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PubMed2006

The MMPI-2 Restructured Clinical (RC) Scales and restraints to innovation, or "what have they done to my song?".

Rogers, Sewell, Harrison, and Jordan (2006/this issue) largely replicate in an independent clinical sample the MMPI-2 Restructured Clinical (RC) Scales developed by Tellegen et al. (2003). Nichols (2006/this issue) raises numerous concerns about the development and utility of the RC Scales, which on close appraisal did not change our view that the scales are well conceived and potentially valuable to researchers and clinicians alike. We present two case studies in which the RC Scales helped clarify complex MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles with multiple elevations on the Clinical, Content, Supplementary, and Personality Psychopathology Five (Harkness, McNulty, Ben-Porath, & Graham, 2001) scales. When interpretations refined by the RC Scales were discussed with the clients, each seemed to feel deeply understood. Reservations about instrument innovation can be appreciated as helping to counterbalance change and thereby ensure the MMPI-2's successful ongoing evolution. We discuss specific ways the MMPI-2 community could avoid polarization about the RC Scales.

Adult↗

PubMed1998

Prenatal cocaine exposure and child behavior.

OBJECTIVE: The aim of this study was to evaluate previous teacher reports that children exposed to cocaine prenatally have more problem behaviors. METHODS: A historical, prospective design was used. Maternal subjects (n = 116) of 6-year-old singleton, term (>/=36 weeks) children, and the children's first-grade teachers (n = 102) agreed to participate. The child's first-grade teacher, blinded to study design and exposure status, rated the child's behavior with the Conners' Teacher Rating Scales (CTRS) and an investigator-developed scale, the Problem Behavior Scale (PROBS 14), measuring behaviors reported by educators to be specific to cocaine exposure. Mothers were interviewed by telephone regarding demographic and socioeconomic factors. RESULTS: Although the cocaine-exposed group had higher (more problem behaviors) for each of the CTRS subscales, the overall multivariate analysis of variance for the CTRS was not significant. Children exposed to cocaine prenatally had higher scores (more problem behaviors) for 11 of the 14 PROBS items and the overall multivariate analysis of variance relating prenatal cocaine exposure to the PROBS was significant (Wilkes' lambda =.775), even after controlling for gender and prenatal exposure to alcohol and cigarettes. CONCLUSIONS: This pilot study supports that teachers blinded to exposure status of early elementary students did rate the cocaine-exposed group as demonstrating significantly more problem behaviors than control children. Although an important first step, postnatal factors that also may influence behavior were not evaluated; hence, causation is not addressed.

Case-Control Studies↗

PubMed2004

[Changes of the oral mucous membrane in patients after transplantation of haematopoietic cells].

Myeloablative chemotherapy used prior stem cell transplantation produces epithelial injury including oral cavity. Both damage by chemotherapy and subsequent infections cause mucositis. The aim of the study was to evaluate mucositis in a group of 31 patients. Patients aged 18-67 yrs (mean 42 yrs): 28 with blood neoplasms and 3 with aplastic anemia, were observed on days 0, 3, 5, 7, 9, 14 and 30 after transplantation of haematopoietic cells (autologous in 20 cases and allogeneic in 11 cases). The intensity of mucosal inflammation was evaluated according to 3 scales: WHO, Bearmann and 5-degree scale developed by the authors. This last scale, unlike other scales, was based on an accurate stomatological evaluation of the mucosal changes. A positive correlation was found between the intensity of mucosal inflammation and granulocytopenia <500/microl (p<0.01) and also between the presence of petechiae with blood platelet level <20.000/microl (p<0.001).

Adult↗

PubMed1994

[Assessment of the deepness of coma in children. Evolution of clinical thoughts].

