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PubMed2004

Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data.

BACKGROUND: Administrative hospital discharge data are widely used to assess quality of care in patients undergoing certain procedures. However, little is known about the validity of administrative coding of procedure data. We conducted a detailed chart review to evaluate the accuracy and completeness of information on procedures in administrative data. METHODS: We randomly selected 1200 hospital separations in the period April 1, 1996, to March 31, 1997, from administrative discharge data of 3 acute adult hospitals in Calgary, Alberta, Canada. Each separation record in administrative data contains up to 10 procedure coding fields. The corresponding medical charts were reviewed for recording presence or absence of procedures. We then determined sensitivity to quantify the accuracy of coding presence of procedures in administrative data when these are present in the chart data (criterion standard). RESULTS: The agreement between the 2 databases varied greatly across 35 procedures studied. The sensitivity ranged from 0% to 94%. Of 6 major procedures studied, validity of coding was generally good, with 5 procedures having coding sensitivity of 69% and over and only 1 (lysis of peritoneal adhesion) with a low sensitivity of 41%. In contrast, many minor procedures had low sensitivities. Of 29 minor procedures studied, sensitivity was lower than 50% for 15 procedures, between 50% and 79% for 10, and 80% and over for 4. CONCLUSION: Validity of information on procedures in administrative discharge data appears to be related to type of procedures. Major procedures that are usually performed in operating rooms are reasonably well-coded. Meanwhile, minor procedures that are routinely performed on wards or in radiology departments are generally undercoded.

Alberta↗

PubMed2004

Confirmatory factor analysis of the Reasons for Smoking Scale in alcoholics.

The Reasons for Smoking Scale (RSS), a self-assessment tool for identifying smokers' motives, has been in use for over 30 years. Previous factor validity studies, which relied exclusively on exploratory factoring procedures, have consistently extracted six scales from the RSS. In the present study, confirmatory factor analysis was conducted on the RSS in a mixed-gender sample of 189 treatment-seeking alcoholics. The objective was to validate the six-factor model of the instrument in a clinical sample of highly nicotine-dependent smokers. Results indicated strong support for the hypothesized six-factor solution. Internal consistency and convergent validity of the factors also were found to be good. The RSS appears to be an internally valid instrument for assessing smoking motives in alcoholics.

Adolescent↗

PubMedDate not supplied

[Psychometric characteristics of questionnaires designed to assess the knowledge, perceptions and practices of health care professionals with regards to alcoholic patients].

