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At least 1,531 records · Page 85Linked to original sources
PubMed2006

Construct validation of a novel hybrid surgical simulator.

BACKGROUND: Simulated minimal access surgery has improved recently as both a learning and assessment tool. The construct validation of a novel simulator, ProMis, is described for use by residents in training. METHODS: ProMis is a surgical simulator that can design tasks in both virtual and actual reality. A pilot group of surgical residents ranging from novice to expert completed three standardized tasks: orientation, dissection, and basic suturing. The tasks were tested for construct validity. Two experienced surgeons examined the recorded tasks in a blinded fashion using an objective structured assessment of technical skills format (OSATS: task-specific checklist and global rating score) as well as metrics delivered by the simulator. RESULTS: The findings showed excellent interrater reliability (Cronbach's alpha of 0.88 for the checklist and 0.93 for the global rating). The median scores in the experience groups were statistically different in both the global rating and the task-specific checklists (p < 0.05). The scores for the orientation task alone did not reach significance (p = 0.1), suggesting that modification is required before ProMis could be used in isolation as an assessment tool. CONCLUSIONS: The three simulated tasks in combination are construct valid for differentiating experience levels among surgeons in training. This hybrid simulator has potential added benefits of marrying the virtual with actual, and of combining simple box traits and advanced virtual reality simulation.

Computer Simulation↗
PubMed2003

The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials.

To comprehend the results of a randomised controlled trial (RCT), readers must understand its design, conduct, analysis, and interpretation. That goal can be achieved only through total transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by use of a checklist and flow diagram. The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, and Discussion. The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect, or because the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage of participants through an RCT. The revised flow diagram depicts information from four stages of a trial (enrollment, intervention allocation, follow- up, and analysis). The diagram explicitly shows the number of participants, for each intervention group, included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis. In sum, the CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.

Humans↗
PubMed2005

The role of a computerised case-based testing procedure in practice performance assessment.

INTRODUCTION: For postgraduate training of doctors there is a need for valid and reliable instruments to assess their daily performance. Various instruments have been suggested, some of which use incognito simulated patients (SPs). These methods are resource intensive. Computerised Case-based testing (CCT) is logistically simpler and may still predict performance well. The research question was to evaluate the predictive validity of CCT for performance. METHODS: Seventeen rheumatologists were each visited by eight incognito SPs presenting various rheumatological complaints, and scoring the performance of the rheumatologists using a predefined checklist. From this checklist a panel of experts identified essential items. In addition the rheumatologists sat a CCT test containing 55 cases with a total of 121 items. RESULTS: Negative correlations were found between the SP scores and the CCT scores. This was unexpected. Therefore, background variables on experience were used to compare both methods. The correlation between these and CCT were high and positive and with the SP scores high and negative. This pattern did not differ when using the essential items of the checklist. Reliabilities of the SP scores were markedly high. DISCUSSION: Although CCT was not predictive of SP scores, it was related to working experience. There are good reasons to assume that although SP-scores were more authentic, they were less valid than CCT scores, mainly because they focussed more on thoroughness than on efficiency in data gathering. The results underpin the assumption that for valid performance assessment the most important issue is what information about the candidate is collected and now how authentic the method is.

Clinical Competence↗
PubMed2006

Medical school application interview score has limited predictive validity for performance on a fourth year clinical practice examination.

BACKGROUND AND PURPOSE: : Data supporting the predictive validity of the medical school admission interview are mixed. This study tested the hypothesis that the admission interview is predictive of interpersonal interactions between medical students and standardized patients. METHOD: : We determined correlations between admission interview scores and performance on a senior-year Clinical Practice Examination piloting US National Board of Medical Examiners stations. We also completed regression analyses controlling for undergraduate academic performance, gender and ethnicity. Outcome measures included an Interpersonal Skills score and a separate Overall Checklist performance score, completed by standardized patients. RESULTS: : The applicant interview had limited but statistically significant correlation with the Interpersonal Skills (r = 0.15; p < 0.05) score. The applicant interview had a correlation of 0.13 with the Overall Checklist score (p = .056). In linear regression models, the applicant interview had limited but statistically significant correlations with the Interpersonal Skills score and the Overall Checklist score. CONCLUSION: : As practiced at this medical school, the admission interview has limited predictive validity for future interactions with standardized patients. More comprehensive assessment of interpersonal skills during the medical school selection process will be needed in order to better select matriculants with desirable interpersonal skills.

