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PubMed2001

Testing a predictive model of what makes a critical thinker.

The goal of nursing education is to help individuals become self-determining, independent thinkers. Cognitive development may be the outcome that best characterizes such a thinker. The purpose of this study was to test a model of cognitive development in which four independent variables--knowledge base, critical thinking skills, critical thinking dispositions, and experience--were used to predict cognitive development. Data were analyzed from 232 practicing registered nurses. Three hierarchical levels of cognitive development were examined: dualism, relativism, and commitment. Critical thinking skill was a significant contributor only to the dualistic level of cognitive development. Critical thinking dispositions contributed to all three levels of cognitive development. Experience contributed only to the commitment level. The results of this study suggest that the development of a critical thinker may require time and experience. These findings can be used to examine current policy regarding the criteria used to evaluate nursing education.

Clinical Competence↗
PubMed2005

World Health Organization grade 'a' motility and zona-binding test accurately predict IVF outcome for mild male factor and unexplained infertilities.

BACKGROUND: The aim of this study was to determine the pronostic value of a sperm-zona pellucida (ZP) binding assay, combined with World Health Organization (WHO) grade 'a' sperm motility on the day of the IVF attempt, to predict sperm fertilizing ability in unexplained and moderate male factor infertilities. METHODS: In total, 84 couples (64 unexplained infertility; 20 male factor) underwent both a sperm-ZP binding assay and an IVF attempt, irrespective of the test's result. The test was negative when grade 'a' motility was #5% and/or the ZP binding index was <0.7. Fertilization and pregnancy rates were related to the test's results. RESULTS: Thirty-one patients had a negative test (group N) and 53 a positive test (group P). A difference was observed concerning the fertilization rate [median (range): 0 (0-75%) versus 50 (0-100%); P = 0.0001] and the number of cycles with fertilization rate <20% (65 versus 23%; P = 0.0002) between groups N and P respectively. In the group of unexplained and male factor infertilities, the test showed a sensitivity of 83 and 60%, specificity of 50 and 90%, positive predictive value of 76 and 86%, and negative predictive value of 61 and 69% respectively. CONCLUSION: Sperm-ZP binding test, combined with WHO grade 'a' motility assessment, is relevant to prevent IVF fertilization failures in unexplained infertility and, most particularly, in moderate male factor infertility.

Adult↗
PubMed2000

Clinical importance of risk factors and exercise testing for prediction of significant coronary artery stenosis in women recovering from unstable coronary artery disease: the Stockholm Female Coronary Risk Study.

BACKGROUND: The objectives of this study were to investigate the relation between coronary risk factors, exercise testing parameters, and the presence of angiographically significant coronary artery disease (CAD) (> or =50% luminal stenosis) in female patients previously hospitalized for an acute CAD event. METHODS AND RESULTS: All women younger than age 66 years in the greater Stockholm area in Sweden who were hospitalized for acute coronary syndromes during a 3-year period were recruited. Besides collection of clinical parameters, coronary angiography and a symptom-limited exercise test were performed in 228 patients 3 to 6 months after the index hospitalization. The mean age was 56 +/- 7 years. Angiographically nonsignificant CAD (stenosis <50%) was verified in 37% of the patients; significant CAD was found in 63%. The clinical parameters that showed the strongest relation with the presence of significant CAD after adjusting for age were history of myocardial infarction (odds ratio [OR] 4.91, 95% confidence interval [CI] 2.35 to 7.49), history of diabetes mellitus (OR 3.83, 95% CI 1.63 to 14.31), serum high-density lipoprotein cholesterol <1.4 mmol/L (OR 2.11, 95% CI 1. 20 to 3.72), and waist-to-hip ratio >0.85 (OR 1.78, 95% CI 1.02 to 3. 10). A low exercise capacity and associated low change of rate-pressure product from rest to peak exercise were the only exercise testing parameters that were significantly related to angiographically verified significant CAD (<90% of the predicted maximal work capacity adjusted for age and weight, OR 1.91, 95% CI 1. 04 to 3.50). CONCLUSIONS: In female patients recovering from unstable CAD, exercise capacity was the only exercise testing parameter of value in the prediction of significant CAD. The consideration of certain clinical characteristics and coronary risk factors offer better or complementary information when deciding on further coronary assessment.

