<p>The standard of diagnosing and categorizing mental disorders in the United States has long been the Diagnostic and Statistical Manual of Mental Disorders (DSM), but the DSM has been criticized through evidence suggesting it lacks appropriate validity, reliability, and clinical utility. The Hierarchical Taxonomy of Psychopathology (HiTOP) has been offered as a solution to these criticisms. But the recommendation to replace the DSM and its categorical diagnostic system has been met with doubt and criticism by others in the field. A common sentiment in these critiques is a lack of evidence that the HiTOP dimensions are clinically useful or that clinicians would be open to applying them to their patients. The goal of the present study was to compare clinician perceptions of the HiTOP and DSM systems for the conceptualization of clinical cases. A sample of actively practicing clinicians (<i>n</i> = 143) rated one of three clinical vignettes using the HiTOP and DSM systems then rated the two approaches on seven indices of clinical utility. HiTOP was favored for overall clinical utility score as well as utility for formulating effective intervention, communicating clinical information to the client, comprehensively describing client psychopathology, describing global functioning, and ease of applying the system to the individual. There was no preference between HiTOP and the DSM for communicating with other mental health providers. The DSM was not favored for any clinical utility outcome. These results suggest interest in HiTOP and dissatisfaction with the DSM among clinicians.</p>

The Brief Adjustment Scale-6 (BASE-6) was recently developed and initially examined as a brief, reliable, no-cost survey for measuring general psychological functioning within Measurement-Based Care (MBC). This study aims to further evaluate the psychometric properties of the BASE-6 in both clinical and nonclinical populations. More specifically, psychometric properties including reliability and validity, generalizability for different race/ethnic samples, and clinical utility within the context of MBC were examined. Three adult samples participated in this study: online community participants (Sample 1: n = 394), college students (Sample 2: n = 249), and individuals receiving outpatient clinical services (Sample 3: n = 80). Participants within the clinical sample regularly completed the BASE-6 while receiving evidence-based treatment in a community based psychological training clinic, where the practice of MBC is standard. Results showed that the BASE-6 had a high level of internal consistency and good test-retest reliability. It showed high convergent validity through a significant positive correlation with total and subscale scores of the Depression Anxiety Stress Scale-21 (DASS-21). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) results supported a unidimensional model that strongly fit the data. All results were uniform across samples. When comparing the clinical and nonclinical samples, participants from the clinical sample demonstrated higher scores in total and most of the single items of the BASE-6. Finally, within the clinical sample, the BASE-6 was sensitive enough to capture change over time by demonstrating a large effect size of pre-post treatment changes and significant linear change in multilevel growth modeling. These results support the BASE-6 as a reliable and valid measure that has a one-factor structure, regardless of race/ethnicity and participants’ clinical status. Additionally, it can sensitively detect clinical change in individuals over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment. / M.S. / The Brief Adjustment Scale-6 (BASE-6) is a short, no-cost survey that assesses general psychological adjustment. It can be used in a psychotherapy setting to evaluate overall functioning of individuals on a regular basis. This study aims to further investigate the BASE-6 in both clinical and nonclinical populations, more specifically, whether the BASE-6 questionnaire is reliable, consistent, and valid with various race/ethnic populations. Additionally, it was examined if the BASE-6 can sensitively capture the change in psychological adjustment over the course of treatment. Three adult groups participated in this study: online community participants (Sample 1: n = 394), college students (Sample 2: n = 249), and individuals receiving outpatient clinical services (Sample 3: n = 80). Participants within the clinical sample regularly completed the BASE-6 while receiving psychotherapy in a community based psychological training clinic. Results showed that the BASE-6 was a reliable, consistent measure and the items all measured the same construct – general psychological adjustment. The BASE-6 was also highly correlated with depression, anxiety, and stress. Results did not differ across samples or race/ethnicity. When comparing the clinical and nonclinical samples, participants from the clinical sample showed higher scores of the BASE-6. Finally, within the clinical sample, the BASE-6 was sensitive enough to capture change over time by demonstrating large treatment changes from the beginning until the end of the treatment. These results support the BASE-6 as a reliable and valid measure regardless of race/ethnicity and participants’ clinical status. Additionally, it can sensitively detect clinical changes in clients over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment.

This thesis concerns optimal designs and estimation approaches for a class of nonlinear dose response models, namely multi-response Emax models. These models describe the relationship between the dose of a drug and two or more efficacy and/or safety variables. In order to obtain precise parameter estimates it is important to choose efficient estimation approaches and to use optimal designs to control the level of the doses administered to the patients in the study. We provide some optimal designs that are efficient for estimating the parameters, a subset of the parameters, and a function of the parameters in multi-response Emax models. The function of interest is an estimate of the best dose to administer to a group of patients. More specifically the dose that maximizes the Clinical Utility Index (CUI) which assesses the net benefit of a drug taking both effects and side-effects into account. The designs derived in this thesis are locally optimal, that is they depend upon the true parameter values. An important part of this thesis is to study how sensitive the optimal designs are to misspecification of prior parameter values. For multi-response Emax models it is possible to derive maximum likelihood (ML) estimates separately for the parameters in each dose response relation. However, ML estimation can also be carried out simultaneously for all response profiles by making use of dependencies between the profiles (system estimation). In this thesis we compare the performance of these two approaches by using a simulation study where a bivariate Emax model is fitted and by fitting a four dimensional Emax model to real dose response data. The results are that system estimation can substantially increase the precision of parameter estimates, especially when the correlation between response profiles is strong or when the study has not been designed in an efficient way. / <p>At the time of the doctoral defence the following papers were unpublished and had a status as follows: Paper 1: Manuscript; Paper 2: Manuscript; Paper 3: Manuscript; Paper 4: Manuscript.</p>