Clinical Competence↗
PubMed2004

Early indicators of autism spectrum disorders in the second year of life.

Three groups of 18 children were selected for this study, one group with autism spectrum disorders (ASD), one group with developmental delays in which ASD was ruled out (DD), and one group with typical development (TD), from a pool of 3026 children who were screened with the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP, Wetherby & Prizant. 2002) Infant-Toddler Checklist under 24 months of age. The CSBS DP Behavior Sample was videotaped on selected children as a second-level evaluation during the second year of life. The Infant-Toddler Checklist had a sensitivity and specificity of 88.9% for this sample of children. Significant group differences were found on the Infant-Toddler Checklist and the Behavior Sample, however, these differences did not distinguish children with ASD and DD with high accuracy. The videotapes of the Behavior Sample were reanalyzed to identify red flags of ASD. Nine red flags differentiated children in the ASD group from both the DD and TD groups and four red flags differentiated children in the ASD Group from the TD group but not the DD group. These 13 red flags were found to discriminate the three groups with a correct classification rate of 94.4%.

Age Factors↗
PubMed1994

A pilot experience with competency-based clinical skills assessment in a surgical clerkship.

This investigation examines a competency-based clinical skills assessment program for surgical clerks using checklists and rating forms for precise measurement of physical exam (PE) skills, physician-patient interaction (PPI) skills, and patient write-up (PW) skills. Analysis of variance demonstrated improvement in PW skills across the academic year when measured by the rating instrument, but this improvement was not detected on traditional subjective rating forms (SRF). PPI skills improved between first rotations across 2 academic years with the addition of orientation to expectations (mean, 79% versus 92%, P = 0.000). Poor correlation was noted between the National Board of Medical Examiners Surgery Subtest scores and PE skills (r = .19), PW skills (r = .20), and PPI skills (r = .15). While the overall ratings given by faculty on SRF correlated with the SRF ratings of PE skills (r = .77) and PPI skills (r = .58), these same faculty ratings correlated poorly with these skills as assessed by checklist (r = .16 and r = .14, respectively). This pilot experience demonstrates that PE skills, PW skills, and PPI skills (1) improve only with orientation to expectations and feedback, (2) correlate poorly with fund of knowledge assessment, and (3) are best assessed with precise measurement (eg, checklist, direct observation), which avoids the halo effect of overall evaluation that occurs with subjective rating forms.

Clinical Clerkship↗
PubMed1995

A method assigned for the identification of ergonomic hazards - PLIBEL.

A checklist is presented for the identification of ergonomic hazards, with relevance to different body regions. Literature on the association between certain work characteristics and occupational musculoskeletal disorders was studied, and relevant items were chosen for the checklist. The method was tested for validity through workplace observations performed with the checklist and a well documented method (AET). The agreement between matching items was considerable. The inter-observer reliability yielded kappa values expressing a fair to moderate agreement. The applicability of the method is demonstrated through references to studies where it has been used.

Journal Article↗
PubMed1996

Assessment of the multiple dimensions of nausea: the Nausea Profile (NP).

Nausea, unlike emesis, is a subjective experience that is difficult to describe to others, be they clinicians or researchers. Previous research has been limited to examining the frequency, severity, and duration of nausea. The goal of this study was to design a questionnaire that would allow for the evaluation of the characteristics of nausea across individuals and situations. This study consisted of 4 stages: descriptors were generated, categorized into 3 dimensions, and reevaluated to verify their reliability; in the final stage, the developed checklist was compared to a visual-analogue-scale (VAS) report of nausea in subjects exposed to a rotating optokinetic drum to stimulate nausea. The overall nausea checklist score and the VAS score were highly correlated (r = 0.71, p < 0.01). The development and use of the nausea checklist are discussed.

Adult↗
PubMed1987

Personality development following sexual abuse.

