It is critical for researchers to be confident of the quality of survey data. Problems with data quality often relate to measurement method design, through choices made by researchers in their creation of standardised measurement instruments. This is known to affect the way respondents interpret and respond to these instruments, and can result in substantial measurement error. Current methods for removing measurement error are post-hoc and have been shown to be problematic. This research proposes that innovations can be made through the creation of measurement methods that take respondents' individual cognitions into consideration, to reduce measurement error in survey data. Specifically, the aim of the study was to develop and test a measurement instrument capable of having respondents individualise their own rating-scales. A mixed methodology was employed. The qualitative phase provided insights that led to the development of the Individualised Rating-Scale Procedure (IRSP). This electronic measurement method was then tested in a large multi-group experimental study, where its measurement properties were compared to those of Likert-Type Rating-Scales (LTRSs). The survey included pre-validated psychometric constructs which provided a baseline for comparing the methods, as well as to explore whether certain individual characteristics are linked to respondent choices. Structural equation modelling was used to analyse the survey data. Whilst no strong associations were found between individual characteristics and respondent choices, the results demonstrated that the IRSP is reliable and valid. This study has produced a dynamic measurement instrument that accommodates individual-level differences, not addressed by typical fixed rating-scales.

Drooling management in the neurologically impaired pediatric population is a challenge. Surgery is considered an invasive procedure, while behaviour modification techniques, correction of situational factors and oral-motor therapy do not always produce sustained improvement. In recent years Botox® has been investigated. This study comprised analyses of clinical data obtained from a Drooling Treatment Project (DTP) conducted at a school for special needs children in South Africa. The aims of the DTP were to establish the response of drooling in a number of different contexts, following bilateral submandibular salivary gland injections of Botox®. Two groups of children were involved, 7 children with cerebral palsy and 2 children with operculum syndrome. Drooling was assessed in 5 different situations and at different time points pre- and post Botox® injection up to 6 months. Parents’/primary caregivers’ perceptions of drooling and treatment with Botox® were also measured using an interview form and a quality of life questionnaire. Results showed that drooling was reduced in all situations, with significant reductions in the general and communicating situations. These results indicate that the context in which drooling occurs is an important factor and suggest the value of considering the situational context when making drooling judgements. Further, there was a difference in the pattern of response between the 2 groups. This finding has implications, not only for future research, but also for models of explanation of the effects of Botox®. Most parents/primary caregivers felt their children’s lives and their own had improved following the Botox® injection and would repeat the treatment. Clinical and research implications are discussed, with reference to the South African context.

The objective of this study was to compare the accuracy of self-reported skin cancer risk outcome measures proposed as standards by prevention experts to aggregated estimates of behavior from weekly diaries. Weekly electronic diaries of ultraviolet radiation (UVR) behaviors, initially validated by comparison with daily electronic diaries, were used to assess the accuracy of commonly used end-of-summer self-reported measures among 250 adults. Results revealed low biases, and good correspondence between simple open-ended self-reported estimates of days outside, hours outside, sunbathing days and hours, and days outside when not protected by either sunscreen, long-sleeved shirts, hats, or shade. Rating scale measures commonly used in the current literature and those recently recommended as standards by a workshop of experts showed evidence of being non-interval and lacking precision for more frequent behavior (e.g., >1 h sun exposure daily). These data indicated that open-ended frequency self-reports of skin cancer risk behaviors that follow procedures designed to increase accuracy were reliable over a summer-long period.

Perceptual speech and voice analysis is an essential skill for all speech-language pathologists, but it is a difficult skill to teach. Even the reliability for experienced experts is variable. Some training literature and practices in speech-language pathology suggest that imitating pathological voices may be useful for developing perceptual judgment. Evidence from other fields suggests that motor experience influences perception. Until now the link between production and perception of voice quality has not been addressed. The purpose of this pilot study is to test the hypothesis that imitating pathological voice samples would improve the perceptual discrimination abilities of naïve, inexperienced listeners. Three expert listeners rated 25 voice samples using a perceptual voice evaluation scale, the Grade, Instability, Roughness, Breathiness, Asthenia, Strain Scale (GIRBAS) (Dejonckere et al., 1996), and identified anchor samples for the training protocol. These expert ratings were used to develop summary expert ratings that served as a comparison for the naïve listener ratings. Two groups of naïve undergraduate listeners received training in evaluating voice quality and in administering the GIRBAS. They completed a pretest, a training session, a homework session, and a post-test. During each activity, they rated 6 voices and provided a confidence rating for their scores. The experimental group imitated the voice samples during the study, and the control group completed the training without supplemental motor experience. It was hypothesized that both listener groups would have improved accuracy and confidence levels between the pretest and post-test, with a larger improvement for the experimental group. Data suggested that training improved naïve listener accuracy and confidence levels and that this improvement was maintained for at least seven days after the initial training. Post-test accuracy for both groups was approximately the same. Imitation did not improve the accuracy of ratings, although those subjects had higher confidence levels. The data supported previous research that found that training improved the accuracy of perceptual voice evaluations. However, the hypothesis that imitation could improve perceptual ratings was not supported by this study and bears further investigation due to the small sample size.

