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PubMed2001

Post-Traumatic amnesia: consistency-of-recovery and duration-to-recovery following traumatic brain impairment.

The aim of this research was to examine the nature and order of recovery of orientation and memory functioning during Post-Traumatic Amnesia (PTA) in relation to injury severity and PTA duration. The Westmead PTA Scale was used across consecutive testing days to assess the recovery of orientation and memory during PTA in 113 patients. Two new indices were examined: a Consistency-of-Recovery and a Duration-to-Recovery index. A predictable order of recovery was observed during PTA: orientation-to-person recovered sooner and more consistently than the following cluster; orientation-to-time, orientation-to-place, and the ability to remember a face and name. However, the type of memory functioning required for the recall face and name task recovered more consistently than that required for memorizing three pictures. An important overall finding was that the "order-of-recovery" of orientation and memory functioning was dependent upon both the elapsed days since injury, and the consistency of recovery. The newly developed indices were shown to be a valuable means of accounting for differences between groups in the elapsed days to recovery of orientation and memory. These indices also clearly increase the clinical utility of the Westmead PTA Scale and supply an objective means of charting (and potentially predicting) patients' recovery on the different components of orientation and memory throughout their period of hospitalization.

Adolescent↗

PubMed2001

Communication and consistency: AIDS talk and AIDS attitudes.

The main hypothesis tested in this study is that the frequency of talk about a particular domain is related to the consistency of attitudes in that domain. This hypothesis was developed by viewing talk as one of the ways in which people express their identities and by exploring the interpersonal processes involved in the construction of consistency. The hypothesis was tested with a questionnaire completed by 73 students at Oxford University. The first part of the questionnaire consisted of items related to attitude, and the second part contained questions about respondents' conversations about AIDS and related topics. Strong support was found for the hypothesis relating frequency of talk with consistency of attitudes. Data about who the respondents talked to about AIDS and the perceived agreement between them and their discussion partners demonstrated the homogeneity of the discussion environment. The implications for understanding attitude formation and change in everyday social contexts are considered.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Steatorrhea cannot be excluded where there is a fecal weight below 0.200 kg per day and a high fecal consistency.

We surveyed one year's results of fecal fat (feces alifatic carboxylates) analyses, which are used in the diagnosis of malabsorption (steatorrhea), by calculating the relationship between fecal fat, fecal weight (fecal mass excretion rate) and fecal consistency (in terms of the volume of water added to a fecal mass so that it can be aspirated into a pipette). N=203 analyses from 191 patients. Reference range for fecal fat: 0-24 mmol/24 h. Linear regression and correlation analyses showed an inverse correlation between fecal weight and fecal consistency and a positive correlation between fecal weight and fecal fat. Our results confirmed earlier findings in the literature that approximately 17% of steatorrheic specimens would be missed if a fecal weight below 0.200 kg/24 h was used to exclude further fecal fat analysis. Fewer steatorrheic specimens would be missed if a lower fecal weight were used: 7% at 0.180 kg/24 h, 3% at 0.140 kg/24 h and 0% at 0.120 kg/24 h. There was no correlation between fecal fat and consistency. The mean volume of added water was not different in normal and steatorrheic feces. The fat content could be predicted as normal only in the seven specimens (3.5% (1-7%)) that had more than 3.8 L/kg water added. Thus, an abnormal fecal fat content cannot reliably be excluded, in a routine setting, on the basis of a fecal weight below 0.200 kg/24 h and a high fecal consistency.

Celiac Disease↗

PubMed2003

Pre-performance routine consistency: temporal analysis of goal kicking in the Rugby Union World Cup.

