the physical, mental, social and total wellbeing scales. Respondents assessed the five-point Likert scale as easier in comparison to dichotomise and visual analogue scales.

Adolescent↗
PubMed1997

Abbreviated scale for the assessment of psychosocial status in pregnancy: development and evaluation.

BACKGROUND: Data from five existing psychosocial scales were used to develop an abbreviated scale for the assessment of psychosocial status during pregnancy. METHODS: Scales were self-administered by 842 black and 381 white low-income multiparous women at risk for poor pregnancy outcome. Trait anxiety (Speilberger), self-esteem (Rosenberg), mastery (Pearlin), and depression (CES-D) were assessed at 24-26 weeks' gestation; subjective stress (Schar) was assessed at 30-32 weeks' gestation. The 59 pooled items were examined for redundancy and the discernment of primary factors using principal factor analysis. Regression analysis was used to determine if the resulting abbreviated scale (28 items) would provide information similar to that obtained with the 59 item pool (full scale) in predicting gestational age (GA), birth weight (BW), fetal growth restriction (FGR), and preterm delivery (PTD). RESULTS: The abbreviated scale was highly correlated (r = 0.97) with the 59-item pool and the six factors isolated were generally compatible with the major characteristics assessed by the five original scales. The distribution of FGR and PTD by scale quartile was similar for the abbreviated and the combined scales. Logistic regression analysis of scores for all women revealed that poor (high) scores on both the full (p = 0.0151) and the abbreviated scales (p = 0.0131) were positively associated with FGR, but not with PTD. In linear regression analysis poor (high) scores on both the full (p = 0.0024) and the abbreviated scale (p = 0.0019) were negatively related to BW, but not to GA. When data for black and white women were examined separately, the two scales provided comparable information. CONCLUSIONS: The abbreviated psychosocial scale provided information similar to that obtained with 59 pooled items in predicting GA, BW, FGR, and PTD.

Adult↗
PubMed1998

Validity of the numeric rating scale as a measure of dyspnea.

BACKGROUND: Dyspnea, a devastating sign, is rarely monitored by clinicians. One reason may be the lack of a valid measurement scale that is easy to use in a clinical setting. OBJECTIVES: To establish the validity of the numeric rating scale as a measure of present dyspnea (dyspnea at rest). METHODS: A total of 188 patients with chronic obstructive pulmonary disease rated their present dyspnea by using the Visual Analog Dyspnea Scale and the numeric rating scale. They also rated their usual dyspnea (dyspnea during the past week). Demographic information was collected from each patient's chart, and pulmonary status was assessed with portable spirometry, pulse oximetry, or both. RESULTS: Concurrent validity of the numeric rating scale was supported by the high correlation of its scores with scores from the Visual Analog Dyspnea Scale. Conversion of the numeric rating scale to a 0-to-100 scale and comparison with the visual analog scale (by using a paired t test to determine if the correlated scores were similar for clinical decision making) showed that scores were not significantly different. A paired t test showed a difference in scores on the numeric rating scale obtained before and after ambulation, supporting the construct validity of the numeric rating scale. Scores on the numeric rating scale for present dyspnea were poorly correlated with ratings of usual dyspnea, indicating that present dyspnea and usual dyspnea are different constructs. CONCLUSION: Present and usual dyspnea are different constructs. The numeric rating scale is a valid measure of present dyspnea.

Adult↗
PubMed2005

Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke.

BACKGROUND: Randomized trials of thrombolytic stroke treatment have either excluded patients with posterior circulation ischemia or used inclusion criteria making enrollment of these patients less likely. Consequently, there is less published information on thrombolytic therapy for posterior circulation stroke. OBJECTIVE: To determine effective thrombolytic treatment times for posterior circulation stroke and factors that might help predict clinical outcome. DESIGN: We describe our experience treating 21 consecutive patients with either intravenous or intra-arterial thrombolytic therapy for posterior circulation ischemic stroke between October 9, 1993, and February 19, 2001. MAIN OUTCOME MEASURES: National Institutes of Health Stroke Scale, Glasgow Coma Scale, and modified Rankin Scale scores were evaluated at baseline, and the modified Rankin Scale was measured 3 months after stroke, with a good outcome being a modified Rankin Scale score of 2 or less. RESULTS: Nine patients received intravenous therapy; 12 patients received intra-arterial therapy. The median National Institutes of Health Stroke Scale score at onset was 20 (range, 2-39), and the median Glasgow Coma Scale score was 9 (range, 3-15). Twelve patients were treated within 8 hours of symptom onset (range, 1 1/2 hours to 16 days). Nine patients (43%) had a modified Rankin Scale score of 2 or less at 3 months. The initial Glasgow Coma Scale score and treatment within 8 hours of symptom onset were each associated with good outcome, but the initial National Institutes of Health Stroke Scale score was not predictive. CONCLUSIONS: Thrombolytic therapy for posterior circulation stroke may be beneficial even when initiated 8 hours after symptom onset. Level of consciousness, as measured by Glasgow Coma Scale score, seems to be a more important predictor of outcome than the initial National Institutes of Health Stroke Scale score.

Adult↗