Treatment of Depression Following Spinal Cord Injury: An Evidence-Based Review.

Study Design: Evaluative research review. Objective: Depression is a significant secondary complication of spinal cord injuries (SCI); this study applies the D. L. Sackett (1989) research criteria to evaluate the quality of intervention studies of the treatment of depression among persons with SCI. Method: An extensive range of peer-reviewed published research was identified through established databases, critical reviews, and published meta-analyses. Results: Nine studies met the inclusion criteria. One antidepressant study was rated above Level III; although the psychological intervention studies had control groups, these were not randomized. Conclusion: This review demonstrates the need for randomized clinical trials of psychological and pharmacological interventions for depression and distress among persons with SCI. so that informed decisions concerning cost-effective treatments can be made. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Much ado about something: Violent video game effects and a school of red herring: Reply to Ferguson and Kilburn (2010).

In this article we reply to C. J. Ferguson and J. Kilburn’s (2010) critique of our meta-analysis on violent video game effects (C. A. Anderson et al., 2010). We rely on well-established methodological and statistical theory and on empirical data to show that claims of bias and misinterpretation on our part are simply wrong. One should not systematically exclude unpublished studies from meta-analytic reviews. There is no evidence of publication or selection bias in our data. We did not purposely exclude certain studies; we included all studies that met our inclusion criteria. Although C. J. Ferguson and J. Kilburn believe that the effects we obtained are trivial in size, they are larger than many effects that are deemed sufficiently large to warrant action in medical and violence domains. The claim that we (and other media violence scholars) are attempting to create a false crisis is a red herring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence that therapy works in clincally representative conditions.

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysts provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electron microscopic study of long-term denervated rat skeletal muscle

This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.     

The five factor model of personality and job performance in the European Community.

In 3 prior meta-analyses, the relationship between the Big Five factors of personality and job criteria was investigated. However, these meta-analyses showed different findings. Furthermore, these reviews included studies carried out only in the United States and Canada. This study reports meta-analytic research on the same topic but with studies conducted in the European Community, which were not included in the prior reviews. The results indicate that Conscientiousness and Emotional Stability are valid predictors across job criteria and occupational groups. The remaining factors are valid only for some criteria and for some occupational groups. Extraversion was a predictor for 2 occupations, and Openness and Agreeableness were valid predictors of training proficiency. These findings are consistent with M. R. Barrick and M. K. Mount (see record 1991-22928-001) and L. M. Hough et al (see record 1991-06268-001). Implications of the results for future research and the practice of personnel selection are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applications of cost-effectiveness methodologies in behavioral medicine.

In 1996, the Panel on Cost-Effectiveness in Health and Medicine developed standards for cost-effectiveness analysis. The standards include the use of a societal perspective, that treatments be evaluated in comparison with the best available alternative (rather than with no care at all), and that health benefits be expressed in standardized units. Guidelines for cost accounting were also offered. Among 24,562 references on cost-effectiveness in Medline between 1995 and 2000, only a handful were relevant to behavioral medicine. Only 19 studies published between 1983 and 2000 met criteria for further evaluation. Among analyses that were reported, only 2 studies were found consistent with the Panel's criteria for high-quality analyses, although more recent studies were more likely to meet methodological standards. There are substantial opportunities to advance behavioral medicine by performing standardized cost-effectiveness analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of medication nonadherence on coronary heart disease outcomes. A critical review

A critical review of published literature was performed to assess the impact of medication adherence on morbidity and mortality among patients with or at risk for coronary artery disease and congestive heart failure. Twenty-one original research articles that met our inclusion criteria and related medication adherence to morbidity and mortality are summarized. No clinical trials that specifically tested the impact of a compliance-enhancing intervention on outcome in coronary heart disease were identified. Among 12 studies that compared hospitalization rates and mortality between adherers and nonadherers, 7 showed a significant relationship between medication adherence and outcomes. Three studies showed that adherence to placebo was associated with improved outcomes, suggesting that adherent behavior may be a marker of better prognosis or confers a protective effect on patients with coronary heart disease. Further study is necessary to determine whether adherent behavior can be taught and whether compliance-enhancing strategies improve outcomes in coronary heart disease.     