This study examined the consistency of pre-performance routines in international rugby union goal kickers on kicks of varying difficulty and under different amounts of situational pressure. Concentration times and physical preparation times were calculated from video recordings of the 572 place kicks taken during the 1999 Rugby Union World Cup. In contrast to the view that performers should seek consistent pre-performance routine times, the results revealed a strong positive relationship between kick difficulty and concentration time. Analysis of the effect of situational pressure, determined by the difference in score before the kick, revealed that players tended to have longer concentration times and shorter physical preparation times when the scores were close. There were no differences between the best and worst kickers in the tournament on routine time, consistency or rhythmicity. The view that increasing the temporal consistency of a routine will result in improved performance is challenged.

Adult↗

PubMedDate not supplied

Measuring articulatory error consistency in children with developmental apraxia of speech.

Error inconsistency is often cited as a characteristic of children with speech disorders, particularly developmental apraxia of speech (DAS); however, few researchers operationally define error inconsistency and the definitions that do exist are not standardized across studies. This study proposes three formulas for measuring various aspects of articulatory error consistency: proportion of errors, consistency of error types, and consistency of the most frequently used error type. Each formula is explained using examples of productions from children with DAS and phonological delay. Clinical implications for the use of error consistency to differentially diagnosis DAS and phonological delay are discussed.

Apraxias↗

PubMed2001

Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use "hard drugs".

This study was set up to determine the predictors of condom use in the heterosexual non-commercial sexual relationships of young adults who neither inject drugs nor use cocaine, heroin or crack, in a neighbourhood with widespread drug-use-connected HIV. The analytic sample is 279 young adults, aged 18-24, who have never injected drugs and who have not used heroin, cocaine or crack in the last year. They were recruited in the Bushwick neighbourhood of New York City, July 1997 to September 1999. A face-to-face interview included items about their sociodemographic background, substance use and sexual networks. Sexual relationship and self-reported consistent (100%) condom use over the prior year with the partner in a given relationship was examined. Subjects had 337 heterosexual non-commercial relationships. Consistent condom use was reported in 32% of these relationships. In multiple logistic regression, consistent condom use was more likely in relationships that are not 'very close' (odds ratio = 3.92; 95% confidence interval = 2.08, 7.52); in the relationships of subjects whose peer norms support condom use (OR = 1.94; 95% CI = 1.43, 2.69), who are not problem drinkers (OR = 8.70; 95% CI = 2.22, 58.8), and (perhaps as a result of measurement issues) who are men (OR = 1.95; 95% CI = 1.04, 3.68). In conclusion, consistent condom use remains uncommon among youth in this high-risk neighbourhood. It is thus important to keep HIV from entering the sexual networks of youth in communities like this through programmes aimed at drug injectors and their sexual partners. Programmes to increase condom use among young adults should focus on strengthening norms that promote safer sex to protect oneself and others. In addition, assistance should be provided to youth who are problem drinkers.

Adolescent↗

PubMed1991

Testing for consistency in a single multicenter trial.

One of the criteria for demonstrating efficacy in a single multicenter trial is that the centers are consistent with respect to the direction and significance of results. The purpose of this research is to discuss the use of the noncentrality parameter delta of an F distribution as a means of testing for the consistency of treatment effects across centers. We state the testing problem as H0: (delta > delta 0) versus H1: (delta < or = delta 0), where delta 0 is prespecified, so that H0 represents inconsistency and H1 consistency. Thus, strong evidence from the sample data is required in order to conclude that the treatment effects are consistent across centers. We discuss reasonable choices for delta 0 and develop the alpha-level, uniformly most powerful and unbiased test, which is equivalent to rejecting H0 if the 100(1 - alpha)% uniformly most accurate and unbiased upper confidence limit for delta is less than or equal to delta 0. We examine other tests based on upper confidence limits, such as those calculated from linear estimators of delta and those calculated from a likelihood approach. We investigate the performance of the tests in a small simulation study and present an example from a four-center clinical trial.

Humans↗

PubMed2002

Imaging the breast with EIS: an initial study of exam consistency.