Clinical assessment is an essential fundamental element in the evaluation of comatose states, particularly in children. Paediatricians quickly recognized that the early Glasgow Coma Scale, used for over 20 years in adults, is inadapted for children because it lacks brain stem criteria, involves interpretation of motor response (particularly difficult in infants) and uses verbal response which is of little value before language acquisition. The first attempt at standardized coma assessment in children was the Paediatric Coma Scale, developed in Australia in 1982. This scale improved on the Glasgow scale, removing the motor retraction response, modifying the verbal response scale (normal, words, sounds, crying, or none) and quantifying the best possible score as a function of age. In 1983 a fundamental modification was proposed in the Jacob scale. Besides removing the motor retraction response, this scale replaced the verbal scale with one based on ocular behaviour, thus evaluating consciousness of presence or stimulation. The vestibular response and pupil reactions were also included to assess brain stem activity. In 1987, we introduced the Bicêtre scale which uses ocular behaviour instead of verbal response and separates ocular diameter as a specific criteria. Assessment of four reflexes (mimic, photomotor, cornea and cough) provides precise information on the activities of the different levels of the brain stem. Several comparative studies have been conducted to determine the positive predictive value and interpersonal variability of these scales. In a prospective multicentric study of 277 comatose children aged 6 months to 15 years, we found that the Bicêtre scale had a positive predictive value of 94% for good outcome at 24 hours and that interpersonal disagreement occurred in only 10.1% of 65 cases studied (compared with 13.5% for the Glasgow scale which was studied simultaneously). Paediatricians now have reliable clinical scales for assessing the conscious level in children.

Adolescent↗

PubMed1993

The Chinese General Health Questionnaire in a psychiatric setting: the development of the Chinese scaled version.

The development of the Chinese scaled GHQ-20 was based on the factor analysis of the item responses of 150 general psychiatric patients with the Chinese GHQ-60. The five subscales assessing the symptom areas of dysphoric functioning, health concern, anxious coping, sleep problems, and suicidal ideas were found to discriminate significantly the sample of patients from another sample of 653 nonpatients. As a scale, the Chinese GHQ-20 was also found to be comparable to the full Chinese GHQ-60 in screening for individuals who might benefit from psychiatric consultation. The implications for its use as a refined instrument to monitor therapeutic change of patients in different symptom areas are discussed.

Adolescent↗

PubMed2004

Development and preliminary validation of the Glasgow Content of Thoughts Inventory (GCTI): a new measure for the assessment of pre-sleep cognitive activity.

OBJECTIVE: To develop a self-report measure (the Glasgow Content of Thoughts Inventory [GCTI]) for the assessment of pre-sleep cognitive activity in adults with sleep-onset insomnia. DESIGN: A psychometric, scale development approach was used. METHOD: Over three consecutive nights, 12 people with insomnia provided 'live' audio-recordings of pre-sleep thought content, which were used to generate an item pool. The results were compared to the content and categorical structure of pre-sleep cognitive activity identified by Wicklow and Espie (2000), and commonalities in thought content were used to generate a draft scale. Following further piloting, a 25-item scale was developed and administered to two groups (29 people with insomnia and 29 good sleepers), along with other self-report measures, objective (actigraphic recordings) and subjective (diary) sleep indices, and results analysed to evaluate the psychometric properties of the scale. RESULTS: The GCTI demonstrated evidence of construct validity, successfully discriminated between individuals with insomnia and good sleepers, and was significantly correlated with existing measures of sleep disturbance. A score of 42 yielded a sensitivity of 100% and specificity of 83%. The GCTI demonstrated good test- retest reliability (ICC = .88) and internal consistency (alpha = .87). CONCLUSIONS: The GCTI appears to be a valid and reliable instrument for use with patients with sleep-onset insomnia.

Adolescent↗

PubMedDate not supplied

Newly developed short behavior scale for use in stroke outcome research.

This study was designed to examine the scale quality of our newly developed short behavior scale and to identify its role in predicting the functional outcome of stroke patients. The short behavior scale consists of six items that assess cognitive function related to the daily behavioral status of a patient in activities of daily living and exercise. It can be scored quickly through observation of a patient's behavior. We assessed 190 stroke inpatients, who had a mean age of 61 years. The mean days and length of stay from onset were 47.3 and 138.2, respectively. We examined internal consistency with the Cronbach's alpha coefficient. Interrater reliability was tested by having two examiners evaluate 30 patients independently. We studied how the short behavior scale correlated with the admission Functional Independence Measure, Mini-Mental State Examination scores, and speech and visuospatial functions. We also studied how the short behavior scale contributed to the prediction of discharge Functional Independence Measure raw scores with stepwise multiple regression analysis. In another group of 116 patients, we cross-validated our predictive equation. The Cronbach's alpha coefficient was 0.88. The intraclass correlation coefficient was 0.84 for total score. The short behavior scale correlated significantly with cognitive Functional Independence Measure scores and Mini-Mental State Examination scores. We could explain 70.8% of the variance of discharge Functional Independence Measure scores from the Short Behavior Scale, days from onset to admission, age, speech scores, and admission Functional Independence Measure scores. Stability of the predictive equation was shown in cross-validation to a second sample of 116 patients. In conclusion, our newly developed short behavior scale proved reasonable and would be useful to enhance the precision of outcome prediction in stroke rehabilitation.

