How significant is a significant difference? Problems with the measurement of magnitude of effect.

The use of measures of magnitude of effect (MOE) has been advocated as a way to go beyond statistical tests of significance and to identify effects of a practical size and MOE has been used in meta-analysis to combine results of different studies. Some problems associated with measures of MOE are described, and implications for researchers are discussed. It is demonstrated that one commonly used measure of MOE is heavily dependent on a study's number of treatments and sample size. Such a measure should be used with caution for comparing results of studies of different sizes. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hepatic minimal encephalopathy. The most frequently overlooked, clinically occult "metabolic syndrome" on the cirrhosis patient

The syndrome of minimal hepatic encephalopathy is used to describe discrete psychomental and neuro-psychological abnormalities in patients with chronic liver disease (cirrhosis) or portosystemic shunt, in whom classical clinical investigations reveal no evidence of mental or cerebro-neurological disorders, and who cannot be assigned to any of the usual stages of hepatic encephalopathy. Disorders of cerebral function, such as lack of concentration, impaired ability to think logically, loss of comprehension, impairment of space perception and the recognition of numbers and letters can be very reliably detected by simple psychometric tests (number-connection test, line-tracing test, handwriting), and are present in as many as 70% of cirrhotics. This may be expressed in everyday life by an impairment of driving ability, and at work by impaired ability to operate a machine. The use of established means of lowering blood ammonia levels (lactulose, ornithine-aspartate) results in a rapid improvement in the symptoms of encephalopathy.     

How significant is a significant difference? Average effect size of research in counseling psychology.

Searched the volumes of the Journal of Counseling Psychology for the years 1970–1979 and computed the values of η–2 on each univariate inferential statistic reported during that time. Frequency distributions compiled for the values of η–2 for these data revealed that the median strength of association value for research reported in the journal during the past decade was .0830. It is argued that this median η–2 represents a reasonable, if crude, standard for comparison against which the magnitude of experimental effects of research in counseling psychology might be evaluated. Trends across the individual years of the decade are discussed, as are related issues of the implications of these findings for the design of research in counseling psychology. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applications of the psychotherapy phase model to clinically significant deterioration.

While previous research on deterioration has focused on identifying individuals at risk for negative outcomes, little is known about the nature or pattern by which deterioration occurs. The problem of deterioration is especially salient in training clinics; a setting in which higher deterioration rates have been reported. Two studies were designed to test the applicability of the phase model to deterioration in a training clinic and to replicate the model with a training clinic referral-base sample. In Study 1, the course of therapy was monitored for 135 clients. For the 38 clients who deteriorated during therapy, a model where increased symptoms (demediation) reliably preceded both decreased functioning (dehabilitation) and decreased well-being (demoralization) was found. In Study 2, the same three phases were prospectively monitored for 914 undergraduate students on a weekly basis throughout a single semester. For the 158 individuals who deteriorated during this time, a model where demediation reliably preceded dehabilitation, which preceded demoralization was found. These results have clinical implications for the use of tailored intervention strategies focusing on the deterioration phases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy

The purpose of this research was to evaluate the effect of a CareMap and nursing case management on patient satisfaction and staff job satisfaction, collaboration, and autonomy. The patients who had a CareMap and a nurse case manager were more satisfied with their care. The multidisciplinary staff who worked on the experimental unit had increased job satisfaction and nurses who applied and were selected for case management positions had higher levels of collaboration and increased autonomy. Multidisciplinary team members who developed the CareMap also had higher levels of collaboration than other multidisciplinary staff on the experimental unit and their job satisfaction with quality of care increased under this new care delivery system.     

Predicting patient satisfaction: a study of two emergency departments

To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either "very good" or "very poor" (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either "excellent" or "poor" (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.     

Validity and reliability of a new questionnaire on patient satisfaction in rehabilitative therapy

BACKGROUND: The aim of this study was to examine some psychometric properties of a new questionnaire measuring patients' satisfaction with respect to the quality of care during stay in a rehabilitation unit. The instrument (called SAT-16) is composed of 16 four-level items and 2 open-ended questions. The construct validity of the 16-item section was already demonstrated in a previous study based on factorial analysis. In this study the concurrent validity, further aspects of the construct validity and test-retest reliability were analyzed. METHODS: The SAT-16 was administered to 339 inpatients, admitted consecutively to a Rehabilitation Center. RESULTS: 262 questionnaires (77%) were returned, of which 221 with all items filled in. The SAT-16 correlated well with two other measures of satisfaction (CSQ-8 and global satisfaction regarding the hospital stay). The answers to two open-ended questions came out to be consistent with those to the 16 closed-ended questions. The high values for the indices of test-retest reliability (ICC and kappa) are evidence of the stability of the scores in two repeated administrations. CONCLUSIONS: The SAT-16 was found to be provided with good psychometric characteristics. It can be proposed as a valid instrument for use in clinical practice for the continuous quality improvement of inpatient medical rehabilitation programmes.     

