Examination Of Effect Sizes Research Articles

Classroom Management in an Urban, Alternative School: a Comparison of Mindfulness and Behavioral Approaches

Managing classroom behavior is an important prerequisite to effective teaching and a salient need in alternative schools. Unfortunately, students from these schools are often underrepresented in the intervention literature. The primary aim of this study was to compare the effectiveness of two different theoretical approaches to classroom management, one behavioral (i.e., the good behavior game) and the other mindfulness-based (i.e., mindfulness skills training), with a sample of fifth-grade, predominantly African American students from an urban, high-poverty alternative school. The study examined the effectiveness of the two interventions in comparison to each other and a treatment-as-usual control using a quasi-experimental group design with blocked random assignment. Results revealed that neither intervention led to significant improvements in student internalizing behavior, externalizing behavior, or wellbeing. Though, some practically meaningful treatment effects were found through examination of effect sizes. Mindfulness skills training was the only condition to yield meaningful pre–post change in student outcomes, including a moderate therapeutic effect for externalizing behavior and an iatrogenic effect with respect to student wellbeing. These findings provide preliminary evidence that mindfulness skills training might have differential effects on student mental health outcomes, compared with education as usual and a traditional classwide behavioral intervention. Additionally, study findings make clear the importance of careful deliberation when transporting evidence-based interventions to unique student populations and intervention contexts.

Examining the Validity and Reliability of an Abridged Version of the Perceived Affect Utility Scale (PAUSe)

Abstract. The present research presents evidence of the validity and reliability of an abbreviated version of the Perceived Affect Utility Scale (PAUSe). In Study 1, findings using item response theory (IRT) led to the deletion of one-third of the number of items in the PAUSe. Results from confirmatory factor analysis (CFA) supported the structure of the abbreviated version of the PAUSe, the PAUSe-r. Examining effect sizes between the PAUSe-r and instruments measuring personality, emotion, and depression also supported the convergent validity, discriminant validity, and incremental validity of this measure, even after taking into account ideal affect and the actual experience of emotion. In Study 2, test-retest reliability of the PAUSe-r in a sample of college students is presented. In Study 3, using data from a large, nonstudent sample, we replicated the structure of the PAUSe-r, as well as relations between the PAUSe-r and personality variables, that were found in Study 1.

Effects of dextroamphetamine in subacute traumatic brain injury: A randomized, placebo-controlled pilot study.

Psychostimulants that affect neurotransmitters implicated in cognitive function and neural plasticity have potential to enhance the rate and extent of recovery after traumatic brain injury (TBI). Ten milligrams dextroamphetamine (DEX) or an identical placebo was administered daily for 3 weeks to 32 participants with moderate to severe TBI, engaged in inpatient rehabilitation, at a mean of 2 months post injury. A variety of outcome measures assessing cognitive function and overall functional status was administered at weekly intervals, to examine effect sizes that may inform a larger trial, and to evaluate safety. Results indicated trivial-to-small effect sizes for DEX-placebo differences, with the largest effects seen on speed of information processing (more improvement with DEX) and agitation (exacerbation with DEX). Examination of adverse events and vital signs suggested safety of DEX, but the pattern of results did not suggest accelerated recovery due to the drug. Future trials of DEX in this population need to consider the impact of floor effects of commonly used measures of cognitive and physical function, and the heterogeneity of TBI. Although the small sample precludes definitive conclusions, these findings are not encouraging with regard to clinical trials of DEX in subacute TBI.

Parent perspectives on home participation of high-functioning children with autism spectrum disorder compared with a matched group of children without autism spectrum disorder

Few studies have focused on home participation of high-functioning children with autism spectrum disorder. We employed a mixed-methods design to explore and compare parent perspectives on (1) participation of children with and without autism spectrum disorder in activities at home, (2) the environmental features and resources that affect these children's home participation and (3) the strategies parents use to help their children participate at home. The Participation and Environment Measure for Children and Youth (PEM-CY) was used to gather online survey and qualitative data from parents of 99 high-functioning children with autism spectrum disorder and 241 children without autism spectrum disorder. Independent sample t-tests and χ2 tests were used to explore differences between groups, and Cohen's d was calculated to examine effect sizes. Differences were obtained on all Participation and Environment Measure for Children and Youth dimensions but particularly when comparing parents' satisfaction and perceived environmental barriers to their children's participation. The qualitative analyses revealed that parents in both groups used similar strategies to facilitate their children's participation at home, although parents of children with autism spectrum disorder made use of more distinct modifications. Our results highlight the importance of environmental aspects and point to how practitioners can support families in their efforts to promote their child's participation at home.