Adult↗
PubMed1981

Value of exercise testing for prediction of physical and psychosocial rehabilitation potential 3 months after acute myocardial infarction.

In 147 patients exercise tests were performed at the beginning and after 1 year of an ambulatory rehabilitation program. Measurements of both tests and the degree of functional improvement were correlated with patients' characteristics, the results of a psychological analysis using the Freiburger Personality Inventory and a patient's questionnaire for self-assessment. Among the major determinants for functional improvement were age, location of the infarct, rate of participation and greater initial functional impairment. High degree of psychosomatic impairment accompanied low levels of exercise capacity, the patients' self-assessment showed no correlation with exercise performance.

Adult↗
PubMed2005

"ProC Global": a functional screening test that predicts recurrent venous thromboembolism.

Abnormalities of the Protein C (PC) pathway are found in the majority of patients with thrombophilia. ProC Global is a coagulation assay that reflects the net effect of the PC pathway by measuring the activated partial thromboplastin time (APTT) of patient and control plasma, before and after activation of endogenous PC by Protac, a snake venom. Previous studies have suggested that abnormalities in this test are associated with an increased risk of venous thromboembolism (VTE). A retrospective analysis was performed using frozen plasma samples from 140 patients with confirmed VTE to determine whether an abnormal ProC Global result (in the presence and in the absence of known abnormalities in the PC pathway) is a predictor of initial and recurrent VTE. Patients were tested for the presence of activated protein C resistance, Factor V Leiden, PC and protein S (PS) deficiency, and non-specific inhibitor positivity. Mean ProC Global results were significantly lower in patients with recurrent VTE than in patients without recurrent VTE. The association between abnormal ProC Global result and recurrent VTE showed a strong trend, before (odds ratio, OR 3.6) and after (OR 3.1) exclusion of known thrombophilic abnormalities. Patients with a first episode of idiopathic VTE also expressed significant lower ProC Global results than those with secondary VTE. After exclusion of known PC pathway abnormalities, there was a statistically significant association between abnormal ProC Global and initial idiopathic VTE (p=0.04). These results suggest that ProC Global may serve as a predictor of recurrent VTE and potentially for first episode of idiopathic VTE. ProC Global may help identify patients at increased risk of initial and recurrent VTE.

Activated Protein C Resistance↗
PubMed1997

Doppler velocimetry and nonstress test for predicting outcome of pregnancies with decreased fetal movements.

Because fetal motor activity reflects the fetal condition in utero, maternal counting of fetal movements has been suggested as a useful method for monitoring fetal well-being, based on empirical evidence that a decrease in or absence of fetal movements often presages fetal death. The aim of this study was to compare the predictive capacity of umbilical artery (UA) Doppler velocimetry with that of nonstress test (NST) cardiotocography in 599 women with low-risk pregnancies, reporting decreased fetal movements. In 19 cases the fetus was dead on maternal admission. Umbilical artery Doppler velocimetry and NST were performed in the remaining 580. In 541 the NST and UA velocimetry findings were reassuring, and the women were discharged. There was one perinatal death in this group, due to extreme prematurity and placental abruption 1 week later. Thirty-nine women who gave birth on the day of admission or next day were especially given closer attention. Umbilical artery velocimetry was abnormal in only one fetus. In 6 cases, the NST trace on admission indicated fetal distress, and emergency cesarean section was performed, resulting in 3 infant deaths and 3 infants with sequelae. The umbilical cord pH was normal in 3, suggesting an earlier temporary intrauterine hypoxic event. Overall perinatal mortality was thus 23 (3.8%). Decreased fetal movement perception by mothers should therefore be taken seriously, even though an irreversible insult to the fetus might already have occurred.

Abruptio Placentae↗
PubMed2004

The role of test accuracy in predicting acceptance of genetic susceptibility testing for Alzheimer's disease.

