Validity of the variables on the structured-objective Rorschach test (sort) among alcoholics, neurotics, and psychotics.
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The SIDAM, a new clinical structured interview for the diagnosis and measure of dementia according to DSM-III-R and ICD-10, is described. This instrument comprises a clinical overview, several cognitive tests, including the Mini-Mental State, and a section for clinical judgement and information coming from others. Every item relies on DSM-11-R and ICD-10 algorithms. The SIDAM has a hight test-retest reliability on the clinical diagnosis and the different diagnostic criteria. It is a brief (28 minutes), practical screening instrument. Good congruence is found between SIDEM, DSM-III-R and ICD-10, and the corresponding ICD-9 expert diagnosis. Furthermore the SIDAM Total Score (SISCO), allows a good measurement of low level of cognitive impairments and provides quantification of severity of cognitive disorders. The SIDAM has been translated and adapted into Spanish.
This paper describes and analyses an experimental clinical examination for general practice. Differences in the results obtained by fourth year students, fifth year students and trainee general practitioners highlight some of the dilemmas of medical education. It is concluded that examinations which include clinical tests can increase the credibility of general practice examinations, can be reliably applied to small groups of candidates and therefore have considerable potential for formative assessment. The constraints of assuring inter-examiner reliability in a multicentre design, together with its labour intensive nature, would however make this type of examination difficult to adapt to the needs of national end-of-training examinations.
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PURPOSE: Refined criteria of distinctive patterns of detrusor ultrastructure in geriatric voiding dysfunctions have been developed as standard protocols for pathological evaluation of detrusor biopsies. This study was performed to test completeness and routine applicability of these protocols, corroborate our original ultrastructural/urodynamic correlations in larger material and identify subtle correlations that may have been elusive in our original study of 35 cases. MATERIALS AND METHODS: A total of 71 endoscopic detrusor biopsies was obtained from 44 elderly subjects grouped following comprehensive clinical and urodynamic evaluation into those with normal aging bladder, detrusor overactivity, impaired detrusor contractility, bladder outlet obstruction or a combination. Biopsies were evaluated ultrastructurally and randomly, and blinded to clinical information. Using standard protocols the primary ultrastructural pattern(s) was identified, additional auxiliary features were recorded and pathological diagnoses were made. Biopsies were grouped accordingly, still blindly, and correlated with urodynamic groups determined independently prior to biopsy. RESULTS: Our observations confirmed that the standard protocols are complete and readily applicable to routine ultrastructural evaluation of detrusor biopsies. They corroborated our previously reported ultrastructural/urodynamic matching of the biopsies in every case and revealed new constant features of the normally aging detrusor. We identified ultrastructural correlates distinguishing moderate and severe from mild or borderline (but not moderate from severe) impairment of detrusor contractility. CONCLUSIONS: The proposed protocols are consistently applicable to the routine pathological diagnosis of geriatric voiding dysfunction in detrusor biopsies. A diagnostic algorithm was developed to serve as a practical guide for making such diagnoses, and gaining insights into the pathophysiology of geriatric and possibly other voiding dysfunctions.
St George's Respiratory Questionnaire (SGRQ) has been widely used in the assessment of health related quality of life (HRQOL) in patients with asthma and chronic obstructive pulmonary disease. Introduction of the new language version of the HRQOL questionnaire needs to be preceded by a highly structured process of validation. We aimed to validate the Polish version of SGRQ in the group of 83 patients with asthma. Following the comprehension study, we thus evaluated reliability, validity, reproducibility, responsiveness, and measurement equivalence of the Polish version of SGRQ. Disease severity and health status were also concurrently assessed. The reliability was good, with Cronbach's alpha coefficient exceeding 0.75 for global and all subscale scores. There have been highly significant correlations between spirometric parameters, intensity of symptoms, health status self-assessment, and the degree of depression, and quality of life scores. Reproducibility, stability and responsiveness were confirmed in the follow-up study. Minimal clinically important difference was found to be 5.3 points. Polish version of SGRQ was found to be psychometrically equivalent to four other versions of SGRQ, which underscores its validity in the population of Polish asthmatics.
The available crystal structure for the complex between the Fc fragment of immunoglobulin G (IgG) and the neonatal Fc receptor (FcRn) was determined at low resolution and has no electron density for a large portion of the CH2 domain of the Fc. Here, we use a well validated computational docking algorithm in conjunction with known crystallographic data to predict the orientation of CH2 when bound to FcRn, and validate the predicted structure with data from site-specific mutagenesis experiments. The predicted Fc structure indicates that the CH2 domain moves upon binding FcRn , such that the end-to-end distance of the bound Fc fragment is greater than it is in the crystal structure of isolated Fc. The calculated orientation of the bound CH2 domain is displaced by an average of 6 A from the CH2 orientation in the structure of Fc alone, and shows improved charge complementarity with FcRn. The predicted effects of 11 specific mutations in Fc and FcRn are calculated and the results are compared with experimental measurements. The predicted structure is consistent with all reported mutagenesis data, some of which are explicable only on the basis of our model. The current study predicts that FcRn-bound Fc is asymmetric due to reorientation of the CH2 domain upon FcRn binding, a rearrangement that would be likely to interfere with optimal binding of FcRn at the second binding site of the Fc homodimer.
This study examined how inpatients perceive environmental impacts using the ISM(Interpretive Structural Modeling)method. 18 new items among inpatients perceiving the environmental impacts were selected through a discussion with three researchers, two nurses, and six patients. This was applied to two inpatients who were not in the same ambulatory state in order to establish the validity of the structural models. As a result, the structuring models showed the difference depending on each patient. Therefore the structuring model is effective to assess the environmental impacts on individuals.
