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Assessment Measures (assessment + measure)
Selected AbstractsProspective Evaluation of Two Clinical Scores for Acute Asthma in Children 18 Months to 7 Years of AgeACADEMIC EMERGENCY MEDICINE, Issue 6 2010FRCPC, Serge Gouin MDCM Abstract Objectives:, The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation. Methods:, This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits/year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment. Results:, During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and/or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95% confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95% CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95% CI = 0.42 to 0.65) and PASS (r = 0.55, 95% CI = 0.43 to 0.65). Conclusions:, The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties. ACADEMIC EMERGENCY MEDICINE 2010; 17:598,603 © 2010 by the Society for Academic Emergency Medicine [source] Successfully Translating Language and Culture when Adapting Assessment MeasuresJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 2 2010Juan Bornman Abstract A need exists for culturally valid and reliable developmental assessment tools for children with disabilities that are able to accommodate multiple languages. One way in which this goal can be achieved is through test translations. The purpose of this preliminary study was to examine the use of translations of select developmental assessment instruments from English to Afrikaans and from one cultural context to another (Western to South African). Specifically, we examined children's performance on two measures of development: the Mullen Scales of Early Learning and the Ages and Stages Questionnaires (ASQ). Both measures were completed for 47 typically developing South African preschool children between 3 and 6 years of age. The Mullen was completed by a speech and language therapist and the ASQ by a parent. Both of the measures used yielded similar results, and compared favorably with the existing norms. The procedures provide a framework for expanding such adaptations in other applications. [source] Does progressive stage transition mean getting better?ADDICTION, Issue 10 2007A test of the Transtheoretical Model in alcoholism recovery ABSTRACT Aims To test two central assumptions of stage movement in the Transtheoretical Model (TTM) vis-à-vis alcoholism recovery: (assumption 1) individuals making a forward transition to the action-oriented stages (i.e. preparation/action) will manifest relatively greater drinking improvements than their counterparts remaining in the pre-action stages (i.e. pre-contemplation, contemplation); and (assumption 2) individuals remaining in the pre-action stages across time will not demonstrate clinically relevant improvement in drinking outcomes. Design and setting Secondary data analyses of data from Project MATCH, a large multi-site alcoholism treatment-matching study. Measurements At baseline and 3 months post-treatment, the following variables were measured: stage-of-change (based on the University of Rhode Island Change Assessment measure and the most recent stage assignment algorithm), drinks per drinking day (DDD) and percentage days abstinent (PDA). Findings Six of the eight tests of assumptions 1 and 2 failed to support the basic tenets of the TTM. Our study demonstrated that individuals making a progressive stage transition to the action-oriented stages (i.e. preparation/action) do not necessarily manifest greater improvements in drinking-related behavior than individuals remaining in the pre-action stages (i.e. pre-contemplation, contemplation), and that individuals remaining in the pre-action stages over time actually do manifest statistically significant and clinically important improvements in drinking-related behavior. Conclusions Our findings challenge not only the criterion validity associated with stage movement in the TTM account of alcoholism recovery, but also recent TTM-based substance abuse treatment approaches which systematically promote forward stage transition as a primary clinical goal and marker of therapeutic success. [source] Lifetime substance abuse, family history of alcohol abuse/dependence and novelty seeking in eating disorders: Comparison study of eating disorder subgroupsPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 1 2009Isabel Krug phd Aim:, To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa,restrictive; anorexia nervosa,binge eating/purging; anorexia nervosa to bulimia nervosa). Method:, A total sample of 371 eating disorder patients participated in the current study. Assessment measures included the prevalence of substance abuse and family history of alcohol abuse/dependence as well as the novelty-seeking subscale of the Temperament and Character Inventory,Revised. Results:, Significant differences across groups were detected for lifetime substance abuse, with anorexia nervosa,restrictive individuals exhibiting a significant lower prevalence than the anorexia nervosa to bulimia nervosa and anorexia nervosa,binge eating/ purging patients (P < 0.01). For family history of alcohol abuse/dependence the same pattern was observed (P = 0.04). Novelty seeking was associated with substance abuse (P = 0.002), with the anorexia nervosa to bulimia nervosa group exhibiting significantly higher scores on the novelty-seeking scale than the other two groups (P < 0.001). But family history of alcohol abuse/dependence was not related to novelty seeking (P = 0.092). Conclusion:, Lifetime substance abuse appears