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PubMed1989

Voluntary control of agonist premotor silence preceding limb movements of maximal effort.

The ability to gain voluntary control over agonist premotor silence through electromyographic (EMG) feedback was examined in healthy subjects performing maximal horizontal elbow flexions. Subjects exhibiting premotor silence on at least 50% of the pretest trials showed significantly greater peak angular velocity than subjects who produced the silent period on fewer than 20% of the trials during the pretest. The latter subjects acquired control of agonist premotor silence with practice and graphic feedback regarding their EMG patterns. The subjects who were the most successful in learning to produce the silent period increased their angular velocity to the level of the subjects who naturally exhibited the inhibition. The less successful subjects showed smaller increases in velocity. The data provide further evidence that premotor silence is primarily under central influence, that its control can be acquired, and that it may be functionally related to contractile rate.

Adult↗

PubMed1999

Response covariation. The relationship between correct academic responding and problem behavior.

This article examined the relationship between the accuracy of academic responding and aggression for two boys with mild mental retardation. Their teacher reported low rates of correct responding and high rates of aggressive behavior during spelling instruction. A functional analysis showed that aggression was escape maintained. Following the functional analysis, participants were tested on relations between printed, photographic, and dictated stimuli corresponding to their spelling words. On pretests, they were unable to match printed words to their photographs or to their dictated names; they could neither name the printed words nor spell the photographs or dictated words. High rates of aggression were observed during the pretests. The participants then were taught the letter-by-letter construction of the appropriate words when shown photographs. On posttests, the participants correctly matched printed words to their photographs and dictated names. In addition, they correctly named printed words and spelled dictated words orally. Data showed that rates of problem behavior negatively covaried with improvements in the participants' academic responding.

Achievement↗

PubMedDate not supplied

A stress management intervention for adolescents with type 1 diabetes.

PURPOSE: The purpose of this project was to examine the effectiveness of a stress management training program in helping adolescents with diabetes cope with stress. METHODS: Youths who displayed evidence of metabolic control problems received training in the use of both cognitive-restructuring and problem-solving strategies. Treatment impact was assessed on measures of coping, anxiety level, diabetes-specific stress, and metabolic control. RESULTS: Analyses of covariance showed no differences between the training group and a control group at posttest and follow-up. However, the small sample size and within-group variability may have precluded finding significant results. Therefore, within-group comparisons were conducted, and improvements were found in the training group on pretest to posttest and pretest to follow-up comparisons for anxiety, stress, and coping measures. No differences were found in the control group. CONCLUSIONS: Results suggest that the intervention had some positive impact, although this interpretation must be considered preliminary. Future research should replicate this study and explore the applicability and effectiveness of this intervention in specific populations.

Adaptation, Psychological↗

PubMed2003

The good, the bad, and the healthy: impacts of emotional disclosure of trauma on resilient self-concept and psychological distress.

This study examined the impact of disclosing traumas on resilient self-perceptions and psychological distress. Participants (N = 50) wrote about a traumatic life event or their plans for the next day and completed measures of resilience and distress before disclosing (pretest) and 3 months later (posttest). Results revealed that trauma participants increased in positive self-perceptions (mastery, personal growth, self-acceptance) and decreased in distress (depression, interpersonal sensitivity, anxiety, somatization) from pretest to posttest. Control participants showed no changes except for autonomy, on which they decreased. Results suggest that in addition to reducing psychological distress, disclosing traumas change self-perception, resulting in a more resilient self-concept.

Adaptation, Psychological↗

PubMed2004

Utilization and impact of cigarette pack covers illustrated with antismoking messages.

The authors tested whether smokers would use cigarette pack covers illustrated with antismoking messages. In 2001, visitors to a smoking cessation Web site ordered cigarette pack covers and answered a follow-up questionnaire 52 days later. Participants received by mail cardboard boxes designed to contain cigarette packs and illustrated with antismoking messages. Participants were 393 smokers living in France, Belgium, and Switzerland. Participants used their boxes for 21 days out of a possible 28 days, and 31% were still using them at follow-up. Almost one third (32%) said that the boxes often prompted discussions about smoking. The boxes that were submitted to pretests were preferred to the boxes that were not pretested. The authors concluded that the boxes were welcomed by smokers and enabled the display of antismoking messages for 3 weeks in their immediate environments. The intervention had no impact on smoking cessation, but this was not its primary objective.

Adult↗

PubMed1999

Differential attrition rates and active parental consent.

