Average Administration Time Research Articles

Developing and testing an electronic medication administration monitoring device for community dwelling seniors: a feasibility study

BackgroundMedication non-adherence, polypharmacy, and adverse drug events are major healthcare issues leading to significant morbidity, mortality, and healthcare expenditures. Currently, there are no methods to systematically track medication usage in community-dwelling seniors. The eDosette prototype was created to make medication use patterns visible via the Internet. This study aims to demonstrate feasibility, usability, and acceptability of the eDosette in community-dwelling seniors in primary care.MethodsA 2-week feasibility study involving a convenience sample of 10 patients from an academic family medicine teaching unit in Hamilton, Ontario, Canada, was conducted over a 6-month period between April and October 2015. The eDosette transmitted hourly electronic data via the Internet on each participant’s pattern of medication use; this data was converted into an individualized medication administration record (MAR). Based on the MARs from the 10 participants, the frequency of missed medication doses, the time of dose administration, and each participant’s adherence rate for their prescribed medications could be determined. A medication adherence survey and a patient usability and acceptability survey were administered to all the participants of the study.ResultsThe eDosette was able to record a participant’s medication use and transmit this data electronically via the Internet with sufficient quality to create participant-specific MARs. A total of 418 doses were captured by the eDosette throughout the study; only 5% (n = 22 doses) were missing information or had poor image quality. Analysis of the MARs revealed that 19% (n = 79 doses) were taken outside a 2-h window of the average dose administration time, and two doses were completely missed by all participants during this feasibility study. Participant feedback found the eDosette easy and acceptable to use. Participant feedback also identified hardware and software issues that require attention prior to a larger study.ConclusionsThe eDosette is a feasible and novel technology that can be successfully installed into the homes of community-dwelling seniors to help in monitoring actual medication use patterns. This study provided details for further device development and evidence to support the need for a larger pilot study on the eDosette’s impact on medication adherence.

The clinical application of tinnitus handicap index(THI-12) Chinese version

Objective:The original prospective of this study is to explore a convenient tinnitus severity assessment tool, using Chinese version of THI-12.Method:We surveyed 229 outpatients on their first hospital visits with primary tinnitus as chief complaint. Both the Chinese version THI-12 and the standard THI-25 were administrated. Their tinnitus grading and administration time were compared. The correlation between the two scores was evaluated. A reliability and factor analysis of the Chinese version of THI-12 was also performed.Result:Two hundred and fifteen of the 229 questionnaires were valid with a 93.9% response rate. The average administration time was(18.9±21.0) min for the standard THI-25 and(8.96±4.70)min for the Chinese version THI-12, which was significantly different. Pearson's correlation coefficient between the two total scores was r=0.833(P <0.01), which indicates a strong positive correlation.The tinnitus grading was not statistically significant(Z=-0.307，P >0.05).Cronbach's coefficient of THI-12 was α=0.765, suggesting good reliability and internal consistency. Factor analysis found three entries with characteristic values greater than 1. These three common factors explained 51.77% of the overall variance, suggesting that the 12 entries can be grouped into three dimensions(emotionality, sociality, concentration). Entry"Because of your tinnitus is it difficult for you to concentrate? "had the highest common value(0.78), suggesting that this entry would contribute the most should all entries be divided into three dimensions.Conclusion:The Chinese version THI-12 is time-efficient, has good reliability and internal structural validity, and provides good assessment of tinnitus severity.It can be widely applied in clinical practice.

Development and psychometric testing of the medication taking behavior tool in Thai patients.

The previous Thai version of the 8-item Morisky Medication Adherence Scale (8-item MMAS) showed poor sensitivity and unacceptable internal consistency reliability. To develop and test the psychometric properties of a new medication taking behavior measure for Thai patients (MTB-Thai) including practicality, reliability and validity. This study was conducted with adult outpatients regularly taking any medicines for at least three months from three university hospitals in Bangkok, Thailand, between July 2014 and March 2015. The study was approved by the Ethical Committees of the three hospitals. Practicality was assessed by administration time and the percentage of missing data. Internal consistency and test-retest reliability were evaluated employing Cronbach's alpha and intraclass correlation coefficients (ICCs), respectively. Validity was evaluated with content, construct, convergent and known-groups validity. Of 1156 patients, the 6-item MTB-Thai had an average administration time of 2 min and no missing data. It showed good Cronbach's alpha value of 0.76 and excellent ICCs of 0.83. The MTB-Thai showed good content validity with the item level and scale level of content validity indexes greater than the acceptable levels of 0.8 and 0.9, respectively. Both exploratory and confirmatory factor analyses showed the MTB-Thai had two domains including unintentional and intentional domains. The MTB-Thai correlated well with the overall medication adherence scale with a Pearson's correlation coefficient of 0.62 (p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the MTB-Thai were 76, 35, 55 and 57 %, respectively. The MTB-Thai was practical, reliable and valid in assessing mediation taking behaviors in Thai patients with chronic diseases.

