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Post-training and pretest effects of adrenocorticotropin on retention: the influence of the hour of the day, the training-test interval, and pretest naloxone administration.

Rats received an ip injection of 0.2 microgram/kg of ACTH-(1-39) 1 min after step-down inhibitory avoidance training and/or 5 min prior to retention testing. Experiments were carried out either in the morning or in the afternoon using either a 3- or a 24-h training-test interval. Post-training ACTH induced memory facilitation in the morning and amnesia in the afternoon at both training-test intervals. Pretest ACTH reversed the afternoon amnesic effect, also at both training-test intervals. In addition, pretest ACTH induced a naloxone-reversible memory enhancement, both on its own and in animals treated with a facilitatory post-training dose of ACTH in the morning; this effect was seen only at the 24-h training-test interval. Naloxone had no effect of its own and did not influence the reversal of ACTH-induced amnesia caused by pretest ACTH in the afternoon. The results point to the variety of memory modulatory influences of ACTH, and to some of the factors involved in the elicitation of one or other effect, namely, the presumable basal rate of secretion of endogenous ACTH, and the previous pharmacological history of the animal.

Adrenocorticotropic Hormone↗

Pretest assessment as a component of safer sex intervention: a pilot study of brief one-session interventions for women partners of male injection drug users in New York City.

This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.

Adult↗

Value of assessment of pretest probability of deep-vein thrombosis in clinical management.

BACKGROUND: When ultrasonography is used to investigate deep-vein thrombosis, serial testing is recommended for those who test negative initially. Serial testing is inconvenient for patients and costly. We aimed to assess whether the calculation of pretest probability of deep-vein thrombosis, with a simple clinical model, could be used to improve the management of patients who present with suspected deep-vein thrombosis. METHODS: Consecutive outpatients with suspected deep-vein thrombosis had their pretest probability calculated with a clinical model. They then underwent compression ultrasound imaging of proximal veins of the legs. Patients at low pretest probability underwent a single ultrasound test. A negative ultrasound excluded the diagnosis of deep-vein thrombosis whereas a positive ultrasound was confirmed by venography. Patients at moderate pretest probability with a positive ultrasound were treated for deep-vein thrombosis whereas patients with an initial negative ultrasound underwent a single follow-up ultrasound 1 week later. Patients at high pretest probability with a positive ultrasound were treated whereas those with negative ultrasound underwent venography. All patients were followed up for 3 months for thromboembolic complications. FINDINGS: 95 (16.0%) of all 593 patients had deep-vein thrombosis; 3%, 17%, and 75% of the patients with low, moderate, and high pretest probability, respectively, had deep-vein thrombosis. Ten of 329 patients with low pretest probability had the diagnosis confirmed, nine at initial testing and one at follow-up. 32 of 193 patients with moderate pretest probability had deep-vein thrombosis, three diagnosed by the serial (1 week) test, and two during follow-up. 53 of 71 patients with high pretest probability had deep-vein thrombosis (49 by the initial ultrasound and four by venography). Only three (0.6%) of all 501 (95% CI 0.1-1.8) patients diagnosed as not having deep-vein thrombosis had events during the 3-month follow-up. Overall only 33 (5.6%) of 593 patients required venography and serial testing was limited to 166 (28%) of 593 patients. INTERPRETATION: Management of patients with suspected deep-vein thrombosis based on clinical probability and ultrasound of the proximal deep veins is safe and feasible. Our strategy reduced the need for serial ultrasound testing and reduced the rate of false-negative or false-positive ultrasound studies.

Algorithms↗

Efficacy of intravenous pretesting and antihistamine prophylaxis in radiocontrast media--sensitive patients.

Intravenous pretesting with radiocontrast media (RCM) was performed in 204 RCM-sensitive patients considered for repeat contrast radiography. Group 1 had vague histories of prior anaphylactoid reaction and negative pretests, and 2 of 41 (4.9%) had reactions upon contrast radiography. Groups 2 to 5 had definite histories of prior anaphylactoid reaction. Group 2 had the radiographic study cancelled: 18 of 21 (85.7%) had positive pretests. Group 3 had positive pretests and underwent contrast radiography, and 9 of 15 (60%) had reactions despite premedication. Group 4 (no premedication) and group 5 (diphenhydramine premedication) had negative pretests, but 11 of 53 (20.7%) and 3 of 71 (4.2%), respectively, developed reactions (p less than 0.001). The reaction frequency in group 3 (posivie pretest) of 12 of 18 (66.7%) was greater than that in groups 4 and 5 (negative pretest) combined (14 of 124 (11.3%), p less than 0.001). Intravenous pretesting identified a high-risk group and diphenhydramine premedication decreased the frequency of reaction in patients sensitive to radiocontrast media.