Development and Pilot-Testing of a Cognitive Behavioral Coping Skills Group Intervention for Patients with Chronic Hepatitis C.

Psychosocial interventions for patients with chronic hepatitis C viral (HCV) infection are needed to attenuate the impact of extrahepatic symptoms, comorbid conditions, and treatment side effects on HCV health outcomes. We adapted empirically-supported interventions for similar patient populations to develop a Cognitive Behavioral Coping Skills group intervention for HCV patients (CBCS-HCV) undergoing treatment. The objectives of this paper are to describe the research activities associated with CBCS-HCV development and pilot testing, including: (1) formative work leading to intervention development; (2) preliminary study protocol; and (3) pilot feasibility testing of the intervention and study design. Formative work included a literature review, qualitative interviews, and adaption, development, and review of study materials. A preliminary study protocol is described. We evaluate the feasibility of conducting a randomized controlled trial (RCT) of the CBCS-HCV with 12 study participants in Wave 1 testing to examine: (a) feasibility of intervention delivery; (b) patient acceptability; (c) recruitment, enrollment, retention; (d) feasibility of conducting a RCT; (d) therapist protocol fidelity; and (e) feasibility of data collection. Numerous lessons were learned. We found very high rates of data collection, participant attendance, engagement, retention and acceptability, and therapist protocol fidelity. We conclude that many aspects of the CBCS-HCV intervention and study protocol were highly feasible. The greatest challenge during this Wave 1 pilot study was efficiency of participant enrollment due to changes in standard of care treatment. These findings informed two additional waves of pilot testing to examine effect sizes and potential improvements in clinical outcomes, with results forthcoming.

Association of Industry Sponsorship With Outcomes of Nutrition Studies

Food industry sponsorship of nutrition research may bias research reports, systematic reviews, and dietary guidelines. To determine whether food industry sponsorship is associated with effect sizes, statistical significance of results, and conclusions of nutrition studies with findings that are favorable to the sponsor and, secondarily, to determine whether nutrition studies differ in their methodological quality depending on whether they are industry sponsored. OVID MEDLINE, PubMed, Web of Science, and Scopus from inception until October 2015; the reference lists of included reports. Reports that evaluated primary research studies or reviews and that quantitatively compared food industry-sponsored studies with those that had no or other sources of sponsorship. Two reviewers independently extracted data from each report and rated its quality using the ratings of the Oxford Centre for Evidence-Based Medicine, ranging from a highest quality rating of 1 to a lowest of 5. Results (statistical significance and effect size) favorable to the sponsor and conclusions favorable to the sponsor. If data were appropriate for meta-analysis, we used an inverse variance DerSimonian-Laird random-effects model. Of 775 reports reviewed, 12, with quality ratings ranging from 1 to 4, met the inclusion criteria. Two reports, with data that could not be combined, assessed the association of food industry sponsorship and the statistical significance of research results; neither found an association. One report examined effect sizes and found that studies sponsored by the food industry reported significantly smaller harmful effects for the association of soft drink consumption with energy intake and body weight than those not sponsored by the food industry. Eight reports, including 340 studies, assessed the association of industry sponsorship with authors' conclusions. Although industry-sponsored studies were more likely to have favorable conclusions than non-industry-sponsored studies, the difference was not significant (risk ratio, 1.31 [95% CI, 0.99-1.72]). Five reports assessed methodological quality; none found an association with industry sponsorship. Although industry-sponsored studies were more likely to have conclusions favorable to industry than non-industry-sponsored studies, the difference was not significant. There was also insufficient evidence to assess the quantitative effect of industry sponsorship on the results and quality of nutrition research. These findings suggest but do not establish that industry sponsorship of nutrition studies is associated with conclusions that favor the sponsors, and further investigation of differences in study results and quality is needed.

