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At least 19 recordsLinked to original sources

Post-training and pretest effects of adrenocorticotropin on retention: the influence of the hour of the day, the training-test interval, and pretest naloxone administration.

Rats received an ip injection of 0.2 microgram/kg of ACTH-(1-39) 1 min after step-down inhibitory avoidance training and/or 5 min prior to retention testing. Experiments were carried out either in the morning or in the afternoon using either a 3- or a 24-h training-test interval. Post-training ACTH induced memory facilitation in the morning and amnesia in the afternoon at both training-test intervals. Pretest ACTH reversed the afternoon amnesic effect, also at both training-test intervals. In addition, pretest ACTH induced a naloxone-reversible memory enhancement, both on its own and in animals treated with a facilitatory post-training dose of ACTH in the morning; this effect was seen only at the 24-h training-test interval. Naloxone had no effect of its own and did not influence the reversal of ACTH-induced amnesia caused by pretest ACTH in the afternoon. The results point to the variety of memory modulatory influences of ACTH, and to some of the factors involved in the elicitation of one or other effect, namely, the presumable basal rate of secretion of endogenous ACTH, and the previous pharmacological history of the animal.

Adrenocorticotropic Hormone↗

Pretest assessment as a component of safer sex intervention: a pilot study of brief one-session interventions for women partners of male injection drug users in New York City.

This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.

Adult↗

Value of assessment of pretest probability of deep-vein thrombosis in clinical management.

BACKGROUND: When ultrasonography is used to investigate deep-vein thrombosis, serial testing is recommended for those who test negative initially. Serial testing is inconvenient for patients and costly. We aimed to assess whether the calculation of pretest probability of deep-vein thrombosis, with a simple clinical model, could be used to improve the management of patients who present with suspected deep-vein thrombosis. METHODS: Consecutive outpatients with suspected deep-vein thrombosis had their pretest probability calculated with a clinical model. They then underwent compression ultrasound imaging of proximal veins of the legs. Patients at low pretest probability underwent a single ultrasound test. A negative ultrasound excluded the diagnosis of deep-vein thrombosis whereas a positive ultrasound was confirmed by venography. Patients at moderate pretest probability with a positive ultrasound were treated for deep-vein thrombosis whereas patients with an initial negative ultrasound underwent a single follow-up ultrasound 1 week later. Patients at high pretest probability with a positive ultrasound were treated whereas those with negative ultrasound underwent venography. All patients were followed up for 3 months for thromboembolic complications. FINDINGS: 95 (16.0%) of all 593 patients had deep-vein thrombosis; 3%, 17%, and 75% of the patients with low, moderate, and high pretest probability, respectively, had deep-vein thrombosis. Ten of 329 patients with low pretest probability had the diagnosis confirmed, nine at initial testing and one at follow-up. 32 of 193 patients with moderate pretest probability had deep-vein thrombosis, three diagnosed by the serial (1 week) test, and two during follow-up. 53 of 71 patients with high pretest probability had deep-vein thrombosis (49 by the initial ultrasound and four by venography). Only three (0.6%) of all 501 (95% CI 0.1-1.8) patients diagnosed as not having deep-vein thrombosis had events during the 3-month follow-up. Overall only 33 (5.6%) of 593 patients required venography and serial testing was limited to 166 (28%) of 593 patients. INTERPRETATION: Management of patients with suspected deep-vein thrombosis based on clinical probability and ultrasound of the proximal deep veins is safe and feasible. Our strategy reduced the need for serial ultrasound testing and reduced the rate of false-negative or false-positive ultrasound studies.

Algorithms↗

Use of different D-dimer levels to exclude venous thromboembolism depending on clinical pretest probability.

Currently, the same D-dimer cut-off point is used to define a positive result for all patients with suspected venous thromboembolism, regardless of their pretest probability. However, use of a relatively high D-dimer cut-off point (lower sensitivity) for those with a low clinical pretest probability, and a low D-dimer cut-off point (higher sensitivity) for those with a high clinical pretest probability, may be preferable. To determine if using three different D-dimer cut-off points according to low, moderate or high clinical pretest probability has greater utility for exclusion of venous thromboembolism than using the same single D-dimer cut-off point in all patients. Data from a previously published study of 571 patients was used to identify the highest D-dimer cut-off point with a negative predictive value of at least 98% for the subgroup of patients with low and high pretest probability. The D-dimer cut-off point for those with moderate clinical pretest probability remained unchanged [0.5 fibrinogen equivalent units (FEU) microgram mL(-1)]. Accuracy of D-dimer testing for venous thromboembolism using three cut-off points vs. one cut-off point was than determined. D-dimer cut-off points of 0.2 and 2.1 FEU microgram mL(-1) were selected for the high and low pretest probability groups, respectively. When three pretest probability-specific cut-off points were used instead of the previously determined single D-dimer cut-off point (0.5 FEU microgram mL(-1)), sensitivity and negative predictive value were unchanged (95 and 98%, respectively), but specificity increased from 44.7 to 60.4% (P < 0.001). This resulted in exclusion of venous thromboembolism in 80 additional patients. Use of three pretest probability-specific D-dimer cut-off points rather than a single D-dimer cut-off point for all patients, has the potential to increase the utility of D-dimer testing for the diagnosis of venous thromboembolism.

