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PubMed1997

How distinct is 'distinct quality' of mood?

BACKGROUND: The DSM-IV criteria for melancholia include the clinical feature 'distinct quality', defined as a mood state differing from that experienced in bereavement. Both propositions-its specificity to melancholia and its definition- remain problematical. METHODS: We examine both propositions by analysing an adjective checklist completed by melancholic and non-melancholic depressed subjects, as well as by a bereaved sample. The checklist was refined by a principal components analysis to four scales-one assessing a general 'mood' severity or dysphoric dimension, and the other three assessing dimensions of 'fatigue', 'numbness' and 'guilt'. RESULTS: If the concept of "distinct quality' has validity, we would require specificity of the refined qualitative constructs to melancholic depression. The 'numbness' component met that requirement, but only to a degree. While bereaved subjects did differ from those with melancholic depression on a number of our refined qualitative mood domains, such differences appeared more related to lower levels of depression in the bereaved sample. CONCLUSIONS: We argue for deleting the 'distinct quality' criterion from diagnostic checklists of melancholia until its definition has been improved, its utility demonstrated and its specificity to any depressive subtype established as having clinical significance.

Adult↗
PubMed1989

Mood changes associated with blood glucose fluctuations in insulin-dependent diabetes mellitus.

Individuals with insulin-dependent diabetes mellitus (IDDM) and their healthcare practitioners believe that extreme blood glucose (BG) fluctuations are characterized by changes in subjective mood states and emotional behavior, as well as physical symptoms. This study examined relationships between BG levels and self-reported mood in a group of 34 IDDM adults. The method followed a within-subject, repeated-measures design employed in previous studies of physical symptoms associated with diabetic glucose. Four times each day, participants completed a mood/symptom checklist just prior to a self-measurement of BG until 40 checklists had been completed. Half the items on the checklist described physical symptoms and half described mood states. In addition, half the mood items described negative states and half described positive states. Within-subject correlations and regressions showed that moods were related to BG for the majority of participants and that, like physical symptoms, mood-BG relationships were highly idiosyncratic. Low BG levels tended to be associated with negative mood states, primarily self-reported "nervousness." Positive mood items were almost always associated with high BG. High BG levels also frequently correlated with negative mood states, although the negative mood items that tended to relate to high glucose (anger, sadness) differed from those that tended to relate to low BG. The implications of these findings for self-treatment and glucose perception in the IDDM individual are discussed.

Adult↗
PubMed2006

Inventorying stressful life events as risk factors for psychopathology: Toward resolution of the problem of intracategory variability.

An explosion of research on life events has occurred since the publication of the Holmes and Rahe checklist in 1967. Despite criticism, especially of their use in research on psychopathology, such economical inventories have remained dominant. Most of the problems of reliability and validity with traditional inventories can be traced to the intracategory variability of actual events reported in their broad checklist categories. The purposes of this review are, first, to examine how this problem has been addressed within the tradition of economical checklist approaches; second, to determine how it has been dealt with by far less widely used and far less economical labor-intensive interview and narrative-rating approaches; and, third, to assess the prospects for relatively economical, as well as reliable and valid, solutions.

Conflict, Psychological↗
PubMed1991

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires.

Eighty-one patients with advanced breast cancer completed the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL) to determine how well these questionnaires identified patients suffering from an anxiety state or depressive illness, compared with an independent interview by a psychiatrist who used the Clinical Interview Schedule. A threshold score was defined for each questionnaire which gave the optimal sensitivity and specificity. Seventy-five per cent of patients were correctly identified as suffering from an affective disorder by both the Rotterdam Symptom Checklist and by the Hospital Anxiety and Depression Scale. Twenty-one per cent of 'normal' patients were misclassified by the Rotterdam Checklist and 26% by the Hospital Anxiety and Depression Scale. When the HADs anxiety and depression subscales were analysed separately, the performance of the anxiety items was superior to that of the depression items. Both questionnaires were found to have good predictive value and could be used in patients with advanced cancer to help screen out those with an affective disorder.

Anxiety Disorders↗
PubMed2004

Development of a structured clinical operative test (SCOT) in the assessment of practical ability in the oral surgery undergraduate curriculum.