Background Depression is a very common disorder that causes great suffering for the patient. Recognizing depressed patients in primary care (PC) settings is a challenge and only about half are identified as depressed by their general practitioner (GP). Among patients receiving antidepressants (AD) about 70 % are improved, but only about 35 % reach remission. Hence, there is a need to identify depressed patients and to develop optimal treatment strategies in PC. Self-rating scales can be helpful in assisting the recognition. Patients’ beliefs about the cause of depression and their attitudes towards treatment options have been found to influence their help-seeking behavior, coping strategies, treatment preferences and adherence. To increase depressed patients’ knowledge about their disorder and to help them reach and stay in remission, the “Contactus program” was launched in Sweden, containing patient education and group counseling, as supplement to the usual care in PC. Aims To explore patients’ beliefs about causes and improvement factors for depression, and evaluate if the Contactus program could help to improve treatment outcome. Also, to investigate the psychometrics of two commonly used self-rating scales for depression, HADS and PHQ-9. Methods Treatment outcome among patients participating in the Contactus program (N=205) was compared to a control group (N=114) treated as usual. The outcome was measured by HADS, GAF-self and by questionnaires. Both groups also answered an open-ended question about the cause of their depression at baseline and another question about improvement factors at follow-up after six weeks. To compare HADS and PHQ-9, patients (N=737) visiting their physician because of depression filled in both scales. The scales cut-offs were compared with Cohen’s Kappa, internal consistency was calculated and factor analysis was performed.  Results Depressed patients participating in the Contactus program had a response rate of 55 % compared to 29 % in the control group (p=0.006). Also, remission was reached among 42 % in the Contactus group and 21 % among the controls (p=0.02). The patient’s subjective evaluation of the outcome after six weeks showed that 72% of the Contactus patients considered themselves improved vs. 47% among controls (p=0.01). The most common described reason for depression was current stress, most often work related, and own personality traits. Very few mentioned biological factors. For improvement, the most commonly mentioned aspects were participation in the Contactus program and AD. When comparing HADS to PHQ-9 their agreement at recommended cut-offs, HADS-D≥11 and PHQ-9≥10, was low (k=0.35). The highest Kappa value (0.56) and also equal prevalence of depression were found at HADS-D≥8 and PHQ≥12. Both scales had a high internal consistency (α=0.9). Conclusions The results of this thesis indicate that patient education and group counseling are valuable supplements to usual treatment of depression in PC. It is also clear that patients and professionals often have different opinions about the causes of depression, at least concerning biological factors. The patients were generally positive to professional help. The patients’ own beliefs about their illness must be considered when developing new types of interventions and when trying to reach an understanding in the patient-doctor encounter. Finally, there are many self-rating scales for depression. Here two scales were compared and both showed good psychometric properties in terms of internal consistency and factor structure. However their optimal cut-offs were questioned. In conclusion, self-rating scales are useful in identifying depressed patients in PC and might also be apt for measuring treatment outcome. Offering the patient education about their disorder and possibility to share experiences seems to increase response and remission rates, substantially. More studies are needed to explore the effects of educational programs, group interventions, and how patients’ own believes interact with the choice of treatment, adherence and outcome.

The diagnosis of autism is a comprehensive process that requires trained professionals and is often a time consuming process. Behavior rating scales are common components used by practitioners in evaluations to assess various social, emotional, or behavioral problems. With the rise of awareness, the steady increase of autism diagnoses, and the importance of early identification to increase the effectiveness of intervention, there is a need for screeners to identify the characteristics of Autism Spectrum Disorders. The purpose of the present study was to determine if there was a group of items on the Child Behavior Checklist/1.5-5 that reliably distinguished between children with autism and referred, but non-spectrum children. A behavior rating scale was completed by parents and/or guardians of 156 preschool children with autism and without autism. Analyses of the data revealed a grouping of items that were significantly correlated with the diagnosis of autism. Based on predetermined cutoff scores, sensitivity, and specificity; the group of items may be useful in the recommendation of further assessment of autism.