Algorithms↗

Efficacy of intravenous pretesting and antihistamine prophylaxis in radiocontrast media--sensitive patients.

Intravenous pretesting with radiocontrast media (RCM) was performed in 204 RCM-sensitive patients considered for repeat contrast radiography. Group 1 had vague histories of prior anaphylactoid reaction and negative pretests, and 2 of 41 (4.9%) had reactions upon contrast radiography. Groups 2 to 5 had definite histories of prior anaphylactoid reaction. Group 2 had the radiographic study cancelled: 18 of 21 (85.7%) had positive pretests. Group 3 had positive pretests and underwent contrast radiography, and 9 of 15 (60%) had reactions despite premedication. Group 4 (no premedication) and group 5 (diphenhydramine premedication) had negative pretests, but 11 of 53 (20.7%) and 3 of 71 (4.2%), respectively, developed reactions (p less than 0.001). The reaction frequency in group 3 (posivie pretest) of 12 of 18 (66.7%) was greater than that in groups 4 and 5 (negative pretest) combined (14 of 124 (11.3%), p less than 0.001). Intravenous pretesting identified a high-risk group and diphenhydramine premedication decreased the frequency of reaction in patients sensitive to radiocontrast media.

Contrast Media↗

Validation of the accuracy of pretest and exercise test scores in women with a low prevalence of coronary disease: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.

BACKGROUND: Recently revised American College of Cardiology/American Heart Association guidelines have suggested that exercise test scores be used in decisions concerning patients with suspected coronary artery disease (CAD). Pretest and exercise test scores derived for use in women without known CAD have not been tested in women with a low prevalence of CAD. METHODS: Within the Women's Ischemia Syndrome Evaluation (WISE) study, we evaluated 563 women undergoing coronary angiography for suspected myocardial ischemia. The prevalence of angiographic CAD was 26%. Overall, 189 women underwent treadmill exercise testing. Prognostic end points included death, myocardial infarction, stroke, and revascularization. RESULTS: Each score stratified women into 3 probability groups (P <.001) according to the prevalence of coronary disease: Pretest: low 20/164 (12%), intermediate 53/245 (22%), high 75/154 (49%); Exercise test: low 11/83 (13%), intermediate 22/74 (30%), high 17/32 (53%). However, the Duke score did not stratify as well: low 7/46 (15%), intermediate 36/126 (29%), high 6/17 (35%); P =.44. When pretest and exercise scores were considered together, the best stratification with the exercise test score was in the intermediate pretest group (P <.03). The Duke score did not stratify this group at all (P =.98). Pretest and exercise test scores also stratified women according to prognostic end points: pretest--low 7/164 (4.3%), intermediate 28/245 (11.4%), high 27/154 (17.5%), P <.01; exercise test--low 4/83 (4.8%) and intermediate-high 17/106 (16%), P =.014. CONCLUSION: Both pretest and exercise test scores performed better than the Duke score in stratifying women with a low prevalence of angiographic CAD. The exercise test score appears useful in women with an intermediate pretest score, consistent with American College of Cardiology/American Heart Association guidelines.

Coronary Angiography↗

The interobserver reliability of pretest probability assessment in patients with suspected pulmonary embolism.