UNLABELLED: Failure of the French health care services to diagnose and manage problem drinkers has been established on many occasions. This results from a relative lack of knowledge of the basics of alcoholism and the low level of involvement of health care professionals in the management of these patients. In response to this inadequacy, the French Public Health Ministry promoted the development of managed care and coordination of care for these patients. Teams in charge of coordinating care for problem drinkers have been implanted in 96 French hospitals since 1996. These teams aim to provide support to health care providers caring for problem drinkers. For this purpose, they have delivered continuing medical education designed to prepare health care providers to identify and manage these patients in various settings. However, no formal assessment of the impact of these interventions on the knowledge, perceptions, and practices of health care professionals has been planned. The assessment of these interventions can rely on qualitative methods such as observation, focus groups, or individual interviews. However, qualitative methods require specific skills, are time-consuming, and cannot be implemented on a large scale. In contrast, quantitative methods using survey questionnaires or standardized instruments appear to be more appropriate for large scale or repeated evaluations. However, the accuracy of ratings provided by these instruments can be affected by many methodological factors, including the quality of the instrument in terms of validity, reliability, and sensitivity to changes. The aim of this paper is to describe the properties of French and English language questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients. METHODS: The instruments were retrieved by searching the Medline, Pascal, and Sudoc computerized bibliographic databases from January 1964 to December 2002. The following medical Subject Headings (MeSH) and text words were used: "*alcoholism/psychology/therapy", "questionnaire", "healthy care surveys", "attitude of health personnel", and "*knowledge/attitude/practice". In addition, the table of contents of the French journals devoted to alcoholism that were not indexed in electronic bibliographic databases were examined (Alcoologie et addictologie, Alcoologie). The bibliographies of relevant articles were also examined for additional citations. Finally, a phone survey of 34 professionals caring for alcoholic patients located in French university hospitals was carried out to retrieve unpublished questionnaires. Two authors independently extracted data from each study using a standard date abstract form. Disagreements were resolved through consensus. They extracted information on the development process and properties of validity, reliability, and sensitivity to changes. Validity is a concept concerned with the extent to which an instrument actually measures what it is supposed to measure. It is assessed through different facets (content, construct, criterion, discriminant, and predictive validity). Reliability reflects the amount of error inherent in any measurement. Sensitivity to change corresponds to the property of an instrument to identify small but clinically significant changes in attitude or practice. RESULTS: A total of 57 relevant publications involving 39 original instruments were identified. Eighty questionnaires were not available, despite the solicitation of their developers. Overall, the study included 21 instruments. Of these, 20 were English-language questionnaires and one was in French. The conceptual frameword was specified for only two questionnaires: "the Addiction Belief Scale" and "the Alcohol and Alcohol Problems Perception Questionnaire". The number of items ranged from 9 to 122. Items were derived from qualitative surveys in only two cases. In the other cases, they were derived from the literature, expert panels, or form unknown sources. The internal construct validity of eight questionnaires was assessed using principal component analysis, factor analysis, or cluster analysis. We considered that external construct validity was analyzed by testing empirical hypotheses derived from the literature for 15 of the instruments studied. Predictive validity cas evidenced for only one questionnaire. Internal consistency was documented for seven instruments, using Cronbach's coefficient. Test-retest or inter-rater reliability was assessed for none of the instruments. The sensitivity to change of two instruments was analyzed. The response rate to the instruments ranged from 46% to 93%. DISCUSSION: The main finding of this study is that properties of validity, reliability, and sensitivity of questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are neglected. Moreover, these questionnaires generally lack a theoretical background. Hence, the interpretation of responses to these questionnaires may be misleading. The present study has several limitations. The search strategy could be criticized for searching only a small number of databases, and selecting French and English language questionnaires. However, given the large range of journals included, it was unlikely that the strategy has limited the generality of the results. In addition, we identified no additional relevant articles by contacting professionals working with alcoholic patients in French university hospitals. Articles reporting instruments designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are incomplete. Journals should require minimum evidence of validity, reliability, and sensitivity when reporting results of surveys, development of questionnaires or standardized instruments. CONCLUSION: The psychometric characteristics of French language questionnaires were given very little attention. In order to evaluate the effectiveness of their continuing medical education programs, the teams that train French medical staff caring for alcoholic patients should either develop a standardized survey questionnaire following a strict methodology or translate an English language instrument, which would also require a cross-cultural validation.

Alcoholism↗

PubMed2006

Validity and reliability of the classroom participation questionnaire with deaf and hard of hearing students in public schools.

The Classroom Participation Questionnaire (CPQ) was administered to 136 deaf or hard of hearing (D/HH) students attending general education classrooms in Grades 4-10. The CPQ is a student-rated measure that yields scores for Understanding Teachers, Understanding Students, Positive Affect, and Negative Affect. Validity and reliability of a long (28-item) and a short (16-item) form are reported. We provide evidence of (a) internal structure validity through an examination of the relationships between the subscales and an analysis of interitem reliability within each scale, (b) reliability over time by examining the scores of students over a 3-year period, and (c) external structure validity through an examination of the relationships of the CPQ with measures of teacher-rated academic competence and Stanford achievement scores. The results suggest that both the long and short form of the CPQ can be used to assess participation of D/HH students in general education classrooms.

Adolescent↗

PubMed1983

Establishing diagnostic criteria for mania.