A survey questionnaire regarding perceptions of risk and genetic susceptibility to Alzheimer's disease (AD) was completed by 518 offspring of AD cases from families with multiple affected, ascertained as part of a genetic linkage study of late onset AD. The questionnaire focused on respondents' perceptions of their own risk for AD as well as on the properties of real and hypothetical susceptibility tests, including error rates for false-positive and false-negative test results. Our findings showed that about 20% of the sample would refuse a susceptibility test with zero error rates, about 40% would accept tests with very high error rates in both directions, and the remainder would exercise some discrimination. Acceptance of high test error rates was significantly associated with male gender, low education, and high perceived lifetime risk of AD. In a previous paper related to this work, we showed that physicians caring for these families exercised much more discrimination in judging the acceptability of genetic tests they would offer to these same respondents. The findings show that there is a pressing need to educate the public, particularly those with relatives affected by a complex disease, to expect standards of accuracy for genetic tests comparable to those that prevail in other diagnostic and prognostic testing efforts in the broad field of clinical medicine.

Adolescent↗
PubMed2003

Critical evidence: a test of the critical-period hypothesis for second-language acquisition.

The critical-period hypothesis for second-language acquisition was tested on data from the 1990 U.S. Census using responses from 2.3 million immigrants with Spanish or Chinese language backgrounds. The analyses tested a key prediction of the hypothesis, namely, that the line regressing second-language attainment on age of immigration would be markedly different on either side of the critical-age point. Predictions tested were that there would be a difference in slope, a difference in the mean while controlling for slope, or both. The results showed large linear effects for level of education and for age of immigration, but a negligible amount of additional variance was accounted for when the parameters for difference in slope and difference in means were estimated. Thus, the pattern of decline in second-language acquisition failed to produce the discontinuity that is an essential hallmark of a critical period.

Age Factors↗
PubMed2003

The "new genetics" and clinical practice.

A "new genetics" has emerged driven by knowledge gained at the DNA level. In clinical practice, a practical application of the new genetics is DNA testing, which can be expected to expand with the completion of the Human Genome Project as the functions of new genes are discovered. Genetic DNA testing scenarios include diagnostic DNA testing, prenatal DNA testing, predictive (presymptomatic) DNA testing and screening DNA testing. The challenge for genetic DNA testing and clinical practice will be to define the roles to be played by the general practitioner, the specialist, and other healthcare professionals. From the patients' and families' perspective, the new genetics will best be implemented if a planned approach is adopted in the ordering of DNA tests and the associated counselling and support processes.

DNA↗
PubMedDate not supplied

Proposal for the "Antabuse test".

Author describes development of the "Antabuse test" as preemployment predictive test of susceptibility of workers to carbon disulfide. He reviews all publications of his group, as well as publications of other groups on this subject. In discussion the hypothesis explaining this phenomenon is presented. Also practical suggestions for performing "Antabuse test" are mentioned.

Administration, Oral↗
PubMed1983

The use of a cosyntropin stimulation test to predict adrenal suppression in renal transplant patients being withdrawn from prednisone.

Eighteen renal transplant patients were studied to identify predictors of steroid-induced adrenal suppression. A cosyntropin adrenal stimulation test was administered to each patient and the response was correlated with the past transplant course and their subsequent prognosis. Eight (44%) of the 18 patients studied had a suppressed cosyntropin stimulation test. The suppressed adrenal response could not be predicted accurately by any one factor, although a history of a total prednisone dose greater than 25 g or a duration of steroid therapy of more than 12 months occurred more often among the suppressed patients. Four of the five deaths occurred among the suppressed patients. These deaths occurred despite maintenance of steroid administration. The cosyntropin stimulation test can be easily performed to identify renal transplant patients at risk of steroid-induced adrenal suppression when rapid steroid tapering is desired. An unsuppressed response gives assurance that steroid withdrawal is safe.

Adolescent↗
PubMed1984

[A predictive thermographic test of the effect of lumbar sympathectomy].

