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Biomedical subjects

D V Cicchetti

Publications and source records attributed to D V Cicchetti.

At least 73 records · Page 4Linked to original sources
PubMed1987

Appendicitis in children. Accuracy of the barium enema.

The barium enema (BE) may be useful in the diagnosis of atypical appendicitis in children. We analyzed our experience with 18 children in whom appendicitis was suspected and BE was performed. All of the children underwent surgical exploration. Nonfilling of the appendix with cecal indentation, extravasation of barium from the appendix, or both, were considered positive signs of an inflamed appendix on BE. Using these criteria, 12 of 14 cases of proved appendicitis were true positive and two were equivocal. Four children were proved not to have appendicitis; one of these patients had a true-negative BE, two had equivocal BEs, and there was one false-positive BE (Schönlein-Henoch purpura). Extravasation of barium into the peritoneal cavity was noted in one patient; this was a rare complication.

Adolescent↗
PubMed1986

False conclusions about Vineland standard scores: Silverstein's type I errors and other artifacts.

Silverstein expressed concern that Vineland means and standard deviations (SDs) vary considerably from age group to age group in the national standardization sample. He concluded that as a result the following assessments are compromised: standard errors of measurement, domain strengths and weaknesses, and domain pairwise comparisons. This reply serves to document that Silverstein's reasoning is invalid and is directly attributable to his inexplicable failure to control for Type I error in his comparing 61 sample means and 61 sample SDs to population values of 100 and 15, respectively. Vineland users are cautioned to disregard caveats that are based upon flawed reasoning and invalid biostatistical arguments.

Activities of Daily Living↗
PubMed1985

Predicting quality of alliance in the initial psychotherapy interview.

A constellation of theoretically relevant pretherapy patient variables--object relations, psychological mindedness, hope for success, psychic pain, and intrapsychic flexibility--were used to predict patient therapeutic alliance readiness during the initial psychoanalytic psychotherapy interview. Therapeutic alliance readiness was viewed as a dual concept, assessed by psychological freedom, a variable measuring patient expressiveness, and quality of alliance, a variable measuring patient collaborativeness. A significant amount of the variance (approximately 40%) in the combined dependent alliance readiness variables was predicted from the pretherapy constellation of variables. As anticipated by psychoanalytic theory and related psychotherapy research, quality of object relations accounted for the greatest part of the variance (about 30%) in both the expressive and collaborative dimensions of psychoanalytic alliance readiness behavior. These findings are discussed in terms of predictor variables specific to alliance behavior, and eventually to outcome, as anticipated by the theory within any particular form of psychotherapy. A model for future psychotherapy research, based on a prediction-type equation approach, is presented.

Adult↗
PubMed1985

Experimental acute tubular necrosis: US appearance.

Dichromate-induced acute tubular necrosis (ATN) was created in 16 experimental animals and compared with four controls. An increase in cortical echogenicity, greatest on days 4 and 7 after injection, was noted using both histogram analysis and blinded observer readings. These findings closely correlated with proportional outer cortical blood flow. Good interobserver correlation was noted. Based on this experiment, clinical observations, and the literature, we propose that three different entities with different sonographic appearances are included under the term ATN. Drug-induced nephrotoxicity is associated with increased cortical echogenicity; ischemic ATN leads to no change in cortical echogenicity with normal medullary echogenicity; and precipitation of Tamm-Horsfall protein in the pyramids leads to echogenic pyramids with normal cortical echogenicity.

Acute Kidney Injury↗
PubMed1985

Reliability and accuracy of localization by scalp ictal EEG.

One hundred forty-four scalp ictal EEGs from 54 patients were analyzed independently by three electroencephalographers for side and lobe of seizure onset. Observers did not know the patients' identities. Accuracy was determined by depth EEG. We found 58 to 60% agreement between observers for lobe, and 64 to 74% for side, of seizure onset; 21 to 38% agreement with depth EEG for lobe, and 46 to 49% agreement for side, of seizure onset; best accuracy for lateralization of seizure onset in temporal lobe seizures, but erroneous in 3 to 17%. More formal criteria are needed before scalp ictal records can be used reliably or accurately for localization.

Adolescent↗
PubMed1985

Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children.