Applicability of the single-breath carbon monoxide diffusing capacity in a Norwegian Community Study

The test of single-breath diffusing capacity for carbon monoxide (DLCO) has been widely used in population surveys. However, little is known about the effect of meeting or failing to meet the criteria for acceptability of this test. The American Thoracic Society (ATS) recommends a breathholding time of 9 to 11 s, two measurements within +/- 10% or 3 ml CO(STPD)/min/mm Hg of the average DLCO, and an inspiratory vital capacity (IVC) of at least 90% of the largest previously measured forced vital capacity (FVC) as criteria for this test. The objective of the present study was to examine the extent to which these criteria were met in a community study. To do this, a random sample of 3,740 persons, aged 15 to 70 yr, of the general population of the city of Bergen and 11 surrounding municipalities on the southwest coast of Norway were enrolled in a two-phase cross-sectional study. In the second phase, a stratified sample (n = 1,512) of the respondents to the postal questionnaire used for recruitment for the study (n = 3,370) were invited to a clinical and respiratory physiologic examination that included the DLCO test. The attendance rate was 84% (1,275 of 1,512). In the examination, all subjects were able to maintain a breathholding time of 9 to 11 s, and 98% had two DLCO values within +/- 10% or 3 ml CO(STPD)/min/mm Hg of the average DLCO. The criterion of an IVC of at least 90% of FVC in the two tests was met by 68% of the subjects. Younger age was an independent predictor of failure to meet the required criteria. Thus, only two-thirds of the participants fulfilled all of the ATS criteria for the DLCO test, the main reason for failure being an IVC of less than 90% FVC. This should not necessarily lead to the exclusion from further analysis of those failing to meet this criterion.     

Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review

CONTEXT: Many computer software developers and vendors claim that their systems can directly improve clinical decisions. As for other health care interventions, such claims should be based on careful trials that assess their effects on clinical performance and, preferably, patient outcomes. OBJECTIVE: To systematically review controlled clinical trials assessing the effects of computer-based clinical decision support systems (CDSSs) on physician performance and patient outcomes. DATA SOURCES: We updated earlier reviews covering 1974 to 1992 by searching the MEDLINE, EMBASE, INSPEC, SCISEARCH, and the Cochrane Library bibliographic databases from 1992 to March 1998. Reference lists and conference proceedings were reviewed and evaluators of CDSSs were contacted. STUDY SELECTION: Studies were included if they involved the use of a CDSS in a clinical setting by a health care practitioner and assessed the effects of the system prospectively with a concurrent control. DATA EXTRACTION: The validity of each relevant study (scored from 0-10) was evaluated in duplicate. Data on setting, subjects, computer systems, and outcomes were abstracted and a power analysis was done on studies with negative findings. DATA SYNTHESIS: A total of 68 controlled trials met our criteria, 40 of which were published since 1992. Quality scores ranged from 2 to 10, with more recent trials rating higher (mean, 7.7) than earlier studies (mean, 6.4) (P<.001). Effects on physician performance were assessed in 65 studies and 43 found a benefit (66%). These included 9 of 15 studies on drug dosing systems, 1 of 5 studies on diagnostic aids, 14 of 19 preventive care systems, and 19 of 26 studies evaluating CDSSs for other medical care. Six of 14 studies assessing patient outcomes found a benefit. Of the remaining 8 studies, only 3 had a power of greater than 80% to detect a clinically important effect. CONCLUSIONS: Published studies of CDSSs are increasing rapidly, and their quality is improving. The CDSSs can enhance clinical performance for drug dosing, preventive care, and other aspects of medical care, but not convincingly for diagnosis. The effects of CDSSs on patient outcomes have been insufficiently studied.     

Four-year longitudinal study of conduct disorder in boys: Patterns and predictors of persistence.

A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent Development of Cognitive and Neuropsychological Assessment in Asian Countries.

