Patterns of psychological test use in Hong Kong.

We surveyed the use of tests among 42 clinical psychologists in Hong Kong. Results showed that intelligence tests, objective and projective personality tests, and some neuropsychological tests were used frequently. Patterns of test use across settings revealed some homogeneity in that a few tests were frequently used in all the settings, and at the same time heterogeneity with some tests were preferred in particular settings. We identify the need for the development of culturally relevant tests in Hong Kong. The results are compared with survey results obtained in the United States, and recommendations are made with regard to the future of testing in Hong Kong. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conformational stability and antibody response to the 18kDa heat-shock protein formulated into different vehicles

Physicians sometimes order diagnostic tests to reduce the risk of malpractice liability. The authors develop an expected-utility model that links a rational physician's concerns about malpractice liability to increases in the use of diagnostic tests and use this model to assess the effects of defensive testing on patients' interests. To do so, they adapt the threshold approach to clinical decision making to incorporate the physician's interests, focusing on 1) the effect of the physician's expected liability risks and 2) the effect of any expected liability reduction due to diagnostic testing. Surprisingly, the mere existence of liability risks is often sufficient to widen the range of disease probabilities for which diagnostic testing is the preferred clinical strategy. If testing reduces the physician's expected liability risks, the testing range is widened further. For some disease probabilities, testing is preferred by the physician even though it is not in the patient's best interests. When tests are performed in such instances, utility is transferred from the patient to the physician and the physician's insurer. Although the defensive use of diagnostic tests improves clinical outcomes for some patients, it worsens clinical outcomes for others. Moreover, defensive testing worsens the expected outcomes of all patients whose clinical strategies are changed. Physicians should realize that defensive testing necessarily reduces the overall quality of patient care.     

Laboratory medicine in ulcer disease

The role of laboratory medicine in ulcer disease is poorly defined. However there is increasing evidence of the clinical usefulness of some laboratory tests that investigate secretory functions and defensive properties of the stomach, gastrointestinal hormones and Helicobacter pylori infection. These tests may modify the clinical management of patients with peptic ulcer by identifying H. pylori positive subjects, patients with high acid output, patients who do not respond to antisecretory therapy, and patients with high gastrin levels in whom Zollinger-Ellison syndrome may be suspected. Here we review the clinical value of laboratory tests in ulcer disease, particularly as concerns the cost/benefit ratio. The relative merits of these tests are described giving an indication of their possible role in the diagnostic algorithm.     

Lessons from in vitro testing of spinal needles

In vitro testing of spinal needles is intended to identify a best buy, but such tests are not necessarily good indicators of clinical performance and some bench tests appear to conflict with mock clinical assessments. Discrepancies can be explained by examining the role of the hub. The Visual Probability Test, which assesses the needle as a complete unit, would appear to be more useful than the more complex measurements of shaft flow. Not all needle manufacturers use the same gauge, creating confusion when comparisons are made. Packaging frequently fails to give adequate information. Changes in hub design could permit earlier identification of dural puncture.     

Acquired colour deficiency in patients with Parkinson's disease

The blue cone pathway is reported to be affected early in Parkinson's disease (PD) and acquired type three (tritan) defects may occur. Sixty-one patients attending a treatment and rehabilitation centre for PD were examined with clinical colour vision tests. Seven of 13 patients, for whom the diagnosis of PD was equivocal or who had other medical conditions, were identified as having tritan colour deficiency. Results for the remaining 44 PD patients were compared with 40 age matched controls. Ten PD patients (22.7%) had tritan defects. Tritan defects were not found in the control group but performance on some tests was age related. We conclude that clinical tests for tritan colour deficiency are unlikely to be helpful in identifying PD.     

Online assessment: Desirable or dangerous?

Internet-mediated psychological assessment procedures can play an important role in behavioral telehealth, but their use is not unproblematic. Possible uses of World Wide Web-based tests are discussed. Published empirical evaluations of Web-based personality tests indicate that they can be reliable and valid. However, evidence exists that Web-based versions of tests may not always measure the same constructs as their traditional antecedents: Equivalence cannot be assumed. Web-based clinical assessment seems viable, but there are potential difficulties with measurement of some constructs (particularly negative affect), as well as ethical considerations. While offering great potential, online tests of clinical constructs require stringent validation and cautious use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Allergy testing in serious cutaneous drug reactions--harmful or beneficial?

