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PubMed1999

Outpatient exercise training in children with cystic fibrosis: physiological effects, perceived competence, and acceptability.

Exercise training is currently advocated as part of the treatment of patients with cystic fibrosis (CF). However, data are few that document physiologic benefits or changes in patients' perceptions of long-term training programs in children with CF. The aim of this study was to investigate the effects and acceptability of a home cycling program in children with CF. Fourteen patients (9 boys, 5 girls) with CF, mean (SD) age 14.1 (2.0) years, with mild to moderate impairment of lung function (forced expiratory volume in 1 s, mean (SD) 58.3 (16.3)% of predicted) were studied for 1 year. The first half of the study year was used to obtain baseline values at 0 and 6 months. During the second half of the year, a cycle program was carried out 5 times a week, for 20 min each day at a level of work that resulted in a heart rate of 140-160 beats/min. Once a week the cycle program was supervised by a physiotherapist. Measurements were repeated at 12 months. Effects of the exercise program were measured in terms of lung function, nutritional status, growth, muscle strength, exercise performance, perceived competence, and attitude towards the training program. Differences between the changes during the 6-month training period as compared to the 6-month control period were analyzed by multivariate statistics and nonparametric tests. Statistically significant differences (P < 0.05) between the two periods were found with respect to muscle strength of knee extensors and ankle dorsiflexors, and with respect to maximal oxygen consumption per kg body weight as well as per kg fat free mass. All changes were positive. No adverse effects were found. Perceived competence showed significant positive changes in feelings about physical appearance, general self-worth, and Total Perceived Competence Score. Scores concerning perceived acceptability of the program were significantly lower at the end of the training period; however, patients reported that they did want to continue with other sorts of training. We conclude that an exercise training program in the home can produce beneficial effects on oxygen consumption, muscle force, and perceived competence in children with CF. However, acceptability of the program was low, suggesting that long-term adherence would be poor, and hence, other sorts of training need to be identified.

Adolescent↗
PubMed1976

Acceptance of general personality interpretations prior to and after receipt of diagnostic feedback supposedly based on psychological, graphological, and astrological assessment procedures.

There was no difference in the acceptance of a general personality interpretation supposedly based on psychological, graphological, or astrological assessment procedures. Ss told that their general personality interpretation was based on one of the three assessment procedures, however, accepted the interpretation to a greater degree than did Ss told the interpretation was "generally true of people." S faith in all assessment procedures and perceived diagnostician skill increased significantly from before to after receipt of the diagnostic feedback. Ss elicited a halo response after they had received the interpretation, such that they generated a highly consistent positive (or negative) view of the assessment procedures and diagnostician skills. Implications of results from this acceptance paradigm were discussed for diagnosticians and therapists.

Aptitude↗
PubMed2000

Definition, interpretation and calculation of cost-effectiveness acceptability curves.

This paper discusses the definition, interpretation and computation of cost-effectiveness (CE) acceptability curves. A formal definition of the CE acceptability curve based on the net benefit approach is provided. The curve can be computed using parametric or non-parametric techniques and for both computational approaches we establish a formal relation between the CE acceptability curve and statistical inference based on confidence intervals and P values in CE analysis.

Cost-Benefit Analysis↗
PubMed2003

Videoconferencing for practice-based small-group continuing medical education: feasibility, acceptability, effectiveness, and cost.

INTRODUCTION: Small-group, practice-based learning is an effective and well-accepted method of continuing medical education (CME). However, one limitation is that many physicians work in communities with fewer than the minimum number recommended for an effective learning group. Videoconferencing has the potential to remove this limitation. The purpose of this study was to evaluate the feasibility, acceptability, effectiveness, and cost of conducting practice-based, small-group CME learning by videoconference. METHODS: Through a videoconferencing link, 10 learners in three communities were guided through four practice-based learning modules by a trained facilitator at a fourth site. Data were collected through evaluation questionnaires, direct observation by the research team, pre- and post-knowledge tests, a focus group, and an interview. RESULTS: A total of 31 learners participated in the four modules. Videoconferencing was generally well accepted by learners. The facilitator and research team observers noted that muting microphones, video quality, audio quality, and audio lag all somewhat hindered discussion. Overall, the facilitator found moderating by videoconference only slightly more difficult than a face-to-face session. There was evidence of knowledge gain, with post-test scores being 20% higher than pretest scores (p = .006). Learners reported nine practice changes from taking the modules. At commercial rates, telecommunications costs per videoconferenced module were approximately CAN$1,200. DISCUSSION: Videoconferencing has the potential to bring the benefits of small-group, practice-based learning to many physicians; however, strict attention to videoconferencing techniques is required. Cost is also an important consideration.