Thirty-seven girls and twelve boys who had been sexually abused at an average of 2.6 years previously were traced and reviewed. The nonoffending parents participated in a structured interview and the children were assessed using the Piers-Harris Self-Concept Scale and the Achenbach Child Behavior Checklist. Each child was matched with a child not known to have been sexually abused and these control children underwent a similar psychological assessment. Interviews with the nonoffending parents found that 76% of the children were thought to be less confident than before, 30% had fewer friends, and 20% were more aggressive. Increased sexual awareness was noted in 24%. School teachers reported that 28% still had behavior problems, 17% had repeated a year at school, and a further 17% had deteriorated in their school work. The sexually abused girls had significantly lower self-esteem than the control girls. There was no difference in self-esteem between the control and the sexually abused boys. There was a higher incidence of stranger assault in the boys compared with the girls. The Child Behavior Checklist completed by the parents, the Teacher Report Form, and the Youth Self-Report of the Child Behavior Checklist showed that a highly significant proportion of sexually abused children fell into the clinical range. Sexual abuse appears to have long-term adverse consequences for many of the victims. This may have implications for their ability to relate to others, for the adult friendships they will make, and eventually for the way they will relate to their own children.

Adolescent↗
PubMed1995

Placebo-controlled acute dosage naltrexone study in young autistic children.

In a double-blind, placebo-controlled crossover trial 23 autistic children were treated with a single 40-mg dose of the opiate antagonist naltrexone. Drug effects were monitored by detailed playroom observations, actometers, and parents' checklist ratings (Aberrant Behavior Checklist, social items and target behaviors). Naltrexone treatment failed to produce significant changes in social behavior, but it did reduce irritability and target scores on behavior checklists. The playroom data indicated that naltrexone significantly affected indices of activity and attention.

Attention↗
PubMed1995

Exploring the iceberg of morbidity: a comparison of different survey methods for assessing the occurrence of everyday illness.

This paper examines problems in measuring the occurrence of acute symptoms of ill health. Health interview surveys and health diaries often lead to different results. Two key hypotheses assume that: 1, interviews using checklists are more sensitive to the respondent's psychological distress than are the open-ended questions of health diaries; and 2, health diaries demand high levels of compliance leading to underreporting of symptoms. An additional 3rd hypothesis assumes that the effect of psychological distress on response patterns is strong for reporting psychological symptoms but insignificant for musculoskeletal symptoms. The hypotheses were tested and explored with data from the Dutch Survey of General Practice, a nationwide study among 161 GPs. A random sample of 100 patients per GP was approached for a health interview and asked to keep a structured health diary during three weeks. Symptoms were recorded during the interview with a checklist and queried in the health diary with open-ended questions. The occurrence of symptoms was modelled with logistic regression. High levels of psychological distress increase the likelihood of recording symptoms for both instruments, but the increase is greater for the interviews. Respondents who have only received limited education, heavy smokers and those who suffer from chronic conditions have a significantly lower likelihood of recording symptoms in the diary as compared to the questionnaire. There was no significant effect of taking an interest in health matters, gender, and work and domestic role obligations. Taking the nature of symptoms into account, it was found that psychological distress had indeed a great effect on the response pattern for psychological symptoms, but not for musculoskeletal symptoms. The criticism that symptom checklists are sensitive to psychological distress rather than to physical illness alone, is confirmed in this study. Open-ended questions prevent biased responses, but result in fewer symptoms being recorded. Health diaries with open-ended questions 'produce' more symptoms but take more effort to complete, requiring sufficiently motivated respondents. It is recommended that a less biased specific list for the assessment of acute symptoms be developed.

Adult↗
PubMed1996

A reliable and valid method for evaluating cardiopulmonary resuscitation training outcomes.