to be more prevalent in anorexia nervosa patients with bulimic features. Higher novelty-seeking scores may be associated with diagnosis cross-over. [source] The impact of age at onset of bipolar I disorder on functioning and clinical presentationACTA NEUROPSYCHIATRICA, Issue 4 2009Frances Biffin Objectives: Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample. Methods: Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode. Results: Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20,39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance. Conclusion: Early AAO is associated with an adverse outcome. [source] Appraisal of Social Concerns: A cognitive assessment instrument for social phobiaDEPRESSION AND ANXIETY, Issue 4 2004Michael J. Telch Ph.D. Abstract The current study describes the validation of a new cognitive assessment measure for social phobia, entitled the Appraisal of Social Concerns (ASC). Item content is relevant to a range of social situations. The ASC can be used to tailor interventions to patients' idiosyncratic concerns. Data are presented from both clinical (n=71) and non-clinical (n=550) samples. Preliminary data indicate that the ASC has good internal consistency and test,retest reliability. The construct validity of the ASC is comparable to that of well-established measures in use with social phobics. A strength of the ASC is its sensitivity to the effect of treatment. An exploratory factor analysis yielded three factors tapping concerns about negative evaluation, observable symptoms, and social helplessness. Subscale scores were strongly correlated. Preliminary findings suggest that the ASC is a psychometrically sound, time efficient instrument that can be used for both clinical and research purposes. Depression and Anxiety 19:217,224, 2004. © 2004 Wiley-Liss, Inc. [source] How and when does complex reasoning occur?JOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 6 2009Empirically driven development of a learning progression focused on complex reasoning about biodiversity Abstract In order to compete in a global economy, students are going to need resources and curricula focusing on critical thinking and reasoning in science. Despite awareness for the need for complex reasoning, American students perform poorly relative to peers on international standardized tests measuring complex thinking in science. Research focusing on learning progressions is one effort to provide more coherent science curricular sequences and assessments that can be focused on complex thinking about focal science topics. This article describes an empirically driven, five-step process to develop a 3-year learning progression focusing on complex thinking about biodiversity. Our efforts resulted in empirical results and work products including: (1) a revised definition of learning progressions, (2) empirically driven, 3-year progressions for complex thinking about biodiversity, (3) an application of statistical approaches for the analysis of learning progression products, (4) Hierarchical Linear Modeling results demonstrating significant student achievement on complex thinking about biodiversity, and (5) Growth Model results demonstrating strengths and weaknesses of the first version of our curricular units. The empirical studies present information to inform both curriculum and assessment development. For curriculum development, the role of learning progressions as templates for the development of organized sequences of curricular units focused on complex science is discussed. For assessment development, learning progression-guided assessments provide a greater range and amount of information that can more reliably discriminate between students of differing abilities than a contrasting standardized assessment measure that was also focused on biodiversity content. © 2009 Wiley Periodicals, Inc. J Res Sci Teach 46: 610,631, 2009 [source] The School Health Portfolio System: A New Tool for Planning and Evaluating Coordinated School Health ProgramsJOURNAL OF SCHOOL HEALTH, Issue 9 2004Robert M. Weiler ABSTRACT: The School Health Portfolio System (SHPS), developed originally to evaluate the Florida Coordinated School Health Program Pilot Schools Project, offers a new and innovative system for planning and evaluating a coordinated school health program at the individual school level. The SHPS provides practitioners a detailed but easy-to-use system that enables schools to create new programs or modify existing programs across all eight components of the CSHP model, as well as administrative support critical to sustainability. The System comes packaged as a self-contained, notebook-style manual divided into 15 sections. It includes electronic templates of key documents to guide school teams in creating a customized portfolio, and a list of sample goals and artifacts that confirm achievement of a goal related to the school's coordinated school health program. An evaluation rubric provides a structured method to assess a program portfolio's contents, and the extent to which the contents document achievement of program goals. The rubric produces both a qualitative assessment, such as a narrative summary of program strengths and areas for improvement, and a quantitative assessment, such as a numerical score (0,100), letter grade (A-F), or 5-star system (* - *****). The physical structure, function, and scoring of the rubric depend on the method of assessment. The SHPS enables schools to set goals based on individual school needs, and incorporate CSHP goals into school improvement plans - a critical factor in sustainability and accountability. The System also offers teams the option of coordinating their efforts with CDC's School Health Index as a companion assessment measure. This article outlines the process a team would follow in developing a portfolio, and includes a sample assessment for the area of School Health Education. (J Sch Health. 