Attitude of Health Personnel↗
PubMed2003

Acceptance of dementia screening in continuous care retirement communities: a mailed survey.

BACKGROUND: In a recent systematic review of the evidence for dementia screening to support recommendations from the US Preventive Services Task Force, we found no evidence regarding the interest or willingness of older adults to be screened, and insufficient evidence to provide an estimate of the potential harms of dementia screening. OBJECTIVE: In an attempt to address the acceptability of dementia screening, we asked older adults living in two Continuous Care Retirement Communities (CCRC) if they would agree to routine screening for memory problems. DESIGN: Cross-sectional study using self-administered mailed survey questionnaires. SETTING: Two CCRCs in Orange County, North Carolina. PARTICIPANTS: 500 residents of the independent living section of CCRCs. RESULTS: There was a 64% survey response rate. Of these, 49% of participants stated they would agree to routine screening for memory problems. In comparison to people who would not agree to routine memory screening, those who accepted memory screening were more likely to accept depression screening, be male, use drug-administration assisted devices, and take more medications. CONCLUSION: Approximately half of the residents in this affluent residential community setting were not willing to be screened routinely for memory problems. This high refusal rate indicates that dementia screening may be associated with perceived harms. We must improve our understanding of the decision-making process driving individual's beliefs and behaviors about dementia screening before implementing any broad-based screening initiatives for dementia or cognitive impairment.

Aged↗
PubMed2006

Bayesian cost-effectiveness analysis with two measures of effectiveness: the cost-effectiveness acceptability plane.

Cost-effectiveness analysis (CEA) compares the costs and outcomes of two or more technologies. However, there is no consensus about which measure of effectiveness should be used in each analysis. Clinical researchers have to select an appropriate outcome for their purpose, and this choice can have dramatic consequences on the conclusions of their analysis. In this paper we present a Bayesian cost-effectiveness framework to carry out CEA when more than one measure is considered. In particular, we analyse the case in which two measures of effectiveness, one binary and the other continuous, are considered. Decision-making measures, such as the incremental cost-effectiveness ratio, incremental net-benefit and cost-effectiveness acceptability curves, are used to compare costs and one measure of outcome. We propose an extension of cost-acceptability curves, namely the cost-effectiveness acceptability plane, as a suitable measure for decision taking. The models were validated using data from two clinical trials. In the first one, we compared four highly active antiretroviral treatments applied to asymptomatic HIV patients. As measures of effectiveness, we considered the percentage of patients with undetectable levels of viral load, and changes in quality of life, measured according to EuroQol. In the second clinical trial we compared three methadone maintenance programmes for opioid-addicted patients. In this case, the measures of effectiveness considered were quality of life, according to the Nottingham Health Profile, and adherence to the treatment, measured as the percentage of patients who participated in the whole treatment programme.

Anti-Retroviral Agents↗
PubMed2001

Representing uncertainty: the role of cost-effectiveness acceptability curves.

Decision-making in health care is inevitably undertaken in a context of uncertainty concerning the effectiveness and costs of health care interventions and programmes. One method that has been suggested to represent this uncertainty is the cost-effectiveness acceptability curve. This technique, which directly addresses the decision-making problem, has advantages over confidence interval estimation for incremental cost-effectiveness ratios. However, despite these advantages, cost-effectiveness acceptability curves have yet to be widely adopted within the field of economic evaluation of health care technologies. In this paper we consider the relationship between cost-effectiveness acceptability curves and decision-making in health care, suggest the introduction of a new concept more relevant to decision-making, that of the cost-effectiveness frontier, and clarify the use of these techniques when considering decisions involving multiple interventions. We hope that as a result we can encourage the greater use of these techniques.