In order to compare the quality of CPR performance after various training methods, training outcome assessment must provide meaningful data and do it in a way that is reliable. Few studies have provided details of their assessment procedures, and even fewer report on whether the measures to evaluate performance are reliable (yielding information consistently over multiple trials), or valid (measuring the outcome intended). Few studies have attempted to replicate assessment methods used by other authors. Conventional skill sheets have not been shown to assess compressions and ventilations reliably and validly. When using an instrumented manikin, skill checklists can be simplified by eliminating qualitative assessment of compressions and ventilations. Using a sample of 171 CPR trainees rated by trained evaluators, we provide details of agreement between two evaluators and use an established statistic (Cronbach's alpha) to assess the reliability of a 14-item simplified CPR checklist. The level of agreement between two raters was high (Pearson product-moment correlation = 0.87) as was the reliability estimate obtained by Cronbach's alpha (0.89). As criterion-related evidence of the validity of the CPR checklist to assess CPR performance, a correlation with a five-point subjective overall rating of CPR was estimated (Spearman correlation = 0.92). We urge standardized reporting of CPR training outcomes in order to achieve comparability across studies.

Adult↗
PubMed2005

Assessment of resident surgical skills: is testing feasible?

OBJECTIVE: We have previously shown that in a single residency program objective structured assessment of technical skills (OSATS) is a reliable and valid method of assessing surgical competency. Our goal was to establish feasibility of this evaluation instrument when administered at multiple residency programs throughout the US, and assess the impact of a laboratory-based surgical curriculum on results. STUDY DESIGN: An OSATS exam was administered to 116 residents from 5 residency programs. One of the residency programs had participated in a comprehensive surgical curriculum over a 4-year period of time. The exam consisted of 3 open and 3 laparoscopic tasks. Residents were graded by both a blinded and unblinded examiner with task-specific checklist, global rating scale, pass/fail assessment, and tasks were timed. All tasks were performed on life-like models. RESULTS: Examinations were successfully completed at all sites. Each exam required 90 minutes of resident time. Reliability indices calculated with Cronbach's alpha were .97 for overall global rating and .95 for checklists. Interrater reliability between blinded and unblinded examiners ranged from .71 to .97 for individual tasks and was .95 overall. Assessment of construct validity (the ability to distinguish among residency levels) found significant differences among the residents for both blinded and unblinded examiners for all evaluation outcomes except time. For the test overall, the global rating scale showed significant differences among all 4 residency levels. The checklist showed significant differences at three levels (PGY3-4 >PGY2 >PGY1). Approximate cost for replaceable items was 40 US dollars to 150 per resident depending on which tasks were chosen. Comparison of scores between residents who received a laboratory-based curriculum and those who did not revealed significantly higher scores and shorter time to complete tasks for the group who received additional training. CONCLUSION: Large-scale testing has confirmed that OSATS is an objective, reliable, and valid method to assess surgical skills, and can easily be administered in most residency programs. A laboratory-based surgical curriculum improved test results and reduced time to complete tasks.

Clinical Competence↗
PubMed2006

A surgical skills laboratory improves residents' knowledge and performance of episiotomy repair.

OBJECTIVE: This study was undertaken to assess whether a surgical skills laboratory improves residents' knowledge and performance of episiotomy repair. STUDY DESIGN: Twenty-four first- and second-year residents were randomly assigned to either a surgical skills laboratory on episiotomy repair or traditional teaching alone. Pre- and posttests assessed basic knowledge. Blinded attending physicians assessed performance, evaluating residents on second-degree laceration/episiotomy repairs in the clinical setting with 3 validated tools: a task-specific checklist, global rating scale, and a pass-fail grade. RESULTS: Postgraduate year 1 (PGY-1) residents participating in the laboratory scored significantly better on all 3 surgical assessment tools: the checklist, the global score, and the pass/fail analysis. All the residents who had the teaching laboratory demonstrated significant improvements on knowledge and the skills checklist. PGY-2 residents did not benefit as much as PGY-1 residents. CONCLUSION: A surgical skills laboratory improved residents' knowledge and performance in the clinical setting. Improvement was greatest for PGY-1 residents.

Clinical Competence↗
PubMed2006

Who disrupts from placement in foster and kinship care?