Activities of Daily Living↗

PubMed2004

[Development of a scale to measure Korean smoking temptation].

PURPOSE: Smoking temptation is the central concept related to relapse within the context of smoking. Therefore for effective smoking cessation interventions, a scale to measure smoking temptation is necessary. This study was carried out to develop scale to measure smoking temptation. METHOD: This study utilized Cronbach's alpha, spilt-half coefficient and test-retest correlation in analyzing the reliability of the collected data and expert group, factor analysis, item analysis multitrait-multimethod method and known-group technique to analyze validity. RESULT: Twenty-five items were selected from a total of 33 items. The Cronbach's alpha coefficient for internal consistency was .93, spilt-half coefficient .91, and 2 week interval test-retest correlation .93 for the 25 items on the smoking temptation scale. Five factors evolved by factor analysis, which explained 57.28 % of the total variance. The smoking temptation scale was effective in differentiating the subjects at each stage of change for smoking cessation and there were significant negative correlations between smoking temptation and self efficacy for smoking cessation and significant positive correlations between smoking temptation and the Fagerstrom Tolerance Questionnaire. CONCLUSION: The scale for measuring smoking temptation in Korean in this study was evaluated as a tool with a high degree of reliability and validity.

Adult↗

PubMed1999

[Comparison between the poisoning severity score and specific grading scales used at the Department of Clinical Toxicology in Krakow].

The aim of the present study has been to assess the concordance in severity grading when using the Poisoning Severity Score (PSS), proposed by IPCS/EC/EAPCCT vs. some specific grading scales. Cases of acute poisoning admitted to the Department of Clinical Toxicology in Kraków during months January, March, May, July, August and October 1998 (n = 820) were evaluated. Severity grading was performed in all cases using both the PSS and special grading scales developed by the poisons centre in Kraków. The PSS is assessing severity on the basis of observed clinical signs and symptoms (at their maximum), but does not take into account potential risks or plasma/serum concentrations. The Kraków scales include both clinical symptoms on admission and results of toxicological analyses. Ethanol (39.4%), drugs (36.2%) and carbon monoxide (7.9%) were the most commonly involved toxic agents. Overall concordance between the PSS and the Kraków scales was at hand in 596 cases (72.7%). The lack of concordance was most evident for ethanol and carbon monoxide cases--the PSS generally giving a lower grade. The discordance was less pronounced for grade 3 (life-threatening) poisonings. Significant number of ethanol poisoning in Kraków centre require medicolegal certification thus ethanol concentration (blood or expired air) is considered while evaluating the poisoning severity. Moreover majority (more than 70%) of acutely ethanol poisoned patients treated at the Department are chronic alcoholics so clinical evidence of intoxication may be minimal at blood ethanol levels higher than 3.0 g/L. For ethanol intoxication the blood ethanol concentration was considered in the Kraków scale but not in the PSS, and when the blood concentrations were disregarded and clinical symptoms only were evaluated the concordance improved between the different systems from 72.7% to 92.3%. Thereby also the overall concordance in the study increased to 82.9%. The less satisfying concordance for carbon monoxide cases was mainly caused by discrepancies in the evaluation of neurological symptoms. Also the blood lactate concentration, COHb level, duration of exposure and patient's age are considered in the Kraków scale but not in PSS. The PSS is intended as a general scheme for grading severity of acute poisoning. In this study an acceptable concordance between the PSS and some locally developed grading scales was at hand in the majority of cases, but it seems that for specific poisons, like carbon monoxide, some modifications and additional criteria may be justified. Further studies to test the reliability of the PSS are encouraged.

Adult↗

PubMed2005

Scaled suction for microneurosurgery: technical note.