2004;74(9):359,364) [source] Reactivity to alcohol assessment measures: an experimental testADDICTION, Issue 8 2009Scott T. Walters ABSTRACT Aims Previous research has suggested that alcohol screening and assessment may affect drinking. Design This study was a randomized test of reactivity to alcohol assessment questionnaires among a group of heavy drinking college students. Setting and participants A total of 147 university students completed a screening questionnaire and were randomized to either immediate assessment or delayed assessment. The immediate assessment group completed a set of drinking questionnaires at baseline, 3, 6 and 12 months, while the delayed assessment group completed questionnaires only at 12 months. Measurements Primary outcomes included overall volume of drinking, risky drinking and use of risk reduction behaviors. Findings We found a significant effect of assessment on measures of risky drinking and risk reduction behaviors, but not on overall volume of drinking. Specifically, at 12 months, participants who had previously completed drinking assessments had a lower peak blood alcohol concentration (BAC) (d = ,0.373), were more likely to report a low score on the Alcohol Use Disorders Identification Test (AUDIT; odds ratio = 2.55) and tended to use more strategies to moderate their alcohol consumption (d = 0.352). Risk reduction behaviors that were affected tended to be those that limited alcohol consumption, rather than those that minimized consequences. Conclusions These results may have implications for the development of brief interventions. [source] How to deal with multiple endpoints in clinical trialsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2006Markus Neuhäuser Abstract Multiple endpoints are common in clinical trials. This article discusses statistical methods that can be applied to control the rate of false positive conclusions at an acceptable level. The considered methods include the Bonferroni adjustment and related methods, the intersection-union test, ordered hypotheses and gatekeeper procedures, composite endpoints and global assessment measures, closed testing procedures, and combinations of different approaches. [source] Headache and Psychological Functioning in Children and AdolescentsHEADACHE, Issue 9 2006Scott W. Powers PhD Headache can affect all aspects of a child's functioning, leading to negative affective states (eg, anxiety, depression, anger) and increased psychosocial problems (for instance, school absences, problematic social interactions). For children and adolescents who experience frequent headache problems, comorbid psychological issues are a well-recognized, but poorly understood, clinical phenomenon. The confusion surrounding the relationship between pediatric headache and psychopathology exists for several reasons. First, in some cases, headache has been inappropriately attributed to psychological or personality features based on anecdotal observations or interpretations that go beyond the available data. Additionally, measures of psychopathology have not always adhered to the American Psychiatric Association's diagnostic criteria, thus reducing the reliability of diagnostic judgments. Furthermore, the diagnosis of headache has not always followed standard criteria, and has been complicated by the emergence of new terms and evolving measures. Finally, methodological shortcomings, such as incomplete descriptions of the procedures and criteria used for the study, inadequate descriptions of headache severity, lack of a control group for comparison with individuals without headaches, reliance primarily on cross-sectional research designs that are often discussed with inferences to causal hypotheses, and the use of unstandardized assessment measures, have significantly limited the validity of research findings. The goal of the current review is to examine the extant literature to provide the most up-to-date picture on what the research has made available about the magnitude, specificity, and causes of psychopathology in children and adolescents with headache, in an effort to further elucidate their relationship and prompt a more methodologically rigorous study of these issues. [source] Assessment and Intervention to Teach Age Recognition Skills: a Suggested Programme Using the Example of a Case Study to IllustrateJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2000Dorothy M. Bell A 43-year-old man with mild intellectual disabilities was referred after several contacts with the law when he had been seen in the street talking to children who were unknown to him. Some staff members feared that he had a sexual interest in children. Other colleagues considered that the behaviour was innocent, reflecting his friendly nature, but that it was a behaviour which was misinterpreted by others. The present paper charts the assessment of this man's difficulties and abilities over a wide range of relevant areas, and a reassessment following an intensive period of one-to-one training on age-recognition skills. Although the training was unsuccessful, the measures used assisted in making a detailed assessment and providing clear instructions to care staff, all of which was to the subject's long-term benefit. The present paper