Use of electrical impedance spectroscopy (EIS) to image the breasts of women with both normal and abnormal conditions requires the ability to deliver a consistent and repeatable exam. To investigate the degree to which our current imaging system can meet this requirement we conducted an initial study of exam consistency. The trial involved the imaging of 25 breasts stratified into four separate substudies with increasing levels of electrode placement uncertainty. The degree of complexity ranged from single-placement single-session imaging to multiple-placement single-session imaging to multiple-placement multiple-session imaging. Both visual analysis and quantitative comparisons using mean squared difference (MSD) measures between pairs of permittivity and conductivity images were performed. A new breast interface with the improved vertical and radial electrode array positioning capability required to complete this study is described. Not surprisingly, the results show a dominant trend of increased image variability with increased electrode placement uncertainty. Importantly, quantitative levels of image consistency are reported through MSD analysis. On average across all frequencies analysed, MSDs for single placements are well below 1%, near 2-3% for repositioned breasts during the same session and approximately 15% for re-examined breasts in multiple sessions conducted over time. Overall, these results suggest that EIS breast exams are consistent provided the electrode placement is well controlled, typically with better than 1 cm accuracy.

Algorithms↗

PubMed1993

Improving consistency in cervical cytology reporting.

BACKGROUND: During the 1970s, the Papanicolaou method of classifying cervical cytology specimens and reporting diagnoses was replaced by more descriptive reporting systems. The plethora of reporting terms caused much confusion and a lack of standardization. To improve this situation, "The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses" was approved at a National Cancer Institute Workshop in 1988. In Australia, the Victorian Cervical Cytology Registry (VCCR) was established in 1989. Because of the absence of a standard format for reporting cervical cytology in that country, a coding schedule was developed by local cytopathologists. While the pattern of reporting smear diagnoses was found to be reasonably consistent within individual laboratories, substantial variation in reporting abnormal cervical smear diagnoses by 29 laboratories in Victoria, Australia, was observed. In 1992, a working party of the National Health and Medical Research Council of Australia proposed that a modified Bethesda System be adopted by Australian laboratories. PURPOSE: The aim of this study was to promote more uniform reporting of cervical/vaginal cytologic diagnoses by cytopathology laboratories in Victoria, Australia. METHODS: From the computer database, VCCR staff identified 80 slides that had been registered during the first half of 1991 and that covered the range of low-grade reports and negative reports. Each slide was identified by research number only. Two sets of 40 slides were compiled. Of the 29 laboratories that had worked with the VCCR during 1991, 22 agreed to participate in this study in 1992. One slide set was sent to each laboratory. An evaluation of the intralaboratory and interlaboratory consistency in reporting a set of 40 slides was undertaken. Analysis of the results compared the degree of consistency using current descriptive terminology that operates locally in Victoria with that which would pertain if the proposed Australian modification to the Bethesda System were adopted. RESULTS: Intralaboratory agreement with previously reported slides was low on the squamous descriptor (49% agreement with original report) but higher on the human papillomavirus descriptor (76% agreement with original report) when the results were analyzed using the current terminology. Wide variation in reporting was apparent between laboratories; only 5% of the slides had agreement by all laboratories. Both intralaboratory and interlaboratory agreement improved substantially when results were grouped into the categories of the proposed Australian modification of the Bethesda Reporting System. CONCLUSION AND IMPLICATION: Substantial improvement in the consistency of reporting cervical cytology specimens would be likely if terminology incorporating the broad categories of the Bethesda System were adopted.

Australia↗

PubMed1996

Determining consistency of elbow joint threshold angle in elbow flexor muscles with spastic hypertonia.