The benefit of lumbar sympathectomy in the treatment of arteriopathy of the lower limb has been widely proved. To predict objectively its efficiency we developed a simple pharmacologic test under thermographic control. 1 mg of Reserpine is injected in a femoral artery, a digitalized thermography enables to follow the chronological evolution of temperatures of the lower limbs. Thirty patients were investigated, 27 responded positively. The mean increase in temperature of the injected limb reached 1.62 degrees C beginning 2 h 46 after the injection of Reserpine.

Aged↗
PubMed2000

High suicidal ideation in persons testing for Huntington's disease.

This study examined the first participants who registered for the Huntington's disease predictive testing program 1990-1995 in Stockholm, Sweden. A psychosocial investigation was performed to evaluate potential effects of the presymptomatic testing. The results showed no significant differences between 13 gene carriers and 21 noncarriers in pretest attitudes, expectations, general well-being, life satisfaction and lifestyle, the need for support, estimated sense of wellbeing or degree of health. However, both groups showed high suicidal ideation and self-injurious behavior. Noncarriers had a very high frequency of attempted suicide, and both groups had similarly pronounced psychiatric dysfunction. Their relatives also had high frequencies of psychiatric diseases, suicide or suicidal attempts. Most of the participants had a desire to meet a psychologist or a social worker. The need for counseling, using a well designed protocol, and the importance of focusing on suicide risk of participants in predictive testing programs is emphasized.

Adult↗
PubMed1987

The ability of biochemical and haematological tests to predict recovery in periparturient recumbent cows.

Blood samples from 433 periparturient recumbent cows submitted by veterinary practitioners to Ruakura Animal Health Laboratory during 1983 and 1984 were analysed and results related to whether cows recovered, died or were euthanased. Generally cows were sampled only once and the time varied from 15 minutes to 20 days after becoming recumbent. During 1983 serum calcium, magnesium, phosphorus, creatine phosphokinase (CK), aspartate amino transferase (AST), glutamate dehydrogenase (GDH), gamma glutamyl transferase (GGT) were analysed. In 1984 serum urea, creatinine, fibrinogen and haematological examination (haemoglobin, haematocrit, total and differential white cell counts) were added to the panel. Overall 39% of cows recovered, 30% died and 32% were destroyed. Precalving cows had 111% more deaths and 7% less survivors than postcalving recumbent cows (P<0.1). There was little difference (3%) in euthanasia prevalence. Tests that were most useful in predicting a lack of recovery were serum urea and muscle enzymes. Using these tests and duration of recumbency when sampled a model was produced to predict the probability of recovery from 254 cases.

Journal Article↗
PubMed1990

[The evaluation of thyroid suppression test in predicting the outcome of Graves' disease treated by short-term antithyroid drugs].

One hundred and fifteen new patients with Graves' hyperthyroidism were received thyroid suppression test after cessation of 6 month course of drug therapy. The results of follow up for another 12 months were that one of them had lost, 48 cases were in remission, and 66 cases had relapsed. The present study shows that thyroid suppression test, including the 4th, 6th and 24th hour suppression rates, is useful in predicting the outcome of drug therapy. The effect of 6th hour suppression rate is better than that of 24th and 4th hours, with 75.8% sensitivity, 75.0% specificity and 75.4% accuracy when 30% of thyroid suppression rate is as out-off point which is decided by ROC curve. It is suggested that 6 hour 30% suppression rate is better than the traditional 24 hour 50% suppression rate in the prediction of outcome of drug therapy.

Adult↗
PubMed1994

The significance of gonadotropin-releasing hormone test for predicting fertility after varicocelectomy.

To predict the surgical outcome in 30 infertile men with varicocele, endocrinologic evaluation by the GnRH test was performed before and 6 months after the high ligation of the left internal spermatic vein. Semen analysis was performed and the levels of basal T and PRL were examined preoperatively and 6 months postoperatively. In the pregnancy group, the preoperative excessive response of LH to the GnRH test decreased significantly after surgery. Significant reduction in the LH response is considered to be a valuable parameter for predicting fertility.

Adult↗