<p>This thesis focuses on routine outcome measurement in occupational therapy; specifically the use of the Canadian Occupational Performance Measure (COPM) in inpatient geriatric rehabilitation.</p> <p>The purpose of the first study (Chapters two and three) was to: 1) determine if routine COPM use was associated with improved functional outcome; 2) gather therapist perceptions on routine COPM use; and, 3) propose a template for summarizing COPM data. A cohort study with a therapist participant survey measured the difference in Functional Independence Measure (FIM^™) change scores between an experimental group (n = 45) that implemented the routine use of the COPM for evaluation/planning and a historical “usual care” comparison group (n = 58). Using generalized linear modeling, it was found that both groups had significant changes in FIM^™scores over time (p <. 05). Differences between groups were not significant. Therapists perceived that the COPM facilitated treatment but experienced challenges in routine use. Therapists placed more importance on individual than group data.</p> <p>The second study (Chapter four) determined if routine use of the COPM was associated with changes in five domains of practice: focus of care on occupation, knowledge of client perspective, clinical decision-making, clinician ability to articulate outcomes, and documentation. Twenty-four occupational therapists on eight geriatric rehabilitation units completed a before-and-after study with a repeated baseline. Domains of practice during three months of standard care (no COPM) were compared using Chart Stimulated Recall and chart audit as outcome measures to three months of intervention (COPM). Mean practice scores indicated a significant effect for time (p < .0001) but no effect based on the frequency of COPM use. Chart audit indicated that COPM use resulted in more occupation-focused issue identification.</p> <p>This thesis challenges assumptions regarding the value of measurement and contains the first study to demonstrate that routine outcome measure use affects occupational therapy practice.</p> / Doctor of Philosophy (PhD)

No description available.

Vestibular-evoked myogenic potentials (VEMPs) supplement the vestibular test battery by providing diagnostic information about otolith organ function. The purpose of this presentation is to provide an update on the clinical use of the cervical VEMP and ocular VEMP as clinical tests of otolith function

The overall aim of the present thesis was to explore and compare professional co-operation in child welfare investigations, explore the psychometric properties, and describe the clinical utility from different perspectives of a translated Swedish version of the standardized assessment instrument the Home Observation for Measurement of the Environment (the HOME Inventory). Social workers in Sweden, Denmark, Britain, Germany, and Texas (USA) co-operated with different professionals around a fictitious child welfare case. Differences were found between and within country-based samples, indicating an unsystematic work procedure in the social work agencies studied. The psychometric properties of the translated Early Childhood version (EC-HOME) and Middle Childhood version (MC-HOME) of the HOME Inventory were explored in terms of inter-observer reliability and by Rasch analysis. The samples were authentic Swedish child welfare cases recruited from a field setting. Inter-observer reliability was satisfactory. Results were ambiguous regarding measurement construction of the two versions studied. Because of the differentiating ability of the EC-HOME and MC-HOME, total scores could provide an indication of inadequate home environments. Experiences of social work practitioners of the clinical utility of the HOME Inventory suggested that they considered the instrument to be comprehensive and have explicit potential benefits, i.e. to be clinically useful. Correspondingly, caregivers’ overall perceptions of the HOME Inventory were positive, determining the content relevant and the format acceptable. However, certain flaws have to be rectified before the HOME Inventory is to be implemented and used successfully. Further, education and the possibility to practice administering the instrument seemed to be essential conditions for future use according to social workers. When social workers and teachers’ apprehensions about support and stimulation provided by caregivers to children in their home environments were compared, preschool teachers’ apprehensions correlated poorly with the social workers’ assessment. These results suggest that the HOME Inventory is promising but cultural adaptation and further studies of psychometric properties are necessary. Different forms of support to practitioners and agencies for successful implementation are required. Awareness of the type of information provided by different sources is important when co-operating in child welfare.

The value proposition of Personalized Medicine is to deliver the “right drug, to the right patient, at the right time”. Companion diagnostics is the required tool for Personalized Medicine used to aid clinical decision making with the aim to identify patients who are most suitable for a given treatment approach and to avoid adverse effects. However, even 16 years after the first co-approval of a therapeutic drug and an associated diagnostic test (trastuzumab (Herceptin1) from Genentech and the HercepTest1 from Dako), the co-development and co-approval of drug-diagnostic pairs is a challenging task.This study has the aim to identify major challenges for diagnostics companies when developing and commercializing companion diagnostics. This is achieved by (1) a literature research and (2) an empirical case study in form of interviews with diagnostics companies. The collected data is analyzed and discussed with focus on current regulatory and reimbursement frameworks in the USA and European Union. The co-development strategies and business models of companion diagnostics developers are identified.The conclusion of this study is that the major hurdles for companion diagnostics development and commercialization are gaps in scientific evidence and lacking regulatory guidelines for co-development and clinical biomarker studies. Companion diagnostics commercialization is further challenged by poor reimbursement levels. The main strategy of diagnostics companies to address these challenges is the demonstration of a beneficial outcome for patients in form of clinical studies. Small companies with limited resources for clinical research receive funding from academic research grants, patient support groups, pharmaceutical industry, and governmental Innovation agencies.Finally the formation of a new “pharma-diagnostics” sectoral innovation system as a result of the emerging paradigm of stratified medicine has been proposed.

No description available.