Early identification of autism is important in order to maximize the potential of intervention efforts. However, the identification of autism can require extensive training and experience. Psychologists routinely use behavior rating scales to assess children for various social, emotional, or behavioral problems when completing evaluations in the school or clinical setting. The focus of the current study is to determine whether a behavior rating scale can accurately distinguish between referred preschoolers with autism and referred preschoolers without autism. Parents of 82 preschoolers referred to a nonprofit child development clinic because of behavioral or developmental concerns completed two behavior rating scales as part of the initial evaluation. The findings revealed that while statistically significantly differences were found between the scores for the two groups on a number of scales, the practical implications were unclear. The use of behavior rating scales as screeners for autism in preschoolers would result in a very high false positive rate.

The first step in developing or updating a licensure or certification examination is to conduct a job or task analysis. Following completion of the job analysis, a survey validation study is performed to validate the results of the job analysis and to obtain task ratings so that an examination blueprint may be created. Psychometricians and job analysts have spent years arguing over the choice of scales that should be used to evaluate job tasks, as well as how those scales should be combined to create an examination blueprint. The purpose of this study was to determine the relationship between individual and composite rating scales, examine how that relationship varied across industries, sample sizes, task presentation order, and number of tasks rated, and evaluate whether examination blueprint weightings would differ based on the choice of scales or composites of scales used. Findings from this study should be used to guide psychometricians and job analysts in their choice of rating scales, choice of composites of rating scales, and how to create examination blueprints based upon individual and/or composite rating scales. A secondary data analysis was performed to help answer some of these questions. As part of the secondary data analysis, data from 20 survey validation studies performed during a five year period were analyzed. Correlations were computed between 29 pairings of individual and composite rating scales to see if there were redundancies in task ratings. Meta-analytic techniques were used to evaluate the relationship between each pairing of rating scales and to determine if the relationship between pairings of rating scales was impacted by several factors. Lastly, sample examination blueprints were created from several individual and composite rating scales to determine if the rating scales that were used to create the examination blueprints would ultimately impact the weighting of the examination blueprint. The results of this study suggest that there is a high degree of redundancy between certain pairs of scales (i.e., the Importance and Criticality rating scale are highly related), and a somewhat lower degree of redundancy between other rating scales; but that the same relationship between rating scales is observed across many variables, including the industry for which the job analysis was being performed. The results also suggest the choice of rating scales used to create examination blueprints does not have a large effect on the finalized examination blueprint. This finding is especially true if a composite rating scale is used to create the weighting on the examination blueprint.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Submitted by Claudia Rocha (claudia.rocha@udesc.br) on 2018-02-16T11:12:33Z No. of bitstreams: 1 PGCA16MA187.pdf: 1684727 bytes, checksum: 5568c061fa23561e4110c551eb567400 (MD5) / Made available in DSpace on 2018-02-16T11:12:33Z (GMT). No. of bitstreams: 1 PGCA16MA187.pdf: 1684727 bytes, checksum: 5568c061fa23561e4110c551eb567400 (MD5) Previous issue date: 2016-02-19 / Capes / Chapter I: The aim of this study was to evaluate the analgesic effect of intraoperative and postoperative continuous infusion of ketamine in addition to their cardiovascular, blood gas and respiratory changes. 