BACKGROUND AND PURPOSE: Threshold angle, the point in passive range of motion where a muscle response or torque change is elicited, may be a potentially valid measure of hypertonus. Because the relationship of initial muscle length to threshold angle has not been addressed previously, this preliminary study examined whether starting elbow joint position and speed of stretch to elbow flexor muscles affect threshold angle. SUBJECTS: Five subjects with stroke-induced hypertonia of the elbow flexor muscles participated. METHODS: Two starting angles and two designated stretch speeds were applied randomly by a torque motor at each of three testing sessions. RESULTS: Starting angle, subject, and session affected threshold angle. A 90-degree starting angle at a stretch speed of approximately 1.0 radian/s produced the most consistent threshold angles between sessions within subjects, and threshold angle was relatively consistent for some subjects, irrespective of speed. CONCLUSION AND DISCUSSION: If future research indicates that these data can be generalized, the use of threshold angle as a consistent measure of hypertonia will require comparison within individuals, use of a consistent starting angle, and a movement condition of a 90-degree starting angle and an approximate movement speed of 1.0 radian/s across sessions.

Adult↗

PubMed1996

Genetic factors affecting the consistency and magnitude of changes in plasma cholesterol in response to dietary challenge.

We examined the role of common genetic variation in determining the consistency and magnitude of change in plasma total cholesterol (TC) levels in response to two separate changes from a high-saturated (SFA) to a low-saturated/high-polyunsaturated-fat (PUFA) diet, in a group of free-living healthy men and women. Consistent responders were defined as those whose mean difference in the change in TC was within one SD of the mean for all participants, and the remainder were defined as variable responders. DNA was obtained from 55 individuals and genotype determined at the apolipoprotein (apo) B locus (signal peptide, SP), apoCIII (C1100-T) and lipoprotein lipase (LPL) gene loci (HindIII). In the 38 consistent responders, the apoBSP24 allele was significantly more common than in the 17 individuals with a variable response (0.29 vs. 0.12; p < 0.05). No other polymorphism showed a significant frequency difference between groups. In the group as a whole, the correlation between the change in TC level in response to the first and second dietary change was 0.28 (p = 0.05), but those with one or more apoB SP24 alleles and those with the apoCIII genotype CC had a significantly higher correlation than those with other genotypes (0.46 (p = 0.05) vs. 0.12 (NS) and 0.31 (p = 0.05) vs. 0.02 (NS), respectively). In the group as a whole, mean response left TC 10% higher on the SFA than on the PUFA diet, and neither apoB nor apoCIII genotypes affected the magnitude of this response. However, individuals with the LPL HindIII genotype H+ H+ had a significantly smaller change in mean TC in response to diet than those with one or more H- allele (9.3% vs. 14.4%; p = 0.03). Thus variation at the apoB and apoCIII loci affects the consistency of response to change in dietary fat content, while variation at the LPL gene locus affects magnitude of response.

Apolipoproteins B↗

PubMed1998

Testing internal consistency and construct validity during evaluation of performance in a patient simulator.

UNLABELLED: The primary goal of this study was to test the items in a rating system developed to evaluate anesthesiologists' performance in a simulated patient environment. A secondary goal was to determine whether the test scores could discriminate between resident and staff anesthesiologists. Two 5-item clinical scenarios included patient evaluation and induction and maintenance of anesthesia. Rating scales were no response to the problem (score = 0), compensating intervention (score = 1), and corrective treatment (score = 2). Internal consistency was estimated using Cronbach's coefficient alpha. Scores between groups were compared using the Cochran-Mantel-Haenszel test. Subjects consisted of 8 anesthesiology residents and 17 university clinical faculty. The Cronbach's coefficient alpha was 0.27 for Scenario A and 0.28 for Scenario B. Two items in each scenario markedly decreased internal consistency. When these four items were eliminated, Cronbach's coefficient alpha for the remaining six items was 0.66. Faculty anesthesiologists scored higher than residents on all six items (P < 0.001). A patient simulator-based evaluation process with acceptable reliability was developed. IMPLICATIONS: The reliability of anesthesia clinical performance in a patient simulation environment was assessed in this study. Of 10 items, 4 were poor in the evaluation process. When these items were removed, the reliability of the instrument improved to a level consistent with other studies. Because faculty scored higher than resident anesthesiologists, the instrument also showed discriminant validity.