A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

Objective The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Methods A nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and Mann-Whitney tests. Results Eighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention (n = 45) and standard care (n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c (p = 0.228), but p values were borderline significant for blood pressure (p = 0.054) and mental-health related quality of life (p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. Conclusions Findings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health.

Combining moderators to identify clinical profiles of patients who will, and will not, benefit from aripiprazole augmentation for treatment resistant late-life major depressive disorder

Personalizing treatment for late-life depression requires identifying and integrating information from multiple factors that influence treatment efficacy (moderators). We performed exploratory moderator analyses using data from a multi-site, randomized, placebo-controlled, double-blind trial of aripiprazole augmentation. Patients (n = 159) aged ≥60 years had major depressive disorder that failed to remit with venlafaxine monotherapy. We examined effect sizes of 39 potential moderators of aripiprazole (vs. placebo) augmentation efficacy using the outcome of percentage reduction in depressive symptom after 12 weeks. We then incorporated information from the individually relevant variables in combined moderators. A larger aripiprazole treatment effect was related to: white race, better physical function, better performance on Trail-Making, attention, immediate, and delayed memory tests, greater psychomotor agitation and suicidality symptoms, and a history of adequate antidepressant pharmacotherapy. A smaller aripiprazole treatment effect was observed in patients with: more pain and more work/activity impairment and libido symptoms. Combining information from race and Trail-Making test performance (base combined moderator (Mb*)) produced a larger effect size (Spearman effect size = 0.29 (95% confidence interval (CI): 0.15, 0.42)) than any individual moderator. Adding other individually relevant moderators in the full combined moderator (Mf*) further improved effect size (Spearman effect size = 0.39 (95% CI: 0.25, 0.52)) and identified a sub-group benefiting more from placebo plus continuation venlafaxine monotherapy than adjunctive aripiprazole. Combining moderators can help clinicians personalize depression treatment. We found the majority of our patients benefited from adjunctive aripiprazole, but a smaller subgroup that is identifiable using clinical measures appeared to benefit more from continuation venlafaxine plus placebo.

Performance on a computerized neurocognitive battery in 22q11.2 deletion syndrome: A comparison between US and Israeli cohorts

Increasingly, the effects of copy number variation (CNV) in the genome on brain function and behaviors are recognized as means to elucidate pathophysiology of psychiatric disorders. Such studies require large samples and we characterized the neurocognitive profile of two cohorts of individuals with 22q11.2 deletion syndrome (22q11DS), the most common CNV associated with schizophrenia, in an effort to harmonize phenotyping in multi-site global collaborations. The Penn Computerized Neurocognitive Battery (PCNB) was administered to individuals with 22q11DS in Philadelphia (PHL; n=155, aged 12–40) and Tel Aviv (TLV; n=59, aged 12–36). We examined effect sizes of performance differences between the cohorts and confirmed the factor structure of PCNB performance efficiency in the combined sample based on data from a large comparison community sample. The cohorts performed comparably with notable deficits in executive function, episodic memory and social cognition domains that were previously associated with abnormal neuroimaging findings in 22q11DS. In mixed model analysis, while there was a main effect for site for accuracy (number of correct response) and speed (time to correct response) independently, there were no main site effects for standardized efficiency (average of accuracy and speed). The fit of a structural model was excellent indicating that PCNB tests were related to the targeted cognitive domains. Thus, our results provide preliminary support for the use of the PCNB as an efficient tool for neurocognitive assessment in international 22q11DS collaborations.

Memantine and Cognition in Parkinson's Disease Dementia/Dementia With Lewy Bodies: A Meta-Analysis.