Contrast Media↗

White noise as a pretest sensitizer for neonatal hearing screening.

To determine the effects of white noise as a pretest sensitizer in neonatal hearing screening, 450 neonates were tested under 18 test conditions which also permitted examination of infant state and criterion stimuli (warble tone versus narrow band noise) as variables. There were three pretest conditions: No pretest sensitizer; 90 dB pretest sensitizer, and 100 dB pretest sensitizer. Each pretest condition was followed by either a 90 or a 100 dB criterion stimulus. Analysis concerned an increase in the number and in the strength of the responses. Generally, there was no benefit associated with the use of white noise as a pretest sensitizer.

Acoustic Stimulation↗

Naloxone eliminates passive avoidance retention deficits produced by pretest exposure to novelty in rats.

Pretest exposure to novelty or injections of beta-endorphin can enhance passive avoidance (PA) retention (e.g., Izquierdo & McGaugh, 1985). Enhanced retention may result from a "state-dependent" match between the CNS state during test and the novelty-induced beta-endorphin state that is obtained during training in a novel apparatus. Our Experiment 1 suggests that, unlike PA, Pavlovian fear conditioning in a conditioned lick suppression (CLS) paradigm may be beta-endorphin "state-independent." Rats were given one tone-shock pairing in a novel environment. Baseline lick rates and CLS tested 48 h later in a familiar environment were not affected by pretest exposure to novelty and/or injections of 3.33 mg/kg naloxone HCl. In Experiment 2, the same rats were PA trained/tested in a new apparatus. Saline or naloxone injections and various exposure (novel, familiar, none) conditions preceded (1h) the 24-h retention test. Pretest exposure to novelty reduced retention and naloxone eliminated that deficit. In Experiment 3, naive rats given pretest exposure to novelty also showed a PA retention deficit. The results of Experiments 2 and 3 may complement rather than contradict previous findings. Pretest induction of a beta-endorphin state by novelty may either enhance state-dependent retrieval of a "weak" memory trace or make a "strong/well consolidated" training memory more vulnerable to retroactive interference from "new learning" during the pretest exposure period.

Animals↗

Prediction of severe adverse reactions to ionic and nonionic contrast media in Japan: evaluation of pretesting. A report from the Japanese Committee on the Safety of Contrast Media.

In a nationwide prospective study of adverse reactions to intravenous contrast media (CM), the Japanese Committee on the Safety of Contrast Media compared high-osmolar ionic CM with low-osmolar nonionic CM. A total of 337,647 cases were analyzed. The reliability of pretesting with an intravenous injection of a small amount of CM as a means of predicting severe or fatal reactions was also evaluated. The predictive values of the pretest were 1.2% for ionic and 0.0% for nonionic CM, and the sensitivity values were 3.7% and 0.0%, respectively. Such low values render this test meaningless for predicting which patients are at risk of a severe adverse reaction. A comparison of the incidence of severe adverse reactions between the nonpretested and pretested patients, as well as between the nonpretested and pretested patients with negative results, disclosed no statistically significant differences. Also, no beneficial effects of premedication in patients with a positive pretest were proved. The authors therefore conclude that pretesting with an intravenous injection of a small amount of CM is not useful in predicting severe reactions to ionic or nonionic CM.

Contrast Media↗

Pretest and treatment effects in an elementary school-based alcohol misuse prevention program.

Forty-nine schools (N = 5,680 fifth and sixth grade students) were assigned to pretest/treatment, pretest/no treatment, no pretest/treatment, and no pretest/no treatment conditions in the context of an alcohol misuse prevention study. At the first posttest, five months after the pretest and two months after the intervention, the effects of the pretest and of the intervention were examined. The analyses showed that failure to correct for the design effect due to clustering within schools resulted in the overestimation of the significance of treatment and pretest effects. After correction for the design effect, a significant treatment effect in the hypothesized direction was found with respect to students' awareness of the content of the curriculum. As hypothesized, significant treatment effects on the alcohol use and misuse measures had not yet developed but are expected to occur at subsequent posttest occasions. Significant pretest effects were found for indices measuring trouble with peers resulting from students' alcohol use, students' internal health locus of control, and their perceptions of adults as a locus of control for their health. Two of the three pretest effects were in the direction that would be hypothesized if the pretest were providing the same impetus as the intervention. Implications of these findings for school-based substance abuse prevention programs are discussed.