Confidence Intervals↗
PubMed2005

Occurrence of pharmaceutically acceptable anions and cations in the Cambridge Structural Database.

The occurrence of a number of pharmaceutically acceptable counterions in the Cambridge Structural Database (CSD) has been investigated. The results have been compared to the occurrence of the same counterions in a list of known pharmaceutical salts. Chloride salts are by far the highest occurring in both groups. The occurrence of hydrates in the structures of salts of pharmaceutically acceptable counterions in the CSD has also been investigated. It was found that salts of these counterions show an increased tendency to hydrate when compared to the database average. The CSD was also searched for co-crystals of the list of pharmaceutically acceptable acids and bases corresponding to the list of counterions used for the salt investigation.

Acids↗
PubMed2006

Risk acceptance in composite-tissue allotransplantation reconstructive procedures.

Composite-tissue allotransplantation (CTA) is a new therapeutic modality to reconstruct major tissue defects of the face, larynx, and extremities. Unlike most life-saving organ-transplantation procedures, CTA is considered to improve quality of life. Therefore, the question arises, do the risks posed by the immunosuppression drugs that patients must take to prevent rejection justify the benefits of these procedures? The purpose of this study was to assess the relative risk that individuals are willing to accept in order to receive the benefits of CTA procedures. We used a psychometrically reliable and valid instrument to question two primary populations of individuals: those who live with the risks of immunosuppression, and healthy individuals. The level of risk acceptance for the seven transplant procedures tested (foot, single hand, double hand, larynx, kidney, hemiface, and full face) showed significant differences in research participants' risk acceptance for the different transplant procedures, but no significant differences between groups. Based on these findings, we conclude that certain CTA procedures convey benefits to recipients that are perceived by subjects, including individuals who live with the risks of immunosuppression, to warrant the risks of these procedures.

Adolescent↗
PubMed1993

Prenatal diagnosis of the acute form of proximal spinal muscular atrophy: experience on the acceptance of linkage analyses by the families.

The acute form of proximal spinal muscular atrophy (SMA) is a severe autosomal recessive inherited neuromuscular disorder. It has been mapped to chromosome 5q 11.2-13.3. Using restriction fragment length polymorphisms (RFLPs) or (CA)n repeats of DNA probes in this region, prenatal diagnosis is, in principle, possible. Misdiagnosis can be due to incorrect diagnosis in the index patient, and crossing-over events. Using the DNA probes D5S6, D5S112, D5S39, and D5S78, we cover a region of 10.4 mega-base pairs (Mbp) of partially NotI-digested genomic DNA without overlap of fragments. The DNA probes D5S6 and D5S112, most likely flanking the SMA gene, cover a distance of about 6.6 Mbp. This corresponds to the genetic distance of 6 cM (Morrison et al., 1992; Daniels et al., 1992). But since the precise localization of the SMA gene is still unknown (Simard et al., 1992), a 10 per cent risk of misdiagnoses due to crossing-over events cannot be excluded. The acceptance of this 10 per cent risk for prenatal diagnoses differs in SMA families. We observed a case in which a woman accepted a 25 per cent risk because RFLPs and (CA)n repeats were both uninformative. In contrast, another family did not accept the minimal 10 per cent risk and the pregnancy was terminated. In two families, we performed prenatal diagnosis by linkage analysis. One child predicted to be healthy has been born in the meantime and has shown no indication of SMA during her first 8 months.

Acute Disease↗
PubMed2006

Factors influencing laboratory workers' decisions to accept or decline anthrax vaccine adsorbed (AVA): results of a decision-making study in CDC's anthrax vaccination program.