OBJECTIVE: To identify reliable, inexpensive predictors of foster care placement disruption that could be used to assess risk of placement failure. METHODS: Using the Parent Daily Report Checklist (PDR), foster or kinship parents of 246 children (5-12 years old) in California were interviewed three times about whether or not their foster child engaged in any of the 30 problem behaviors during the previous 24 h. PDR was conducted during telephone contacts (5-10 min each) that occurred from 1 to 3 days apart at baseline. Disruptions were tracked for the subsequent 12 months. Other potential predictors of disruption were examined, including the child's age, gender, and ethnicity, the foster parent's ethnicity, the number of other children in the foster home, and the type of placement (kin or non-kin). RESULTS: Foster/kin parents reported an average of 5.77 child problems per day on the PDR checklist. The number of problem behaviors was linearly related to the child's risk of placement disruption during the subsequent year. The threshold for the number of problem behaviors per day that foster and kinship parents tolerated without increased risk of placement disruption for these latency-aged children was 6 or fewer. Children in non-kin placements were more likely to disrupt than those in kinship placements. There was a trend for increased risk of disruption as the number of children in the home increased. CONCLUSIONS: The PDR Checklist may be useful in predicting which placements are at most risk of future disruption, allowing for targeted services and supports.

California↗
PubMed2005

The CONSORT Statement: revised recommendations for improving the quality of reports of parallel-group randomized trials 2001.

To comprehend the result of a randomized controlled trial (RCT), readers must understand its design, conduct, analysis and interpretation. That goal can be achieved only through complete transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by using a checklist and flow diagram. The revised CONSORT statement presented in this article incorporates new evidence and addresses some criticism of the original statement. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, and Comment. The revised checklist includes 22 items selected because empirical evidence indicates that not reporting the information is associated with biased estimates of treatment effect or because the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage or participants through an RCT. The revised flow diagram depicts information from 4 stages of a trial (enrollment, intervention allocation, follow-up and analysis). The diagram explicitly includes the number of participants, according to each intervention group, included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have performed an intention-to-treat analysis. In sum, the CONSORT statement is intended to improve the reporting or an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.

Guidelines as Topic↗
PubMed2004

Diagnostic information in implantable devices that pertain to endpoints in atrial fibrillation studies.

Implantable devices can store significant information about physiologic parameters relating to rhythm and rate control. The primary objective of our analysis was to evaluate the relationship between changes in these parameters and changes in clinical outcomes in patients with atrial tachyarrhythmias (AT). Because the present guidelines do not provide quantitative definition of rhythm and rate control, we used the percent of time in AT and frequency of such episodes as measures of rhythm control. Rate control was measured as the percent of time spent at a ventricular rate >120 beats/min, as well as the median ventricular rate during AT. Analysis was conducted in 643 patients with a history of AT and bradycardia receiving pacemakers to evaluate whether changes in these parameters were correlated with changes in cardiac hospitalization rates and SF-36 and symptom checklist scores. All patients were followed at 1, 4, and 7 months postimplant, during which rhythm and rate control data were collected. Positive correlation was observed between changes in cardiac hospitalization rate and changes in AT burden, as well as frequency of AT (P = 0.01, r = 0.08 for each). Changes in SF-36 or symptom checklist scores did not correlate with changes in rhythm and rate control measures. This patient cohort had relatively asymptomatic atrial fibrillation (symptom checklist frequency and severity scores of 14.3 +/- 9.5 and 11.5 +/- 7.9, respectively), and this may have contributed to the lack of correlation with SF-36 and symptom scores. Data stored in implantable devices offer a unique opportunity to monitor parameters of rhythm as well as rate control in patients with AT. In patients implanted with pacemakers for management of bradyarrhythmias who have a history of AT, a significantly positive but weak correlation was observed between changes in rhythm control measures (AT burden and frequency) and changes in cardiac hospitalization rate.

Aged↗
PubMed2006

A users guide to measurement in medicine.

Measurement is fundamental to science. In medicine measurement underpins most clinical decisions. Outcome measures for rheumatoid arthritis clinical trials (OMERACT) is an informal collaborative group of professionals dedicated to improving outcome measurement in the rheumatic disease. The methodologic hallmark of the OMERACT process is captured in the OMERACT filter--truth, discrimination, and feasibility. Using the key elements of the OMERACT filter a comprehensive checklist for evaluating reported measures is provided. The checklist guides the potential user through a series of questions. The checklist is also an important resource for researchers working in the field of measurement.

Arthritis, Rheumatoid↗