Preliminary development and validation of a multidimensional life satisfaction scale for children.

Two studies describe the development and preliminary validation of a multidimensional measure of children's life satisfaction, the Multidimensional Students' Life Satisfaction Scale (MSLSS). In the 1st study, a preliminary version of the MSLSS was administered to a sample of 312 elementary school students. The final version of the scale demonstrated a 5-factor solution and acceptable internal consistency for the total and subscale scores. In the 2nd study, the factor structure findings were cross-validated with an independent sample of 413 elementary school students. Acceptable internal consistency estimates were obtained again for total and subscale scores. For the most part, MSLSS subscales correlated in expected ways with various criterion measures. Total satisfaction scores also related predictably to demographic variables. The MSLSS appears useful for research purposes with preadolescent students (Grades 3–5). Suggestions for further research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact on patient satisfaction of the introduction of family medicine residents into a model practice facility

This study examines the effects on patient satisfaction of the introduction of family medicine residents into the staff of an ongoing private practice that joined a Department of Family Medicine. Questionnaires were administered to clinic patients during a four-week period four months prior to when residents began seeing patients at the clinic and again five months after residents joined the clinic staff. Satisfaction at both times was high; however, significant declines from Time 1 to Time 2 were noted on most items. Analysis showed that this decline was not related to dissatisfaction within the residents. A questionnaire was also mailed to a sample of patients who had not visited the clinic more than once during the first year of the resident program there. Three fourths of these individuals still viewed themselves as patients of the clinic. Implications of these findings for family medicine residency training programs are discussed.     

Polyphasic taxonomic study of clinically significant actinomadurae including the description of Actinomadura latina sp.nov

Thirty-one strains received either as Actinomadura madurae or Actinomadura pelletieri were assigned to four phena, clusters 1 to 4, in a numerical phenetic survey of the genus Actinomadura. Clusters 2 and 4 corresponded to the validly described species A. madurae and A. pelletieri whereas clusters 1 and 3 encompassed strains received as A. madurae and A. pelletieri, respectively. The two clusters that contained A. madurae strains formed a single taxon when a dataset lacking the antibiotic sensitivity entries was examined. Results from pyrolysis mass spectrometric and DNA amplification fingerprinting analyses underpinned the taxonomic status of clusters 2, 3 and 4 and suggested that the A. madurae strains accounted for a relatively wide range of variation. It is proposed that the cluster 3 strains be given species status within the genus Actinomadura given the congruence found between the chemical, molecular and numerical phenetic data. The name Actinomadura latina is proposed for the new taxon. The type strain is DSM 43382.     

A prospective study to assess the effect of ambulatory teaching on patient satisfaction

PURPOSE: To assess the effect of ambulatory teaching on patients' satisfaction. METHOD: In 1996, 103 adult patients presenting to the Walter Reed General Medicine Walk-in Clinic completed a patient-satisfaction questionnaire immediately following their visits, during which they were initially seen by a trainee (third-year medical student or intern) and then seen by a faculty preceptor. The questionnaire included five items from the validated Medical Outcomes Study (MOS)-9 questionnaire as well as two open-ended questions. Fourteen staff physicians, 13 students (49% of the visits), and 11 interns (51% of the visits) participated in the study. Satisfaction was analyzed by level of training, and the responses from the study patients were compared with the responses from 372 usual-care (i.e., non-teaching) patients from the same clinic, using the chi-squared test. RESULTS: The study patients were typically pleased with their encounters, rating their overall satisfaction as excellent (61%), very good (29%), or good (9%). Nearly two thirds of the patients rated their satisfaction with waiting time to be very good or excellent. Compared with the usual-care patients, the study patients reported equal or greater satisfaction for all five MOS-9 items. Ninety-five percent of the study patients said they would be willing to be seen by a trainee-staff team on future visits. There was no difference in patient satisfaction by trainee level. The study patients cited enhanced interaction (45%), enhanced education (34%), and improved care (26%) as benefits of trainee-involved care, and increased waiting time (18%) and worse care (5%) as drawbacks. CONCLUSION: The results of this study suggest that ambulatory teaching does not adversely affect patient satisfaction, regardless of trainee level, and that patients who have been seen by trainee-staff teams are willing to experience such encounters again.     