INTRODUCTION: Pretest probability assessment and objective testing are combined to appropriately manage patients with suspected pulmonary embolism (PE). However, the interobserver reliability of pretest probability assessment has not been investigated. We sought to determine (for patients with suspected PE) the interobserver reliability of pretest probability assessment (by overall impression (gestalt) versus an explicit clinical model). MATERIALS AND METHODS: A prospective cohort study was conducted at an urban university hospital. For patients referred for ventilation and perfusion (V/Q) scanning for suspected PE, structured assessments (11 history and 4 physical examination parameters) were performed by a referring physician and a designated thrombosis physician. The referring and thrombosis physicians also assigned a pretest probability for PE (low, moderate, or high) by gestalt. An explicit seven-point clinical model for suspected PE was later applied to each structured assessment to determine the pretest probability. Assessments were performed independently and prior to diagnostic test results. Interobserver reliability (two rater unweighted Kappa (kappa) statistic) was determined for each parameter on the structured assessment and the pretest probability assessments (gestalt vs. explicit clinical model). RESULTS: One hundred and ten patients with suspected PE received duplicate assessments. Historical features demonstrated substantial to almost perfect interobserver reliability (kappa=0.60-0.95). For the physical findings, only heart rate had substantial interobserver reliability (kappa=0.60). Pretest probability assessment was not reliable when using physician's gestalt (kappa=0.33), but produced substantial interobserver reliability using the explicit clinical model (kappa=0.62). CONCLUSIONS: Given the inadequate interobserver reliability of pretest probability assessment by overall impression (or gestalt), physicians should use explicit clinical models in the diagnostic management of patients with suspected pulmonary embolism.

Adolescent↗

White noise as a pretest sensitizer for neonatal hearing screening.

To determine the effects of white noise as a pretest sensitizer in neonatal hearing screening, 450 neonates were tested under 18 test conditions which also permitted examination of infant state and criterion stimuli (warble tone versus narrow band noise) as variables. There were three pretest conditions: No pretest sensitizer; 90 dB pretest sensitizer, and 100 dB pretest sensitizer. Each pretest condition was followed by either a 90 or a 100 dB criterion stimulus. Analysis concerned an increase in the number and in the strength of the responses. Generally, there was no benefit associated with the use of white noise as a pretest sensitizer.

Acoustic Stimulation↗

Naloxone eliminates passive avoidance retention deficits produced by pretest exposure to novelty in rats.

Pretest exposure to novelty or injections of beta-endorphin can enhance passive avoidance (PA) retention (e.g., Izquierdo & McGaugh, 1985). Enhanced retention may result from a "state-dependent" match between the CNS state during test and the novelty-induced beta-endorphin state that is obtained during training in a novel apparatus. Our Experiment 1 suggests that, unlike PA, Pavlovian fear conditioning in a conditioned lick suppression (CLS) paradigm may be beta-endorphin "state-independent." Rats were given one tone-shock pairing in a novel environment. Baseline lick rates and CLS tested 48 h later in a familiar environment were not affected by pretest exposure to novelty and/or injections of 3.33 mg/kg naloxone HCl. In Experiment 2, the same rats were PA trained/tested in a new apparatus. Saline or naloxone injections and various exposure (novel, familiar, none) conditions preceded (1h) the 24-h retention test. Pretest exposure to novelty reduced retention and naloxone eliminated that deficit. In Experiment 3, naive rats given pretest exposure to novelty also showed a PA retention deficit. The results of Experiments 2 and 3 may complement rather than contradict previous findings. Pretest induction of a beta-endorphin state by novelty may either enhance state-dependent retrieval of a "weak" memory trace or make a "strong/well consolidated" training memory more vulnerable to retroactive interference from "new learning" during the pretest exposure period.

Animals↗

Prospective multicenter study of quantitative pretest probability assessment to exclude acute coronary syndrome for patients evaluated in emergency department chest pain units.

STUDY OBJECTIVE: We compare the diagnostic accuracy of 3 methods--attribute matching, physician's written unstructured estimate, and a logistic regression formula (Acute Coronary Insufficiency-Time Insensitive Predictive Instrument, ACI-TIPI)--of estimating a very low pretest probability (< or = 2%) for acute coronary syndromes in emergency department (ED) patients evaluated in chest pain units. METHODS: We prospectively studied 1,114 consecutive patients from 3 academic EDs, evaluated for acute coronary syndrome. Physicians collected data required for pretest probability assessment before protocol-driven chest pain unit testing. A pretest probability greater than 2% was considered "test positive." The criterion standard was the outcome of acute coronary syndrome (death, myocardial infarction, revascularization, or > 60% stenosis prompting new treatment) within 45 days, adjudicated by 3 independent reviewers. RESULTS: Fifty-one of 1,114 enrolled patients (4.5%; 95% confidence interval [CI] 3.4% to 6.0%) developed acute coronary syndrome within 45 days, including 4 of 991 (0.4%; 95% CI 0.1% to 1.0%) patients, discharged after a negative chest pain unit evaluation result, who developed acute coronary syndrome. Unstructured estimate identified 293 patients with pretest probability less than or equal to 2%, 2 had acute coronary syndrome, yielding sensitivity of 96.1% (95% CI 86.5% to 99.5%) and specificity of 27.4% (95% CI 24.7% to 30.2%). Attribute matching identified 304 patients with pretest probability less than or equal to 2%; 1 had acute coronary syndrome, yielding a sensitivity of 98.0% (95% CI 89.6% to 99.9%) and a specificity of 26.1% (95% CI 23.6% to 28.7%). ACI-TIPI identified 56 patients; none had acute coronary syndrome, yielding sensitivity of 100% (95% CI 93.0% to 100%) and specificity of 6.1% (95% CI 4.7% to 7.9%). CONCLUSION: In a low-risk ED population with symptoms suggestive of acute coronary syndrome, patients with a quantitative pretest probability less than or equal to 2%, determined by attribute matching, unstructured estimate, or logistic regression, may not require additional diagnostic testing.