The aim of this work was to utilize meta-analysis in examining the effects of memantine on neuropsychological functioning in patients with Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB). Included studies fulfilled these criteria: included objective cognitive measures, a comparison group of participants not taking memantine, and provided sufficient data for calculation of effect size. We examined effect sizes across global cognition and five specific neuropsychological domains. Moderator variables examined included neuropsychological domain, diagnostic cohort (PDD, DLB, or mixed PDD-DLB cohort), study design (open label or placebo-controlled), and trial length. Six publications met inclusion criteria totaling 57 effects. Homogeneity analysis across cognitive domains revealed a small overall effect size (d = 0.25) that was significantly heterogeneous (P < 0.001). Specific neuropsychological domains did not moderate effect size, though. Moderator analysis studies using a mix of DLB and PDD subjects showed larger effects than those that included DLB or PDD patients only. Additionally, open-label trials had significantly (P < 0.001) larger effect sizes (d = 1.32) than placebo-controlled trials (d = 0.12). The present study indicates that effect-size heterogeneity across studies of memantine in DLB and PDD patients is moderated by diagnostic makeup of the cohort and study design. The small overall effect size noted in placebo-controlled trials versus open-label trials indicates that memantine has minimal effects on cognition in PDD and DLB and is unlikely to demonstrate clinically significant improvements in cognition.

Measuring positive affect and well-being after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Positive Affect and Well-being bank and short form

ObjectiveTo develop an item response theory (IRT)-calibrated spinal cord injury (SCI)-specific Positive Affect and Well-being (PAWB) item bank with flexible options for administration.DesignQualitative feedback from patient and provider focus groups was used to expand on the Neurological Disorders and Quality of Life (Neuro-QOL) positive affect & well-being item bank for use in SCI. New items were created and revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis, graded response IRT modeling and evaluation of differential item functioning (DIF).SettingWe tested a 32-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital.ParticipantsA total of 717 individuals with SCI answered the PAWB questions.ResultsA unidimensional model was observed (Confirmatory Fit Index = 0.947; Root Mean Square Error of Approximation = 0.094) and measurement precision was good (reliability in theta of –2.9 to 1.2 is roughly equivalent to classical reliability of 0.95 or above). Twelve items were flagged for DIF, however, after examination of effect sizes, the DIF was determined to be negligible and would have little practical impact on score estimates. The final calibrated item bank resulted in 28 retained itemsConclusionsThis study indicates that the Spinal Cord Injury – Quality of Life PAWB bank represents a psychometrically robust measurement tool. Short form items are also suggested and a computer adaptive test is available.

Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form

ObjectiveTo describe the development and psychometric properties of the Spinal Cord Injury - Quality of Life (SCI-QOL) Resilience item bank and short form.DesignUsing a mixed-methods design, we developed and tested a resilience item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory based analytic approaches, including tests of model fit and differential item functioning (DIF).SettingWe tested a 32-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs medical center.ParticipantsA total of 717 individuals with SCI completed the Resilience items.ResultsA unidimensional model was observed (CFI = 0.968; RMSEA = 0.074) and measurement precision was good (theta range between −3.1 and 0.9). Ten items were flagged for DIF, however, after examination of effect sizes we found this to be negligible with little practical impact on score estimates. The final calibrated item bank resulted in 21 retained items.ConclusionThis study indicates that the SCI-QOL Resilience item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.

Measuring grief and loss after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Grief and Loss item bank and short form

ObjectiveTo develop an item response theory (IRT) calibrated Grief and Loss item bank as part of the Spinal Cord Injury – Quality of Life (SCI-QOL) measurement system.DesignA literature review guided framework development of grief/loss. New items were created from focus groups. Items were revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF).SettingWe tested a 20-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital.ParticipantsA total of 717 individuals with SCI answered the grief and loss questions.ResultsThe final calibrated item bank resulted in 17 retained items. A unidimensional model was observed (CFI = 0.976; RMSEA = 0.078) and measurement precision was good (theta range between −1.48 to 2.48). Ten items were flagged for DIF, however, after examination of effect sizes found this to be negligible with little practical impact on score estimates.ConclusionsThis study indicates that the SCI-QOL Grief and Loss item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.

Improving physical functional and quality of life in older adults with multiple sclerosis via a DVD-delivered exercise intervention: a study protocol

IntroductionThere is a need to identify innovative, low-cost and broad-reaching strategies for promoting exercise and improving physical function in older adults with multiple sclerosis (MS).Methods and analysisThis randomised controlled pilot...

Evaluating the Validity Indices of the Personality Assessment Inventory-Adolescent Version.