The effects of visual magnification and physical movement scale on the manipulation of a tool with indirect vision.

Modern tools often separate the visual and physical aspects of operation, requiring users to manipulate an instrument while viewing the results indirectly on a display. This can pose usability challenges particularly in applications, such as laparoscopic surgery, that require a high degree of movement precision. Magnification used to augment the view and, theoretically, enable finer movements, may introduce other visual-motor disruptions due to the apparent speed of the visual motion on screen (i.e., motion scaling). In this research, we sought to better understand the effects of visual magnification on human movement performance and control in operating a tool via indirect vision. Ten adult participants manipulated a computer mouse to direct a pointer to targets on a display. Results (Experiment 1) showed that, despite increased motion scaling, magnification of the view on screen enabled higher precision control of the mouse pointer. However, the relative effectiveness of visual magnification ultimately depended on the scale of the physical movement, and more specifically the precision limits of the whole-hand grip afforded by the mouse. When the physical scale of the hand/mouse movement was reduced (Experiment 2), fine-precision control began to reach its limits, even at full magnification. The role of magnification can thus be understood as “amplifying” the particular skill level afforded by the effecting limb. These findings suggest a fruitful area for future research is the optimization of hand-control interfaces of tools to maximize movement precision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Semantic and visual determinants of face recognition in a prosopagnosic patient

Prosopagnosia is the neuropathological inability to recognize familiar people by their faces. It can occur in isolation or can coincide with recognition deficits for other nonface objects. Often, patients whose prosopagnosia is accompanied by object recognition difficulties have more trouble identifying certain categories of objects relative to others. In previous research, we demonstrated that objects that shared multiple visual features and were semantically close posed severe recognition difficulties for a patient with temporal lobe damage. We now demonstrate that this patient's face recognition is constrained by these same parameters. The prosopagnosic patient ELM had difficulties pairing faces to names when the faces shared visual features and the names were semantically related (e.g., Tonya Harding, Nancy Kerrigan, and Josee Chouinard -three ice skaters). He made tenfold fewer errors when the exact same faces were associated with semantically unrelated people (e.g., singer Celine Dion, actress Betty Grable, and First Lady Hillary Clinton). We conclude that prosopagnosia and co-occurring category-specific recognition problems both stem from difficulties disambiguating the stored representations of objects that share multiple visual features and refer to semantically close identities or concepts.     

A statistically significant sex difference in the number of colony-forming cells from human peripheral blood

PURPOSE: To assess the current profile and the natural disease history of patients with oral lichen planus (OLP) and evaluate their responses to treatment. MATERIALS AND METHODS: Ninety-five community-referred patients with OLP, who were examined in our Oral Medicine Clinic between May 1995 and August 1996, comprised the study group. RESULTS: The OLP patients had been followed for 1-20 years (mean 6.1). The average age at first-recognized onset was 59 years, and there was a 2.3 to 1 female predominance. Only five of the patients knew of a family history of lichen planus. There were no evident associations with smoking, candida, systemic disease or medications. Of the 222 involved mucosal sites, the buccal mucosa was involved most often (79%) and the erosive form was most frequent. Of 70 patients who received systemic and/or topical corticosteroid treatment for pain (83%) or annoying irritation (17%), all but five obtained complete or satisfactory relief. A squamous cell carcinoma developed at a lesion site in three patients (3.2%) during the observation period.     

Does the quality of advanced prosthetic dentistry determine patient satisfaction?