Competence in undergraduate oral surgery involves assessment of the students' knowledge, practical skill and attitude. The assessment of practical skills can be achieved using a formative assessment method such as the structured clinical operative test (SCOT) which uses a checklist for the assessment of a clinical task. The aim of this study was primarily to determine whether SCOTs could be integrated into the oral surgery undergraduate course, and secondarily to collect feedback from both the students and the staff on this assessment. A validated checklist was used by trained examiners to assess the performance of 49 students in their second clinical year undertaking simple exodontia. Feedback was collected from the students by questionnaire and from the staff by interview. The SCOT was well received by both students and staff. The main problem highlighted by the students was the perceived inter-examiner variability and by the staff, the disruptive effect on the clinics. The checklist must be objective enough to prevent misinterpretation. Despite these limitations, the SCOT provides a more objective assessment and serves to highlight weaker students, allowing them to be targeted for closer supervision and instruction as well as providing the students with a tool to measure their progress in oral surgery. The use of peer assessment by students may alleviate the burden on the staff.

Clinical Competence↗
PubMed2005

"Do I know what I need to do?" A social communication intervention for children with complex clinical profiles.

PURPOSE: Speech-language pathologists frequently address social communication difficulties in children with diverse clinical profiles. The purpose of this study was to investigate the feasibility of a social communication intervention for a school-age child with a complex cognitive and behavioral profile secondary to diagnosis of a fetal alcohol spectrum disorder. METHOD: A case study is presented to describe the implementation of the intervention targeting mental state verb production and social cognitive skills. The intervention included group role play of social scripts and a checklist to elicit the participant's statements about others' perspectives and strategies for completing the social script. Treatment data monitored the participant's responses to the checklist questions. Probe sessions, consisting of theory of mind false belief tasks, were used to examine mental state verb use. RESULTS: Treatment data demonstrated that the participant stated more strategies in response to checklist questions. The participant did not produce any mental state verbs during baseline probes, but did produce mental state verbs during the treatment phase. CLINICAL IMPLICATIONS: The results support use of this intervention to change children's linguistic and social cognitive skills. Suggestions for extending this intervention to include a generalization plan targeting classroom social communication interactions are provided.

Behavior↗
PubMed1997

Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life.

AIM: In this study of patients with irritable bowel syndrome (IBS), we evaluated the relationship between patient-rated severity of IBS and patients' physical and psychological symptoms, health care resource use and quality of life. METHODS: One hundred and twenty-six patients diagnosed with IBS were administered a series of questionnaires, including the Bowel Symptom Checklist, the Symptom Checklist-90-R (a psychological symptom checklist), the IBSQOL (a disease-specific quality of life instrument), the SF-36 (a general health status instrument), and a health resource utilization assessment that measured health care use, time loss from work, impact on productivity, and days worked with symptoms. RESULTS: No relationship was found between IBS severity and gastrointestinal symptoms, except for a feeling of unpassed stool. IBS severity was also not related to psychological symptom severity. Direct traditional indicators of resource use (e.g. physician visits, hospital admissions and emergency room visits) were not significantly associated by severity level; however, indirect measures of resource use (e.g. number of days with pain, productivity and number of bed days) were related to severity. Quality of life was clearly associated with perceived IBS severity. Patients who rated themselves as very severe reported the lowest scores and had the poorest health for all quality of life dimensions measured. CONCLUSIONS: These findings suggest that perceived IBS severity is defined by the limitations the disease imposes, rather that by the symptoms. Patients with reduced productivity and decreased functioning for most of the quality of life indicators were those who rated their IBS as very severe.

Absenteeism↗
PubMed2003

Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts.

BACKGROUND: Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. OBJECTIVES: To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. METHODS: Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean +/- SEM sensitivity, specificity and diagnostic accuracy, and kappa (kappa) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. RESULTS: There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the kappa intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. CONCLUSIONS: We demonstrated that Web-based training is an effective tool for teaching dermoscopy.

Clinical Competence↗
PubMed2001

Assessment of the convergent validity of the Questions About Behavioral Function scale with analogue functional analysis and the Motivation Assessment Scale.

