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PubMed1992

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Evaluation Studies as Topic↗
PubMed2002

Factors contributing to failed trials of new agents: can technology prevent some problems?

For psychiatry to contribute to the development of the next generation of antidepressant pharmacotherapies, effective use of clinical trial methods is as critical as innovation in neurochemical research. Results from clinical trials on the efficacy of a new drug can be obscured by methodological problems. Accurate diagnosis and precise measurement of the clinical symptoms during conduct of the clinical trials are crucial to obtaining interpretable outcomes. As tools that reliably diagnose disorders and assess symptoms become available, computer administration of rating instruments may improve the accuracy of clinical trial results. This article describes methodological factors that can confound study outcomes and discusses the potential for interactive voice response (IVR) technology to address some of these problems.

Antidepressive Agents↗
PubMed1985

Children's type A interview: interrater, test-retest reliability, and interviewer effect.

The Miami Structured Interview--1 was developed to assess Type A behavior in preadolescents and adolescents in the United States and Greece. This report describes the interrater and test-retest reliability of the Miami Structured Interview--1, and the effect of different interviewers on the assessment process. Interrater agreements on the A vs not A scale were 73% for Greek American (k = 0.49, p less than 0.01, n = 88), 80% for Mixed American (k = 0.61, p less than 0.01, n = 69), and 88% for Native Greek interviews (k = 0.76, p less than 0.01, n = 65). Exact agreements on a five-point scale were 48% (weighted k = 0.73, p less than 0.01), 42% (weighted k = 0.70, p less than 0.01), and 48% (weighted k = 0.80, p less than 0.01), respectively. Although levels of agreement were all greater than chance, rater bias was observed. Test-retest administrations within 10 min showed 91% agreement (k = 0.82, p less than 0.01) on the A vs not A scale. Analyses suggest interviewers can affect the assessment of Type A behavior. These findings indicate the Miami Structured Interview--1 can (1) reach acceptable levels of interrater reliability, (2) is susceptible to rater bias, (3) has sufficient test-retest reliability for use in longitudinal studies, and (4) must be presented in a standardized way before ratings from interviews conducted by different interviewers can be combined or compared. The strengths and limitations of the Miami Structured Interview-1 are discussed.

Adolescent↗
PubMed2001

Support for instruction about homosexuality in South Carolina public schools.

Research has demonstrated that recognition of sexual orientation begins in adolescence. However, students who identify as gay or lesbian report that the subject of homosexuality is virtually absent from classroom instruction. In South Carolina public schools, the subject of homosexuality may not be discussed except during instruction about sexually transmitted diseases. In 1997, survey data were obtained from 534 South Carolina registered voters to determine level of support for school-based sexuality education, including support for instruction about homosexuality. Overall, support for sexuality education was strong, however, homosexuality was the least-supported subject in the survey. In addition, registered voters were less sure as to what grade level instruction about homosexuality should begin. Characteristics of voters who supported and opposed instruction about homosexuality in the public schools were examined and compared. These data may be useful in building support for sexuality education programs that address this controversial topic.

Adolescent↗
PubMedDate not supplied

Navigating the job search superhighway.

The recent Cyberforum on "Navigating the Job Search Superhighway" gave 131 American College of Physician Executive members the opportunity to discuss the job search process, addressing questions and sharing what they've learned through their experiences in the medical management job market. Several comments that convey the essence of the discussion are listed, representing the various viewpoints of the participants. The words are from physician executives who have gone through the job search process and from some who have been involved in hiring decisions. The topics range from the value of experience to the importance of having a management degree to tips on networking to preparing for the interview. The final section on contract negotiation is a composite of comments on the subject during the Cyberforum.

Humans↗
PubMed1986

[Admission to a home for the aged; a solution for the lonely aged?].

The suitability of criteria on the base of which elderly are admitted to residential homes is a topic of current debate. The present research project explored the significance of the criterion of 'loneliness'. Data for this study were obtained from interviews with elderly inhabitants of Alkmaar. Individuals who spontaneously mentioned loneliness as an argument for admittance, as well as individuals who provided other criteria only, were part of the sample. In addition the respondents were classified according to gender, and to (still) living independently versus living in an institution. The data revealed that the elderly who spontaneously mentioned loneliness in their application differed in a number of ways from the other individuals in the sample. For example, their average scores on (validated) loneliness measuring instruments were significantly higher in the period prior to admittance to a residential institution. After admittance no significant differences in loneliness scores could be found between people who had previously mentioned loneliness as an argument and those who had not.