Cross-cultural validation of the paediatric Gait, Arms, Legs, Spine (pGALS) tool for the screening of musculoskeletal disorders in Mexican children.

The aim of this study was to validate the paediatric Gait, Arms, Legs, Spine (pGALS) tool for Mexican Spanish to screen Mexican paediatric population for musculoskeletal (MSK) disorders. A cross-sectional study was performed in the Paediatric Hospital of the Mexican Social Security Institute in Guadalajara, Jalisco. The validation included children and adolescents aged 6-16years, 87 patients with musculoskeletal disorders and 88 controls without musculoskeletal disorders. The cross-cultural validation followed the current published guidelines. The average pGALS administration time was 2.9min (SD 0.54). The internal consistency score (Cronbach's α) was 0.90 (0.89 for inflammatory and 0.77 for non-inflammatory disorders) for MSK disorders, with a sensitivity of 97% (95% CI 92-99%), a specificity of 93% (95% CI 86-97%), a LR+ of 14.3, and a ROC curve of 0.95 (95% CI 0.92-0.98%). The inflammatory disorders group had a sensitivity of 97% (95% CI 86-99%), a specificity of 93% (95% CI 86-97%), a LR+ of 14.2, and a ROC curve of 0.95% (95% CI 0.91-0.99%). The non-inflammatory disorders group had a sensitivity of 98% (95% CI 89-99%), a specificity of 93% (95% CI 86-97%), and a LR+ of 14.37, with a ROC curve of 0.95% (95% CI 0.92-0.98%). pGALS is a valid screening tool, fast, easy to administer, and useful for detecting musculoskeletal disorders in Mexican children and adolescents.

Diagnostic Accuracy of the Primary Care Screener for Affective Disorder (PC-SAD) in Primary Care

Background:Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care.Methods:A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results:Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions:While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available.

Cultural adaptation and validation of the Pelvic Floor Distress Inventory Short Form (PFDI-20) and Pelvic Floor Impact Questionnaire Short Form (PFIQ-7) Spanish versions

ObjectiveTo develop a linguistically adapted and psychometrically validated Spanish version of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire Short Forms (PFDI-20 and PFIQ-7) to assess symptoms and quality of life in Spanish women with pelvic floor disorders. Study designCross-cultural linguistic adaptation was performed following the translation–backtranslation method in 30 native Spanish-speaking women with pelvic floor disorders to obtain PFDI-20 and PFIQ-7 Spanish versions. The psychometric properties were evaluated in 114 women with pelvic floor disorders. We calculated the reliability with the intraclass correlation coefficient and Cronbach's alpha coefficient, the validity with Spearman coefficient, the feasibility with the response rate and the filling time, and the ceiling and floor effects. ResultsSpanish versions of the PFDI-20 and PFIQ-7 achieved good semantic, conceptual, idiomatic and content equivalence. Concerning the psychometric validation, internal consistency was high with Cronbach's alpha coefficient of 0.837 (p<0.001) for PFDI-20 and 0.967 (p<0.001) for PFIQ-7. The test–retest reliability was 0.644 (p<0.001) for the PFDI-20 and 0.786 (p<0.001) for the PFIQ-7. Good construct validity was found with questionnaires: SF-12, EPIQ and ICIQ-SF. The average administration time was 10.1 (5.8)min for the PFDI-20, and 7.5 (4.7)min for the PFIQ-7. A ceiling effect was detected in the PFIQ-7 (25.4%). ConclusionsThe PFDI-20 and PFIQ-7 Spanish versions showed semantic, conceptual, idiomatic and content equivalence with the original versions. Both instruments are reliable, valid and feasible to evaluate symptoms and quality of life in Spanish women with pelvic floor disorders.

