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PubMed1999

Mouse models of airway responsiveness: physiological basis of observed outcomes and analysis of selected examples using these outcome indicators.

The mouse is an ideal species for investigation at the interface of lung biology and lung function. As detailed in this review, there are well-developed methods for the quantitative study of lung function in mice. These methods can be applied to mice in both terminal and nonterminal experiments. Terminal experimental approaches provide more detailed physiological information, but nonterminal measurements provide adequate data for certain experiments. In this review, we provide two examples of how these models can be used to further understanding of the primary pathobiology of airway responsiveness in both the absence and the presence of induced airway inflammation. The first model is a dissection of chromosomal loci linked to the variance in airway responsiveness observed in the absence of any manipulation to induce airway inflammation. The second model explores the role of T-cell costimulatory signals in the induction of airway hyperresponsiveness. As the number of mice with targeted deletions of effector genes or insertion of informative transgenes grows, additional examples are likely to accrue.

Allergens↗
PubMed1991

Perinatal events and future developmental outcome--assessment of a newborn's individual prognosis. 2. Prediction of outcome on the basis of perinatological data--results of multivariate discriminant analysis.

The aim of the prospective study described in this paper was to elaborate a prognostic screening method which allows to give an individual prognostic estimate for every newborn, with an accuracy acceptable for clinical purposes. This second part informs about the results of multivariate discriminant analysis, using the data from case histories as well as from the clinical and laboratory findings in the neonates (including "criteria of hypoxia"). According to the kind and number of abnormalities found on the occasion of out-patient consultations during the course of the first two years of life, and according to the developmental status reached at the age of two and six years, the children were classified under two alternative groups. Satisfying results were achieved in the discrimination between the groups of six-year-old children. As compared with the literature, the prognostic method proposed in this paper yields a relatively high accuracy of individual predictions, and therefore promises to become a good tool for clinical practice.

Child↗
PubMed2004

The effect of outcome information on doctors' evaluations of their own diagnostic decisions.

BACKGROUND: Outcome bias is a psychological tendency to use outcome information in order to evaluate the quality of a previous decision, where decisions with bad outcomes are undervalued and decisions with good outcomes are overvalued. In some circumstances, being affected by outcome when evaluating a diagnostic decision might have important educational consequences: bad diagnostic decisions resulting, by chance, in good outcomes might be repeated in the future, whilst good diagnostic decisions with bad outcomes might be abandoned. However, no previous studies have tested whether outcome bias affects doctors' evaluations of their own diagnostic decisions. METHODS: A total of 91 practising Italian doctors (69 general practitioners, 22 neurologists) chose a diagnosis for a neurological case and then evaluated it after receiving outcome information (positive outcome, adverse outcome or no outcome). RESULTS: Outcome information affected the doctors in many ways: the quality of the decision was overrated following good outcomes, and underrated following bad outcomes; the difficulty of making the diagnosis was underrated after good outcomes and overrated after bad outcomes, and the memory of weightings assigned to signs and symptoms consistent with the diagnosis was overrated after good outcomes and underrated after bad outcomes (and vice versa for the weighting of evidences inconsistent with the diagnosis). CONCLUSIONS: Outcome bias in medical decisions is discussed in terms of its possible adverse effects on doctors' learning and knowledge revision processes: although sensitivity to outcomes may be desirable in some circumstances, in other circumstances it can cause either the fixing of incorrect knowledge or the improper revision of correct knowledge.

Adult↗
PubMed2006

Improving the use of research evidence in guideline development: 6. Determining which outcomes are important.

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the sixth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on determining which outcomes are important for the development of guidelines. METHODS: We searched five databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct a complete systematic review ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: We did not find a systematic review that addresses any of the following key questions and we found limited relevant research evidence. What methods should WHO use to identify important outcomes? Methods of outcome identification should be transparent and explicit. The consultation process should start with identification of all relevant outcomes associated with an intervention. Those affected, including consumers, should be involved in the selection of outcomes. A question driven approach (what is important?) is preferable to a data driven approach (what data are at hand?) to identify important outcomes. What type of outcomes should WHO consider and how should cultural diversity be taken account of in the selection of outcomes? Desirable (benefits, less burden and savings) and undesirable effects should be considered in all guidelines. Undesirable effects include harms (including the possibility of unanticipated adverse effects), greater burden (e.g. having to go to the doctor) and costs (including opportunity costs). Important outcomes (e.g. mortality, morbidity, quality of life) should be preferred over surrogate, indirect outcomes (e.g. cholesterol levels, lung function) that may or may not correlate with patient important outcomes. Ethical considerations should be part of the evaluation of important outcomes (e.g. impacts on autonomy). If the importance of outcomes is likely to vary across cultures, stakeholders from diverse cultures should be consulted and involved in the selection of outcomes. How should the importance of outcomes be ranked? Outcomes should be ranked by relative importance, separated into benefits and downsides. Information from research on values and preferences should inform the ranking of outcomes whenever possible. If the importance of outcomes is likely to vary across cultures, ranking of outcomes should be done in specific settings. If evidence is lacking for an important outcome, this should be acknowledged, rather than ignoring the outcome.