also illustrates the way in which difficulties of this nature can be assessed and uses allied assessment measures which may be helpful in looking at the whole picture of any person with such problems. It also considers how these areas may then be addressed. Although, in this case, the subject was unable to learn to discriminate specific age groups despite intensive training, he was consequently able to be advised in a manner which should keep him from getting into trouble in the future and the now detailed knowledge of his abilities in all these areas is valuable for his long-term support in the community. [source] Dementia and Driving: Autonomy Versus SafetyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2005Article first published online: 23 SEP 200, Charlene Hoffman Snyder MSN, NP-BC Purpose This article reviews the effects of various types of dementia on driving skills, the available assessment measures, legal considerations, and the important role played by the nurse practitioner (NP) in the process of recommending driving cessation. It provides strategies and resources that may offer guidance to NPs who are attempting to balance the continued independence of patients with dementia, as represented by driving, with the safety not only of such patients but also of the public at large. Data sources A review of the biomedical literature, resources available on the World Wide Web, and illustrative case studies were used. Conclusions The diagnosis of dementia alone is often insufficient to determine driver competence because the topographic losses of dementia are complex. Recognizing when cessation should occur is made more difficult because objective assessment tools do not exist to predict impaired driving skills. Recommending driving cessation at the appropriate time can be a challenge for NPs, who must balance such a significant impact on the driver's autonomy with concerns about public safety if the patient continues to drive despite progressive impairment. Implications for practice The progressive loss of cognitive abilities in dementia presents a series of ongoing challenges for the patient throughout the disease continuum. Unfortunately, the recommendation to stop driving can present one of the more immediate issues confronting the patient, the family, and the healthcare provider. Failure to assess diminished driving skill can lead either to premature or to delayed driving cessation. Either outcome can have adverse effects on the patient, the patient's family, and public safety. [source] Using Electronic Portfolios for Second Language AssessmentMODERN LANGUAGE JOURNAL, Issue 2009PATRICIA W. CUMMINS Portfolio assessment as developed in Europe presents a learner-empowering alternative to computer-based testing. The authors present the European Language Portfolio (ELP) and its American adaptations, LinguaFolio and the Global Language Portfolio, as tools to be used with the Common European Framework of Reference for languages and the American national standards, which reference the American Council on the Teaching of Foreign Languages proficiency scale. The ELP's characteristic three-part format, consisting of a language passport, a language biography, and a dossier, builds on earlier research on portfolios and second language assessment. The portfolios' qualitative assessment complements other types of quantitative assessment measures. The authors also explore the unique affordances offered by electronic portfolios to connect teaching and learning to assessment, discuss the effectiveness of portfolios as an assessment tool, and point to future directions for e-portfolio research and development for language learning. [source] Effectiveness of Monetary Incentives in Modifying Dietary Behavior: A Review of Randomized, Controlled TrialsNUTRITION REVIEWS, Issue 12 2006FAFPHM, Joanne Wall MBChB To review research evidence on the effectiveness of monetary incentives in modifying dietary behavior, we conducted a systematic review of randomized, controlled trials (RCTs) identified from electronic bibliographic databases and reference lists of retrieved relevant articles. Studies eligible for inclusion met the following criteria: RCT comparing a form of monetary incentive with a comparative intervention or control; incentives were a central component of the study intervention and their effect was able to be disaggregated from other intervention components; study participants were community-based; and outcome variables included anthropometric or dietary assessment measures. Data were extracted on study populations, setting, interventions, outcome variables, trial duration, and follow-up. Appraisal of trial methodological quality was undertaken based on comparability of baseline characteristics, randomization method, allocation concealment, blinding, follow-up, and use of intention-to-treat analysis. Four RCTs were identified as meeting the inclusion criteria. All four trials demonstrated a positive effect of monetary incentives on food purchases, food consumption, or weight loss. However, the trials had some methodological limitations including small sample sizes and short durations. In addition, no studies to date have assessed effects according to socioeconomic or ethnic group or measured the cost-effectiveness of such schemes. Monetary incentives are a promising strategy to modify dietary behavior, but more research is needed to address the gaps in evidence. In particular, larger, long-term RCTs are needed with population groups at high risk of nutrition-related diseases [source] Intervertebral Disc Biacuplasty