Acute Disease↗

Assessment of pretest probability of pulmonary embolism in the emergency department by physicians in training using the Wells model.

INTRODUCTION: Assessment of pretest probability should be the initial step in investigation of patients with suspected pulmonary embolism (PE). In teaching hospitals physicians in training are often the first physicians to evaluate patients. OBJECTIVE: To evaluate the accuracy of pretest probability assessment of PE by physicians in training using the Wells clinical model and to assess the safety of a diagnostic strategy including pretest probability assessment. PATIENTS AND METHODS: 291 consecutive outpatients with clinical suspicion of PE were categorized as having a low, moderate or high pretest probability of PE by physicians in training who could take supervising physicians' advice when they deemed necessary. Then, patients were managed according to a sequential diagnostic algorithm including D-dimer testing, lung scan, leg compression ultrasonography and helical computed tomography. Patients in whom PE was deemed absent were followed up for 3 months. RESULTS: 34 patients (18%) had PE. Prevalence of PE in the low, moderate and high pretest probability groups categorized by physicians in training alone was 3% (95% confidence interval (CI): 1% to 9%), 31% (95% CI: 22% to 42%) and 100% (95% CI: 61% to 100%) respectively. One of the 152 untreated patients (0.7%, 95% CI: 0.1% to 3.6%) developed a thromboembolic event during the 3-month follow-up period. CONCLUSION: Physicians in training can use the Wells clinical model to determine pretest probability of PE. A diagnostic strategy including the use of this model by physicians in training with access to supervising physicians' advice appears to be safe.

Adolescent↗

Prediction of severe adverse reactions to ionic and nonionic contrast media in Japan: evaluation of pretesting. A report from the Japanese Committee on the Safety of Contrast Media.

In a nationwide prospective study of adverse reactions to intravenous contrast media (CM), the Japanese Committee on the Safety of Contrast Media compared high-osmolar ionic CM with low-osmolar nonionic CM. A total of 337,647 cases were analyzed. The reliability of pretesting with an intravenous injection of a small amount of CM as a means of predicting severe or fatal reactions was also evaluated. The predictive values of the pretest were 1.2% for ionic and 0.0% for nonionic CM, and the sensitivity values were 3.7% and 0.0%, respectively. Such low values render this test meaningless for predicting which patients are at risk of a severe adverse reaction. A comparison of the incidence of severe adverse reactions between the nonpretested and pretested patients, as well as between the nonpretested and pretested patients with negative results, disclosed no statistically significant differences. Also, no beneficial effects of premedication in patients with a positive pretest were proved. The authors therefore conclude that pretesting with an intravenous injection of a small amount of CM is not useful in predicting severe reactions to ionic or nonionic CM.

Contrast Media↗

Pretest and treatment effects in an elementary school-based alcohol misuse prevention program.

Forty-nine schools (N = 5,680 fifth and sixth grade students) were assigned to pretest/treatment, pretest/no treatment, no pretest/treatment, and no pretest/no treatment conditions in the context of an alcohol misuse prevention study. At the first posttest, five months after the pretest and two months after the intervention, the effects of the pretest and of the intervention were examined. The analyses showed that failure to correct for the design effect due to clustering within schools resulted in the overestimation of the significance of treatment and pretest effects. After correction for the design effect, a significant treatment effect in the hypothesized direction was found with respect to students' awareness of the content of the curriculum. As hypothesized, significant treatment effects on the alcohol use and misuse measures had not yet developed but are expected to occur at subsequent posttest occasions. Significant pretest effects were found for indices measuring trouble with peers resulting from students' alcohol use, students' internal health locus of control, and their perceptions of adults as a locus of control for their health. Two of the three pretest effects were in the direction that would be hypothesized if the pretest were providing the same impetus as the intervention. Implications of these findings for school-based substance abuse prevention programs are discussed.