There has been general agreement on the symptoms of mania, but the validity of criteria for diagnosing mania have not been studied. The present study evaluates diagnostic criteria for mania by examining their internal construct validity, i.e., whether they are consistent with structure implicit in the concept of diagnostic criteria. Symptom information from 235 patients with varying diagnoses were studied. Elevated, expansive, or irritable mood, hyperactivity, and rapid or pressured speech were found to define a diagnostic classification of mania. Grandiosity and flight of ideas were related to this classification but did not contribute to its definition. Results suggested new diagnostic criteria for mania, with patients being diagnosed manic if they had at least two of the three designated symptoms. Additional information on the presence or absence of grandiosity and/or flight of ideas changed the diagnoses of only seven patients (3 per cent), all of whom had had the lowest certainty of diagnosis based on three symptoms. The entire study was replicated on an independent sample of 182 patients with nearly identical results.

Bipolar Disorder↗

PubMed2004

Status and prospects of in vitro tests in risk assessment.

According to the new chemicals policy of the European Union (EU), most chemicals, i.e. the 20,000 chemicals manufactured or imported at 1-10 tons annually, should be tested primarily by using in vitro methods. Also, for other chemicals, the use of in vitro methods is encouraged in the testing strategies given in the draft EU legislation. However, the validation and international acceptance of in vitro tests has been slow. Only recently has the OECD approved four new in vitro test methods, validated by the European Centre for the Validation of Alternative Methods. An analysis of ten randomly selected risk assessment reports of the EU Existing Chemicals Risk Assessment Programme showed that in vitro studies, for example, on cytotoxicity to different cell cultures, cell transformation, metabolism and skin penetration (a total of 115 studies) were used for the assessments. Key metabolic pathways and mechanisms of toxicity have been elucidated, for some chemicals, by using in vitro methods. On the other hand, the results of in vitro studies were regarded as secondary or unreliable in some cases. For several toxic endpoints, in vitro methods will probably serve as screening tools and for mechanistic studies, while target organ toxicity or physiologically regulated adverse effects caused by long-term exposure are difficult to observe without the use of animal models.

Animal Testing Alternatives↗

PubMed2004

A disease activity score for polymyalgia rheumatica.

OBJECTIVE: To develop a composite score for measurement of disease activity in polymyalgia rheumatica (PMR) and assess its internal and external validity. METHODS: A PMR activity score (AS) was designed and assessed for internal and external validity in two patient cohorts: 57 international patients evaluated primarily for development of the PMR-AS at baseline, weeks 4 and 24; and for validation, 24 Austrian patients assessed at baseline, week 4, and at a mean (SD) point of week 33.6 (24.5). The PMR-AS was calculated as: CRP (mg/dl)+VAS p (0-10)+VAS ph (0-10)+(MST (min)x0.1)+EUL (3-0); Cronbach's alpha was calculated. Factor analysis by linear regression was applied, and responses calculated on the basis of the PMR response criteria and the PMR-AS applied. PMR-AS values at different times were compared by paired t tests. RESULTS: Cronbach's alpha for the composite score was 0.91 and 0.88 in the two cohorts. Factor analysis showed that each single item contributed significantly to the total score and the relative weight of each item in both cohorts was equally distributed. Mean PMR-AS at baseline was 27.54 and 28.72, respectively, at week 4, 5.99 and 8.99, and at the final visit 5.35 and 5.92 (NS). PMR-AS values at baseline and at later visits were significantly different (p<0.0001). PMR-AS values <7 indicated low disease activity, 7-17 medium disease activity, and >17 high PMR activity. In a third control cohort the PMR-AS correlated highly with patient's global assessment, patient satisfaction, and ESR (p<0.001). CONCLUSION: The PMR-AS provides an easily applicable and valid tool for monitoring disease activity, and in combination with the PMR response criteria provides a better description of response.

Aged↗

PubMed1991

Coronary heart disease knowledge test: developing a valid and reliable tool.