for the Treatment of Lumbar Discogenic Pain: Results of a Six-Month Follow-UpPAIN MEDICINE, Issue 1 2008Leonardo Kapural MD ABSTRACT Objective., Intradiscal biacuplasty (IDB) is a novel bipolar cooled radiofrequency system for the treatment of degenerative disk disease. We present the results of a pilot trial with 6-month follow-up. Design, Setting, Patients, and Interventions., Fifteen patients, 22,55 years old, underwent one- or two-level IDB treatment of their painful lumbar discs. All had chronic low back pain >6 months, back pain exceeding leg pain, concordant pain on provocative discography, disc height >50% of control, and evidence of single- or two-level degenerative disc disease without evidence of additional changes on magnetic resonance imaging. IDB was performed under fluoroscopy using two radiofrequency probes positioned bilaterally in the intervertebral disc. Thirteen patients completed follow-up questionnaires at 1, 3, and 6 months. Pain disability was evaluated with Oswestry and Short Form (SF)-36 questionnaires. Results., Median visual analog scale pain scores were reduced from 7 (95% confidence interval [CI] 6, 8) to 4 (2, 5) cm at 1 month, and remained at 3 (2, 5) cm at 6 months. The Oswestry improved from 23.3 (SD 7.0) to 16.5 (6.8) points at 1 month and remained similar after 6 months. The SF-36 Physical Functioning scores improved from 51 (18) to 70 (16) points after 6 months, while the SF-36 Bodily Pain score improved from 38 (15) to 54 (23) points. Daily opioid use did not change significantly from baseline: from 40 (95% CI 40, 120) before IDB to 5 (0, 40) mg of morphine sulfate equivalent 6 months after IDB. No procedure-related complications were detected. Conclusions., Patients showed improvements in several pain assessment measures after undergoing IDB for discogenic pain. A randomized controlled study is warranted and needed to address the efficacy of the procedure. [source] Adherence and health-related quality of life in adolescent liver transplant recipientsPEDIATRIC TRANSPLANTATION, Issue 3 2008Emily M. Fredericks Abstract:, Adolescence is a particularly high-risk period for non-adherence with post-transplant medical regimens. There remains a lack of research investigating factors related to non-adherence in adolescent LT recipients. The present study empirically assessed the relationship between adherence and HRQOL in adolescent LT recipients. Participants included 25 adolescents (mean = 15.1 yr, range 12,17.9) and their parent/guardian(s). Adherence was assessed using multiple indices including clinician-conducted interviews, rate of clinic attendance, and s.d. of consecutive tacrolimus blood levels. HRQOL was examined using self-report and parent-proxy report on well-validated assessment measures. Results indicated that 76% of participants were non-adherent on at least one measure of adherence, and HRQOL was significantly lower than normative data for healthy children. Tacrolimus s.d. were significant related to poor HRQOL across domains of physical, school, and social functioning. Non-adherent adolescents reported poorer health perceptions, self-esteem, mental health, family cohesion, and more limitations in social and school activities related to physical, emotional, and behavioral problems. These results suggest that empirically based assessment of HRQOL may help identify those at highest risk for behavior, emotional and school difficulties, as well as non-adherence. The examination of tacrolimus s.d. may also help identify patients who may benefit from intervention to promote adherence and HRQOL. Prospective investigations are necessary to further identify the impact of HRQOL on adherence and long-term health outcomes to further guide clinical intervention. [source] The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure)PSYCHO-ONCOLOGY, Issue 9 2007K. Hodgkinson Abstract Background: Many cancer survivors experience ongoing morbidity over the survivorship continuum and their supportive care needs have yet to be comprehensively assessed. Methods: This study aimed to develop and empirically evaluate a self-report measure of cancer survivors' supportive care needs. In Phase I, questionnaire items were generated based upon previous qualitative research that identified both unique and shared needs in survivors and their partners; items were constructed into the Cancer Survivors' Unmet Needs measure (CaSUN). In Phase 2, the CaSUN was completed by 353 cancer survivors who had been diagnosed with cancer between 1 and 15 years earlier and were currently disease-free. Results: After modification, the CaSUN included 35 unmet need items, 6 positive change items and an open-ended question. Good acceptability, internal consistency and validity were demonstrated, although test,retest reliability was low. Maximum likelihood factor analysis identified five discrete factors: Existential Survivorship, Comprehensive Care, Information, Quality of Life and Relationships. Conclusions: Preliminary data indicates that the CaSUN meets the majority of psychometric criteria for assessment measures, although its low test,retest reliability awaits further investigation. The CaSUN will facilitate the evaluation of supportive care services and generation of service delivery recommendations for cancer survivors. Copyright © 2006 John Wiley & Sons, Ltd. [source] Emanuel Miller Lecture: Attachment insecurity, disinhibited attachment, and attachment disorders: where do research findings leave the concepts?THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 5 2009Michael Rutter Background:, Despite the