Child↗

[The consideration and performing of pretesting of contrast medium: surveying in Kanagawa].

The pretesting of contrast medium is world widely recognized to be an invaluable method to predict the adverse reactions. It was still required to perform on patients who shall have a contrast examination until recently in Japan. In May of 1990 the contrast drug package insert was reviewed and a statement of "there is no known method to predict the adverse reactions" was included. Although two reports suggested that the percentage of not performing the pretesting was increasing gradually since then, the clinical communications between institutes did not support the truth. This study investigated the problem by surveying the area in Kanagawa-ken neighboring to Tokyo and revealed that: 1. The percentage of non-performing the pretesting is high in radiologist and urologist (both are 40%) but low in other physicians (18%). 2. The risky performances of pretesting in the area without emergent equipment are occurring daily. 3. The percentage of the approval to abandon the pretesting increased significantly (from 46% to 89% with p < 0.01) after the accurate information on pretesting was given. 4. To prevent the tragedy caused by risky performance, actively contacting with and offering the information are necessary.

Contrast Media↗

Influence of pretest waiting time and duration of induction on kinesthetic aftereffect.

The influence of pretest hand-resting time and induction time on kinesthetic aftereffect was determined for 22 males and females. Aftereffect was assessed with the apparatus of Koehler and Dinnerstein (1947). Three separate tests of aftereffect were administered. Each was preceded by either a 10-, 20-, or 30-min. hand-resting period. Significant differences in aftereffect were not found between pretest conditions. Scores were also determined for varying induction times at each pretest condition. Induction periods totaling 90-, 180-, and 300-sec. were used. Aftereffect was significantly less pronounced following 90 than 180 sec. of induction for the 10-and 20-min. pretest conditions but was the same following 90, 180, and 300 sec. of induction for the 30-min. condition. Results indicated that less than 300 sec. of induction could be used regardless of the duration of the pretest period. However, because the internal validity of the 180-sec. score was significantly better than the 90-sec. score, it was concluded that at least 180 sec. of induction were needed.

Female↗

Effect of the pretest probability of intrauterine growth retardation on the predictiveness of sonographic estimated fetal weight in detecting IUGR: a clinical application of Bayes' theorem.

Four hundred and five women with singleton pregnancies and fetal age determination by crown-rump length were classified on the basis of their prenatal clinical findings into four risk categories for intrauterine growth retardation (IUGR), defined as a neonatal weight below the 10th percentile of age-dependent birth weight distribution curve. The incidence of IUGR in these four groups were 3.5% (very low risk), 20.6% (low risk), 49.6% (intermediate risk), and 88.0% (high risk). Severe growth retardation (birth weight less than 2.5th percentile) increased from 0% to 76.0% as the incidence of IUGR increased throughout the risk groups. The effect of these pretest risks on the prediction of severe IUGR by sonographic estimated fetal weight (EFW) was evaluated. The positive predictive value of the test, as well as the probability of having a growth-retarded infant after a normal EFW was obtained were considerably higher when the pretest probability of IUGR increased. In the very low risk group, the probability of severe IUGR was negligible regardless of the EFW. When the EFW was less than 10th percentile of our age-dependent EFW curve, the probability of severe IUGR in the other risk groups was high enough to warrant fetal well-being surveillance and/or timely interruption of gestation as appropriate. However, when the pretest probability was high, the risk of severe IUGR in spite of an EFW within the 10th percentile to 90th percentile remained sufficient to require fetal well-being surveillance as well. The study shows that placing ultrasound results in the context of the pretest risk of IUGR may improve clinical decision making in pregnancies complicated by fetal growth retardation.

Bayes Theorem↗

Facilitation of memory retrieval by pretest morphine mediated by mu but not delta and kappa opioid receptors.

Mice were trained to avoid electric shock (0.6 mA) in a step-through type passive avoidance learning task, retention being measured 24 h after the training trial. Morphine 10 mg/kg administered 30 min before the test trial (pretest) facilitated memory retrieval, and the effect was completely antagonized by 1 mg/kg naloxone, a selective mu-opioid receptor antagonist. On the other hand, pretest administration of 0.01-10 mg/kg DTLET, a selective delta-opioid receptor agonist, did not produce the same effect as morphine. Nor-binaltorphimine, a kappa-opioid receptor antagonist, did not antagonize the effect of pretest morphine, at doses of 1 and 2 mg/kg. These results suggest that the facilitation of memory retrieval by pretest morphine is mediated through mu- but not delta- or kappa-opioid receptors.

Analgesics↗

Strain differences in open-field and elevated plus-maze behavior of rats without and with pretest handling.