Child↗

[The consideration and performing of pretesting of contrast medium: surveying in Kanagawa].

The pretesting of contrast medium is world widely recognized to be an invaluable method to predict the adverse reactions. It was still required to perform on patients who shall have a contrast examination until recently in Japan. In May of 1990 the contrast drug package insert was reviewed and a statement of "there is no known method to predict the adverse reactions" was included. Although two reports suggested that the percentage of not performing the pretesting was increasing gradually since then, the clinical communications between institutes did not support the truth. This study investigated the problem by surveying the area in Kanagawa-ken neighboring to Tokyo and revealed that: 1. The percentage of non-performing the pretesting is high in radiologist and urologist (both are 40%) but low in other physicians (18%). 2. The risky performances of pretesting in the area without emergent equipment are occurring daily. 3. The percentage of the approval to abandon the pretesting increased significantly (from 46% to 89% with p < 0.01) after the accurate information on pretesting was given. 4. To prevent the tragedy caused by risky performance, actively contacting with and offering the information are necessary.

Contrast Media↗

Some unexamined aspects of analysis of covariance in pretest-posttest studies.

The use of an analysis of covariance (ANCOVA) model in a pretest-posttest setting deserves to be studied separately from its use in other (non-pretest-posttest) settings. For pretest-posttest studies, the following points are made in this article: (a) If the familiar change from baseline model accurately describes the data-generating mechanism for a randomized study then it is impossible for unequal slopes to exist. Conversely, if unequal slopes exist, then it implies that the change from baseline model as a data-generating mechanism is inappropriate. An alternative data-generating model should be identified and the validity of the ANCOVA model should be demonstrated. (b) Under the usual assumptions of equal pretest and posttest within-subject error variances, the ratio of the standard error of a treatment contrast from a change from baseline analysis to that from ANCOVA is less than 2(1)/(2). (c) For an observational study it is possible for unequal slopes to exist even if the change from baseline model describes the data-generating mechanism. (d) Adjusting for the pretest variable in observational studies may actually introduce bias where none previously existed.

Analysis of Variance↗

Influence of pretest waiting time and duration of induction on kinesthetic aftereffect.

The influence of pretest hand-resting time and induction time on kinesthetic aftereffect was determined for 22 males and females. Aftereffect was assessed with the apparatus of Koehler and Dinnerstein (1947). Three separate tests of aftereffect were administered. Each was preceded by either a 10-, 20-, or 30-min. hand-resting period. Significant differences in aftereffect were not found between pretest conditions. Scores were also determined for varying induction times at each pretest condition. Induction periods totaling 90-, 180-, and 300-sec. were used. Aftereffect was significantly less pronounced following 90 than 180 sec. of induction for the 10-and 20-min. pretest conditions but was the same following 90, 180, and 300 sec. of induction for the 30-min. condition. Results indicated that less than 300 sec. of induction could be used regardless of the duration of the pretest period. However, because the internal validity of the 180-sec. score was significantly better than the 90-sec. score, it was concluded that at least 180 sec. of induction were needed.

Female↗

Pretest probability estimates: a pitfall to the clinical utility of evidence-based medicine?

OBJECTIVES: The Bayesian application of likelihood ratios has become incorporated into evidence-based medicine (EBM). This approach uses clinicians' pretest estimates of disease along with the results of diagnostic tests to generate individualized posttest disease probabilities for a given patient. To date, there is minimum scientific validation for the clinical application of this approach. This study is designed to evaluate variability in the initial step of this process, clinicians' estimates of pretest probability of disease, to assess whether this approach can be expected to yield consistent posttest disease estimates. METHODS: This cross-sectional cohort study was conducted at an urban county teaching hospital by using a sample of emergency and internal medicine residents and faculty, as well as emergency department (ED) midlevel practitioners. Participants read clinical vignettes designed to raise consideration for common ED disorders and were asked to estimate the likelihood of the suggested diagnosis based on the history and physical examination findings alone. No information about laboratory results or imaging studies was provided. RESULTS: Mean pretest probability estimates of disease ranged from 42% (95% confidence interval [95% CI] = 36.6% to 47.4%) to 77% (95% CI = 72.9% to 81.1%). The smallest difference in pretest probability magnitude for a single vignette was 70% (range 30-100%; interquartile range [IQR] 64-80%), whereas the largest was 95% (range 3-98%; IQR 30-60%). CONCLUSIONS: Wide variability in clinicians' pretest probability estimates of disease may present a possible concern about decision-making models based on Bayes' theorem, because it may ultimately yield inconsistent posttest disease estimates.

Bayes Theorem↗