Aged↗
PubMed1992

Community hospital ethics consultation: evaluation and comparison with a university hospital service.

BACKGROUND: Ethics consultants may improve patient care by responding to physician requests for assistance with problems they identify as ethical issues. OBJECTIVE: To examine three aspects of ethics consultation: the clinical questions asked; the helpfulness of the consultation to requesting physicians; and the differences between consultations performed at a community teaching hospital and those performed at a university hospital. SETTINGS: A community teaching hospital and a university teaching hospital. SUBJECTS: Physicians who formally requested ethics consultations in both hospitals and the patients for whom they requested them. METHODS: Over 2 years (January 1, 1988, to December 31, 1989), we prospectively evaluated a newly established clinical ethics consultation service in a community teaching hospital using confidentially completed, pretested, structured questionnaires, and compared our data with previously reported university hospital data. RESULTS: During the 2-year study, 104 consultation requests were received from 68 physicians in eight departments. Requesters most often requested consultation about deciding to forego life-sustaining treatment (74%), resolving disagreements (46%), and assessing patient competence (30%). Requesters found the consultation "very helpful" or "helpful" in one or more aspects of patient care in 86% of cases, or in one or more aspects of physician education in 86% of cases. These data are similar to university hospital data.

Adolescent↗
PubMed1998

Subjective and objective assessments in patients with seasonal allergic rhinitis: effects of therapy with mometasone furoate nasal spray.

BACKGROUND: Efficacy of topical nasal steroid therapy for allergic rhinitis is usually evaluated by patient and clinician assessments of subjective symptom changes in diaries and at clinical interviews. OBJECTIVE: We sought to complement the subjective measures with objective measures of nasal cytology, biochemistry, and function. METHODS: In this double-blind, randomized study patients with seasonal allergic rhinitis (SAR) 12 years of age or older received 200 microg mometasone furoate nasal spray (n = 80) or placebo spray (n = 41) once daily for 2 weeks. Subjective assessments by clinician and patient comprised symptom/sign scores and overall therapeutic response evaluations. Objective measures included nasal cytology, nasal biochemistry, nasal airway resistance (NAR), mucociliary clearance, and olfactory functions. RESULTS: Mometasone furoate produced a significantly greater decrease than placebo in subjective measures of SAR for total symptom score (-46% vs -30%, p < 0.05), total nasal score (-47% vs -30%, p < 0.024), individual nasal symptom scores, and overall therapeutic response. The objective measures of eosinophil, basophil, and neutrophil counts and mucociliary clearance were significantly better in mometasone furoate- than in placebo-treated patients. Similarly, within-treatment statistically significant improvements were produced by mometasone furoate but not by placebo sprays for levels of eosinophilic cationic protein, tryptase and albumin, NAR, and odor identification. Significant positive correlations were found between NAR and nasal stuffiness and between eosinophils, basophils, and neutrophils and both eosinophilic cationic protein and albumin. CONCLUSION: Subjective measures of SAR were significantly improved in the mometasone furoate group by comparison with placebo-treated patients. Objective assessments supported the subjective findings because within-treatment measures were frequently significantly improved after mometasone furoate treatment but not after placebo treatment.

Administration, Intranasal↗
PubMed1999

Underreporting sensitive behaviors: the case of young women's willingness to report abortion.

Accurate reports are important in health research, yet abortions are underreported in surveys by almost half. This study examined influences on reporting of abortion among adolescents. Participants were 63 young women from varied ethnic backgrounds who had undergone abortions at urban abortion clinics. Participants reported on their willingness to be honest about their abortion in various research settings and in comparison with other sensitive topics. Willingness to report was also examined in relation to the sponsor of the research, the mode of administration, and the characteristics of the interviewer. Adolescents indicated less willingness to report abortion than some behaviors such as cigarette smoking, but they were more willing to report abortion than family income, oral sex, or anal sex. Comparison of willingness to report across research settings indicated that face-to-face interviews appear to generate more accurate reporting than telephone surveys. The implications of these findings for the study of other health behaviors are discussed.

Abortion, Legal↗