AB0220 Translation, cultural adaptation and the reproducibility of the oxford shoulder score questionnaire for brazil

ObjectivesTo translate, perform a cultural adaptation and to test the reproducibility of the Oxford Shoulder Score version for Brazil.MethodsFirst, the Oxford Shoulder Score (OSS) was translated into Portuguese by two...

Screening for depression with Centre for Epidemiological Studies Depression Scale Revised and its implication for consultation–liaison psychiatry practice among cancer subjects: a perspective from a developing country

Co-morbidity of depressive symptomatology is a common indication for use of mental health services in oncology. In this regard, screening instruments are useful for prompt identification of mental disorders in cancer. This study is set to evaluate the diagnostic validity of Centre for Epidemiological Studies Depression Scale Revised (CES-DR) for depression screening in cancer. The CES-DR and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were administered by the researchers on 200 attendees of a Nigerian hospital with histological diagnoses of cancer. Subsequently, the diagnostic validity of CES-DR was compared with SCAN. Ninety-eight (49.0%) participants had significant depressive symptomatology (CES-DR scores of ≥ 16) as against the diagnosis of depression in 55 (27.5%) participants following SCAN interview. Furthermore, of these 55 (27.5%) depressed participants, two (3.6%) participants had CES-DR scores <16 (non-cases). The Cronbach's alpha reliability of CES-DR was 0.86, and sensitivity and specificity of CES-DR were 96.4% and 68.7%, respectively, whereas positive and negative predictive values of CES-DR were found to be 0.54 and 0.98, respectively, in this study. The average administration time of CES-DR was 6 (± 2) min, and an inter-rater reliability of 93.7% was observed. The CES-DR was found in this study to be a useful tool for screening for depression in cancer but with diagnostic limitation when compared with SCAN. The development as well as popularization of screening instrument(s) with improved diagnostic and administration property for prompt identification of mental disorders to improve consultation-liaison psychiatry services in cancer care is recommended. Furthermore, replication of similar research is warranted.

Effects of intravenous low-dose recombinant human atrial natriuretic peptide on renal function in the perioperative management for gastrointestinal perforation or ileus: A retrospective single-center study

PurposeWe studied the effectiveness of human atrial natriuretic peptide (hANP) on management of acute kidney injury. MethodsThis retrospective single-center study included 43 patients from January 2007 to February 2010 who had undergone non-elective abdominal surgery for gastrointestinal perforation and ileus. Patients were separated into 2 groups according to whether hANP was administered or not, and 4 subgroups according to whether or not baseline serum creatinine <1.2 mg/dL; normal cre/hANP (−) (n = 22), high cre/hANP (−) (n = 10), normal cre/hANP (+) (n = 4), and high cre/hANP (+) (n = 7). The administration of hANP was started during operation. ResultsThe administration rate of hANP ranged between 0.02 and 0.05 μg/kg per minute, except for one patient and the average postoperative administration time of hANP was 167 ± 237 h (range, 8-888 h). There were no significant differences in characteristics of patients within four subgroups, except for patient's weight. Serum creatinine in high cre/hANP (+) got to decrease more than high cre/hANP (−). Outcomes such as 28-day mortality were not significantly different among four subgroups. No patients required renal replacement therapy in each subgroup. ConclusionIntravenous low dose of hANP was useful as acute kidney injury management in gastrointestinal perforation and ileus patients undergoing non-elective surgery.

Validity of a Brief Interview for Assessing Reflective Function

The Reflective Function Scale was developed by Fonagy and colleagues (1998) to empirically measure the capacity to mentalize thoughts, intentions, feelings, and beliefs about oneself and others. Reflective Function (RF) has been reliably measured by the Adult Attachment Interview (AAI; Main and Goldwyn 1998), but its length (45-90 minutes) and the labor required to administer, transcribe, and code for RF may be prohibitive for many research studies. The present study measured the reliability and validity of the Brief Reflective Function Interview (BRFI; Rudden, Milrod, and Target 2005) by administering it to 27 undergraduate participants previously assessed using the AAI in another research study (Morrison 2010). The BRFI was coded reliably by two independent raters (ICC = .79) and yielded a highly significant positive correlation (r = .71) between RF scores obtained by BRFI and by AAI. The average administration time of the BRFI (M = 24.15 minutes) was significantly shorter than that of the AAI (M = 44.65 minutes). These findings suggest that the BRFI may offer a reliable, valid, and streamlined alternative to the AAI as a measure for coding RF.

