Use In Clinical Assessment Research Articles

Normative data for the Novaco Anger Scale from a non-clinical sample and implications for clinical use.

To provide non-clinical normative data for the Novaco Anger Scale. To identify the ability of the scale to discriminate between clinical and non-clinical populations. Postal survey of individuals from a non-clinical sample. A non-clinical sample of 212 NHS employees was sent a questionnaire pack, including the Novaco Anger Scale. A clinical sample of 58 outpatient anger-management referrals was identified from a retrospective case-note analysis. Descriptive data are presented for both samples. t-score conversions are provided, based on the non-clinical data. Results from a discriminant function analysis demonstrated that the Novaco Anger Scale classified participants as clinical or non-clinical with 94% accuracy. From this study it appears that the Novaco Anger Scale is able to discriminate between clinical and non-clinical populations. These data offer further support to the validity of the Novaco Anger Scale and its use in clinical assessment.

Are Oxygen Indices Effective for Predicting Pathological Intrapulmonary Shunt in Mechanically Ventilated Children?

Background This study was undertaken to evaluate whether oxygen indices accurately predict pathological intrapulmonary shunt (Qsp/Qt), and to evaluate the sensitivity and specificity of the FiO 2-required formula to obtain a desired arterial oxygen tension (PaO 2) in mechanically ventilated children. Methods A prospective, hospital-based, comparative study was conducted on 50 mechanically ventilated children at the Intensive Care Units of the National Institute of Pediatrics (INP) in Mexico City. Blood gas data were prospectively collected from 50 critically ill, mechanically ventilated children, 50 taken before and 40 after FiO 2 change. Assessment of Qsp/Qt, P(A-a)O 2, PaO 2/FiO 2, PaO 2/PAO 2, and P(A-a)O 2/PaO 2 was carried out before and after FiO 2 change. Results In first blood gas data, 31 patients were hypoxemic (PaO 2 <90 Torr), 10 were normal, and 9 were hyperoxemic (PaO 2 >100 Torr). Forty patients required FiO 2 modifications that were carried out according to Maxwell’s formula. Five children showed persistent oxygen disturbance after FiO 2 changes. P(A-a)O 2, PaO 2/FiO 2, PaO 2/PAO 2, and P(A-a)O 2/PaO 2 had sensitivities of 0.66, 0.71, 0.98, and 0.93, respectively, and specificities of 0.79, 0.91, 0.29, and 0.64, respectively, to detect pathological Qsp/Qt. All oxygen indices changed significantly after FiO 2 modifications compared from initials; Qsp/Qt also showed significant change after FiO 2 change. Pearson product-moment showed lineal correlation between each index, and Qsp/Qt demonstrated their significant correlation ( p <0.01). Correlation of Qsp/Qt and PaO 2/FiO 2 and PaO 2/PAO 2 was significantly higher in younger children (<13 years) p <0.05. The FiO 2-required formula to obtain a desired PaO 2 had a sensitivity of 0.93 and a specificity of 0.75. Conclusions The oxygen indices showed sufficient efficacy to detect pathological intrapulmonary shunt, and to have a statistically significant lineal correlation that permits its use during the clinical evaluation of oxygen transport data in most mechanically ventilated children, which is consistent with other reports on adult populations. However, one limitation for its use in clinical assessment, as reported in previous studies, would be that all indices in the present study are FiO 2-dependent; therefore, when the FiO 2 varies, the use is misleading. The FiO 2-required formula is efficient for defining the appropriated FiO 2 for the obtaining of the desired PaO 2, but will always be merely a guide that should be confirmed through blood gas analysis.