This study tested the validity and reliability of a written test designed to assess knowledge of coronary heart disease (CHD) and its risk factors. The subjects were 93 males diagnosed with CHD. Subjects were classified into a treatment group (n = 48) or a control group (n = 45) based on whether or not they participated in a cardiac rehabilitation program (CRP). An additional 38 subjects were used to pilot test the original form of the knowledge test, which consisted of 80 multiple-choice questions. Content validity was established by a five-member jury of cardiac rehabilitation experts. Each question was rated using a Likert-type scale. Questions that did not receive an average rating of at least four were eliminated. The revised form was pilot tested for validity and internal consistency with the discrimination index (point biserial correlation coefficient) and the Kuder-Richardson formula 20 (KR-20). Questions with a discrimination index of less than 0.14 were eliminated; thus, the final form of the test consisted of 40 questions. Validation of this test yielded difficulty ratings (DRs) between 0 percent and 98 percent, with an average DR of 63 percent. Construct validation indicated that the average test score of subjects participating in a CRP was significantly higher than that of non-participants (t = 3.51, df = 91, p less than or equal to 0.01). The internal-consistency reliability of the test was 0.84. The results indicate that this test is a valid and reliable tool for assessing patients' knowledge of CHD and its risk factors.

Adult↗

PubMed2005

Validation of a modified version of the brief pain inventory for painful diabetic peripheral neuropathy.

Neuropathic pain is the focus of current clinical research, clinical identification, and treatment. It is unique from nociceptive pain and requires evaluation of the relevance and utility of common pain measures created for other painful conditions. This study evaluated the psychometric properties of a modified Brief Pain Inventory (BPI) for patients with painful diabetic peripheral neuropathy (BPI-DPN). Participants were patients with painful DPN (n=255) enrolled in a DPN Burden of Illness survey referred through 17 outpatient settings (primary care physicians, endocrinologists, neurologists, and anesthesiologists). Patients completed the BPI-DPN, and self-report measures of health-related quality of life, mood sleep, and healthcare utilization. Construct, criterion and discriminant validity, and internal consistency reliability were evaluated. Principal axis factoring with oblimin rotation revealed two interpretable factors (eigenvalues>1.0), consistent with most published BPI validation studies; a severity scale comprising the four BPI Severity items and an interference scale comprising the seven Interference items, which satisfied criteria for interpretability and model fit. Cronbach's alpha was high (0.94) for both scales. Mean pain Severity was highly correlated with Bodily Pain from the Medical Outcomes Study Short Form-12, version 2 (rs=0.63, P < 0.001), the Pain/Discomfort item in the Euro-QoL (rs=0.58, P < 0.001), and a verbal rating scale measure of pain severity (rs=0.74, P < 0.001). Individual BPI-DPN Interference domains were moderately correlated (rs's >0.5, P < 0.001) with analogous measures, and the Sleep Interference item had a high, significant association with the three primary Medical Outcome Study-Sleep scale subscales (rs's=0.66-71, P < 0.001). Worst Pain and Interference ratings were significantly associated with hospital utilization and outpatient visits due to DPN. These results replicate, in a pure peripheral neuropathic pain condition, the BPI psychometric characteristics documented in populations with nociceptive or mixed pain conditions. The BPI-DPN is a promising instrument in the evaluation of painful DPN.

Adolescent↗

PubMed2005

Validation of a modified version of the Brief Pain Inventory for painful diabetic peripheral neuropathy.

Neuropathic pain is the focus of current clinical research, clinical identification, and treatment. It is unique from nociceptive pain and requires evaluation of the relevance and utility of common pain measures created for other painful conditions. This study evaluated the psychometric properties of a modified Brief Pain Inventory (BPI) for patients with painful diabetic peripheral neuropathy (BPI-DPN). Participants were patients with painful DPN (n = 255) enrolled in a DPN Burden of Illness survey referred through 17 outpatient settings (primary care physicians, endocrinologists, neurologists, and anesthesiologists). Patients completed the BPI-DPN and self-report measures of health-related quality of life, mood sleep, and health care use. Construct, criterion and discriminant validity, and internal consistency reliability were evaluated. Principal axis factoring with oblimin rotation revealed two interpretable factors (eigenvalues > 1.0), consistent with most published BPI validation studies: a severity scale comprising the four BPI Severity items and an interference scale comprising the seven Interference items, which satisfied criteria for interpretability and model fit. Cronbach's alpha was high (0.94) for both scales. Mean pain Severity was highly correlated with Bodily Pain from the Medical Outcomes Study Short Form-12, version 2 (r(s) = 0.63, P < .001), the Pain/Discomfort item in the Euro-QoL (r(s) = 0.58, P < .001), and a verbal rating scale measure of pain severity (r(s) = 0.74, P < .001). Individual BPI-DPN Interference domains were moderately correlated (r(s)'s > 0.5, P < .001) with analogous measures, and the Sleep Interference item had a high, significant association with the three primary Medical Outcome Study-Sleep scale subscales (r(s)'s = 0.66-71, P < .001). Worst Pain and Interference ratings were significantly associated with hospital use and outpatient visits because of DPN. These results replicate, in a pure peripheral neuropathic pain condition, the BPI psychometric characteristics documented in populations with nociceptive or mixed pain conditions. The BPI-DPN is a promising instrument in the evaluation of painful DPN.