There is a growing trend of research in neuropsychological assessment in Asia: The mean number of published studies increased from 1.8 in the 1980s to 16.0 in 2 recent years. About 40% of the studies reviewed concerned test development or adaptation, with the latter greatly outnumbering the former. To facilitate the test selection for clinical use, 36 clinical measures were evaluated based on some statistical criteria. The results showed that only 8 neuropsychological tests (5 Chinese. 2 Korean, and 1 Japanese) met the criteria. Given that Asian and Western populations differ on certain cognitive processes, future development of neuropsychological assessment measures in Asia should move from the adaptation of Western tests toward the construction of original tests with better ecological validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in ion channel expression during in vitro differentiation of trout oligodendrocyte precursor cells

A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved).     

Intense fear, helplessness, “and” horror? An empirical investigation of DSM-IV PTSD Criterion A2.

In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM–IV; American Psychiatric Association [APA]), an experiential response was added to the posttraumatic stress disorder (PTSD) traumatic stressor criterion (Criterion A). In addition to witnessing or experiencing an event involving serious threat to one's life or physical integrity (Criterion A1), a traumatic stressor must also evoke an intensely negative emotional response (Criterion A2), operationalized as “intense fear, helplessness, or horror” (emphasis added, p. 428). There has been some question about, but little empirical investigation of, the PTSD predictive value of Criterion A2. Toward this end, a study was conducted to examine differential rates of PTSD among individuals who met Criterion A2 by reporting 1, 2, or all 3 A2 responses. Participants included 205 military personnel, military retirees, and military family members who were receiving services from 4 treatment programs at an army medical center. Forty-three percent of individuals who reported all 3 A2 responses met diagnostic criteria for PTSD; however, only 9% of individuals who reported fewer than 3 A2 responses met criteria for PTSD. The results suggest that the definition of PTSD Criterion A2 may be too broad. A revision or refinement of Criterion A2 in the next edition of the DSM may be indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obstacles to donor eye procurement and their solutions at the University of Iowa

Shortages in transplantable corneas are common, yet little appears in the medical literature about patterns of tissue donation and factors affecting procurement. We have analyzed data on eye donations and taken measures to improve procurement rates based on our findings. Fifty consecutive Cardiovascular Intensive Care Unit (CVICU) deaths were reviewed to compare the number of transplant-eligible donors to the amount of tissue received. An anonymous survey of 250 house staff and nurses was undertaken to identify obstacles to donor eye procurement. Although 12 of 50 potential donors in the CVICU met transplant eligibility criteria, only 1 became a donor. A required request policy notwithstanding, the most common reason for nonprocurement was failure to make a request. According to the survey, the most significant impediments to making the request were (a) not thinking to ask, (b) unfamiliarity with eligibility criteria, (c) unfamiliarity with enucleation procedures, (d) feeling that someone else should make the request, and (e) reluctance to impose on a grieving family. Very few cited religious reasons or being too busy. Education based on the specific concerns listed in the survey was undertaken. During the 12 months after this initiative, the number of transplantable corneas donated from our facility doubled, as compared with the same period in 1992. Despite required request laws and regulations, failure to request tissue donation is common in our facility and may be common elsewhere. Systematic analysis of obstacles to donor eye procurement and their solutions may help to improve our country's performance in this area.     

Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis

The objective of this study was to determine if perioperative antimicrobial prophylaxis decreases the incidence of subsequent shunt infection in patients who require placement of internal CSF shunts. Data sources included a computerized search of two biomedical data bases, contact with colleagues, and a review of abstracts of meetings and of references of identified trials and reviews. Studies were chosen for detailed review if they involved human subjects who underwent CSF shunt placement, with random allocation of patients to groups receiving perioperative systemic antimicrobial agents or to a control group and an outcome measure of subsequent shunt infection. Twelve (32%) of 37 studies met selection criteria and were included. Features of trial design were extracted and trial quality was evaluated with use of a predetermined protocol by three independent investigators who were blinded to titles, authors, and institutions. Individually, only one of 12 trials achieved statistical significance favoring prophylaxis; in the aggregate, the use of prophylactic antibiotics was associated with a significant reduction in subsequent CSF shunt infection (Mantel-Haenszel weighted risk ratio: 0.52; 95% confidence interval: 0.37, 0.73; P = .0002; approximate risk reduction: 50%). This systematic overview of 12 trials of 1,359 randomized patients demonstrates that perioperative use of antimicrobial agents in CSF shunt placement significantly reduces the risk of subsequent infection.     