Adult↗

PubMed1999

Consistency, inter-rater reliability, and validity of 441 consecutive mock oral examinations in anesthesiology: implications for use as a tool for assessment of residents.

BACKGROUND: Oral practice examinations (OPEs) are used extensively in many anesthesiology programs for various reasons, including assessment of clinical judgment. Yet oral examinations have been criticized for their subjectivity. The authors studied the reliability, consistency, and validity of their OPE program to determine if it was a useful assessment tool. METHODS: From 1989 through 1993, we prospectively studied 441 OPEs given to 190 residents. The examination format closely approximated that used by the American Board of Anesthesiology. Pass-fail grade and an overall numerical score were the OPE results of interest. Internal consistency and inter-rater reliability were determined using agreement measures. To assess their validity in describing competence, OPE results were correlated with in-training examination results and faculty evaluations. Furthermore, we analyzed the relationship of OPE with implicit indicators of resident preparation such as length of training. RESULTS: The internal consistency coefficient for the overall numerical score was 0.82, indicating good correlation among component scores. The interexaminer agreement was 0.68, indicating moderate or good agreement beyond that expected by chance. The actual agreement among examiners on pass-fail was 84%. Correlation of overall numerical score with in-training examination scores and faculty evaluations was moderate (r = 0.47 and 0.41, respectively; P < 0.01). OPE results were significantly (P < 0.01) associated with training duration, previous OPE experience, trainee preparedness, and trainee anxiety. CONCLUSION: Our results show the substantial internal consistency and reliability of OPE results at a single institution. The positive correlation of OPE scores with in-training examination scores, faculty evaluations, and other indicators of preparation suggest that OPEs are a reasonably valid tool for assessment of resident performance.

Anesthesiology↗

PubMed2001

Consistency of performance on the functional capacity assessment: static strength and dynamic endurance.

OBJECTIVE: To explore the degree of consistency in a subject's performance in physical strength and endurance. DESIGN: Thirty healthy men, aged 19 to 26 yr, were recruited to participate in protocols to assess static strength and dynamic endurance tests on their upper limbs with the Baltimore Therapeutic Equipment Primus. Retests were conducted 7 days after the initial test. RESULTS: The intraclass correlation coefficients were 0.71 to 0.97 and 0.32 to 0.90 for static and dynamic endurance strengths, respectively. These results indicated that the consistency of the subjects' performance across occasions was high for testing static strength, although it was more varied for testing endurance strength. CONCLUSIONS: Higher consistency was observed among subjects in the assessment of static strength than dynamic endurance strength. The range of motion traveled by the limb, speed of performance, and ergonomic design of attachments seemed to confound the subjects' performance on the instrument. Stringent assessment protocols, ergonomically designed hardware, and clear instructions and practice trials before the formal testing were essential to maximize the subjects' consistency of performance. The results of this study were applicable and generalized to other performance-based instruments for physical and functional capacity evaluation and work simulators.

Activities of Daily Living↗

PubMed1996

Consistency of rotator-cuff calcifications. Observations on plain radiography, sonography, computed tomography, and at needle treatment.