BACKGROUND: Laboratory technicians, laboratory supervisors, decontamination/remediation workers, and environmental investigators are at increased risk for repeated occupational exposure to Bacillus anthracis. In 2002, the Advisory Committee on Immunization Practices (ACIP) recommended pre-exposure vaccination for these occupational groups. OBJECTIVES: To determine (1) the factors that influenced an individual's decision to either accept or decline Anthrax Vaccine Adsorbed (AVA), and (2) if laboratory workers' concern about AVA safety was related to their information needs and trust in the information provided. METHODS: We conducted a decision-making survey of 404 participants at 44 Laboratory Response Network laboratories located throughout the United States. All participants were enrolled between October 2002 and December 2004, and all were eligible to receive AVA according to the 2002 ACIP recommendations. Chi-square tests and multivariate logistic regression were used in the analyses. RESULTS: The response rate of eligible individuals at participating laboratories was 94% (404/430). Sixty-six percent of respondents accepted and 34% declined AVA. Laboratory workers who declined AVA were more likely to rate their risk of exposure to inhalation anthrax as low (OR = 6.9; 95%CI 1.7, 28.3), report being very concerned (OR = 4.1; 95%CI 1.8, 9.3) or concerned (OR = 2.0; 95%CI 1.3, 3.1) about the safety of the vaccine, report that they did not trust the information provided in the Vaccine Information Statement (VIS) (OR = 2.3; 95%CI 1.1, 4.5), and to be enrolled in the study during 2002 (OR = 24.7; 95%CI 6.4, 95.3) or 2003 (OR = 5.0; 95%CI 2.5, 9.8), the first 2 years of the study. Furthermore, we found a significant association between a participant's level of concern about the safety of AVA and their perception that they received enough information and/or trusted the information in the VIS. CONCLUSIONS: Low perceived necessity, concern about the safety of the vaccine, and a lack of trust in the VIS were associated with the decision of laboratory workers to decline AVA. Results of this decision-making study may be used to try to improve acceptance rates of AVA among persons considered at high risk, and may inform educational efforts for other adult vaccines.

Adult↗
PubMed2000

Effects of variety and repeated in-home consumption on product acceptance.

The present study was designed to investigate the effect of variety on long-term product acceptance and consumption in a home-use situation. Subjects (N= 105) consumed a meat sauce once a week at dinner at home for a period of 10 weeks. Three variety groups were designed. The monotony group (N= 45) consistently received the same flavour of meat sauce across all 10 weeks; the imposed variation group (N= 30) received one from three different flavours of the meat sauce in random order, and the free choice (N= 30) in variation group was allowed to choose among three flavours of the meat sauce. Results showed a substantial increase in boredom and decline in acceptance ratings after repeated consumption. As hypothesized, this effect was the largest for the monotony group and was least pronounced in the free-choice group, with the imposed variation group in between. Consumption data were in line with these acceptance ratings; the monotony group consumed less of the food than the free-choice group over that time. In conclusion, repeated consumption of a food product only once a week at home resulted in a remarkable increase of boredom over time. The boredom effect was the largest for subjects who consistently received the same food, and was least pronounced for subjects who were allowed to choose among three different flavours of the food.

Adult↗
PubMed2000

Demonstrations of the influence of the eating environment on food acceptance.

In two independent demonstrations, pre-prepared food was served in different environments: first, identical prepared meals were served in both a training restaurant and in a student cafeteria; second, a prepared main dish was served in a food science laboratory class, and as part of an entire meal in two student cafeterias and in a training restaurant. In the training restaurants and in the student cafeterias, people selected and paid for their meals. The acceptability ratings of the food served varied across the three different environments in the following order: restaurant>laboratory>cafeteria. Differences in acceptance were attributed to contextual effects and the expectations they produce, actual product differences, and a number of possible covariates. Ratings of sensory attributes tended to mirror the acceptability effects. The difficulty of comparing contexts within actual food service systems is discussed.

Eating↗
PubMed1998

Validating new toxicology tests for regulatory acceptance

Before a new or revised toxicology test is considered acceptable for safety evaluation of new substances, the test users and the industrial and regulatory decision makers must feel comfortable with it, and the decisions it supports. Comfort with, and the acceptance of, a new test comes after knowing that it has been validated for its proposed use. The validation process is designed to determine the operational characteristics of a test, that is, its reliability and relevance, in addition to its strengths and limitations. The reliability of a test is measured by its reproducibility. Its relevance is judged by its mechanistic relationship to the health effects of concern, and its ability to predict or identify those effects. The U.S. government has recently formed the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) to work with federal agencies and test developers to coordinate the evaluation and adoption of new test methods. The ICCVAM will provide guidance to agencies and other stakeholders on criteria and processes for development, validation, and acceptance of tests; coordinate technical reviews of proposed new tests of interagency interest; facilitate information sharing among agencies; and serve as an interagency resource and communications link with parties outside of the federal government on matters of test method validation. Copyright 1998 Academic Press.