Common methodological problems in research on the addictions.

Among the common methodological problems in research on the addictions are (a) selective, incomplete, or biased reviews of prior research; (b) reliance on inadequate or incomplete diagnostic criteria in choosing Ss; (c) choice of inappropriate comparison groups; (d) use of inadequate alcoholic analogs when alcoholic Ss are unavailable; (e) failure to adequately account for treatment dropouts; (f) unwarranted choice of single-S over group designs and vice versa; (g) failure to ensure that comparably trained, equivalently committed therapists provide both experimental and control treatments; (h) failure to ensure that patients in both experimental and control treatments receive treatments as therapist- and time-intensive; (i) failure to follow patients for adequate lengths of time posttreatment; (j) failure to provide for adequate, multidimensional treatment outcome measures tapping a full range of patient behavior; (k) failure to exercise restraint, scientific modesty, and criticality in reporting results of one's own research; and (l) failure to recognize differences between statistical and clinical significance. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder treatment in correctional settings: A brief review of the empirical literature and suggestions for future research.

This article reviews the available empirical studies of posttraumatic stress disorder (PTSD) treatments for correctional populations. Despite the large numbers of prisoners and their high rates of victimization and traumatic disorders, few targeted treatments are available, and even fewer have been studied and empirically supported. The treatment modalities that have been studied include two exposure, two cognitive, and two skills-based approaches investigated in a total of eight studies. Four studies that met criteria for this review were conducted with women, three with juvenile males, and one with a single man. The studies possess many methodological weaknesses, and some outcomes have been disappointing. In the hopes of preventing further suffering, revictimization, and recidivism, it is imperative that further development and investigation of targeted treatments continue in this understudied and vulnerable population. Much progress has been made in the treatment of PTSD in the general population, so these approaches could be explored in the correctional system as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic tests for bacterial infection from birth to 90 days--a systematic review

AIM: To determine the clinical value of common diagnostic tests for bacterial infection in early life. METHODS: A Medline search (1966-95) was undertaken to identify studies that reported the assessment of a diagnostic "test," predicting the presence or absence of bacterial infection in infants up to 90 days of age. The quality of each selected study was assessed using defined criteria. Data were extracted twice to minimise errors. RESULTS: Six hundred and seventy articles were identified. Two independent investigators agreed that 194 studies met the inclusion criteria (kappa = 0.85), 52 of which met primary quality criteria; 23 studies reported data on (a) haematological indices, (b) C reactive protein evaluation, and (c) surface swab assessment. For haematological indices, the likelihood ratios for individual tests ranged from 20.4 (95% confidence interval 7.3 to 56.8) for a white cell count < 7000/mm3 to 0.12 (0.04 to 0.37) for an immature:total (I:T) white cell ratio < 0.2. For C reactive protein evaluation, the likelihood ratios ranged from 12.56 (0.79 to 199.10) for a value of > 6 mg/l to 0.22 (0.08 to 0.65) for a negative value. For surface swab assessment, the likelihood ratios ranged from 33.6 (2.1 to 519.8) for a positive gastric aspirate culture to 0.08 (0.006 to 1.12) for microscopy of ear swab material that did not show any neutrophils. Likelihood ratios for combinations of these individual tests ranged from 10.17 (3.64 to 28.41) to 0.47 (0.22 to 1.00). CONCLUSIONS: The methodological quality of studies assessing the accuracy of diagnostic tests is generally poor. Even in rigorous studies, the reported accuracy of the tests varies enormously and they are of limited value in the diagnosis of infection in this population.