Comparative Net Cost Impact of the Utilization of Romiplostim and Intravenous Immunoglobulin for the Treatment of Patients with Immune Thrombocytopenia in Quebec,

Abstract 4211 Background:Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by increased platelet destruction and suboptimal platelet production, which results in low platelet counts and mild to severe bleeding. Bleeding events may range from petechiae and purpura to severe intracranial and gastrointestinal haemorrhage. Approximately 5% of adult ITP patients suffer from a fatal bleeding event. However, the risk of severe, fatal bleeding is significantly higher for patients who are unresponsive or intolerant to current therapies, over the age of 60 years, or refractory to splenectomy. The prevalence of diagnosed cases of chronic ITP in the overall population in Canada is reported to be 20.3 per 100,000; thus, it is estimated that there are about 160,000 people in Quebec with chronic ITP.Therapeutic management of ITP include the use of corticosteroids, immunosuppressive agents, and intravenous immunoglobulins (IVIg). IVIg is an expensive and occasionally scarce blood product. Surgical management includes splenectomy. Most recently, thrombopoietin (TPO) mimetic agents such as romiplostim and eltrombopag have been used to treat ITP.Romiplostim is indicated in Canada to increase the platelet levels in adult patients with chronic immune (idiopathic) thrombocytopenic purpura: •Who are non splenectomized and have had an inadequate response or are intolerant to corticosteroids and/or immunoglobulin; •Who are splenectomized and have had an inadequate response to splenectomy.Romiplostim does not have public reimbursement in the province of Quebec. Although the public drug program expert review acknowledged the benefit of romiplostim in substantially reducing the use of IVIg, the reviewers did not recognize the use of IVIg as a maintenance therapy. The objective of this study was to conduct a net cost analysis to determine if using romiplostim instead of IVIg can result in savings to the provincial health care budget in Quebec. Methods:A net cost impact model was developed to provide a detailed analysis of the cost implications of romiplostim utilization compared with IVIg, including the drug treatment costs, costs related to the preparation and administration of medications, monitoring costs, and indirect costs such as patients' time away from usual activities or work. Expert consultation with physicians, pharmacists and nurses in Quebec was used to define treatment algorithms including all health resource utilization required when using romiplostim and IVIg. Costs were assigned to direct (e.g., drugs, medical supplies, laboratory testing, healthcare professionals' time) and indirect (e.g., productivity) healthcare resources. Results:Based on the median weekly dose (3mcg/kg) observed in the pivotal romiplostim clinical trial in splenectomised patients, the annual cost of romiplostim per patient was $47,244. The annual per patient cost of IVIg was $114,548 based on an average dose suggested by a clinical expert (1g/kg every 4 weeks and average administration time of 3.5 hours). Lower costs for drug preparation and administration ($284 vs. $1355) and less time lost from work (valued at $447 vs. $2141) were attributed to romiplostim compared to IVIg. The time attributed to monitoring was the same for both romiplostim and IVIg ($115). The total average annual per patient costs including medication, drug administration, monitoring and lost productivity for romiplostim vs. IVIg were, respectively, $48,090 and $118,159. The use of romiplostim would save, on average, about $70,069 per patient per year. Conclusion:From a societal perspective, treating ITP patients with romiplostim can provide a lower cost alternative to IVIg for the overall provincial healthcare budget. Compared with IVIg, the use of romiplostim results in lower direct costs, reduced health care resource utilization and less indirect costs. As a precious commodity, blood products must be used wisely. As stated by the expert review committee in Quebec, IVIg should remain a last resort option to treat ITP. Romiplostim can allow for improved healthcare resource allocation by reserving IVIg for use in other areas of greater need while also providing cost savings. Romiplostim also potentially improves patients' quality of life by reducing the time required for drug infusion and avoids the risks associated with IV administration. Disclosures:Pettigrew:Amgen Canada Inc.: Consultancy. Deuson:Amgen: Employment, Equity Ownership. Garces:Amgen Canada: Employment, Equity Ownership.