The present study examined the convergent validity of the Questions About Behavioral Function (QABF) scale, a behavioural checklist for assessing variables maintaining aberrant behaviour, with analogue functional analyses and the Motivation Assessment Scale (MAS). The two checklists were more highly correlated with each other than either checklist with results from the analogue sessions, and the QABF was more highly correlated with analogue sessions than the MAS. Using analogue sessions, the experimenters failed to ascertain behavioural function for a number of subjects because the behaviour problems in question were low frequency/high intensity and failed to appear during the course of the analysis, pointing out a limitation of this technology. These findings, taken together with recent research outlining the psychometric properties of the QABF, seem to support the use of the QABF in a hierarchical model of functional analysis. The implications of the findings are discussed.

Adult↗
PubMed2000

The procedural validity of retrospective case note diagnosis.

OBJECTIVE: Deriving diagnoses from retrospective case note examination is a common practice in psychiatric research. The Operational Criteria (OPCRIT) diagnostic checklist is essentially a checklist built up of operational criteria defined by a comprehensive glossary and is designed to assign reliable diagnoses from case notes. However, the validity of such a procedure compared with procedures involving prospective assessment has never been tested. We examined the procedural validity of the OPCRIT diagnostic system in relation to four other diagnostic procedures mostly employing prospectively gathered information. METHOD: Three experienced psychopathology raters rated the case notes and clinical abstracts, using the OPCRIT method of diagnostic assignment, of 50 subjects who had participated in an early procedural validity study as an adjunct to the DSM-IV Field Trial for psychotic disorders. The setting was the Early Psychosis Prevention and Intervention Centre (EPPIC), which focuses on first episode psychosis. RESULTS: The pairwise concordance with the other procedures for DSM-III-R diagnoses assigned by OPCRIT using ratings derived from either the clinical abstracts or the case notes was found to be only poor to moderate when compared with the pairwise concordance of the four other procedures. The per cent agreement between OPCRIT clinical abstracts diagnoses and the other procedures ranged from 49% to 60% with kappa values between 0.30 and 0.45, and for OPCRIT case note diagnoses and the other procedures the per cent agreement range was between 44% and 57% and the kappa values were between 0.35 and 0.49. CONCLUSIONS: The procedural validity of diagnoses assigned via the application of checklists of operational criteria to case notes and clinical abstracts alone is unacceptably poor. Such sources need to be buttressed by other data, particularly direct patient interview and informant material.

Adolescent↗
PubMed1997

[Computerized tomography of paranasal sinuses--a preoperative check list].

BACKGROUND: Computed tomography (CT) is being used increasingly both to evaluate location and extent of sinus disease and to detect anatomic abnormalities prior to surgery. Analysis of the CT scan should be undertaken in a routine, standardized fashion to ensure that important details are not missed. To aid in this evaluation, a checklist has been developed which focuses on the most salient and potentially dangerous areas of the paranasal sinuses. Regular preoperative analysis using this system may prevent unforeseen technical difficulties and excess morbidity. MATERIALS AND METHODS: Before obtaining a CT scan, the patient is placed on optimal medical therapy including antibiotics, and topical and occasionally systemic steroids. Coronal scans are then performed with 3 mm sections through the frontal and sphenoid sinuses and 2 mm sections through the ethmoid region. Intravenous contrast is used. The study is then analyzed focusing on specific critical anatomic landmarks. When additional information is required due to severe pathology or atypical anatomy, axial sections are added. RESULTS: Out of 300 CT examinations that where analyzed, a preoperative checklist was developed with eight items that must be evaluated preoperatively. Methods for the identification and analysis of this anatomy as well as the types of anatomic variation are discussed. We have found this evaluation to be extremely useful and efficacious in preventing morbidity in endoscopic sinus surgery. CONCLUSIONS: Evaluation of the preoperative CT examination with a strictly applied checklist of important details and landmarks allows the recognition of hazardous anatomy and pathology which should increase the safety and efficacy of paranasal sinus surgery.

Chronic Disease↗
PubMed2003

Use of audit tools to evaluate the efficacy of cleaning systems in hospitals.

