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PubMed1991

The definition and operational criteria for treatment outcome of major depressive disorder. A review of the current research literature.

A review of research articles published in nine journals over a 2-year period was conducted to determine how critical changes in the clinical course of depressive disorder are defined in the research literature. These change points, labeled by terms such as response, recovery, and relapse, are critical for evaluation and communication of study results. The review focused on studies of unipolar depression that used a criterion-based diagnostic system and involved some form of therapeutic maneuver. The review showed significant inconsistency in the labeling and definition of change points and indicated the need for more precise conceptual definitions and operational criteria to enhance comparison, generalization, and application of results from clinical studies of depression.

Depressive Disorder↗
PubMed1996

Psychotherapy of depression. Implications for reform of the health care system.

This article reviews the empirical evidence supporting the role of psychotherapy and psychosocial interventions in the treatment of patients with depression. Treatment models and the evidence for their effectiveness in the acute-and maintenance-treatment phases are reviewed. Whereas the sophistication of research designs and data analysis for the study of psychotherapy have substantially improved, the review highlights current gaps in our knowledge. Most important for reform of the health care system is the need for studies of efficacy to lead to large-scale investigations of effectiveness.

Adult↗
PubMed1988

Testing cholesterol accuracy. Performance of several common laboratory instruments.

The national emphasis on assessing coronary risk by cholesterol testing mandates that analytical determinations be as accurate and precise as is medically necessary. One goal of the National Cholesterol Education Program is to improve the quality of laboratory tests. Currently, 5% limits of imprecision and 5% of bias vs the nationally accepted Abell-Kendall reference method is recommended, with a goal of reducing these limits to 3% by 1992. Clinicians must be aware of how the cholesterol values are obtained, and especially whether the laboratory's method meets the performance goals. We assayed patients' serum samples for cholesterol using several commercially available, routinely used enzymatic methods and by the Abell-Kendall reference method. Precision of these methods was also assessed using serum-based controls. All instruments were operated precisely according to the manufacturers' instructions. Performance was objectively judged based on the National Cholesterol Education Program goals and on medically allowable total error. In all cases, the DuPont aca, the Kodak Ektachem, the Hitachi 737, and the Cobas FARA determined cholesterol levels acceptably. The precision and accuracy goals of 3% are achievable by these methods.

Adult↗
PubMedDate not supplied

Incomplete quality of life data in randomized trials: missing forms.

Analysing quality of life (QOL) data may be complicated for several reasons, such as: repeated measures are obtained; data may be collected on ordered categorical responses; the instrument may have multidimensional scales, and complete data may not be available for all patients. In addition, it may be necessary to integrate QOL with length of life. The major undesirable effects of missing data, in QOL research, are the introduction of biases due to inadequate modes of analysis and the loss of efficiency due to reduced sample sizes. Currently, there is no standard method for handling missing data in QOL studies. In fact, there are very few references to methods of handling missing data in this context. The aim of this paper is to provide an overview of methods for analysing incomplete longitudinal QOL data which have either been presented in the QOL literature or in the missing data literature. These methods of analysis include complete case, available case, summary measures, imputation and likelihood-based approaches. We also discuss the issue of bias and the need for sensitivity analyses.

Bias↗
PubMed2000

Mediator and moderator variables in nursing research: conceptual and statistical differences.

Mediators and moderators are variables that affect the association between an independent variable and an outcome variable. Mediators provide additional information about how or why two variables are strongly associated. In contrast, moderators explain the circumstances that cause a weak or ambiguous association between two variables that were expected to have a strong relationship. Mediators and moderators are often overlooked in research designs, or the terms are used incorrectly. This article summarizes the conceptual differences between mediators and moderators. The statistical analysis of moderators and mediators in multiple regression is briefly described and two examples are presented.

Humans↗
PubMed2004

Habit retraining for the management of urinary incontinence in adults.