OBJECTIVE: The purpose of this study was to use transmission electron microscopy to examine four representative high-palladium alloys and gain insight into possible strengthening mechanisms. METHODS: Castings of two Pd-Cu-Ga alloys and two Pd-Ga alloys were thinned by jet polishing and ion milling, followed by plasma cleaning, to yield foil specimens. Multiple specimens were prepared for each alloy. Bright-field images, dark-field images and selected-area electron diffraction patterns for the alloys in the as-cast condition, after simulated porcelain-firing heat treatment, and after annealing at 980 degrees C were analyzed by standard transmission electron microscope (TEM) techniques. The overall compositions of the ultrastructures for the specimen foils were determined by conventional standardless energy-dispersive spectroscopic analyses with the TEM, and mean values of the elemental compositions were compared to the nominal alloy compositions provided by the manufacturers. RESULTS: There was generally good agreement (differences less than 2 wt%) between the overall ultrastructure composition and each nominal alloy composition, except for Protocol from which in may have been lost during casting or formed intermetallic compounds that were not detected by TEM. The same fine-scale tweed structure within parallel bands of approximately 100-200 nm width was observed for all four alloys in the as-cast condition and after simulated porcelain-firing heat treatment. The persistence of the ultrastructure in the specimens of the two Pd-Cu-Ga alloys annealed at 980 degrees C and quenched in ice water indicated very rapid formation from the palladium solid solution. The presence of ?100? and ?110? forbidden reflections for the <001> zone suggested that the tweed structure is ordered, although further research is necessary to establish this conclusion. SIGNIFICANCE: The presence of a similar tweed structure in both the Pd-Cu-Ga alloys and the Pd-Ga alloys of substantially lower hardness shows that some other strengthening mechanism accounts for the high hardness and strength generally observed for Pd-Cu-Ga alloys.     

Evaluation of counseling outcomes at a university counseling center: The impact of clinically significant change on problem resolution and academic functioning.

The main purpose of this study was to investigate how receiving personal counseling at a university counseling center helps students deal with their personal problems and facilitates academic functioning. To that end, this study used both clinical and academic outcome measures that are relevant to the practice of counseling provided at a counseling center and its unique function in an institution of higher education. In addition, this study used the clinical significance methodology (N. S. Jacobson & P. Truax, 1991) that takes into account clients' differences in making clinically reliable and significant change. Pre-intake and post-termination surveys, including the Outcome Questionnaire (M. J. Lambert, K. Lunnen, V. Umphress, N. Hansen, & G. Burlingame, 1994), were completed by 78 clients, and the responses were analyzed using clinical significance methodology. The results revealed that those who made clinically reliable and significant change (i.e., the recovered group) reported the highest level of improvement in academic commitment to their educational goals and problem resolution, compared with those who did not make clinically significant change. The implications of the findings on practice for counseling at university counseling centers and for administrators in higher education institutions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intensity difference thresholds after lesions of the visual Wulst in pigeons.

Studied visual intensity difference thresholds before and after telencephalic lesions in 8 White Carneaux pigeons. Ss with visual Wulst lesions showed initial postoperative threshold elevations that represented losses of 19–49% of their preoperative sensory capacity. This initial loss was correlated with the extent of damage to 3 components of the visual Wulst: nucleus intercalatus hyperstriati accessorii, hyperstriatum intercalatus suprema, and hyperstriatum accessorium. The damage to hyperstriatum dorsale, another component of the visual Wulst, made no contribution to the initial deficit. The sensory capacity of all but 1 S improved as a result of postoperative retraining. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability and validity of a self-administered questionnaire of patient health care behavior and satisfaction

The genes encoding the envelope glycoprotein H (gH) and gB homologues were identified by sequencing genomic clones of human herpesvirus-7 (HHV-7), strain JI. A gB cDNA clone from HHV-7 strain AL was also identified. The deduced primary translation products of the gH and gB genes are a protein of 690 amino acids, with a predicted mass of 80.4 kD, and a protein of 822 amino acids, with a predicted mass of 93.3 kD, respectively. Both the predicted proteins have the characteristics of transmembrane glycoproteins, containing signal and transmembrane sequence motifs and characterized by the presence of 10 (gH) and 11 (gB) potential motifs for N-glycosylation. Comparison of amino acid sequence of HHV-7 gH and gB with the homologous sequences of the other human herpesviruses reveals closest homology with HHV-6 (38.8% identity for gH, 56.2% identity for the gB). In addition, significant sequence similarity was also observed between the gH and gB of HHV-7 and the homologs encoded by human cytomegalovirus (21.6% identity for gH, 37.6% identity for gB). No significant differences existed between the gB sequence of the two different HHV-7 strains analyzed. The products of the HHV-7 gH and gB expressed transiently in eukaryotic cells were specifically recognized by an HHV-7-reactive human serum in immunofluorescence assays.     

The importance of caring as a determinant of patient satisfaction among active duty beneficiaries

The satisfaction scores of active duty Department of Defense beneficiaries with the medical care they receive in military facilities are compared to test the hypothesis that caring is a primary determinant of patient evaluations. Patient satisfaction scores and sociodemographic and social psychological correlates of patient satisfaction were regressed to illuminate the attributes patients use to judge their health care experiences. Results show that very specific interpersonal aspects, such as reassurance, support, and interest in outcomes of the care experience, are important to patients.