We report on 3 cases of adverse cutaneous drug reactions of erythema multiforme type. Despite the serious previous clinical conditions, patch tests with the possible causative drugs have been performed in all our patients, because of multiple candidate drugs and the need of the patients for further treatment with at least some of the agents. We demonstrate that patch tests are a good and safe approach to initial evaluation of the nature of a cutaneous drug reaction. In the case of a positive patch test reaction to one of the substances, re-exposure to the non-reactants in a clinical setting is recommended. If a one-side-blinded placebo-controlled challenge test is well tolerated, then the clinician should be able to reintroduce drugs previously suspected as causing the allergy.     

Poor stereopsis can support size constancy in albinism

PURPOSE: The size of a retinal image is inversely related to the distance to the object that generates the image. Normal subjects therefore exhibit size constancy, in which the perceived size of an image is scaled according to its perceived distance. Albinos usually have such poor binocular vision that they perform very poorly on clinical tests for stereopsis. To investigate the functional consequences of this poor stereopsis, we investigated whether stereopsis in these subjects could support size constancy. METHODS: The stereothresholds of 10 albinos and 12 normal control subjects were measured. The presence of absence of size constancy was investigated by having subjects equate the subjective size of stereoscopically presented images whose image disparity indicated that they were at different distances. RESULTS: Laboratory results indicated that eight albinos (including five whose clinical tests indicated a lack of stereopsis) had measurable stereopsis of several thousand are seconds or better. Of these, four also exhibited size constancy. CONCLUSIONS: Albinos who do not demonstrate stereopsis on clinical tests can have stereoscopic perception that commonly used clinical tests do not detect. Moreover, some of these patients even use this poor stereopsis in judging the size of stereoscopically presented images.     

Occupational bronchial asthma

Examination of 400 patients with occupational bronchial asthma helped to identify various clinical and pathogenetic variants of the disease in accordance with independent and combined occupational allergens and irritants. The authors evaluated diagnostic value of endonasal tests with occupational allergen, rhinocytologic tests and some specific allergologic blood tests in vitro.     

Extraorganic vascular system of adrenal glands in human fetuses

PURPOSE: To identify ancillary tests for which there are criteria defining the earliest interval at which a repeat test might be indicated, to determine how often each test is repeated earlier than these intervals and, if repeated, provides useful information. SUBJECTS AND METHODS: We performed a retrospective cohort study of 6,007 adults discharged from a large teaching hospital during a 3-month period in 1991. We measured the proportion of commonly performed diagnostic tests that were redundant, and their associated charges. RESULTS: Of the 6,007 patients discharged, 5,289 (88%) had at least one of 12 target tests performed. Overall, 78,798 of the target tests were performed during the study period, of which 22,237 (28%) were repeated earlier than test-specific predefined intervals. This percentage varied substantially by test (range, 2% to 62%). To assess how many early repeats were justified, we performed chart reviews in a random sample stratified by test. For two tests, nearly all the initial results in the sample were abnormal, and all repeats were considered justified. Of early repeats following a normal initial result for the remaining 10 tests, chart review found no clinical indication for 92%, and a weighted mean of 40% appeared redundant. Overall, 8.6% of these 10 tests appeared redundant; if these were not performed, the annual charge reductions would be $930,000 at our hospital, although the impact on costs would be much smaller. CONCLUSIONS: For some tests, an important proportion are repeated too early to provide useful clinical information. Most such tests might be eliminated using computerized reminder systems.     

Study of behavioral phenotypes: goals and methodological considerations

The test principle and the optimization of the reactive ingredients are described for the one-step dip and-read immunochromatographic FRONTLINE rapid tests for drugs-of-abuse testing in urine samples. In a multicenter evaluation the rapid tests were compared with FPIA and EMIT immunoassays. Discrepant results were further analyzed by gas chromatography-mass spectrometry methods. In the comparison of the cannabinoids rapid tests versus both immunoassays using clinical and forensic urine samples (399 versus FPIA and 755 versus EMIT), sensitivities and specificities were 97% or better for both comparisons. For cocaine, a sensitivity of 100% versus both routine technologies was obtained, whereas the specificity was reduced somewhat to 91% because of some cross-reactivity with metabolites of methadone and of clozapine. Specificity was very high for the cocaine rapid tests (98-100%) when applied to urine samples of persons not in a methadone maintenance program. Sensitivities and specificities for the opiates rapid tests were 99% or better at all sites when compared with the routine methods. In the screening of about 1200 clinical urine samples for cannabinoids, cocaine or opiates misuse only six samples would have stayed undetected by rapid test analyzes. These results show the FRONTLINE assays allow a reliable and immediate screening for drugs of abuse.     