Journal Article↗
PubMed2005

A review of the outcome expectancy construct in physical activity research.

BACKGROUND: Outcome expectancy is a central construct in social cognitive models of health behavior widely used as frameworks for physical activity research. PURPOSE: This article provides a review of the outcome expectancy construct and its application to research on physical activity. METHODS: Theoretical articles describing definitions and placement of outcome expectancy within social cognitive models, as well as empirical research on outcome expectancy and physical activity, were reviewed. RESULTS: Self-efficacy theory, the transtheoretical model, the theory of planned behavior, and protection motivation theory differ in their labeling and conceptualization of outcome expectancy but unanimously include expected outcomes of behavior. Preliminary empirical investigation of the role of outcome expectancy in understanding physical activity has yielded mixed results. Positive outcome expectancy appears to be more predictive of physical activity in older adults than in young to middle-aged adults, and personal barriers appear to be the most predictive subtype of negative outcome expectancy. In addition, a small number of studies indicate relations between outcome expectancy and other theoretical variables, including behavioral intention, stage of change, and self-efficacy. CONCLUSIONS: Further research on the role of outcome expectancy is necessary to design effective physical activity interventions. New directions in outcome expectancy research could involve (a) expanding the conceptualization of outcome expectancy to include expected outcomes of sedentary behavior and affective responses to physical activity, (b) further examination of potential moderators of the relation between outcome expectancy and physical activity (such as outcome value and outcome proximity), (c) distinguishing between the role of outcome expectancy in behavior onset versus behavior maintenance, (d) examining outcome expectancy as a mechanism of change in environmental intervention approaches, and (e) further analysis of interrelations between outcome expectancy and other social cognitive variables.

Attitude to Health↗
PubMed2003

Use of best and final visual acuity outcomes in ophthalmological research.

OBJECTIVE: To evaluate how often visual acuity outcomes are reported in the ophthalmological literature as best or final outcomes, despite potential bias with this type of analysis, as compared with interval outcomes, when a specific condition may continue to cause gain or loss of visual acuity beyond the time that the best or final outcome is determined. METHODS: Each article published in the 3 most frequently cited comprehensive clinical ophthalmological journals in the United States from January through December 2000 was reviewed. Clinical studies were identified in which visual acuity was used as an outcome measure. Visual acuity outcomes were examined throughout the articles and classified as follows: best visual acuity, defined as an outcome at any time during follow-up; final visual acuity, defined as an outcome at last follow-up; and interval visual acuity, defined as an outcome at specified follow-up times. A few factors that might be associated with the different types of outcome were evaluated. Reproducibility of the categorization between 2 ophthalmologists evaluating the articles was determined by using the kappa statistic. RESULTS: A total of 527 clinical studies met the criteria. Among these, authors of 195 reported visual acuity as an outcome measure. Authors of 1 article (0.5%) reported only best visual acuity, authors of 6 (3%) reported both best and final visual acuity, authors of 113 (58%) reported only final visual acuity, and authors of 73 (37%) reported interval visual acuity outcomes. Reproducibility of these categorizations between 2 ophthalmologists was considered excellent, as compared with chance alone (kappa = 0.84). Authors of only 2 of the 120 articles that used either best or final visual acuity outcomes discussed the limitations or potential bias of reporting outcomes in this way. Randomized trials and other prospective study designs more often were associated with interval outcomes than were nonrandomized and retrospective studies. CONCLUSIONS: Despite potential bias with use of best or final visual acuity outcomes, these end points alone were used in most studies published during 2000 in the 3 most commonly cited journals. Authors of clinical studies should consider avoiding use of best or final visual acuity outcomes whenever possible to minimize possible data misinterpretation. If best or final outcomes are used, authors should consider discussing the limitations of these methods and their potential effect on the interpretation of results.

Bias↗