OBJECTIVE: We have developed scaled suction to facilitate the measurement of aneurysm neck width and tumor size during operations. METHODS: We constructed a new suction device scaled every 1 mm from the tip to 3 cm and every 5 mm from 3 to 5 cm. The scaled suction devices have been used in 50 aneurysm and brain tumor operations. RESULTS: The new suction device permits easy measurement of aneurysm neck width, tumor size, the extent of internal decompression of tumor, and depth from the surface of the brain to the lesion. CONCLUSION: Our scaled suction device is a simple and useful navigator for continuously measuring intraoperative variables such as lesion size and distance between the lesion and the surrounding vital structures.

Aneurysm↗

PubMed1996

Development of a scale to measure directive guidance by pharmacists.

OBJECTIVE: To develop and test a questionnaire that can be used to measure directive guidance behaviors by pharmacists. QUESTIONNAIRE DESIGN: The Purdue Pharmacist Directive Guidance (PPDG) scale was developed based on the directive guidance dimension of socially supportive behaviors, as described by Barrera and Ainlay. The final scale consists of 10 items. SUBJECTS: Individuals on the Walker Test Crew database who were 18 years of age or older and self-reported taking medications for asthma, hypertension, and/or diabetes in the past 3 months were eligible for inclusion. All data were collected through telephone interviews. A total of 464 contacts were made, resulting in 300 responses. DATA ANALYSIS: Principal components analysis was performed to determine the construct subscales of the PPDG. Internal consistency of the PPDG and its subscales was assessed using Cronbach's alpha and corrected item-total correlations. Pearson product-moment correlations of the PPDG with measures of family and friend support (FFS) and self-reported medication adherence were used to determine convergent validity. Spearman rank-order correlations of the PPDG with the total number of prescription medications as well as those for asthma, hypertension, and diabetes taken in the past 3 months were obtained. ANOVA and Student's t-tests were used to determine differences in PPDG across demographic characteristics. RESULTS: Principal components analysis yielded two subscales for the PPDG. These were named Instruction and Feedback and Goal Setting, based on their content. The PPDG scale had good internal consistency (Cronbach's alpha = 0.86), and correlated positively and significantly with FFS (r = 0.27), giving some evidence of convergent validity. The PPDG scale and its subscales also had logically intuitive positive and significant correlations with the total number of prescription drugs taken in the past 3 months. CONCLUSIONS: The PPDG is short and easy to administer, and showed validity and reliability. The PPDG scale should be useful in developing a better understanding of the process by which pharmacists influence healthcare outcomes, assessing variations in pharmaceutical care, and as a tool in identifying means of overcoming barriers to higher levels of pharmaceutical care.

Adult↗

PubMed1998

The responsiveness of disease-specific and generic health measures to changes in the severity of asthma among adults.

The objective of the study was to compare the validity of asthma-specific and generic health outcome measures in relation to changes in the severity of asthma and to treatment. Adult patients (n = 142) participating in a randomized placebo-controlled trial at six clinics were assessed at baseline, prior to the withdrawal (placebo) or continuation of treatment with Vanceril and again after 8 weeks. The criterion measures of change in severity included pulmonary function expressed as the percent predicted FEV1, five physician-assessed asthma severity measures (cough, chest tightness, wheezing, shortness of breath and overall condition) and two patient-assessed severity measures (night-time symptoms and overall symptoms). The 8 week change scores were estimated for all generic and specific measures and the results were compared across groups of patients who did and did not change in terms of clinical criteria of disease severity and across treatment groups. The responsiveness of each generic and specific measure was estimated independently using the relative validity (RV) methodology, which compares F-ratios for the mean change scores across measures in analyses of the same comparison groups. RV coefficients estimate how much worse each measure discriminated between comparison groups, relative to the best measure (RV = 1.0). Four standardized asthma-specific measures and a total scale score (based on the Marks questionnaire), an individualized asthma-specific scale measuring limitations in activities most important to each patient (based on the Juniper method) and two newly-developed scales measuring physical and psychosocial symptoms were used as outcome measures, generic health outcome measures included eight functional health and well-being scales as well as the physical and mental health summary scales from the SF-36 health survey. A standardized asthma-specific scale was most valid in discriminating between groups of patients who did and did not change according to all of the clinical criterion variables studied and in discriminating between treated and untreated groups. Different scales performed best, depending on the clinical criterion. The asthma-specific Marks breathlessness scale was significant in all nine comparisons (RV = 0.62-1.0) and was most valid in discriminating between groups in six of nine tests. The overall scale also performed well in all comparisons (RV = 0.58-1.0). The newly-developed physical symptoms scale was significant in discriminating between groups in eight out of nine tests (RV = 0.52-1.0) and was most valid in three of the nine, including the treatment comparison. The psychosocial impact scale discriminated significantly in eight of the nine comparisons (RV = 0.16-0.38), but was less valid than other specific measures. The asthma-specific individualized activities scale discriminated significantly in seven of the nine tests, but performed less well than the other specific measures (RV = 0.21-0.35) and was not significant in the treatment comparison. One or more SF-36 scales discriminated significantly between groups in all nine comparisons. Two of those scales (physical functioning and role-physical) were consistently more valid than the others (RV = 0.17 and 0.58, respectively) and were the only two generic scales that discriminated between groups of patients defined in terms of changes in FEV1 (RV = 0.26-0.58). The SF-36 physical summary scale discriminated significantly between groups in all nine comparisons (RV = 0.19-0.61) and was the most valid generic measure in the treatment comparison (RV = 0.55). The SF-36 mental summary scale was significant only for the two patient-assessed changes in disease severity (RV = 0.31 and 0.32) and for physician-assessed overall severity (RV = 0.12). A comprehensive battery of generic and specific measures is likely to be most useful in understanding the impact of changes in disease severity on the functional health and well-being of adults with asthma, a