RATIONALE AND OBJECTIVES: The author analyzes findings of consistency of rotator-cuff calcifications found at ultrasound (US)-guided needle treatment compared with findings of plain radiography, US, and computed tomography (CT). METHODS: Twenty patients had rotator-cuff calcifications (mean diameter, 1.5 cm; range, 1.1-2.6 cm) resistant to conservative therapy. At needle treatments, the consistency was assessed as hard or soft (slurry calcific deposit). In each imaging examination, the calcifications were divided into two groups. In radiographs, calcifications were divided into "well-defined" and "ill-defined." In US, they were divided into calcifications with acoustic shadow and calcifications with a faint shadow or no shadow. On CT, they were divided into homogeneous or nonhomogeneous calcifications. At CT, the density of the calcifications also was determined. The findings of consistency obtained at needle treatments were compared with the findings of plain radiography, US, and CT. RESULTS: At needle treatments, 45% (9 of 20) of the calcifications were soft or nearly liquid, and 55% (11 of 20) were hard. On plain radiographs, 67% (6 of 9) were as soft and 64% (7 of 11) as hard. On sonograms, 77% (7 of 9) were soft and 82% (9 of 11) were hard. On CT images, 77% (7 of 9) were soft and 91% (10 of 11) were hard; CT attenuation values were 77% (7 of 9) and 91% (10 of 11), respectively. CONCLUSIONS: Ultrasound and CT were reliable in predicting the consistency of rotator-cuff calcifications. Computed tomography attenuation values were the most accurate, and plain radiographs were the least accurate.

Acupuncture Therapy↗

PubMed1990

Consistently high users of medical care among the elderly.

This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.

Aged↗

PubMed2000

Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement.

STUDY DESIGN: A cross-sectional study of interobserver variability in primary care patients. OBJECTIVE: To investigate the consistency of signs and symptoms of nerve root compression in primary care patients with pain irradiating pain into the leg (sciatica). SUMMARY OF BACKGROUND DATA: The literature does not report on all the clinical tests for nerve root compression. In previous studies, most patients had low back pain with no irradiation. Often, little information on examination technique, proportion of positive test results, or clinical patient characteristics was provided. METHODS: A random selection of 91 patients was investigated by a neurologist-resident couple. Agreement percentages, proportions of positive test results, and kappas were calculated. RESULTS: The kappa of the overall conclusion after the history taking was 0.40, increasing to 0.66 after physical examination. Kappas were good for decreased muscle strength and sensory loss (0.57-0.82), intermediate for reflex changes (0.42-0.53), and poor for the examination of the lumbar spine (0.16-0.33). The straight leg raising, crossed straight leg raising, Bragard's sign, and Naffziger's sign were the most consistent nerve root tension signs (> 0.66). CONCLUSIONS: Two clinicians disagreed on the presence of nerve root involvement in one of four patients after history taking, and in one of five patients after physical examination. For a more consistent overall diagnosis, the physician probably should put more emphasis on the history of pain on coughing-straining-sneezing, a feeling of coldness in the legs, and urinary incontinence. The investigation of paresis, sensory loss, reflex changes, straight leg raising, and Bragard's sign provide the most consistent results.

Adolescent↗

PubMed2005

Do SpaceLabs ambulatory non-invasive blood pressure recorders measure blood pressure consistently over several years use?

OBJECTIVE: To assess the measurement consistency of SpaceLabs ambulatory recorders (Spacelabs, Washington, USA) that are in regular use. METHODS: A total of 14 SpaceLabs 90207 and one 90217 ambulatory recorders were tested for measurement consistency using the Dynatech CuffLink (Dynatech, Nevada, USA), a commercially available non-invasive blood pressure (NIBP) simulator. The NIBP recorders were tested at a range of pressures with 20 repeated determinations at a simulated 120/80 mmHg and five repeated determinations at simulated pressures of 80/50, 100/80, 150/100, 200/165 and 250/195 mmHg. Tests were carried out in 1998, 2002 and late 2003 or early 2004. CONCLUSIONS: All 15 SpaceLabs recorders measured consistently over the 6 years with 89.5% of the differences in average pressures, recorded by any particular device at each recorded pressure, less than 2 mmHg between successive test episodes. The maximum difference was 4.5 mmHg and 60.1% of the differences were less than 1 mmHg. The measurements for all devices were within the tolerances specified by the supplier for the device when tested with the simulator. Maintenance records also show that most devices required breakdown maintenance less than once every 3 years. The results show that the SpaceLabs devices maintain measurement consistency in the demanding conditions of ambulatory pressure recording over several years.

Aerospace Medicine↗