Journal Article↗
PubMed1986

Acceptance of antibiotic mixtures by infants and children.

The acceptance by children of two pharmacologically identical phenoxymethyl-penicillin potassium and erythromycin ethylsuccinate mixtures, differing only in their flavouring agents, was compared in a randomised blind manner. The time a nurse required to give the drug to a child was recorded and a score of the acceptance was given by the nurse. The mean time to give erythromycin Brand 1 was 29 s (SD +/- 21, number of children = 20) and mean time to give Brand 2 it was 16 s (SD +/- 13, n = 18); the difference was significant (p less than 0.05). The mean scores were 2.9 (SD +/- 0.6) and 3.4 (SD +/- 0.5), difference -0.5 (p less than 0.025). The difference between the two penicillin products was not significant. The time required to give a medicine was a useful way to compare the effect of different flavouring mixtures on the acceptance of drugs by infants and children.

Child↗
PubMed1994

Acceptability, sensitivity and content validity of the VECS and VSSS in measuring expectations and satisfaction in psychiatric patients and their relatives.

The Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) are two newly developed, multidimensional instruments that measure expectations and satisfaction with community-based psychiatric services (CPS) in patients, relatives and professionals. This paper reports on the acceptability, sensitivity and content validity of the VECS and VSSS in 75 patients and 76 relatives attending the South-Verona CPS. The acceptability of the VECS and the VSSS to subjects was good: most items were easily understood and the vast majority of subjects cooperated and gave accurate evaluations. The VECS and VSSS proved to be sensitive to variation both between groups and across dimensions. We demonstrated that the VECS and VSSS questionnaires had a higher sensitivity than unstructured interviews in measuring service expectations and satisfaction and that a domain-specific measurement had a higher sensitivity than an overall one. The content validity of the questionnaires, according to patients' and relatives' views, was very good. We demonstrated that a key characteristic of the content validity was the questionnaire's multidimensionality, with major contributions from the dimensions "Professionals' Skills and Behaviour" and "Types of Intervention". The findings presented in this paper constitute the first complete study available in the literature on the psychometric properties of the measurement of expectations and satisfaction in a psychiatric setting. They indicated that it is possible to measure such subjective aspects in an acceptable, sensitive and valid way and that the VECS and VSSS have good psychometric properties. The data presented appear promising in the qualitative evaluation of the South-Verona CPS and the method should be of interest to those evaluating CPS in other settings.

Attitude↗
PubMed1991

Parental acceptability of treatments for children's hypercholesterolemia.

This study examined the acceptability ratings of three alternative treatments applied to case descriptions which varied in their level of problem severity. Evaluations were provided by 40 parents seeking services in a Pediatric Preventive Cardiology Clinic for treatment of their children's hypercholesterolemia. Results indicated that both diet and diet plus goal setting were rated as significantly more acceptable than medication. Ratings of diet and diet plus goal setting did not vary as a function of problem severity, however, medication was rated as more acceptable when applied to a more severe case example, as opposed to a mild case example. Findings are discussed in relation to the clinical significance of these findings and the need for future research.

Attitude to Health↗
PubMed1984

Peer assessment of the social behavior of accepted, rejected, and neglected children.

Positive and negative sociometric nominations were used with second and fifth-grade children to select 26 socially accepted, 32 rejected, and 28 neglected children. A total of 358 of their classmates evaluated these children by indicating whether each of 19 descriptions of social behavior was characteristic of each child. Rejected children were perceived by their peers as being more aggressive, disruptive, irritable, domineering , dishonest , and selfish than accepted and/or neglected children. Neglected children, in contrast, differed from accepted children only in being less likely to brag about physical prowess . While the low sociometric status of rejected children appears to be related to the negative impact of their behavior on peers, this does not appear to be the case for neglected children. Females were generally perceived as behaving more positively with peers, but no interactions were found between sex and sociometric status. In general, the test-retest reliability of peer evaluation items was higher for fifth- than for second-grade children, but significant grade by sociometric status interactions were found for only two items.

Age Factors↗