A study of recorded versus live voice word recognition

Objective: To determine administration times for word recognition presented via monitored live voice (MLV) and compact disc (CD) recordings. Design: A quasi-experimental design was used. Fifty-word NU-6 lists were presented in three conditions: (1) MLV, (2) short ISI CD recording, and (3) long ISI CD recording. Study sample: Listeners with normal hearing (NH) and hearing impairment (HI) participated in this study. Results: Average administration time using MLV was significantly shorter than using recorded word lists for both groups of listeners. MLV presentation to the NH listeners was significantly faster than the MLV presentation to the HI listeners. There were no significant differences between groups in the administration times for any of the recorded lists (long or short ISI). Considerably more variability in administration time was observed for MLV presentation compared to recorded presentations. Conclusions: MLV presentation was about one minute faster than the shortest CD recording of the NU-6 fifty-item word lists, but it was only 49 seconds quicker when administering tests to individuals with hearing loss. Because the majority of our patients are hearing impaired, the difference of 49 seconds is not clinically significant. This difference is even less when 25-item word lists are used.SumarioObjetivo: Determinar los tiempos de presentación para el reconocimiento de palabras presentadas con voz viva monitorizada (MLV) o con grabaciones de disco compacto (CD). Diseño: Se utilizó un diseño quasi-experimental. Se presentaron listas NU-6 de cincuenta palabras en tres condiciones: (1) MLV, (2) grabación corta ISI CD y (3) grabación larga ISI CD. Muestra de estudio: Participaron en este estudio personas con audición normal (NH) y con pérdida auditiva (HI). Resultados: El tiempo promedio de presentación usando MLV fue significativamente más corto que al usar listas grabadas de palabras, en ambos grupos. La presentación con MLV en personas del grupo NH fue significativamente más rápida que la presentación MLV a las personas del grupo HI. No se apreciaron diferencias significativas entre ambos grupos en los tiempos de presentación con cualquiera de las listas grabadas (ISI larga o corta). Se observó una variabilidad considerablemente mayor en los tiempos de administración con material MLV, comparado con las presentaciones grabadas. Conclusiones: La presentación con MLV fue cerca de un minuto más rápida que las grabaciones más cortas en CD de las listas de palabras NU-6 de cincuenta cada una, pero fue solamente 49 segundos más rápida cuando se presentaron las pruebas a personas con pérdida auditiva. Como la mayoría de nuestros pacientes tiene problemas auditivos, la diferencia de 49 segundos no es clinicamente significativa. Esta diferencia es incluso menor cuando se usan listas de 25 palabras.

Translation, cultural adaptation and reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil

OBJECTIVE:To translate, to perform a cultural adaptation of and to test the reproducibility of the Cochin Hand Functional Scale questionnaire for Brazil.METHODS:First, the Cochin Hand Functional Scale questionnaire was translated into Portuguese and was then back-translated into French. These translations were reviewed by a committee to establish a Brazilian version of the questionnaire to be tested. The validity and reproducibility of the Cochin Hand Functional Scale questionnaire was evaluated. Patients of both sexes, who were aged 18 to 60 years and presented with rheumatoid arthritis affecting their hands, were interviewed. The patients were initially interviewed by two observers and were later interviewed by a single rater. First, the Visual Analogue Scale for hand pain, the Arm, Shoulder and Hand Disability questionnaire and the Health Assessment Questionnaire were administered. The third administration of the Cochin Hand Functional Scale was performed fifteen days after the first administration. Ninety patients were assessed in the present study.RESULTS:Two questions were modified as a result of the assessment of cultural equivalence. The Cronbach's alpha value for this assessment was 0.93. The intraclass intraobserver and interobserver correlation coefficients were 0.76 and 0.96, respectively. The Spearman's coefficient indicated that there was a low level of correlation between the Cochin Hand Functional Scale and the Visual Analogue Scale for pain (0.46) and that there was a moderate level of correlation of the Cochin Scale with the Health Assessment Questionnaire (0.66) and with the Disability of the Arm, Shoulder and Hand questionnaire (0.63). The average administration time for the Cochin Scale was three minutes.CONCLUSION:The Brazilian version of the Cochin Hand Functional Scale was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

Cuestionario para evaluación de la función sexual en mujeres con prolapso genital y/o incontinencia. Validación de la versión española del “Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)”