Some comments on frequently used multiple endpoint adjustment methods in clinical trials

Confirmatory clinical trials often classify clinical response variables into primary and secondary endpoints. The presence of two or more primary endpoints in a clinical trial usually means that some adjustments of the observed p-values for multiplicity of tests may be required for the control of the type I error rate. In this paper, we discuss statistical concerns associated with some commonly used multiple endpoint adjustment procedures. We also present limited Monte Carlo simulation results to demonstrate the performance of selected p-value-based methods in protecting the type I error rate.     

Enhancement of the biodegradability of model wastewater containing recalcitrant or inhibitory chemical compounds by photocatalytic pre-oxidation

Aminopyrine, antipyrine and trimethadione have been widely used for some time as probe drugs to assess non-selective P450 liver function. They have proved useful in evaluating pre- and post-operative liver function when performing surgery, transplantations, etc., in addition to a general evaluation of liver function and drug interactions. Progress has recently been made both in these non-selective P450 function tests and in the analysis of drug-metabolizing enzymes at a molecular level, which has resulted in more selective P450 function tests. The caffeine (CYP1 A2), chlorzoxazone (CYP2E1), lidocaine (CYP3 A) and midazolam (CYP3 A) function tests and the erythromycin breath test (CYP3 A) are currently being used as specific probes. The future use of these tests needs to be discussed in terms of potential clinical implications.     

Mesial temporal sclerosis (II): clinical features and complementary studies

OBJECTIVE: To collect clinical data and diagnostic characteristics of the mesial temporal sclerosis syndrome (MTS). Development. CLINICAL FEATURES: In MTS repeated temporal lobe seizures, difficult to control pharmacologically, are seen in patients with neuropsychological defects which can be shown by appropriate tests. There is no pathognomonic clinical data. However, there is frequently: 1. Onset of seizures during childhood (6-10 years old). 2. Presence of some type of aura. The only significantly related types are visceral, olfactory and uncinate. 3. A pattern of conduct typical of ictus, although this is nonspecific: Early ipsilateral manual automatism and contralateral tonic posture. 4. Infrequent generalization. Surface EEG: Acute elements and/or slow waves in interictal recordings localized to the anterior temporal region, either unilateral or bilateral and with independent expression. MR of encephalum: Two typical ipsilateral findings at the electric focus of independent presentation and not mutually exclusive: a) Hippocampal hyperdensity in T2 sequences. b) Atrophy of hippocampal structures. FDG-PET: Interictal pattern of ipsilateral temporal hyperperfusion with typical maximal involvement of the polar region. SPECT-HMPAO: Early ictal and post-ictal pattern of ipsilateral temporal hyperperfusion. CONCLUSIONS: MTS is a clinical syndrome with its own identity from the clinical and diagnostic point of view. Results of the non-invasive tests currently available make invasive tests unnecessary in the preoperative guidelines for these patients.     

Diagnostic testing for endolymphatic hydrops

The development of a sensitive and specific diagnostic test for endolymphatic hydrops has eluded investigators for over 30 years. The absence of such a test has hampered basic and clinical research into Meniere's disease and related entities. Presently used tests are limited in their applicability because of their low sensitivity and specificity and a poor understanding of the underlying physiologic principles. Despite this, it is generally agreed that some of these studies have merit in selected situations. This article reviews the present state of diagnostic testing for endolymphatic hydrops. The use of nonspecific studies, such as basic audiometry and tests for recruitment, and "specific" studies, such as electrocochleography and dehydration testing, are critically reviewed.     

Current diagnosis of chronic nonviral hepatitis

Apart from viruses, hepatotoxins, hereditary metabolic disorders, immunological factors and cholestasis may cause chronic hepatitis both clinically and histologically. As far as the etiology is concerned, a complete history can be very helpful. The clinical examination, however, is rarely diagnostic. Nevertheless, some clinical signs (e.g. ascites, splenomegaly, spider naevi) are suggestive of cirrhosis. The activities of gammaglutamyl transferase and ALT in the serum are augmented in most of the patients with chronic hepatitis independent of its etiology. Electrophoresis reveals disturbance of serum albumin and globulin ratios. "Basic' laboratory tests are supplemented by carefully selected additional investigations (e.g. immunological tests) according to the history and clinical data of the individual patient. Retrograde cholangiography is diagnostic in the majority of patients suffering from primary-sclerosing cholangitis. Liver histology, best obtained during laparoscopy, allows classification (and prognosis) of the underlying liver disease in many patients. Results of iron and copper determination in liver tissue are diagnostic in cases of congenital liver disease (hemochromatosis, M. Wilson).     