In order to study the occurrence and positive predictive value of history and physical examination findings suggestive of serious illness in ill-appearing and well-appearing febrile children, 103 consecutive children aged less than or equal to 24 months with fever greater than or equal to 38.3 degrees C were evaluated from July 1, 1982 to Nov 24, 1982. Patients were initially classified by an attending physician (A) as to whether they appeared ill (Yale Observation Scale score greater than 10) or well (scale score less than or equal to 10). The history was then taken by two attending physicians (A and B) and a resident; the physical examination was performed by attending physician B and the same resident. As history and physical examination findings were elicited, they were scored as to whether they did or did not suggest a serious illness. Serious illness was defined as the presence of a positive laboratory test. Ill-appearing patients had a significantly greater (P less than .001, Fisher's exact test) occurrence of physical examination findings suggesting serious illness (14 of 22, 64%) than well-appearing children (12 of 81, 15%). The positive predictive values of abnormal physical examination findings for serious illness in ill-appearing (11 of 14, 79%) and well-appearing children (3 of 12, 25%) were significantly different (P = .02 by Fisher's exact test). The trends for abnormal history findings in ill-appearing and well-appearing children were similar to those for abnormal physical examination findings but did not achieve statistical significance. The results, indicating an important interaction between a febrile child's appearance and physical examination findings, are discussed in terms of probability reasoning in clinical decision making.

Bayes Theorem↗
PubMed1984

A comparison of the Norris and Killip coronary prognostic indices.

Of the two most frequently used indices for classifying prognosis of patients with an acute myocardial infarction, the Killip index, because of its greater simplicity, is sometimes used instead of the more complicated and time consuming Norris index. The purpose of the current research was to correlate the classification of patients on the two indexes, and to determine reasons for disagreements in classification. Study patients for this comparison included 151 patients who died of a myocardial infarction and who were matched to each of 151 survivors for age, sex, race, and date hospitalization. Pertinent data were extracted from each patient's medical record by specially trained research technicians. The results indicate that many patients were "misclassified": 40% of the deaths were placed in the two lowest severity classes using the Killip scale, and 12% using the Norris index. Good agreement was found for comparisons between the 4-category Killip scale and the continuous scale Norris index ( Jaspen 's multiserial r = 0.67), but only fair agreement was noted when the Norris index was arranged into ordinal categories. Deficiencies in the Killip index included absence of crucial clinical features with prognostic power (e.g., age, systolic blood pressure, infarct location), while the Norris index was deficient in its requirement for a chest radiograph to estimate the presence of pulmonary edema and of cardiac enlargement. If future prospective studies confirm our analysis, research findings which have been based on one or the other of these indices should not be interpreted similarly.

Epidemiologic Methods↗
PubMed1984

The behavior inventory for rating development (BIRD): assessments of reliability and factorial validity.

In an earlier investigation (Sparrow & Cicchetti, 1978) the authors assessed the reliability and validity of a new instrument for assessing types and levels of adaptive behaviors. Although there was strong evidence for both, the sample was small (N = less than or equal to 45) and consisted only of institutionalized mentally retarded children. The current investigation included a much larger sample of non-institutionalized mentally retarded and other developmentally disabled subjects. As previously, results indicated reliability levels between "good" and "excellent" for most items (e.g., the criteria of Cicchetti & Sparrow, 1981). Also, factor analyses were performed to determine the correlation between the resulting factors and an a priori classification of the BIRD into several areas (subscales) of adaptive behavior (Cognitive Development, Self-Help, Physical Development, Social Behavior, Self-Control). As before, a 4 factor oblique solution was interpretable in terms of a 4 subscale classification of BIRD items (Cognitive Development, Physical Development, Social Behavior, and Self-Control).

Adolescent↗
PubMed1984

Cross-national reliability study of a schedule for assessing personality disorders.

The inter-rater reliability of a schedule used to assess personality disorders was examined. The Personality Assessment Schedule (PAS) involves an interview with both the patient and a close informant and the ratings for the informant are given most weight in the final scoring. Videotaped interviews with 23 psychiatric patients, most of whom had a clinical diagnosis of personality disorder, and a close informant were scored by seven raters, four in the United Kingdom and three in the United States. Overall inter-rater reliabilities (using the intraclass correlation coefficient, RI) were generally good to excellent for each of the 24 personality variables tested, ranging between .66 and .94 for informants and between .51 and .91 for subjects. Corresponding reliability coefficients for overall mean PAS scores were .82 and .75, respectively. Consistent with these findings, there was little bias between the scores of American and British raters, although there was some tendency for American raters to score higher for the trait of eccentricity and lower for the trait of conscientiousness than was true for British raters. There was less bias for informants' ratings than for those of subjects. In a second set of analyses, it was shown that inter-rater reliability levels (using the Kappa statistic) were also good to excellent (.6 to .8) for the categorical diagnosis of personality disorder. These results, taken together, demonstrate that abnormal personality can be reliably assessed by both British and American raters.