Activities of Daily Living↗

PubMed1997

Development and validation of an instrument to measure factors related to colorectal cancer screening adherence.

This report describes the development and refinement of a set of scales for use in research on predictors of colorectal cancer screening adherence. The study population included 2693 of 4490 eligible white male automotive employees who answered a mailed questionnaire (60% response rate) on beliefs and attitudes related to colorectal cancer and screening. Exploratory and confirmatory factor analyses and multitrait scaling analysis were used to evaluate the construct validity of a priori scales developed to measure salience and coherence, perceived susceptibility, worries about screening, screening efficacy, social influence, and intention. Analyses supported the construct validity of scales for salience and coherence, perceived susceptibility, and worries about screening. Four items originally assigned to the salience and coherence construct loaded on a separate factor that appeared to measure self-efficacy. There was no empirical support for scales measuring screening efficacy and social influence, and there was limited empirical support for a scale measuring intention. Confirmatory factor analysis of the scales measuring salience and coherence, self-efficacy, perceived susceptibility, and worries about screening showed a similar factor structure in white men with and without a personal history of polyps, indicating that the scales may be useful for studies of both colorectal cancer screening and surveillance. Multitrait scaling analysis showed some support for internal consistency reliability of those scales in women (n = 42) and in African-American men (n = 56), and there was some support for the factor structure in those two subgroups. Future studies should evaluate the psychometric properties of these and similar scales in diverse population subgroups.

Adult↗

PubMed2002

Measuring Chinese psychological well-being with Western developed instruments.

We explored the possibility of applying 4 psychological scales developed and commonly used in the West to Chinese culture. The participants, 273 Chinese and 302 Americans, completed measures of self-esteem (Self-Esteem Scale; Rosenberg, 1965), depression (Center for Epidemiologic Studies-Depression Scale; Radloff, 1977), social support (Multidimensional Scale of Perceived Social Support; Zimet, Dahlem, Zimet, & Farley, 1988), and suicidal ideation (Scale for Suicide Ideation; Beck, Kovacs, & Weissman, 1979). All scales were found to be reliable and valid cross culturally. Comparative analyses suggest that gender differences on all 4 scales are smaller among the Chinese than the Americans. Americans were more likely to score higher on the socially desirable scales (self-esteem and social support) and lower on the socially undesirable scale (suicidal ideation). However, no cultural differences were found in this study on the measure of depression. Results suggest that, with a few considerations or potential modifications, the current measures could be used in Chinese culture.

Adaptation, Psychological↗

PubMed2003

Development of a scale to predict decline in patients with mild Alzheimer's disease.