Behavior of two rat strains was analyzed with and without 1-week pretest handling. Male rats (150-200 g body weight) of the strains PVG/OlaHsd (PVG) and Hsd:Sprague-DawleySD (SPRD) were tested once in a standard open field and an enriched open field and twice in an elevated plus-maze. Behavioral analysis revealed significant differences between the two strains and differential effects of the pretest handling procedure. SPRD rats displayed higher levels of activity and exploratory behavior than the PVG rats, whereas PVG rats were obviously less anxious. One-week pretest handling had an "anxiolytic" effect and changed activity and exploration-related behavior of the animals in both strains. Activity-related parameters were mainly affected in SPRD rats and anxiety-related ones in PVG rats. The data give evidence that differences in behavior of rats are not only determined genetically but also by preceding handling procedures. Because the two rat strains responded differentially to the pretest handling, we recommend to use a well-defined handling procedure before starting a behavioral test, especially when drug applications are included.

Animals↗

Memory facilitation by posttraining and pretest ACTH, epinephrine, and vasopressin administration: two separate effects.

Rats were trained in a step-down inhibitory avoidance task using a 0.3-mA, 2-s, 60 Hz footshock and tested 24 hr later. The animals received, 1 min after training and/or 5 min before testing, an ip injection of saline, ACTH (0.2 microgram/kg), lysine-vasopressin (10 micrograms/kg), epinephrine (5 micrograms/kg), naloxone (0.4 mg/kg), or a combination of naloxone with one of the hormones. Both the posttraining and the pretest injection of the hormones enhanced retention test performance; the enhancement was larger in animals that received the two treatments. Posttraining, but not pretest, naloxone administration also caused an enhancement. However, posttraining naloxone potentiated, and pretest naloxone antagonized, the effect of the concomitantly injected hormones. These data show that the posttraining and the pretest effect of the hormones are independent, are due to different mechanisms, and can be additive. In addition, it does not seem possible to explain posttraining memory facilitation by the hormones as owing to an addition to the reinforcement.

Adrenocorticotropic Hormone↗

Understanding pretest and posttest reactions to cognitive ability and personality tests.

To understand the nature of test reactions and their relationship to test performance, the relationships among belief in tests, pretest reactions, test performance, and posttest reactions were modeled for cognitive ability and personality tests. Results from structural equation models that were fitted to responses from 197 undergraduate examinees supported the hypothesized relationships. On the cognitive ability test, pretest reactions affected test performance and mediated the relationship between belief in tests and test performance. Test performance affected posttest reactions even after taking into account the effect of pretest reactions. On the personality test, belief in tests affected pretest and posttest reactions, but the three variables were unrelated to test performance (Conscientiousness scores). Conceptual, methodological, and practical implications of the findings are discussed in the context of research on test reactions and test performance.

Cognition↗

Power in randomized group comparisons: the value of adding a single intermediate time point to a traditional pretest-posttest design.

Adding a pretest as a covariate to a randomized posttest-only design increases statistical power, as does the addition of intermediate time points to a randomized pretest-posttest design. Although typically 5 waves of data are required in this instance to produce meaningful gains in power, a 3-wave intensive design allows the evaluation of the straight-line growth model and may reduce the effect of missing data. The authors identify the statistically most powerful method of data analysis in the 3-wave intensive design. If straight-line growth is assumed, the pretest-posttest slope must assume fairly extreme values for the intermediate time point to increase power beyond the standard analysis of covariance on the posttest with the pretest as covariate, ignoring the intermediate time point.

Humans↗

Pretest probability assessment for selective rest sestamibi scans in stable chest pain patients.

The objective of this study was to determine whether pretest probability assessments permit more selective testing of chest pain patients with technetium-99m sestamibi scanning. Pretest probabilities of cardiac ischemia were measured both objectively (Acute Cardiac Ischemia Time-Insensitive Predictive Instrument [ACI-TIPI]) and subjectively (physician's estimate of the probability of unstable angina). Two groups were defined: patients whose postsestamibi scan led to a "downgrade" of the intensity of monitoring and those that resulted in no change in monitoring intensity. Sixty-five patients met study criteria; 25 had a disposition downgrade and 40 had no change. Pretest ACI-TIPI scores were similar in the two groups (29% +/- 18% versus 27% +/- 11%, mean +/- standard deviation; P = .95) as were the physician's assessment of unstable angina (39% +/- 22% versus 40% +/- 24%; P = .75). Objective or subjective pretest probabilities are not significantly different in patients who are likely to have their disposition altered by sestamibi scanning.

Aged↗