This article summarizes the work done to adapt and to validate the short form of Pelvic Organ Prolapse /Urinary Incontinence Sexual Questionnaire (PISQ-12) for its use in Spain. It will become the first validated questionnaire in this country for the evaluation of the sexual function in women with Pelvic Organ Prolapse and/or Urinary Incontinence. Patients and method. 49 women who visited a specialized unit with symptoms of pelvic floor were included. Patients filled in the Spanish version of the questionnaire to validate (PISQ-12), the Urinary Incontinence Questionnaire (ICIQ-UI-SF); the Female Sexual Function Questionnaire (FSM) and the Bladder Control Autoevaluation Questionnaire (CACV). Factibility, reliability and validity of the new questionnaire were evaluated ResultsFactibility: 99.83% of the sample answered all the items (only one patient did not answer one of the items); average administration time 3.5 (1.5) minutes. Reliability: Cronbach’s alpha was 0,829. Validity: PISQ-12 correlation with FSM was 0,71; with ICIQ-UI-SF it was -0,038; with the CACV “symptoms” dimension the correlation was -0,30 and with the “discomfort” dimension it was -0,40.The existence of the same three dimensions of the PISQ-12 original version in the adapted Spanish questionnaire is checked through a factorial analysis. The score in PISQ-12 was worse (lower) in the case of women with Hyperactive Bladder symptoms and discomfort measured with the CACV questionnaire and in women with sexual dysfunction measured with FSM ConclusiónPISQ-12 is an instrument with the appropriate psychometric characteristics to evaluate sexual function in women with pelvic floor problems

Screening for Depressive Disorders in Patients with Skin Diseases: A Comparison of Three Screeners

Despite being common, depression often goes undetected in patients with skin diseases. Our aim was to examine and compare the performance of three depression screeners. We studied dermatological inpatients aged 18-65 years. They completed the questionnaires Primary Care Screener for Affective Disorders (PC-SAD), Patient Health Questionnaire (PHQ) and General Health Questionnaire (GHQ-12) and were administered a standardized psychiatric interview (SCID-I) by a mental health professional, who was unaware of the questionnaire answers. The analysis was performed on 141 patients with complete data (79% of all eligible patients, 89% of all patients who agreed to participate). The prevalence of the main forms of depression, major depressive disorder and dysthymic disorder, was 8.4% and 6.3%, respectively. For major depressive disorder, the sensitivity and specificity of the questionnaires were as follows: PC-SAD, 73% and 88%; PHQ, 55% and 91%; GHQ-12, 73% and 78%. For dysthymic disorder, the sensitivity and specificity were as follows: PC-SAD, 56% and 95%; PHQ, 44% and 90%; GHQ-12, 56% and 76%. The small sample size suggests caution in drawing conclusions about the relative merits of these screeners. Although both the GHQ and the PHQ are short and easily hand scored, the first is a generic screener for psychiatric morbidity that is not specific for depression, while the second displayed modest sensitivity. The PC-SAD, with short average administration time, acceptable sensitivity and high specificity, might be particularly useful in settings where the technology for computer automated scoring is available. Although screening programmes might be useful, they should be supplemented by quality improvement programmes and by the development of consultation-liaison services.

The Application of a WISC-III Short Form for Screening Gifted Elementary Students in Canada

This investigation explored the accuracy of a short form of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III} in predicting Full Scale IQ when administered as a separate test. The Dumont-Faro short form (i.e., Picture Completion, Information, Coding, Block Design, and Vocabulary; Dumont &amp; Faro, 1993) was administered to 60 Canadian elementary students who were referred for gifted eligibility purposes. The remaining WISC-III standard subtests, coupled with two supplementary subtests, were administered immediately following the Dumont-Faro short form so that Full Scale IQ scores could be calculated. In order to determine the actual amount of time saved by using the short form, administration times were recorded for each WISC-III subtest. When administered as a separate test, the Dumont-Faro short form IQ scores correlated highly (.88) with the Full Scale IQ scores. Moreover, this instrument reduced the average administration time of the WISC-III standard battery by 55%. It was concluded that the Dumont-Faro short form is an effective screening instrument to use with elementary students who are referred for gifted eligibility purposes in Canada. This instrument can assist school psychologists in meeting increased service demands while still providing effective intellectual assessment.

Case-finding instruments may help identify depression in primary care

(2002) Gen Hos Psych 24, 225; Williams J, Pignone M, Ramirez G, Stellato C. . Identifying depression in primary care: a literature synthesis of case-finding instruments. . Jul-Aug; . :...