OBJECTIVE: To develop a measure of parent adjustment related to caring for a child with a chronic illness and to evaluate the reliability and validity of the measure with a group of parents of children with brain tumors. METHODS: One-hundred forty-nine parents of patients (age <1-17 years) diagnosed with a brain tumor were assessed using the 25-item self-report Parent Experience of Child Illness (PECI). Internal consistency, construct validity, and factor structure were assessed. RESULTS: Exploratory factor analysis yielded four theoretically coherent factors including: Guilt and Worry, Emotional Resources, Unresolved Sorrow and Anger, and Long-term Uncertainty. Internal reliability for the PECI scales ranged from .72 to .89, suggesting acceptable reliability. As evidence of construct validity, the PECI scales show significant, positive correlations with scales from established measures of parent adjustment. CONCLUSION: The PECI augments the current literature by providing a brief measure of parents' subjective distress and perceived Emotional Resources, domains that are critical but understudied in children with chronic illness and their caregivers.
BACKGROUND: To date, all clinical trials using a single therapeutic modality (psychotherapy or pharmacotherapy) have found that even the best validated treatments for adults with chronic Posttraumatic Stress Disorder (PTSD) leave a substantial proportion of patients with disabling residual symptoms. METHOD: We reviewed the treatment course of three research patients with PTSD who received trauma-focused psychotherapy after experiencing a partial response to medication. Structured diagnostic interviews, validated symptom measures, and standardized treatment approaches were used to assess treatment response. RESULTS: All patients partially benefited from medication treatment, and the degree of benefit varied substantially. Also, all patients experienced an additional reduction in PTSD symptoms after a time-limited course of prolonged exposure therapy (PE). This finding differs from anecdotal observations among U.S. War veterans and has never been documented systematically among civilian adults with chronic PTSD. CONCLUSION: Maximizing treatment outcome in adults with chronic PTSD may require additional psychotherapy after a partial medication response, and further study is warranted.
A major time-consuming step of protein NMR structure determination is the generation of reliable NOESY cross peak lists which usually requires a significant amount of manual interaction. Here we present a new algorithm for automated peak picking involving wavelet de-noised NOESY spectra in a process where the identification of peaks is coupled to automated structure determination. The core of this method is the generation of incremental peak lists by applying different wavelet de-noising procedures which yield peak lists of a different noise content. In combination with additional filters which probe the consistency of the peak lists, good convergence of the NOESY-based automated structure determination could be achieved. These algorithms were implemented in the context of the ARIA software for automated NOE assignment and structure determination and were validated for a polysulfide-sulfur transferase protein of known structure. The procedures presented here should be commonly applicable for efficient protein NMR structure determination and automated NMR peak picking.
This article reports on a scale to measure the psychiatric rehabilitation beliefs, goals, and practices of staff who provide services to consumers. The scale's reliability, validity, and factor structure are presented based upon 469 staff members and 191 people in rehabilitation. The scale appears to be a stable measure of staff members' knowledge of modern psychiatric rehabilitation beliefs, goals, and practices as elaborated by the field's leadership. It also appears to provide a valid measure of staff members' actual practice patterns as they relate to the consumer outcomes of empowerment, quality of life, independent living, and competitive employment. Consumers, program administrators, educators, researchers, and practitioners may find the scale useful as a measure of some of the beliefs, goals, and practices that currently define modern psychiatric rehabilitation.
This study reports on the validity of a structured, standardized interview designed for selecting applicants for dental schools. The interview provides a score on nongrade attributes in 14 dimensions and was based on characteristics of successful dentists. A class of 86 fourth-year dental students at the University of Iowa was interviewed. Sufficient validity was found to justify the use of the interview for admissions purposes for the 1978 class.
UNLABELLED: This activity is designed for pharmacists, physicians, physician assistants, nurses, and other healthcare team members; payers for health services; and healthcare executives. GOAL: To provide basic information on the methods used and computer software available for evaluating invariant factorial structures, such as those found in health status measurement tools. OBJECTIVES: 1. Discuss why comparison of mean scores may not be appropriate when interpreting humanistic outcomes results. 2. Identify alternative methods for evaluating data from health status measurement tools, such as the SF-36. 3. Define validity, reliability, and structure. 4. Understand the value of structural equation modeling when using health status measurement tools, such as the SF-36. 5. Describe the statistical software used to perform structural equation modeling.
The diverse levels of individual functioning and constantly changing membership in short-term acute care groups challenge the development of true group process. The authors review the recently developing literature on short-term acute care groups, emphasizing the unique characteristics of the groups, their goals, and the therapeutic techniques that can be used to lead them. They then present an approach to short-term acute care therapy that is based on five processes identified in the literature as therapeutic for inpatient ward milieus: containment, support, structure, involvement, and validation. The applicability of the processes to the ward group serves to unify group therapy with other ongoing inpatient treatment.
This paper presents a structured pictorial instrument, the Dominic questionnaire, to assess mental disorders in 6- to 11-year-old children. Ninety-nine drawings represent situations corresponding to DSM-III-R based ADHD, CD, ODD, MDD, SAD, OAD, and SPh. However, cognitive limitation of 6- to 11-year-old children do not allow for time-related measurement. The instrument takes 15-20 min to administer. Reliability and validity of the Dominic questionnaire were studied in Parent DISC-2 positive and negative outpatient and general population samples and against clinical judgement. The pictorial approach provides acceptable test-retest reliability and the instrument makes standardized assessment possible for children as young as 6 years of age.