BACKGROUND: Habit retraining is toileting assistance given by a caregiver to adults with urinary incontinence. It involves the identification of an incontinent person's natural voiding pattern and the development of an individualised toileting schedule which pre-empts involuntary bladder emptying. OBJECTIVES: To assess the effects of habit retraining for the management of urinary incontinence in adults. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised register (9 May 2002), MEDLINE (January 1966 to December 2002), EMBASE (January 1980 to Week 18 2002), CINAHL (January 1982 to February 2001), PsycINFO (January 1972 to current), Biological Abstracts (January 1980 to December 2000), Current Contents (January 1993 to December 2001) and the reference lists of relevant articles. We also contacted experts in the field, searched relevant websites and hand searched journals and conference proceedings. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing habit retraining delivered either alone or in conjunction with another intervention for urinary incontinence in adults. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment were undertaken by at least two people working independently of each other. Any differences were resolved by discussion. The relative risks for dichotomous data were calculated with 95% confidence intervals. Where data were insufficient for a quantitative analysis, a narrative overview was undertaken. MAIN RESULTS: Three trials with a total of 337 participants met the inclusion criteria, describing habit retraining combined with other approaches compared with usual care. Participants were primarily care-dependent elderly women with concurrent cognitive and/or physical impairment, residing in either a residential aged-care facility or in their own home. Outcomes included incidence and/or severity of urinary incontinence, the prevalences of urinary tract infection, skin rash and skin breakdown, cost and caregiver preparedness, role strain and burden. Caregivers found it difficult to maintain voiding records and to implement the toileting program. A 61% compliance rate was reported in one trial. There were no statistically significant differences in the incidence and in the volume of incontinence between groups. Within group analyses did however show improvements on these measures. Reductions were also reported for the intervention group in one study for skin rash, skin breakdown and in caregivers' perceptions of their level of stress. Descriptive data on the intervention suggests that habit retraining is a labour-intense activity. Electronic loggers, used as an adjunct to caregiver-delivered wet/dry checks, were reported as providing more accurate data than that from caregiver conducted wet/dry checks. To date, no analysis of the time and resources associated with these comparisons is available. REVIEWERS' CONCLUSIONS: Data on habit retraining are few and of insufficient quality to provide a firm basis for practice.

Habits↗
PubMed1980

The quantitative genetics of disease: ambiguities.

Here I review briefly some terms appropriate to the formal discussion of the genetics of disease. The motive for writing is that at least three kinds of participating experts are involved: pathologists, geneticists, and statisticians. Not only may some of the terms used in one field be unfamiliar to experts from another, the same term may be used in diverse ways among, or even within, fields. Such ambiguity may create illusory understanding or even frank confusion.

Genetics, Medical↗
PubMed1994

[Not Available].

In most instances, knowledge is passed on through the medium of language. The author tries to demonstrate to what extent the Latin present in early medieval Latin medical treatises failed to fulfill its role as an efficient medium of communication, which factors may account for this failure and how scholars in the middle ages strove to restore sense in texts in various stages of corruption, an attempt that was bound to be unsuccessful in many cases owing to a lack of reliable dictionaries.

Europe↗
PubMed1995

Methodological and statistical problems in the construction of composite measurement scales: a survey of six medical and epidemiological journals.

Composite measurement scales (CMS) are increasingly used in medicine to measure complex phenomena or concepts such as disease risk and severity, physical and psychological functioning and quality of life. To investigate the methodology currently used in the construction of CMS, we examined 46 studies recently published in six major medical and epidemiological journals. Important measurement properties such as measurement level, content and construct validity and reliability are often neglected. Statistical methods, particularly multivariate methods are frequently misused; verifications of model relevance and assumptions, and cross-validations to avoid overfitting are seldom performed. We propose recommendations for the construction and the presentation of CMS, to help authors and investigators to report and choose, respectively, measurement instruments for a complex phenomenon.

Data Collection↗
PubMed1985

Growth and development of biofeedback: a bibliographic analysis.

A computerized search was performed, and a bibliography was prepared on the subject of biofeedback covering the years from 1964 to 1985. Growth curves were produced for various publication media. The search produced references to 2,431 journal articles, 102 books, 79 popular magazine articles, and 551 doctoral dissertations. The journal articles were sorted according to the country of publication, language, and primary topic of the journal. Citations were found from 35 countries, written in 18 languages. All the media studied showed a period of rapid growth during the early to middle 1970s, but there was a tendency for leveling off or slight decline during the early 1980s. Publication of articles in medical journals has shown the greatest growth, and more articles are published yearly in medical journals than in journals of any other discipline or all specialty journals combined. Publication in psychological journals has shown a decline since 1977. Dental, nursing, and educational journals have shown a low rate of publication of biofeedback articles, indicating little or no growth.

Academic Dissertations as Topic↗
PubMed1988

Clinical-pathologic staging of large-bowel cancer. A report of the ASCRS Committee.

After surgical treatment in patients with large-bowel cancer, a prediction about the likelihood for cure remains uncertain despite the availability of several different types of staging systems. A committee of the American Society of Colon and Rectal Surgeons has reviewed the available data and concludes that future assessments of prognosis should be based on a combination of clinical and pathologic prognostic factors, using multivariate statistical techniques for the analysis. Although many important prognostic factors are known, there is much to learn about these and other items before a confident prediction of long-term outcome can be made. An extension of these methods should be possible to assist in prospective clinical decision-making based on clinical and investigational data. Such a system would be of particular value for patients with rectal cancer for whom cost-benefit relationships of alternative treatments can be so controversial. It is concluded that an accepted, standard nomenclature is required to reach both these objectives using large multicenter studies.

Colonic Neoplasms↗