Identifying depression in primary care: a literature synthesis of case-finding instruments

We evaluated the usefulness of case-finding instruments for identifying patients with major depression or dysthymia in primary care settings using English language literature from Medline, a specialized trials registry and bibliographies of selected papers. Studies were done in primary care settings with unselected patients and compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. A total of 16 case-finding instruments were assessed in 38 studies. More than 32,000 patients received screening with a case-finding instrument; approximately 12,900 of these received criterion standard assessment. Case-finding instruments ranged in length from 1 to 30 questions. Average administration times ranged from less than 2 min to 6 min. Median sensitivity for major depression was 85% (range 50% to 97%); median specificity was 74% (range 51% to 98%). No significant differences between instruments were found. However for individual instruments, estimates of sensitivity and specificity varied significantly between studies. For the combined diagnoses of major depression or dysthymia, overall sensitivity was 79% (CI, 74% to 83%) and overall specificity 75% (CI, 70% to 81%). Stratified analyses showed no significant effects on overall instrument performance for study methodology, criterion standard choice, or patient characteristics. We found that multiple instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments’ ability to serve additional purposes, such as monitoring severity or response to therapy.

Is this patient clinically depressed?

Depressive disorders are highly prevalent in the general population, but recognition and accurate diagnosis are made difficult by the lack of a simple confirmatory test. To review the accuracy and precision of depression questionnaires and the clinical examination for diagnosing clinical depression. We searched the English-language literature from 1970 through July 2000 using MEDLINE, a specialized registry of depression trials, and bibliographies of selected articles. Case-finding studies were included if they used depression questionnaires with easy to average literacy requirements, evaluated at least 100 primary care patients, and compared questionnaire results with accepted diagnostic criteria for major depression. Eleven questionnaires, ranging in length from 1 to 30 questions, were assessed in 28 published studies. Reliability studies for the clinical examination required criterion-based diagnoses made by at least 2 clinicians who interviewed the patient or reviewed a taped examination. Fourteen studies evaluated interrater reliability. Pairs of authors independently reviewed articles. For case-finding studies, quality assessment addressed sample size and whether patients were selected consecutively or randomly, the criterion standard was administered and interpreted independently of and blind to the results of the case-finding instrument, and the proportion of persons receiving the criterion standard assessment was less than or more than 50% of those approached for criterion standard assessment. For reliability studies, quality assessment addressed whether key patient characteristics were described, the interviewers collected clinical history independently, and diagnoses were made blinded to other clinicians' evaluations. In case-finding studies, average questionnaire administration times ranged from less than 1 minute to 5 minutes. The median likelihood ratio positive for major depression was 3.3 (range, 2.3-12.2) and the median likelihood ratio negative was 0.19 (range, 0.14-0.35). No significant differences between questionnaires were found. For mental health care professionals using a semistructured interview, agreement was substantial to almost perfect for major depression (kappa = 0.64-0.93). Nonstandardized interviews yielded somewhat lower agreement (kappa = 0.55-0.74). A single study showed that primary care clinicians using a semistructured interview have high agreement with mental health care professionals (kappa = 0.71). Multiple, practical questionnaires with reasonable performance characteristics are available to help clinicians identify and diagnose patients with major depression. Diagnostic confirmation by mental health care professionals using a clinical interview or by primary care physicians using a semistructured interview can be made with high reliability.

Case-finding instruments for depression in primary care settings.

To evaluate the usefulness of case-finding instruments for identifying patients with major depression in primary care settings. A MEDLINE search of the English-language medical literature; bibliographies of selected papers; and experts. Studies that were done in primary care settings with unselected patients and that compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. 9 case-finding instruments were assessed in 18 studies. More than 15,000 patients received screening with a case-finding instrument; approximately 5300 of these received criterion standard assessment. Case-finding instruments ranged in length from 2 to 28 questions. Average administration times ranged from less than 2 minutes to 6 minutes. Sensitivities and specificities for detecting major depression ranged from 67% to 99% and from 40% to 95%, respectively. No significant differences between instruments were found. Overall sensitivity was 84% (95% CI, 79% to 89%); overall specificity was 72% (CI, 67% to 77%). If a case-finding instrument were administered to 100 primary care patients with a 5% prevalence of major depression, the clinician could expect that 31 patients would screen positive, that 4 of the 31 would have major depression, and that 1 patient with major depression would not be identified. Several instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because the operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments' ability to serve additional purposes, such as monitoring severity or response to therapy.