24 dogs were used, adult, with average weight and age of 19,2±10,1 kg and 8,5± 1,7 years, respectively. All animals were premedicated with 0,5 mg/kg of morphine and 0,02 mg/kg acepromazine by the IM route. Anesthesia was induced with propofol 4 mg/kg and maintenance of anesthesia with isoflurane 1 MAC, diluted in 100% oxygen, undergoing mechanical ventilation. Regarding analgesia during surgery the animals received after the induction, an initial bolus of fentanyl in a dose of 2,5 μg/kg by the IM route, followed by continuous infusion at the rate of 10 μg/Kg/h and then were divided into three groups: CP; received bonuses of ketamine at a dose of 2,5 mg/kg in the immediate postoperative and IC ketamine 10 μg/ kg/min in six hours postoperatively. The CTP; received bolus ketamine at a dose of 2,5 mg/kg after induction of anesthesia and IC ketamine 10 μg/ kg/min intraoperatively and ketamine 10 μg/ kg/min in six hours postoperative. And the SP; They received saline bolus after induction and in the immediate postoperative period, followed by saline IC in six hours postoperatively. Redemptions for analgesia, bradycardia and hypotension were performed with fentanyl, atropine and dobutamine, respectively. The surgical procedure was complete unilateral mastectomy, performed always by the same surgeon. Upon completion of the surgical procedure, all animals received meloxicam and morphine at a dose of 0,2 mg/kg and 0,5 mg/kg for IV and IM, respectively. The parameters were evaluated 10 minutes after induction of anesthesia (T0); 5 minutes after bolus injection of ketamine and / or fentanyl (T1); 15 minutes after bolus injection of ketamine and/or fentanyl (T2); After the skin incision (T3) and 30, 45, 60, 75 and 90 minutes after the start of the continuous infusion treatments (T4; T5; T6, T7 and T8). Yet they were recorded the total time of surgery and time to extubation in minutes. For algic animals were evaluated by an evaluator, prior to surgery (M0), 1 (M1), 2 (M2), 4 (M4), 6 (M6), 8 (M8), 12 (M12) and 24 ( M24) hours postoperatively. Morphine dose 0,5 mg/kg by the IM route, was standardized for painkillers redemptions when a score higher or equal to six points was observed, with the help of Pain Scale Composed of Glasgow. The incidence of sedation was evaluated in the same moments of pain assessment through the Adapted Sedation Scale Saponaro, 2014. There was a decrease of FC in T8 in the CP and SP in relation to the CTP. The PAS increased in CTP T3 to T8 and SP from T3 to T7 when compared to the time T0. The CTP decreased in PaCO2 between T2 and T8, relative to T0. The Cl- was higher in the T2 CTP when compared to the SP and the SP greater compared to CTP. Regarding the used sedation scale, there was no statistical difference for the sub item appearance. As for the sub item behavioral interaction significant differences were observed in M0 to M1, M2 and M4 in CP in M1 for CTP and M1 and M2 for the SP. The strength of the analysis, statistical differences were observed from M1 to M24 to the CP, M1 and M2 for the CTP and between M1 and M24 for the SP in relation to the M0 moment. And the answer to palm the M8 time, the SP and CP differed from the CTP showed values similar to those seen in CP and SP. In relation to the total sum of points for GCMPS significant differences were observed in relation to M0 between M1 and M24 to the CP, from M1 to M12 in CTP and M1 to M6 for the SP, and the M24 when the CP showed values different to those observed in SP. The survival curve analysis showed no statistical difference for the perioperative rescue with dobutamine and postoperative morphine between groups, with only difference to the rescue with intraoperative fentanyl, where the CTP group did not need any rescue. Chapter II: The experimental design was carefully similar to Chapter I, but after surgery there was no groups of division or distribution of treatments and the animals were placed in a single group. Thus aimed to evaluate the application of postoperative analgesic redemptions through the correlation of the Visual Analogue Scale (VAS) Glasgow Composite Measure Pain Scale (GCMPS), Acute Pain Scale at the University of Colorado (EDAUC) and University of Melbourne Pain Scale (UMPS) in bitches submitted to unilateral mastectomy full. The algic of the animals was performed with the aid of VAS, EDAUC, UMPS and GCMPS by two assessors, experienced and not experienced before surgery (M0), 1 (M1), 2 (M2), 4 (M4) 6 (M6), 8 (M8), 12 (M12) and 24 (M24) hours postoperatively. The analgesic rescue were performed with morphine 0,5 mg/kg by the IM route, when at least two of scale present a score greater than or equal to 50, 2, 9 and 6 respectively, and when the score was observed only by experienced assessor. There was an increase in the total sum of points for M1 to M12 pain score for the experienced assessor (E) and for non-experienced (NE) for the VAS. In the analysis of EDAUC higher values compared to M0 were observed between M2 to M8 for E and M1 to M12 to the NE. In GCMPS, higher pain scores were observed between M1 to M24 for E and M1 to M12 to the NE. In the analysis of UMPS the increase in the total sum of points for pain scores were evident from M1 to M24 for E and NE. The best overall correlation was 0,775 between GCMPS and EDAUC and among evaluators was 0,925 for