Active parental consent in survey research poses ethical and practical concerns. One common argument against the requirement of active consent procedures is its effect on participation rates. There is additional concern that higher risk groups may be underrepresented in the final sample. Empirical support of differential attrition, however, is lacking. In the current multisite longitudinal study, passive consent procedures were approved for the collection of pretest data. For subsequent years of data collection, active parental consent procedures were required. In this article, we use the pretest data to examine demographic, attitudinal, and behavioral differences between those students for whom active consent was provided and those for whom active consent was either denied or for whom no response was received. The results indicate that active consent procedures produce deleterious effects on participation rates and lead to an underrepresentation of at-risk youth in the sample.

Adolescent↗

PubMedDate not supplied

Intervals for posttest probabilities: a comparison of 5 methods.

BACKGROUND: Several medical articles discuss methods of constructing confidence intervals for single proportions and the likelihood ratio, but scant attention has been given to the systematic study of intervals for the posterior odds, or the positive predictive value, of a test. METHODS: The authors describe 5 methods of constructing confidence intervals for posttest probabilities when estimates of sensitivity, specificity, and the pretest probability of a disorder are derived from empirical data. They then evaluate each method to determine how well the intervals' coverage properties correspond to their nominal value. RESULTS: When the estimates of pretest probabilities, sensitivity, and specificity are derived from more than 80 subjects and are not close to 0 or 1, all methods generate intervals with appropriate coverage properties. When these conditions are not met, however, the best-performing method is an objective Bayesian approach implemented by a simple simulation using a spreadsheet. CONCLUSION: Physicians and investigators can generate accurate confidence intervals for posttest probabilities in small-sample situations using the objective Bayesian approach.

Bayes Theorem↗

PubMedDate not supplied

Efficacy of the stat serum electrolyte panel in the management of older emergency patients.

The serum electrolyte panel (SEP) is commonly ordered in the workup of the emergency department (ED) patient. This study was done: 1) to evaluate the efficacy of the SEP in terms of the identification of clinically significant abnormals (yield) and the impact on therapeutic plan (impact); 2) to evaluate the reasons that the test was ordered; and 3) to compare the expected and realized contributions of the test to patient care. Pretest and posttest questionnaires were administered to physicians managing 800 ED patients greater than or equal to 55 years old for whom SEPs were ordered. The yield of significant abnormals was 16%. Fluid and electrolyte treatment plans were modified after the SEP results became known in 35% of cases. This modification was associated with a normal SEP 48% of the time. Both the yield and the impact of the SEP were related to the reason that the test was ordered. The most common reason given was "to look for an unexpected abnormality" (50%). Physicians' expectations for the contribution of the SEP to patient care decisions were greater than the contributions realized after the results were known. However, in 115 cases, the test contributed more than expected. Physicians predicted that 13% of the tests would contribute nothing to patient care. After the results were known, they felt that 38% had made no contribution. Physicians tend to overestimate the potential impact of the SEP but are occasionally surprised by a result that contributes more than expected. Thus, there is considerable pretest uncertainty about treatment decisions and normal results appear to have a substantial impact.

Aged↗

PubMedDate not supplied

Test-indication curves.

Test-indication curves (TICs) are tools for determining whether a test is indicated for a given patient. They apply the threshold approach of Pauker and Kassirer in graphic form. These curves are composed of two parts: the raw curve, which plots posttest probability versus pretest probability (given values for specificity and sensitivity); and the final curve, in which three straight lines are added to the raw curve by the clinician to generate a TIC for a given treatment threshold. In the final curve, the complete range of pretest probability is segregated into three zones, corresponding to the three groups described by Pauker and Kassirer: those patients in whom disease is assumed to be present and who are thus best treated empirically; at the other extreme, those who require neither testing nor treatment; and, finally, those in the middle, for whom the test is indicated, since the decision to treat would be based on the test result. Thus the clinician could consult the TIC and determine with certainty whether the test should be employed for a given patient. It also could be modified with ease for a different patient, with a different set of threshold values. TICs provide a complete, visual interpretation of a test's diagnostic power, in the context of a given treatment threshold. They foster an intuitive comprehension of Pauker and Kassirer's method, and offer the clinician a facile means to prove that a test is indicated in a given setting. By promoting the use of exactly those tests that are indicated, TICs can help spare the patient the cost, burden, and risk of unnecessary testing, and help spare the physician the cost, burden, and risk of interpreting inconclusive test results.

Cost-Benefit Analysis↗

PubMedDate not supplied

Relative entropy as a measure of diagnostic information.