Past research has established strong psychometric properties of several indicators of response distortion on the Personality Assessment Inventory (PAI). However, to date, it has been unclear whether the response distortion indicators of the adolescent version of the PAI (PAI-A) operate in an equally valid manner. The current study sought to examine several response distortion indicators on the PAI-A to determine their relative efficacy at the detection of distorted responding, including both positive distortion and negative distortion. Protocols of 98 college students asked to either overreport or underreport were compared with 98 age-matched individuals sampled from the clinical standardization sample and the community standardization sample, respectively. Comparisons between groups were accomplished through the examination of effect sizes and receiver operating characteristic curves. All indicators demonstrated the ability to distinguish between actual and feigned responding, including several newly developed indicators. This study provides support for the ability of distortion indicators developed for the PAI to also function appropriately on the PAI-A.

SU‐E‐I‐61: The Role of Interpolation Method in Computing Dose‐Volume Histograms

Purpose:To study the effects of dose interpolation method on DVH computation, in order to make recommendations for quality assurance and consistency of treatment.Methods:We defined two IMRT plans (maximum doses: 84/79Gy) on a physical phantom using a commercial TPS, and exported four dose volumes with different spatial resolutions (2–5mm in‐plane; 2.5–5mm thickness). Contours for fifteen structures were defined on the CT. Using two different voxel counting schemes (partial volume weighting or centre inside) and four different interpolation methods (structures mapped to dose resolution, or nearest neighbour, linear or cubic interpolation of dose to the CT grid), we computed 960 DVHs, each with 1024 bins. Ground truth was taken to be the partial‐volume‐weighted DVHs on the highest‐resolution dose. These were compared to the suboptimal DVHs using the percentage of failing gammas (PFG) distance (doi:10.1088/0031‐9155/55/11/N04) at nine different comparison points (dose differences 1,2,3Gy, volume changes 1,2,3%), giving 8640 PFG measurements. The effects were analysed via multi‐way ANOVA.Results:DVH accuracy depended significantly on dose resolution and interpolation type (p&lt;1e‐15 in both cases). As expected, the plan, contour and PFG parameterization were also significant sources of variation. The least significant source was voxel counting method (p=0.0030). Using the etasquared measure to examine effect size, the interpolation type (eta^2=0.0209) was marginally more important than the dose resolution (eta^2=0.0312). These importances rose to eta^2=0.130 and eta^2=0.0903 respectively if comparisons used the PVW‐DVHs from fine‐grained doses interpolated onto the CT as ground truth instead.Conclusion:For applications where DVH comparability between clinical sites with different TPS is imperative (e.g. multi‐centre studies), the dose resolution and interpolation method should be strictly identical in order for DVHs to be truly comparable. For doses sampled at a lower spatial resolution, using linear — or even better, cubic — interpolation can reduce errors over nearest neighbour.

Meta-Analysis of Associations Between Human Brain Volume And Intelligence Differences: How Strong Are They and What Do They Mean?

Positive associations between human intelligence and brain size have been suspected for more than 150 years. Nowadays, modern non-invasive measures of in vivo brain volume (Magnetic Resonance Imaging) make it possible to reliably assess associations with IQ. By means of a systematic review of published studies and unpublished results obtained by personal communications with researchers, we identified 88 studies examining effect sizes of 148 healthy and clinical mixed-sex samples (> 8,000 individuals). Our results showed significant positive associations of brain volume and IQ (r = .24, R2 = .06) that generalize over age (children vs. adults), IQ domain (full-scale, performance, and verbal IQ), sample type (clinical vs. healthy sample), and sex. Application of a number of methods for detection of publication bias indicates that strong and positive correlation coefficients have been reported frequently in the literature whilst small and non-significant associations appear to have been often omitted from reports. We show that although the positive association of brain volume and IQ seems to be robust, its strength has been overestimated in the literature. While it is tempting to interpret this association in the context of human cognitive evolution and species differences in brain size and cognitive ability, we show that it is not warranted to interpret brain size as a necessary cause or isomorphic proxy of human intelligence differences.