OBJECTIVES: To develop a scale that can assist in predicting likelihood of decline from mild dementia over 1 year in patients with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: University Memory and Aging Center. PARTICIPANTS: Patients with probable or possible AD and Clinical Dementia Rating (CDR) of 1 at baseline, divided into development and validation cohorts (n = 118 each). MEASUREMENTS: The CDR and neurological and neuropsychological assessments were given at baseline and 1 year later. RESULTS: In the development cohort, high education, low Mini-Mental State Examination score, poor insight, psychotic symptoms, and greater activity of daily living impairment predicted decline in CDR from 1 to 2 or 3. Receiver operating characteristics (ROC) curve analysis identified cutoff scores that maximized sensitivity and specificity for each significant predictor of decline. Based on the cutoff, raw scores were recoded to reflect risk for decline, weighted, and summed to create a final scale score. ROC curve analysis established a cutoff to indicate risk for decline on the final scale score. Sensitivity, specificity, and area under the ROC were 0.76, 0.74, and 0.83 in the development cohort and 0.77, 0.69, and 0.80 in the validation cohort, respectively. Positive and negative predictive values were 0.71 and 0.78 in the development cohort and 0.68 and 0.78 in the validation cohort, respectively. CONCLUSIONS: Decline from mild to moderate or severe impairment represents significant clinical change, with implications for patient and caregiver quality of life and treatment options. The clinical scale developed uses data to enhance prediction about change from mild to moderate or severe stages of AD.

Aged↗

PubMed1996

Scale morphogenesis during embryonic development in the lizard Anolis lineatopus.

The development of scales was analysed in embryos of the Jamaican Iguanid lizard Anolis lineatopus after the injection of cell proliferation markers [3H]thymidine and 5-bromodeoxyuridine. Embryos were fixed at successive postinjection periods, from 2 h up to 13 d and sections of developing skin were studied by autoradiography and immunocytochemistry. The epidermis during the initial stages of morphogenesis (flat epidermis and symmetric scale stages) expands chiefly by the tangential proliferation of the basal layer. The superficial periderm took part in its own laminar expansion. The rates of proliferation in the epidermis and dermis were similar during the flat epidermal stage, but dermal proliferation decreased under the wave-like epidermis of symmetric scales. No specific localisation of proliferating cells was visible either in the epidermis and or the dermis at these 2 early stages. Scale asymmetry is brought about by cell multiplication and hypertrophy of the cells of the future outer surface of the scale that behaves as an epithelial placode capable of producing beta-keratinised cells. The growth of the outer surface determines the asymmetry of the scale. Conversely, the future inner side and hinge region showed a lower degree of cell proliferation and cells remained cuboidal or became flat. Also the proliferation of the dermis under the scaling epidermis was significantly diminished. During the asymmetric scale stage, labelled cells were more common in the hypertrophied basel epithelium from 2 h until 4 d postinjection, during which time a few cells moved into the upper keratinizing layers. At 6-13 d postinjection, labelled cells were commonly seen in the upper beta-keratinising layers.

Animals↗

PubMed1988

Guidelines for nonclinical toxicology studies for chemical warfare agent (CWA) antidotes and pretreatments.

The following is a review of FDA's guidelines for nonclinical toxicology studies as applied to chemical warfare agent (CWA) antidotes and pretreatments. These specific guidelines are of major interest to the U.S. Army Medical Research and Development Command which is a full-scale developer of pharmaceuticals and active in the research and development of antidotes and pretreatments against CWAs. Antidotes and pretreatments against CWAs are unique classes of drugs whose nonclinical requirements are unlike most other pharmaceuticals. However, these guidelines have general applicability to pharmaceutical developers in the private sector and apply to any antidote or pretreatment regardless of the indication.

Antidotes↗

PubMed1991

Four-year follow-up of locomotor and language development in 34 twin pairs.

A group of 34 twin pairs was studied at four years of age. Characteristics of the group were a homogeneous social background, good parental interrelationship and conscientious care during pregnancy, delivery and the neonatal period. All the children were tested with the Griffiths' Mental Development Scales. The girls generally showed a higher development quotient than the boys. Birth weight seemed to be the most important factor; at 4 years of age, the twins with a birth weight of less than 2500 grams had a significantly lower locomotor quotient. The language quotient showed a similar trend. This difference was, however, not significant. No significant differences in either locomotor or language development could be observed between MZ and DZ twins.

Birth Weight↗