Relative entropy is a concept within information theory that provides a measure of the distance between two probability distributions. The author proposes that the amount of information gained by performing a diagnostic test can be quantified by calculating the relative entropy between the posttest and pretest probability distributions. This statistic, in essence, quantifies the degree to which the results of a diagnostic test are likely to reduce our surprise upon ultimately learning a patient's diagnosis. A previously proposed measure of diagnostic information that is also based on information theory (pretest entropy minus posttest entropy) has been criticized as failing, in some cases, to agree with our intuitive concept of diagnostic information. The proposed formula passes the tests used to challenge this previous measure.

Clinical Medicine↗

PubMedDate not supplied

Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency.

A patient-based, subjective outcome measure for chronic anterior cruciate ligament deficiency was developed, pretested, and validated. The development of the outcome measure was completed in four stages: 1) item generation (167 items), 2) item reduction (by surveying 79 patients), 3) questionnaire formation and pretesting (20 patients), and 4) reliability, responsiveness, and validity assessment (100 patients). This disease-specific quality of life measure is a 32-item questionnaire using a 100-mm visual analog scale response format. Face validity was derived from extensive direct patient input. Content validity was determined by consensus among 20 knee surgeons. There was no significant difference on test-retest reliability, with an overall average error of 6%. The outcome measure demonstrated responsiveness to clinical change correctly in 21 of 25 patients (84%). Construct validity was shown by the ability of the questionnaire to measure the full spectrum of disease; scores ranged from 8 to 99 out of a maximum score of 100. The questionnaire was able to distinguish patients who went on to have surgery (average score, 31) from those who would be treated nonoperatively (average score, 79). The quality of life outcome measure for chronic anterior cruciate ligament deficiency is the first subjective knee scale of its kind to be validated to measure quality of life in patients with chronic anterior cruciate ligament deficiency.

Adolescent↗

PubMed2006

[Comorbidity in generalized anxiety disorder: prevalence and course after cognitive-behavioural therapy].

OBJECTIVE: To evaluate the prevalence and course of Axis I concurrent disorders in a population of patients who underwent cognitive-behavioural therapy (CBT) to treat their generalized anxiety disorder (GAD). METHOD: This study is a secondary analysis combining patients from 3 treatment studies done at Université Laval. A total of 90 patients with a DSM-IV consistent GAD diagnosis received from 12 to 16 CBT sessions to treat GAD. Symptomatology was assessed at pretest, posttest, and 6 months after treatment, with the Anxiety Disorders Interview Schedule, a structured diagnostic interview. RESULTS: Seventy-three per cent of patients had both GAD and a concurrent diagnosis. The most common diagnoses were simple phobia, social phobia, panic disorder, and major depression. CBT applied to GAD decreases the number of concurrent diagnoses. A panic disorder or a greater number of concurrent diagnoses at pretest is associated with a less efficient treatment at follow-up 6 months later. CONCLUSION: Patients with GAD have a high comorbidity rate with other Axis I disorders, but these significantly decrease after a short CBT aimed at GAD. Implications for GAD treatment and mechanisms that might explain these findings are discussed.

Adult↗

PubMed1997

Outcome evaluation of a short-term mental health day treatment program.

OBJECTIVES: To determine whether a structured, 6-week mental health day treatment program was meeting its objectives and to examine the program's effectiveness with specific patient groups. METHOD: Self-report questionnaires focusing on psychiatric symptoms, assertiveness, stress management, and social functioning were completed by patients directly prior to admission (pretest), at discharge (posttest), and at 4-month follow-up. Clinician ratings, including the DSM-III-R Global Assessment of Functioning (GAF) scale, were collected. Ninety-one participants completed pre- and posttests, and 51 completed the 4-month follow-up. RESULTS: The majority of the participants displayed affective disorders or adjustment disorders. There was significant reduction in psychiatric symptoms and improvement in assertiveness, social functioning, and stress management from pretest to posttest. These gains were maintained at follow-up. All diagnostic groups responded similarly, except the bipolar disorder group. CONCLUSION: These data indicate that the program was meeting its objectives and offer strong support for the usefulness of short-term day treatment for wide range of patients. The bipolar group performed differently compared with the other subsamples. The reliability of the GAF scale and when it may be most useful are discussed.

Adjustment Disorders↗

PubMedDate not supplied

Effect of an intimate partner violence educational program on the attitudes of nurses.