Research Paper Post-traumatic growth following bereavement: A systematic review of the literature

BackgroundBereavement research has traditionally focused on the negative sequel of loss. Recently, however, research has begun to focus on the positive outcomes following loss: post-traumatic growth (PTG).PurposeTo synthesise studies which directly examine PTG following bereavement.DesignThis is the first systematic review which synthesises studies into directly examining PTG following bereavement.Data sourcesFrom the 70 published journal articles reviewed from PubMed, PsychINFO, IsiWeb of Knowledge Google Scholar, Science Direct, Springer Link, Taylor &amp; Francis online, Sage Journals and Wiley Online Library, only 15 studies were directly examining PTG following bereavement and thus, included in this review.ResultsFindings of this systematic review suggest that PTG can indeed occur following bereavement and that certain factors can act as mediators for such growth to emerge. Key factors are: (1) The age of the bereaved; (2) social support; (3) time since death; (4) religion; and (5) active cognitive coping strategies.ConclusionsFurther research should include comparative-longitudinal studies controlling for maturational growth with non-trauma comparisons, as well as meta-analytic studies designed to examine effect sizes for associations among variables theorised to predict PTG following bereavement. Potential clinical applications include therapists becoming better positioned to recognise when PTG is likely to occur and its mediating factors, in order to more effectively facilitate it.

Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia.

Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific interventional approaches designed to address difficulties with memory and other aspects of cognitive functioning. The present review is an update of previous versions of this review. The main aim of the current review was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation for people with mild Alzheimer's disease or vascular dementia in relation to important cognitive and non-cognitive outcomes for the person with dementia and the primary caregiver in the short, medium and long term. The CDCIG Specialized Register, ALOIS, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS and many other clinical trial databases and grey literature sources, was most recently searched on 2 November 2012. Randomised controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting relevant outcomes for the person with dementia and/or the family caregiver, were considered for inclusion. Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for 11 of the primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. The unit of analysis in the meta-analysis was the change from baseline score. Overall estimates of treatment effect were calculated using a fixed-effect model, and statistical heterogeneity was measured using a standard Chi(2) statistic. One RCT of cognitive rehabilitation was identified, allowing examination of effect sizes, but no meta-analysis could be conducted. Cognitive training was not associated with positive or negative effects in relation to any reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to a number of participant and caregiver outcomes, and was generally of high quality. Available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve. However, there is still no indication of any significant benefit derived from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardised outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to obtain more definitive evidence. Researchers should describe and classify their interventions appropriately using available terminology.

Pilot Study of a Physician-Delivered Education Tool to Increase Patient Knowledge About CKD

Limited research exists on physician-delivered education interventions. We examined the feasibility and impact of an educational tool on facilitating physician-patient kidney disease communication. Pilot feasibility clinical trial with a historical control to examine effect size on patient knowledge and structured questions to elicit physician and patient feedback. Adults with chronic kidney disease (CKD) stages 1-5, seen in nephrology clinic. 1-page educational worksheet, reviewed by physicians with patients. Kidney knowledge between patient groups and provider/patient feedback. Patient kidney knowledge was measured using a previously validated questionnaire compared between patients receiving the intervention (April to October 2010) and a historical cohort (April to October 2009). Provider input was obtained using structured interviews. Patient input was obtained through survey questions. Patient characteristics were abstracted from the medical record. 556 patients were included, with 401 patients in the historical cohort and 155 receiving the intervention. Mean age was 57 ± 16 (SD) years, with 53% men, 81% whites, and 78% with CKD stages 3-5. Compared with the historical cohort, patients receiving the intervention had higher adjusted odds of knowing they had CKD (adjusted OR, 2.20; 95% CI, 1.16-4.17; P = 0.02), knowing their kidney function (adjusted OR, 2.25; 95% CI, 1.27-3.97; P = 0.005), and knowing their stage of CKD (adjusted OR, 3.22; 95% CI, 1.49-6.92; P = 0.003). Physicians found the intervention tool easy and feasible to integrate into practice and 98% of patients who received the intervention recommended it for future use. Study design did not randomly assign patients for comparison and enrollment was performed in clinics at one center. In this pilot study, a physician-delivered education intervention was feasible to use in practice and was associated with higher patient kidney disease knowledge. Further examination of physician-delivered education interventions for increasing patient disease understanding should be tested through randomized trials.