Adolescent↗

PubMed1994

[Multidimensional diagnosis in general medicine. Comparative study of the use of various instruments].

This study was performed to test three instruments for functional status assessment in General Practice: the Dartmouth Coop Charts (COOP Charts), the Functional Status Questionnaire (FSQ) and the Duke University Health Profile (DUHP). All the instruments covered a score of functional aspects in physical, mental and social areas, providing a multidimensional measure of health status. We used these three instruments, validated by international studies, to acquire information concerning their feasibility and acceptability among patients from rural communities needing primary care and to test their validity in differentiating between patient subgroups. The COOP Charts, the FSQ and the DUHP were administered by physicians respectively to 98, 100 and 97 patients, waiting for a visit in the ambulatories of their General Practitioner. Answers relating to each instrument were analyzed according to sex, age and education of patients. All the instruments seemed to be feasible and acceptable, but only the COOP Charts and the FSQ were able to discriminate between different sex, age and scolarity groups. Taking into account the need to elaborate answers according to a formula when using the FSQ, we concluded that the best instrument for General Practice to provide a multidimensional measure of health status seems to be the COOP Charts.

Adolescent↗

PubMed2003

Development and initial validation of a measure of coordination of health care.

OBJECTIVE: To describe the development and initial validation of the self-administered Client Perceptions of Coordination Questionnaire. DESIGN: The instrument was developed between 1996 and 1997 through iterative item generation; within a framework of six domains of coordination, addressed across four sectors of health care provision. SETTING: 1193 individuals with complex and chronic health care needs as judged by their general practitioners (GPs), who were participants in a 2-year randomized controlled trial of a coordinated care intervention in Australia. Other samples were collected in one general practice (98) and from attendees of a chronic pain management course (29). MAIN MEASURES: Face and content validity, completion rates, transferability, internal consistency, and construct validity of the 32-item instrument. RESULTS: Most items achieved excellent completion and comprehension rates. The instrument was transferable to another chronically unwell population. Cronbach's alpha of the entire instrument was 0.92, and for six individual scales scores ranged from 0.31 to 0.86. The six scales based on principal components analysis were acceptability, received care, GP, nominated provider, client comprehension, and client capacity. The first four scales were satisfactory, but the client scales were inadequate with poor internal consistency, and convergent and discriminant validity. People with chronic pain syndromes had significantly worse experiences for almost all items, supporting construct validity. CONCLUSION: This instrument is one of the first to attempt to measure coordination of health care. Its strengths include ease of completion, transferability, and promising psychometric properties and construct validity. Problems capturing data about the patient's contribution to coordination highlight a lack of theoretical development in this area. A valid measure of coordination should be useful in needs assessment, program evaluation, and individual provider/practice audit, and would contribute to research into the experience and measurement of patient-focused care.

Adolescent↗

PubMed2003

Evaluating the reliability and validity of three tools to assess the quality of health information on the Internet.

The quality of Internet information needs to be evaluated and several tools exist for this purpose. However, none have demonstrated reliability and validity. This study tested the internal consistency and validity of the information quality tool (IQT), quality scale (QS) and DISCERN using 89 web sites discussing smoking cessation. The inter-rater reliability of the tools was established by exploring the agreement between two independent raters for 22 (25%) of the sites. The IQT and DISCERN possessed satisfactory internal consistency (as measured by Cronbach's alpha). The IQT, QS and DISCERN showed satisfactory inter-rater reliability (as measured by kappa and intraclass correlations). The IQT, QS and DISCERN correlated positively with each other, supporting the convergent validity of the tools. This study provides some evidence for the reliability and validity of the IQT, QS and DISCERN, although this needs testing in further research with different types of Internet information and larger sample sizes.