In Vitro versus In Vivo Assessment of Vein Wall Properties

Venous compliance reflects the mechanical properties of the vein wall. Clinical methods of measurement have not been validated by comparison with the accepted in vitro measurement. Despite this, clinical assessment of vein compliance may have a series of useful applications: (1) to assess the progression of chronic venous insufficiency and the related hemodynamic forces acting on the saphenous vein wall; (2) to determine the suitability of the saphenous vein for replacement of an arterial conduit by testing its mechanical properties; and (3) to select the saphenous vein with preferable mechanical performance for coronary artery bypass. The aim of this study is to assess the relationship between in vitro and two in vivo methods of compliance measurement. Compliance of the saphenous vein was determined in 20 patients, using both an invasive and a noninvasive (A and B, respectively) method. Duplex scanning was used for diameter measurement. Venous pressure was derived either intravenously with a needle transducer, or noninvasively with limb length measurement. Patients underwent saphenous excision with further in vitro compliance measurement of the same vein segment (method C). The compliance values obtained with the three methods showed different degrees of correlation (r= 0.516, p = 0.0001 for method A versus method C; r = 0.658, p = 0.0001 for method B versus method C; r = 0.993, p = 0.0001 for method A versus method B). The relationships with the in vitro measurements that were determined validate both in vivo methods for assessment of saphenous vein compliance. Due to its completely noninvasive design, method B appears to have potential use for clinical assessment of saphenous vein wall properties.

Thoracic gas compression profile during forced expiration in healthy and asthmatic schoolchildren

Gas compression profile may aid in the diagnosis of airway obstruction. However, the behaviour of this parameter in repeated tests and the deviations in patients with bronchial asthma have not been thoroughly described. Thirty-six health subjects aged 6–16 years were studied in two test sessions with a pressure/flow plethysmograph, and 57 asthmatic patients of similar age were studied once. Three volumes of compressed thoracic gas ( V comp ) were obtained: with 25%, 50% and 75% of vital capacity (VC) expired. Relative V comp was calculated using the actual amount of gas remaining in the lungs. Regarding the best and second best manoeuvre, coefficient of variation (CoV) in V comp ranged from 47 to 79% (controls) and from 48 to 112% (patients). Regarding the best manoeuvre in the first and second test session (controls), CoV in V comp ranged from 73 to 159%. Bronchodilator response had an extreme individual variation, and the changes were insignificant in both groups. In the paediatric population, the poor repeatability of V comp invalidates its use in clinical assessment of pulmonary function.

Clinical assessment of modern hearing aids.

The increasing complexity of the non-linear signal processing of modern hearing aids makes the use of clinical assessment of hearing aid benefit more and more important. The paper discusses the general structure of such studies with regard to choice of test subjects, reference hearing aids and the advantage of double-blind and cross-over design. Assessment should contain at least the three dimensions: perceived hearing aid benefit (preferably including perceived sound quality and preference between test and reference aids), speech recognition in noise, and electroacoustic verification by means of real-ear measurements.

Adrenal cortex response to adrenocorticotropic hormone in dairy cattle

Adult dairy cows were treated with a range of doses (0.0125mg to 0.4mg) of synthetic ACTH 1–24 and the plasma cortisol response was measured. Peak response was independent of dose. Higher doses of ACTH had a more prolonged effect such that the integrated response was dose dependent. Dose response curves were examined by regression analyses. Individual cows had a significant effect on y-axis intercept but not on the slope of the regression lines examined. A dose rate of 0.05mg ACTH iv was identified as a suitable dose rate for use in clinical assessment of adrenal cortex function, with 0, 50 and 120 min following ACTH being critical sampling times to identify the response.

Impact of a color-flow duplex surveillance program on infrainguinal vein graft patency: A five-year experience

Purpose and Methods: The contribution of color-flow duplex surveillance to improving vein graft patency was evaluated in two patient groups after 201 infrainguinal bypass procedures were performed during a 5-year period. Incidence of revision procedures and the primary and assisted primary patency rates were compared for 160 bypass grafts monitored during the first 2 years by use of color-flow duplex scanning of the vein graft and adjacent arterial segments (color-flow surveillance group) versus 41 bypass grafts monitored by use of clinical assessment alone (clinical follow-up group). Only grafts that were patent after the first postoperative month are considered.Results: The two groups were comparable with regard to most of the pertinent clinical factors. Stenotic lesions were identified in 58 bypass grafts, and severity was determined by use of intraarterial digital subtraction angiography. Eighteen bypass grafts with stenoses did not undergo a revision for reasons that were determined by the doctor, the hospital, or the patient. The occlusion rates of revised and nonrevised stenotic grafts were compared for lesions of different severity. None of the grafts for stenoses with 30% to 49% diameter reduction (DR) failed during follow-up. Occlusion occurred in 57% of the nonrevised and 9% of revised grafts (p = 0.047) for stenoses with 50% to 69% DR. Stenoses with 70% or greater DR were associated with graft failure in 100% of nonrevised bypasses and in 10% of revised grafts (p = 0.004). The assisted primary patency rate was higher in grafts that underwent color-flow surveillance compared with grafts with that underwent clinical follow-up (3-year patency rates of 91% and 72%, respectively; p = 0.004). The independent correlation of color-flow surveillance with higher patency rates was demonstrated in a proportional hazard analysis. The relative risk (probability of occlusion) in color-flow surveillance grafts is less than one third of the relative risk in bypass grafts that underwent clinical follow-up.Conclusions: We conclude that revision procedures were more optimally used during color-flow surveillance, whereas asymptomatic stenotic graft lesions are missed with clinical follow-up, which results in a higher percentage of graft failures. Overall graft patency rates can be improved with use of color-flow duplex surveillance and repair of significant stenotic lesions.