OBJECTIVE: To examine the effect of an intimate partner violence (IPV) educational program on the attitudes of nurses toward victims. DESIGN: A quasi-experimental study utilizing a pretest and posttest. SETTING: An urban health care system. PARTICIPANTS: Fifty-two inpatient nurses completed both the pretest and posttest. INTERVENTION: One-hour and 3-hour IPV educational programs. MAIN OUTCOME MEASURES: Change in attitude was determined by scores from the Public Health Nurses' Response to Women Who Are Abused (PHNR), a standardized questionnaire that measures nurses' reactions to an IPV scenario. Parallel forms, each with a different scenario, were administered before and 2 months after the 1-hour and 3-hour educational sessions. Scores were analyzed using a repeated measures analysis of variance followed by multiple comparisons with Bonferroni adjustments. RESULTS: Nurses' PHNR scores increased significantly after attending the 1-hour session if they had previous IVP education and after the 3-hour session if they had no previous IVP education. CONCLUSION: Educational offerings should be tailored for nurses. For nurses with previous IVP education, offer a 1-hour update. For nurses with no previous IVP education, provide a 3-hour educational session. Further study is needed to determine if change in nurses' attitudes translates into improved screening, identification, and intervention for IPV victims.

Adult↗

PubMed2003

Evaluation of an educational intervention on breastfeeding for NICU nurses.

The effect of breastfeeding education on breastfeeding knowledge and attitudes of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses (intervention) and pediatric nurses (untreated control) working at a northeastern US children's hospital participated in the pretest/posttest design study. Both groups answered the same breastfeeding questionnaire on 2 occasions. NICU nurses completed the questionnaire the second time after attending the education session. Outcome measures evaluated by questionnaire items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3) baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison groups were similar at pretest on demographic variables and remained so despite attrition between pretesting and posttesting. A significant increase (P < .001) occurred in NICU nurses' breastfeeding knowledge after the education session. Findings suggest that an educational intervention has potential for improving NICU nurses' knowledge and certain attitudes about breastfeeding but may not alter other attitudes of interest in the desired direction.

Analysis of Variance↗

PubMed2004

Breastfeeding attitudes, intention, and initiation in low-income women: the effect of the best start program.

This study compared breastfeeding attitudes, intention, and initiation among low-income women exposed or not exposed to the Best Start program. A between- (experimental vs control group) and within-factor (pretest vs posttest) repeated measures design was employed. A nonprobability sample of 54 subjects was randomly assigned to a control group (n = 28) or an experimental group (n = 26). Using the Breastfeeding Attrition Prediction Tool, statistically significant group by time interaction effects were found for negative breastfeeding sentiment, positive breastfeeding sentiment, and breastfeeding control scales. Compared to the control group, the experimental group had significantly increased positive breastfeeding sentiment (P <.01), decreased negative breastfeeding sentiment (P <.01), and increased breastfeeding control (P <.01) from pretest to posttest. Following exposure to the Best Start program, subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group. Practical implications are discussed.

Adult↗

PubMed2000

Components of variance in a group-randomized trial analysed via a random-coefficients model: the Rapid Early Action for Coronary Treatment (REACT) trial.

Rapid Early Action for Coronary Treatment (REACT) was a multisite trial testing a community intervention to reduce the delay between onset of symptoms of acute myocardial infarction (MI) and patients' arrival at a hospital emergency department. The study employed a group-randomized trial design, with ten communities randomized from within matched pairs to each of two conditions. REACT also employed continuous data collection, based on surveillance of heart attack patients in community emergency departments. They analysed their data by comparing the mean slope for delay time in the ten intervention communities to the mean slope estimated in the ten control communities. Because no estimates of slope variation were available a priori, REACT was sized using approximations based on more traditional designs. In this paper, we present the slope and residual error variances as estimated from the REACT data and examine their influence on the power of the trial post hoc. We also examine the power of the trial as it would have been given a more traditional pretest-post-test design with analysis via a comparison of the net difference in condition means pretest vs post-test.

Ambulances↗

PubMedDate not supplied

Effectiveness of a worksite nutrition education activity in a factory in China.

To evaluate the effectiveness of a worksite nutrition education activity in China, a two-group pretest-posttest nutrition education lesson was designed and carried out in two divisions (N = 240 in each division) of a steel tube factory in Chengdu, Sichuan. Special features of the program were nutrition education materials developed from both (a) the results of a pretest survey of the employees, and (b) focus group discussions conducted with factory hospital and workteam staff; a colloquial style; a slogan; and an illustrated handout depicting the new Chinese Dietary Guidelines and a proposed Food Guide. Analysis of variance, chi-square, and t-tests showed both significant increases (p < 0.05) in nutrition knowledge and attitude scores and significant improvements in dietary practices in the group receiving the education. It is concluded that the method is a useful and practical model for designing and developing worksite nutrition education in China.

China↗