evidence on anomalous attachment patterns, there has been a tendency to interpret most of these as reflecting differences in security/insecurity. Methods:, Empirical research findings are reviewed in relation to attachment/insecurity as evident in both infancy and later childhood, disorganised attachment, inhibited attachment disorder, and disinhibited attachment disorder. Findings:, Substantial differences are found in the correlates and meaning of these different features, as well as in the patterns associated with conditions such as autism, psychopathy, and Williams syndrome. Conclusions:, It is seriously misleading to view all of these patterns through the lens of security/insecurity. This heterogeneity in social relationship features necessarily has implications for the assessment measures for social relationships that need to be used. [source] Psychological Functioning, Nonadherence and Health Outcomes After Pediatric Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2007E. M. Fredericks The present study empirically assessed the relationships between adherence behaviors and HRQOL, parent and child psychological functioning and family functioning, and investigated the relationship between adherence behaviors and health outcomes in children who were within 5 years of their liver transplantation. Participants included 38 children (mean = 8.5 years, range 28 months to 16 years) and their parent/guardian(s). HRQOL and psychological functioning were examined using well-validated assessment measures. Measures of adherence included the rate of clinic attendance and standard deviations (SDs) of consecutive tacrolimus blood levels, which were collected and evaluated retrospectively. Measures of child health status included the frequency of hospital admissions, liver biopsies, episodes of rejection and graft function for the year prior to study participation. Results indicated that nonadherence was related to lower physical HRQOL, more limitations in social and school activities related to emotional and behavioral problems, parental emotional distress and decreased family cohesion. Nonadherence was also related to frequency and duration of hospitalizations, liver biopsies and rejection episodes. These results suggest that empirically based assessment of HRQOL, parenting stress and family functioning may help identify patients at risk for nonadherence, and may allow for the need-based delivery of appropriate clinical interventions. [source] Percutaneous radiofrequency ablation of painful osseous metastasesCANCER, Issue 4 2010A multicenter American College of Radiology Imaging Network trial Abstract BACKGROUND: The study was conducted to determine whether radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease. METHODS: The single-arm prospective trial included patients with a single painful bone metastasis with unremitting pain with a score >50 on a pain scale of 0-100. Percutaneous computed tomography-guided RFA of the bone metastasis to temperatures >60°C was performed. Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, 1 month, and 3 months after RFA. RESULTS: Fifty-five patients completed RFA. Grade 3 toxicities occurred in 3 of 55 (5%) patients. RFA reduced pain at 1 and 3 months for all pain assessment measures. The average increase in pain relief from pre-RFA to 1-month follow-up is 26.3 (95% confidence interval [CI], 17.7-34.9; P < .0001), and the increase from pre-RFA to 3-month follow-up is 16.38 (95% CI, 3.4-29.4; P = .02). The average decrease in pain intensity from pre-RFA to 1-month follow-up was 26.9 (P < .0001) and 14.2 for 3-month follow-up (P = .02). The odds of lower pain severity at 1-month follow-up were 14.0 (95% CI, 2.3-25.7; P < .0001) times higher than at pre-RFA, and the odds at 3-month follow-up were 8.0 (95% CI, 0.9-15.2; P < .001) times higher than at pre-RFA. The average increase in mood from pre-RFA to 1-month follow-up was 19.9 (P < .0001) and 14.9 to 3-month follow-up (P = .005). CONCLUSIONS: This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases. Cancer 2010. © 2010 American Cancer Society [source] How do we achieve optimal cardiovascular risk reduction?CLINICAL CARDIOLOGY, Issue S3 2001Antonio M. Gotto Jr. M.D., D.PHIL Abstract Summary: Optimizing coronary heart disease (CHD) risk reduction requires the application of clinical evidence to patient care, as well as the refinement of risk assessment. Clinical evidence indicates that most patients are not treated to optimal low-density lipoprotein (LDL) cholesterol goals. Despite the efficacy of statin therapy in reducing the incidence of CHD, many treated patients still experience CHD events. Targeting other lipid factors such as high-density lipoprotein cholesterol and triglycerides may augment the risk reduction achieved by lowering LDL cholesterol. Refined global risk assessment can lead to more accurate determinations of absolute risk and to the identification both of high-risk patients needing aggressive intervention and intermediate-risk patients who appear to be at low risk. Previous global risk assessment measures failed to identify a substantial proportion of primary prevention patients who would benefit from therapy. However, revised guidelines issued by the National Cholesterol Education Program introduce new criteria for more precise risk assessment and advocate use of the Framingham scoring system to calculate absolute risk. Although intensified treatment is recommended for high-risk patients, cost considerations may limit drug therapy for some lower-risk individuals. [source] | ||||||||||||||||||||||||||||