Patient-based health status measures in outpatient dialysis. Early experiences in developing an outcomes assessment program.

This paper describes the initial development of a patient-based outcomes assessment program in an outpatient dialysis unit. This project presented four logistical and practical issues that are discussed in this paper: patient acceptance of quarterly administrations of a generic health status survey (the SF-36); timing of administration during dialysis session; respondent burden; and staff burden. Also discussed are three issues related to the clinical use of these assessments: medical record status of SF-36 data; use in clinical decisionmaking; and clinicians' responses to aggregate data from patient-based health status assessments. The investigation reported presents strong evidence of patient acceptance of the SF-36. Data collection problems reflected the nature of a busy dialysis unit, and most have been corrected. Considering functional status, the role functioning of dialysis patients is most adversely affected; among well-being measures, patients are most compromised by pain and lack of energy. Clinicians' reviews of these results point to the need for normative data, information about severity of primary and comorbid diseases, and knowledge of relationships between SF-36 scores and physiologic parameters to make clinical use of generic health outcome assessments.

Role of CA125 and Abdominal Pelvic Computerized Axial Tomogram in the Monitoring of Chemotherapy Treatment of Ovarian Cancer

Twenty four patients with epithelial ovarian cancer, who were treated by chemotherapy after debulking surgery, were monitored by serial monthly CA125 estimation and half-yearly computerized axial tomogram (CAT) of abdomen and pelvis. The efficiency of these monitoring methods and that of clinical examination were compared. The use of CA125 alone was superior to the use of clinical assessment alone in the detection of tumor progression (p less than 0.01). The addition of the expensive routine half-yearly CAT examination did not improve the tumor detection rate (p less than 0.05). Hence, CAT examination should not be used routinely to detect recurrence of tumor in patients without a raised CA125 level. However, in patients with increased CA125 level, CAT examination had a place in locating and in determining the extent of the tumor which in selected patients may enable us to make changes in therapy without laparotomy and in other patients may help us to make a better assessment on whether further debulking is possible.

Selective Management of Anterior Abdominal Stab Wounds

A policy of selective management of anterior abdominal stab wounds was evaluated in 333 consecutive patients. Laparotomy was performed based upon initial clinical assessment in 165 patients. There were six deaths (3.6%), major complications in 23 patients (14%), and 28 negative laparotomies (17%). Eighteen patients developed indications for laparotomy after 10.7 +/- 2.2 hours of observation. There were no deaths, major complications in two patients (11%), and four negative laparotomies (22%). One hundred fifty patients were observed and discharged after 1.8 +/- 0.1 days. Sensitivity, specificity, and positive and negative predictive values for initial clinical evaluation were 91%, 85%, 92%, and 83%, respectively. Length of hospitalization in the initially operated and in the delayed group was 9.5 +/- 0.6 and 10.6 +/- 2.6 days (NS), respectively. Most serious intra-abdominal injuries will declare themselves on initial clinical assessment. The remainder are less severe injuries and these patients can be safely observed without undue sequelae due to delay. The use of clinical assessment alone to prompt laparotomy is also cost effective based on analysis of hospital days for initial illness. No procedures are necessary to define penetration.

An objective method of assessing nasality: a possible aid in the selection of patients for adenoidectomy.