BACKGROUND: Recent publicity has highlighted both the inadequacies of hospital cleaning and high levels of methicillin-resistant Staphylococcus aureus infections in UK hospitals. "Standards for Environmental Cleanliness" (SEC) was a checklist developed in April 1999 by the Infection Control Nurses Association and the Association of Domestic Managers to evaluate cleaning services regardless of who is the provider. More recently, the National Health Service plan (July 2000) was an attempt to generate a rapid improvement in the cleanliness and tidiness of hospitals via a National Health Service patient environment audit (PEA). On the basis of models used in the food industry to manage cleaning practices cost-effectively, a risk-based audit checklist incorporating rapid hygiene monitoring was developed to assess the adequacy of cleaning programs and standards in hospitals. This checklist (Audit for Cleaning Efficacy, or ACE) as well as the SEC and PEA approaches were applied at 4 hospitals, and environmental microbial surface counts were compared. SEC and PEA rely on visual assessment, whereas the ACE approach is more comprehensive and included more specific questions relating to the management and monitoring of cleaning as well as standards on the basis of rapid hygiene monitoring. METHODS: Two wards in each of the 4 hospitals were visited on 3 separate occasions immediately after cleaning was completed. Visual assessment, adenosine triphosphate bioluminescence, and microbiologic sampling of selected environmental sites were performed to evaluate the effectiveness of cleaning. The 3 audits were completed during the final hospital visit. RESULTS: Visual assessment indicated that 90% of sites were satisfactory, whereas adenosine triphosphate bioluminescence showed that 100% and microbiologic sampling showed that 90% of sites did not meet benchmark values. There was no significant difference between the SEC and PEA audits (P =.311), which used visual assessment, and the results suggest that they both are similar in passing surfaces that have microbiologic benchmark values that are too high. However, the ACE audit showed a significant difference (P = <.001) in results compared with the SEC and the PEA audits and did not pass surfaces with microbiologic benchmark values that were too high. The ACE audit, which incorporates rapid hygiene testing, showed a much stronger association with the microbial counts; this was not apparent with the SEC and the PEA audits. CONCLUSION: The data suggest that visual assessment is a poor indicator of cleaning efficacy and that the ACE audit gives a better assessment of cleaning programs compared with the other 2 audit methods in relation to microbial surface counts. It is recommended that hospital cleaning regimes be designed to ensure that surfaces are cleaned adequately and that efficacy is assessed with use of internal auditing and rapid hygiene testing.

Adenosine Triphosphate↗
PubMed2003

Assessing the readability of skin care and pressure ulcer patient education materials.

OBJECTIVE: The purpose of this study was to evaluate the readability of written patient education materials used to teach patients about the prevention and care of skin and pressure ulcers. Other design characteristics of the materials including organization, writing style, appearance, and appeal also were assessed. DESIGN: This study used a nonexperimental, descriptive design. Setting and Stimulus Materials: Ten pamphlets and brochures commonly used in urban hospitals, home care agencies, and public clinics in the Midwest were evaluated. INSTRUMENTS: The study used 2 instruments: The Area Health Education Center (AHEC) checklist and the Simple Measure of Gobbledygook (SMOG) readability formula. METHODS: The investigator used the SMOG readability formula to analyze patient education materials. The AHEC checklist was used to evaluate the design characteristics of the materials, including organization, writing style, appeal, and appearance. RESULTS: The overall readability level of the written materials was 10th grade. At least half of the materials were written at 8th-grade level or below, which is considered acceptable for the general public. Some pamphlets used words such as "seborrheic keratosis" or "actinic keratosis," making the materials difficult to read. An incidental finding was that none of the materials addressed skin care or pressure ulcer experiences of different cultural groups. CONCLUSION: None of the materials was determined to be appropriate teaching tools for low-literacy patients, as measured by the AHEC checklist. Although half the materials were written at the 8th-grade level and below, that level may be too high for many patients.

Educational Status↗
PubMed2003

Objective structured assessment of technical skills for episiotomy repair.

OBJECTIVE: This study was undertaken to estimate the reliability and validity of an objective structured assessment of technical skills (OSATS) for midline episiotomy repair using a lifelike anatomic model. STUDY DESIGN: Eighteen residents were administered an episiotomy OSATS. Two evaluators independently completed an objective score sheet assessing six key components of the repair, seven global surgical skills, and a pass/fail score for each resident. Residents also completed an anonymous self-assessment. RESULTS: Reliability indices were 0.95 for the checklist and global surgical skills rating. Construct validity found significant differences on the checklist, global surgical skills, and pass/fail score sheets by residency level. Residents more often assessed their own global surgical skills performance lower than the independent evaluators. Surprisingly, 61% (11/18) of the residents failed the assessment, including all postgraduate year 1 and postgraduate year 2 residents. CONCLUSION: Episiotomy OSATS that used task-specific and global checklists provide a reliable and valid method of assessing resident skills in this anatomic model, and performance correlates with resident year level of training.