Adolescent↗
PubMed1984

Hirschsprung disease: accuracy of the barium enema examination.

To determine the relative accuracy of the various radiologic signs of Hirschsprung disease (HD), we retrospectively reviewed both radiographs obtained after a barium enema and the medical records of 62 children who had surgery to prove or exclude the diagnosis of HD. The visualization of a rectosigmoid transition zone was highly predictive of HD, but nonvisualization did not rule out HD. A false positive transition zone at the splenic flexure was seen in four neonates who had small left colon syndrome rather than HD. Retention of barium seen on radiographs obtained 24 hours after a barium enema was not a specific sign, but it was the only sign of HD in seven neonates, including two who had total colonic aganglionosis. Anal manipulation prior to the barium enema examination did not affect the diagnostic value of that procedure. We conclude that the single most reliable radiographic sign of HD is the presence of a rectosigmoid transition zone. Statistically, the use of three radiographic features combined (rectosigmoid transition zone, retention of barium, and stool mixed with barium) correlated better with the presence or absence of HD than did any of these features alone. A comparison of 24 and 48 hour postevacuation radiographs may help to differentiate HD from meconium plug syndrome.

Barium Sulfate↗
PubMed1983

Reliability of depression and associated clinical symptoms.

Interrater reliability assessments were undertaken for the Hamilton Depression Rating Scale, the Raskin Depression Rating Scale, and the Degree of Mental Illness Scale. Levels of reliability ranged from "poor" to "excellent" and varied as a function of (1) temporality (assessments made at termination of clinical trial more reliable than those made at randomization into treatment) and (2) unit of scoring (factor or total scores more reliable than single-item assessments). The implications of these results may be considered in the context of further studies evaluating the efficacy of treatment interventions on reduction of symptoms of clinical depression.

Adolescent↗
PubMed1982

Diagnostic styles of attending pediatricians, residents, and nurses in evaluating febrile children.

In order to compare the diagnostic styles of attending pediatricians (A), residents (R), and nurses (N) in judging the degree of illness of a febrile child prior to physical examination, we studied the frequency with which they used 139 different history variables and 186 observation variables in evaluating 162 consecutive children less than or equal to 24 months of age with temperature greater than or equal to 38.3 C. Because individual history and observation variables were not used with sufficient frequency, comparison of diagnostic styles based on the individual variables was not possible. The individual history and observation variables were then combined into 25 history and 30 observation categories respectively. One observation category, "Eyes," was used with sufficient frequency to allow comparison of A, R, and N diagnostic styles. In the Eyes category, there were 11 variables describing visual response to stimuli (e.g., looking at the observer) and 10 variables describing appearance of the eyes (e.g., glassy, shiny). Attendings used variables describing visual response to stimuli significantly more frequently than R or N, which may indicate a greater facility in evaluating age-appropriate behavior and/or may be a technique to increase the sensitivity of clinical judgments. These data demonstrate the variety of diagnostic styles of A, R, and N. There is a need to define valid and reliable observation data to identify serious illness in febrile children.

Child, Preschool↗
PubMed1982

Methods for evaluation of medical therapy of senile and diabetic cataracts.

Loss of transparency in the human lens can be documented by a variety of methods including: (a) slit lamp photography with or without corrections for depth of focus; (b) retroillumination photography alone or coupled to densitometry; (c) high resolution targets projected into the eye and visualized by an ophthalmoscope; (d) drawings and/or measurements of lens opacities; (e) visual acuity determinations after visualization of the macular area and complete eye examination. The advantages and practical uses of each method were reviewed with reference to its value in determining the progression of cataracts in humans. Diabetes accelerates cataract development as determined from graphic plots of cataracts classified after surgical extraction vs the patient's age. Using similar methods high aspirin dosages administered through many years were found to decelerate cataract progression. Drugs for preventing development of diabetic cataracts in animals include inhibitors of aldose reductase or glycosylation such as sulindac (Clinoril), sorbinil or aspirin.

Aged↗