We present an appraisal of an objective technique for assessing nasality, or the nasal component of speech. Evidence suggests that a subjective impression of hyponasal speech is related to the adenoid volume and the radiographic palatal airway, although clinical assessments may have poor inter- and intra-observer agreement. Determination of the oral and nasal acoustic ratio or 'Nasalance' is quick, painless, and non-invasive. There was good agreement and reproducibility within normal subjects when test phrases were used. Words such as 'bananas' which contain nasal consonants showed large reductions in the Nasalance score when the nostrils were occluded and are of use in clinical assessment. This method may be of use in refining the selection of children for adenoidectomy.

Assessing parent-child relationships: a report of normative scores and revalidation of two clinical scales.

Normative score performances on the Child's Attitude toward Mother and Child's Attitude toward Father scales by several adolescent subpopulations important to family therapists and researchers are reported for use in clinical assessment and future research. The instruments were administered to a representative sample of 2,419 Florida adolescents, and subpopulations were constructed based upon parental structure and sex. A previous study investigating psychometric properties of the two instruments was partially replicated. Results indicated that both scales are reliable and valid measures of the magnitude of problems in parent-child relationships from the child's point of view. The scales are recommended for both clinical and research applications.

The precise measurement of knee joint kinematics as an aid in clinical assessment

This study involved the use of a very precise three dimensional tracking system to identify changes in joint condition for use in clinical assessment. CODA-3, a three dimensional position sensing device, proved itself capable of producing very accurate three dimensional information about the position of its set of prismatic landmarks. It allowed the collection of parameters of gait which compared favourably with those acquired using a cinematographic technique. The main advantages of using this system were firstly, the real time data analysis facility and secondly. the ease of attachment and wearing of the prismatic markers. By a radiographic technique it was shown that. as with all surface mounted markers. the CODA-3 landmarks moved over the skin relative to underlying bone.

Use of fables in clinical assessment of contested child custody.

Contested custody cases in divorce proceedings have been recognized as significant life stressors for both the adults and the children involved. Recent efforts have focused on the development of clinical strategies that address the stressors involved in divorce. Assessment of the post-trauma stress experienced by children is discussed. This article reviews the literature on the use of clinical assessment in evaluating the impact of separation and divorce on children. It further provides a unique psychological assessment strategy based on children's fables that may be beneficial to obtaining clinically relevant data with children engaged in custody disputes. Issues and import for the role of clinically relevant data and its use in court are offered.

Rapid synthesis of 123I-labeled iodinated contrast media by “kit”-type labeling procedure

A convenient method for the synthesis and purification of radioiodine-labeled diatrizoate and its derivatives is reported. The reaction conditions are well-suited for preparation of [ 123I]diatrizoate in “kit” form for routine use in nuclear medicine. Its use for clinical assessment of GFR will result in a major reduction in the radiation dose over standard urography and provide accurate diagnostic information not obtainable with other radiopharmaceuticals. Simultaneous determinations of GFR and ERPF are possible when [ 123I]diatrizoate is used in conjunction with [ 131I]orthoiodohippuran.

Dehydration-hydration. Excretory urography: Use in clinical assessment of ureteropelvic junction obstruction : D. E. Johnson and J. R. Robinson. J. Urol. 101:408–410 (March), 1969

Dehydration-hydration. Excretory urography: Use in clinical assessment of ureteropelvic junction obstruction : D. E. Johnson and J. R. Robinson. J. Urol. 101:408–410 (March), 1969

Dehydration-Hydration Excretory Urography: Use in Clinical Assessment of Ureteropelvic Junction Obstructions

Dehydration-Hydration Excretory Urography: Use in Clinical Assessment of Ureteropelvic Junction Obstructions

A fear survey schedule for children (FSS-FC): A factor analytic comparison with manifest anxiety (CMAS)

A Fear Survey Schedule for Children (FSS-FC) was developed. This scale and the Children's Manifest Anxiety Scale (CMAS) were administered to fifty-nine boys and forty girls ages 9 through 12. A factor analysis was performed on each scale yielding factored subscales intended for use in clinical assessment and research in children's fears. A comparison was made between the fear and anxiety scales and an overall correlation of 0.49 between the FSS-FC and CMAS was similar to that obtained in adult studies.