Clinical Competence↗
PubMed1975

Perceived latitude of choice of institutionalized and noninstitutionalized elderly women.

An Importance, Locus and Range of Activities Checklist, designed to assess self-perceived latitude of choice, a self concept and a life satisfaction scale were administered to 25 institutionalized and 25 noninstitutionalized elderly females. The checklist contained statements about 37 activities of daily living which subjects rated for personal importance and degree of choice available to them. The derived latitude of choice score was based jointly on importance and choice ratings for each activity. Institutionalized respondents, living in a relatively restrictive environment, earned significantly lower latitude of choice scores than did noninstitutionalized subjects. Latitude of choice, self concept and life satisfaction scores were significantly correlated. These findings attest to the appropriateness of the technique used to assess perceived latitude of choice. Modifications of the Importance, Locus and Range of Activities Checklist designed to provide a more profound measure of latitude of choice and to improve the applicability of the scale to different categories of respondents were discussed.

Activities of Daily Living↗
PubMed2001

Somatization and symptom reduction through a behavioral medicine intervention in a mind/body medicine clinic.

The authors assessed data from 1,148 outpatients in a 10-week medical symptom reduction program to determine the effectiveness of a behavioral medicine intervention among somatizing patients. The program included instruction in the relaxation response, cognitive restructuring, nutrition, and exercise. Before and after the intervention, the patients were evaluated on the Symptom Checklist-90 Revised (SCL-90R), the Medical Symptom Checklist, and the Stress Perception Scale. They were divided into high- and low-somatizing groups on the basis of the pretreatment SCL-90R somatization scale. At the end of the program, physical and psychological symptoms on the Medical Symptom Checklist and the SCL-90R were significantly reduced in both groups, with the reductions greater in the high-somatizing group. Improvements in stress perception were about the same in both groups, but the absence of an untreated control group precluded estimates of how much the improvements resulted from the behavioral medicine intervention and how much from natural healing over time.

Ambulatory Care Facilities↗
PubMed2003

Evaluation of a brief low-cost intervention to improve antiretroviral treatment decisions.

An earlier pilot study found that US DHHS guidelines for antiretroviral treatment were not being successfully implemented (Mann et al., 2000). A brief and inexpensive intervention (visual aid checklist) was developed with the assistance of HIV-expert physicians in order to aid HIV/AIDS health care providers' and their patients' decisions about antiretroviral therapy. The visual aid checklist consisted of a two-page coloured diagram and explanation of key concepts (T-cell, viral load and resistance) and a checklist of the benefits and risks of antiretroviral therapy. Twenty adult HIV-positive subjects and eight health care providers were studied. Ten subjects were observed with their providers without the intervention being used, and then ten subjects were observed with the intervention. A pre-/post-test format was used to assess the patients' antiretroviral knowledge, patient-provider discussion of the DHHS guidelines, and provider satisfaction with the intervention. No differences in baseline HIV knowledge were found between the two groups. Results showed that patients in the intervention condition had greater knowledge of the benefits and risks of antiretroviral therapy than patients in the control condition. Providers reported that the intervention was useful in aiding and encouraging communication as well as conveying knowledge.

Adult↗
PubMed2004

Major health risk factors in Iranian hand-woven carpet industry.

This paper reviews the role and importance of small-scale industries together with the issue of occupational health problems and their causes in Iranian hand-woven carpet industry as a typical informal small-scale industry in an industrially developing country. The objective of this paper is to review health risk factors and related occupational health and ergonomic problems in the carpet industry. Since the overwhelming majority of weavers' health problems originate from ergonomic risk factors, it is concluded that any improvement program in this industry should focus on ergonomic aspects. To assess ergonomic conditions in weaving workshops, a checklist has been developed and an ergonomics index indicating the ergonomic conditions of the workshop has been proposed. To test and verify the checklist, 50 weaving workshops were visited and their ergonomic conditions were assessed. Based on the results some modifications were made and the checklist was shown to be an effective tool.

Cumulative Trauma Disorders↗