Clinical and instrumental diagnosis of pulmonary embolism

Pulmonary embolism shows a high mortality especially for the difficulty in establishing an early correct diagnosis. The pathophysiology and thus the clinical manifestations of pulmonary embolism (PE) are essentially conditioned by three factors: the size of the embolus, the pre-existing cardiorespiratory condition, the release caused by the embolus, of some substances or the activation of reflexes which tend to worsen the purely mechanical consequences of PE. The clinical manifestations resulting from the combination of these factors result in three clinical patterns: acute cor pulmonare, pulmonary infarction, acute dyspnea. PE symptoms may be absent in a moderate percentage of cases and if present, they are nonspecific. Some laboratory tests were shown to be of no diagnostic accuracy, as enzyme determination, a sign of necrosis, blood gas analysis, and determination of alveolar arterial oxygen gradient. Among blood coagulation tests, D-dimer determination was shown to be of some relevance. However, at present, it cannot be used to confirm the diagnostic suspicion of PE. Among the instrumental cardiologic procedures, while ECG has a poor diagnostic reliability, transesophageal echocardiography in central embolism may be able to visualize the embolus and to accurately assess the hemodynamic effects, supplying sufficient information for PE therapy. Even if imaging procedures as pulmonary angiography and more recently CT or MRI are the most reliable diagnostic tools, the diagnostic suspicion of PE in subjects at risk, the use of the examined methods and the search in these patients for the presence of lower limb deep vein thrombosis, often asymptomatic, may increase the number of treated patients thus decreasing the mortality of this disease.     

Viral serology and detection

Viral detection is an important part of clinical hepatology. For many years practical clinical tests have been serological but recently newer molecular techniques have become available for virus detection, although these have yet to become routine and some, such as PCR of viral nucleic acid in blood or tissue are not yet consistently reliable. Serology remains the mainstay at present for routine diagnosis. Hepatitis A testing in clinical practice is entirely serological, the IgM response representing acute infection and the IgG response immunity, although more sophisticated molecular techniques have been applied experimentally. A second agent of epidemic enteral hepatitis, the hepatitis E virus, has recently been cloned and sequenced and serological tests for this virus are available, although experience in their use is necessarily limited and a commercial IgM assay has yet to be produced. Serological tests for the hepatitis B virus are well developed. The IgM anticore response differentiates acute infection from chronic, the latter being characterized by the persistence of hepatitis B surface antigen for over six months. Chronic carriers are at risk of liver damage and this risk is best assessed by the amount of viral DNA circulating, which can be determined using a hybridization assay. More sensitive techniques such as the branched chain DNA assay or PCR can detect lower levels of viral DNA but their clinical relevance remains to be established. The hepatitis D virus is defective and relies on hepatitis B to replicate. Serology for antibody and antigen is well established although PCR for circulating viral genome may come to supplant hepatic viral antigen as a test for hepatitis D replication. For hepatitis C serology is feasible only for antibodies, not antigens; although early tests were prone both to false positives and false negatives, current versions are more reliable. PCR has been much used for detection of hepatitis C RNA in blood and tissues and a bDNA assay is now commercially available. Cytomegalovirus detection is confounded by the problem of distinguishing asymptomatic viral replication from disease. Serology is helpful, especially in primary infections, but viral culture is a widely used method. PCR (especially quantitative modifications) or the pp65 antigenaemia assay are experimental approaches which may prove specific enough for general use.     

Intentional and incidental memory: Order effects in clinical testing.

Clinicians sometimes worry that the administration of intentional memory tests early in a clinical battery might artificially enhance performance on subsequent incidental memory tests, with possible differential effects for younger vs. older adults. Eighty-one healthy adults (ages 30–80) were blindly assigned to 1 of 2 testing conditions (incidental followed by intentional and vice versa). Contrary to the concerns of some, administration of intentional tests prior to incidental tests did not affect performance on any measures, and there was no interaction with age. Order of administration did not affect performance in older or younger adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opinions and use of psychological tests: A survey of clinical psychologists.

Conducted a survey of clinical psychologists, selected from Division 12 of the American Psychological Association, about their use and opinions of psychological tests. 500 psychologists were mailed questionnaires; the return rate was 50.1%. Results show that both objective and projective tests are used by clinical psychologists of all major therapeutic orientations with substantial percentages of clients. Clinicians indicated that personal clinical experience with a test was more important in their test-use decisions than pragmatic or psychometric considerations. In fact, clinicians repeatedly emphasized the subjective, insightful, and experiential nature of the testing process. Although the psychometric limitations of tests were recognized, tests were considered more valuable than suggested by reliability and validity studies, which were typically considered flawed or inaccurate. It is concluded that clinicians are probably unaffected by negative testing research because (a) there are strong needs to assess, (b) clinicians accord personal clinical experience greater weight than experimental evidence, and (c) there are few practical alternatives to tests. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)