Authorship↗

PubMed2007

Agonist-dependent internalization of D2 receptors: Imaging quantification by confocal microscopy.

In positron emission tomography and single photon emission computed tomography studies using D2 dopamine (DA) receptor radiotracers, a decrease in radiotracer binding potential (BP) is usually interpreted in terms of increased competition with synaptic DA. However, some data suggest that this signal may also reflect agonist (DA)-induced increases in D2 receptor (D2R) internalization, a process which would presumably also decrease the population of receptors available for binding to hydrophilic radioligands. To advance interpretation of alterations in D2 radiotracer BP, direct methods of assessment of D2R internalization are required. Here, we describe a confocal microscopy-based approach for the quantification of agonist-dependent receptor internalization. The method relies upon double-labeling of the receptors with antibodies directed against intracellular as well as extracellular epitopes. Following agonist stimulation, DA D2R internalization was quantified by differentiating, in optical cell sections, the signal due to the staining of the extracellular from intracellular epitopes of D2Rs. Receptor internalization was increased in the presence of the D2 agonists DA and bromocriptine, but not the D1 agonist SKF38393. Pretreatment with either the D2 antagonist sulpiride, or inhibitors of internalization (phenylarsine oxide and high molarity sucrose), blocked D2-agonist induced receptor internalization, thus validating this method in vitro. This approach therefore provides a direct and streamlined methodology for investigating the pharmacological and mechanistic aspects of D2R internalization, and should inform the interpretation of results from in vivo receptor imaging studies.

Animals↗

PubMed2005

Validation of a decision model for preventive pharmacological strategies in postmenopausal women.

BACKGROUND: Benefits and risks of a combined hormone replacement therapy (HRT) based on randomized clinical trial emerged on various disease endpoints in 2002. The Women's Health Initiative (WHI) provides an important health answer for healthy postmenopausal women, such as do not use combined HRT to prevent chronic disease, because of the elevated risk of coronary artery disease (CHD), stroke and venous thromboembolism. In March 2004, the NIH stopped the drugs in the estrogen-alone trial after finding an increase risk of stroke and no effect, neither an increase or a decrease, on risk of CHD after an average of 7 years in the trial. On the other hand, raloxifene, which does not seem to significantly increase the risk of cardiovascular events and could retain skeletal benefits without stimulating endometrial and breast tissue, requires decision-makers since no current data on these disease clinical endpoints have been published. OBJECTIVE: To construct a multi-disease model based on patient-specific risk factor profiles, and to validate the multi-disease model with several tools of internal and external validities. METHODS: A Markov state model was developed. The risks of these various diseases (including coronary artery disease, stroke, hip fracture and breast cancer) are derived from published hazards proportional models which take into account significant risk factors. Canadian-specific rates and data sources for these transition probabilities are derived from published studies and Canadian Health Statistics. The validation of our model were based on several tools of internal and external validities, such as Canadian life expectancy, population-based incidence rate of diseases, clinical trials and other published life expectancy models. RESULTS: First, presumably, small changes in the lifetime probability of dying support the hypothesis that the disease states operate in a largely independent fashion. For instance, the difference in the probability of dying from a particular disease by the complete elimination of a selected disease, such as CHD, stroke or breast cancer, ranged from 0.2 to 2.2% of difference in the lifetime probability of dying of these diseases. Second, we demonstrated that the model adequately predicted the Canadian population lifetable and disease-incidence rates from population-based data among women from 45 to 75 years old. The predictions of the model were cross-checked from non-source data, such as predicted outcomes versus observed outcomes from results of clinical trials. Predicted relative risks of CHD event, breast cancer and hip fracture fell in the reported 95% confidence interval of clinical trials. Finally, predicted treatment benefits are comparable with those of published life expectancy models. CONCLUSIONS: The results of the study demonstrated that this multi-disease model, including coronary artery disease, stroke, hip fracture and breast cancer, is a valid model to predict the impact on life expectancy or number of events prevented for preventive pharmacological interventions.

Aged↗

PubMed2002

Validation of questionnaires from several medical fields regarding the constitution of patients.

INTRODUCTION: To consider or determine an individual's 'warm and cold' constitution is common part of traditional Chinese medicine (TCM), Indian medicine (Ayurveda), anthroposophic medicine and classical natural medicine. OBJECTIVE: Common psychometric characteristics of 4 questionnaires should be examined. METHODS: 110 cancer patients and 110 non-cancer patients were asked to answer these questionnaires twice 4 weeks apart. Subsequent validation of the questionnaires included psychometrical qualities of item acceptability, sensitivity to change, construct validity (homogeneity), re-test reliability and group comparison. RESULTS: The Ayurveda questionnaire was considered suitable after reducing the questions from 22 to 8 (internal construct validity kappa = 0.64). The TCM questionnaire was considered unsuitable in our model because of the absence of construct validity. The questionnaire on anthroposophic medicine was considered a suitable and reliable tool with alpha = 0.57 (Cronbach's alpha) and r = 0.61 (re-test reliability) after reducing the questions from 6 to 4. The questionnaire on sensitivity to temperatures based on classical natural medicine was considered suitable after reducing the questions from 10 to 8 (alpha = 0.58; r = 0.73). Cancer and non-cancer patients differ in only one item, i.e. in their sensitivities to cold. CONCLUSION: The questionnaires for anthroposophic medicine, Ayurveda medicine and sensitivity to temperatures are in part suitable and reliable for determining individual constitutions according to their medical philosophy. The questionnaire based on traditional Chinese medicine failed these criteria. A difference between patients with or without malignant disease was only observed for sensitivity to temperatures. The anthroposophic hypothesis that cancer either changes an individual's thermic constitution or is caused by such a change could not be confirmed in this study.

Body Temperature↗

PubMed2001

Comparing the cost of epilepsy across eight European countries.

To observe the degree to which prices for medical services and anti-epileptic drugs (AEDs) vary between eight European Union (EU) countries, to identify the factors that are likely to contribute to these variations and to consider the validity of international cost-of-illness comparisons. Cost-of-illness study methodology has been used to estimate the national cost of epilepsy in several developed countries. The validity of comparing these studies is unknown. Eight EU member countries were selected. Charges and prices were obtained for important aspects of medical care of patients with epilepsy including AEDs. The perspective taken was that of the major health care payer within each country. Prices were validated by a local panel of doctors expert in treating epilepsy. Prices for similar services were compared between countries. Charges and prices levied to health service payer vary widely between the eight countries considered. The cheapest and most expensive medical services vary by as much as 24 times, whereas the price of AED varies up to 4.4 times. These wide variations suggest that prices do not reflect the true cost of providing these important aspects of epilepsy treatment. International comparisons between national cost-of-illness estimates relying on such prices should be interpreted with caution.

Anticonvulsants↗

PubMed1985

Temporal lobe signs: electroencephalographic validity and enhanced scores in special populations.

Internal and external validity tests were completed for an inventory that has been used to infer signs of temporal lobe lability. Strong, positive correlations were reported for a normal (reference) population between the numbers of responses that referred to paranormal experiences (including feelings of a "presence") and separately to religious beliefs and the numbers of spikes per minute within electroencephalographic recordings from the temporal lobe. Numbers of spikes were also correlated with the subjects' scores on the hysteria, schizophrenia, and psychasthenia scales from the MMPI. These clusters of items were not correlated with electrical activity from the occipital lobe (the comparison region). Numbers of responses to control clusters of mundane experiences were not correlated with the temporal lobe measures. A group of student poets scored higher on different subclusters of temporal lobe signs and on the schizophrenia and mania scales of the MMPI than the reference group. For both groups, there were positive correlations between the amount of alpha activity in the temporal lobe only and answers to items such as "hearing inner voices" and "feeling as if things were not real." These results demonstrate that quantitative measures of electrical changes in the temporal lobe are correlated with (or with the report of) specific experiences that are prevalent during surgical or epileptic stimulation of this brain region.

Adult↗