GCMPS. Chapter I: We conclude that continuous infusion of ketamine promotes adequate cardiorespiratory stability and hemogasometric provides excellent additional analgesia in the perioperative period, but the administration of meloxicam and morphine in the immediate postoperative masked postoperative analgesic effects of ketamine, did there were differences in the application of analgesic rescues with morphine, will be shown between groups. Chapter II: We conclude that the pain scale Consisting of Glasgow, was more sensitive to detect the need for postoperative analgesic rescue bitches submitted to unilateral mastectomy full, requiring no prior experience by the evaluators to painful assessment / Capitulo I: O objetivo deste estudo foi avaliar o efeito analgésico transoperatório e pós-operatório da infusão contínua de cetamina, além de suas alterações cardiovasculares, hemogasométricas e respiratórias. Foram utilizadas 24 cadelas, adultas, com peso e idade médio de 19,2±10,1 Kg e 8,5±1,7 anos, respectivamente. Todos os animais foram pré-medicados com 0,5 mg/Kg de morfina e 0,02 mg/Kg de acepromazina pela via IM. A indução foi realizada com propofol 4 mg/Kg e a manutenção da anestesia com isoflurano 1 CAM, diluído em 100% de oxigênio, submetidos a ventilação mecânica. Quanto à analgesia transoperatória os animais receberam após a indução, um bolus inicial de fentanil na dose de 2,5 μg/Kg, pela via IV seguido da infusão contínua na taxa de 10μg/Kg/h e em seguida foram alocados em três grupos: o CP; receberam bolus de cetamina na dose de 2,5 mg/Kg no pós operatório imediato e IC de cetamina 10μg/Kg/min em seis horas de pós-operatório. O CTP; receberam bolus de cetamina na dose de 2,5 mg/Kg após a indução da anestesia e IC de cetamina 10μg/Kg/min no transoperatório e cetamina 10μg/Kg/min em seis horas de pós-operatório. E o SP; receberam bolus de salina após a indução e no pós-operatório imediato, seguido da IC de salina em seis horas de pós-operatório. Os resgates para analgesia, bradicardia e hipotensão foram realizados com fentanil, atropina e dobutamina, respectivamente. O procedimento cirúrgico foi de mastectomia total unilateral, realizado sempre pelo mesmo cirurgião. Ao término do procedimento cirúrgico, todos os animais receberam meloxicam e morfina na dose de 0,2 mg/Kg e 0,5 mg/Kg pela via IV e IM, respectivamente. Os parâmetros foram avaliados 10 minutos após a indução anestésica (T0); 5 minutos após o bolus de cetamina e/ou fentanil (T1); 15 minutos após o bolus de cetamina e/ou fentanil (T2); após a incisão de pele (T3) e 30, 45, 60, 75 e 90 minutos após o início da infusão contínua dos tratamentos (T4; T5; T6; T7 e T8). Ainda foram contabilizados o tempo total do procedimento cirúrgico e o tempo para extubação em minutos. Para avalição álgica os animais foram avaliados por um avaliador, antes da cirurgia (M0), 1 (M1), 2 (M2), 4 (M4), 6 (M6), 8 (M8), 12 (M12) e 24 (M24) horas de pós-operatório. A morfina na dose 0,5 mg/Kg, pela via IM, foi padronizada para os resgates analgésicos quando uma pontuação maior ou igual a seis pontos fosse observada, com o auxílio da Escala de dor Composta de Glasgow. A ocorrência de sedação também foi avaliada, nos mesmos momentos da avaliação da dor, por meio da Escala de Sedação Adaptada de Saponaro, 2014. Houve diminuição da FC em T8 no CP e no SP em relação ao CTP. A PAS aumentou no CTP de T3 a T8 e no SP de T3 a T7 quando comparados ao momento T0. A PaCO2 diminuiu no CTP entre T2 e T8, em relação ao T0. O Cl- foi maior no T2 em CTP quando comparado ao SP e maior no SP em relação ao CTP. Em relação a escala de sedação utilizada, não houve diferença estatística para o sub item aparência. Já para o sub item interação comportamental diferenças significativas em relação a M0 foram observadas em M1, M2 e M4 no CP, em M1 para o CTP e em M1 e M2 para o SP. Na análise da resistência, diferenças estatísticas foram observadas de M1 a M24 para o CP, M1 e M2 para o CTP e entre M1 e M24 para o SP em relação ao momento M0. E para a resposta à palma no momento M8, o CP diferiu do SP e o CTP apresentou valores semelhantes aos observados em CP e SP. Em relação ao somatório total de pontos pela GCMPS foram observadas diferenças significativas em relação ao momento M0 entre M1 e M24 para o CP, de M1 a M12 no CTP e de M1 a M6 para o SP, sendo que no momento M24 o CP apresentou valores diferentes aos observados em SP. Na análise da curva de sobrevivência não houve diferença estatística para o resgate transoperatório com dobutamina e pós-operatório com morfina entre os grupos, havendo apenas diferença para o resgate transoperatório com fentanil, onde o grupo CTP não necessitou de nenhum resgate. Capítulo II: O delineamento experimental foi criteriosamente semelhante ao do capítulo I, porém no pós operatório não houve divisão de grupos ou distribuição de tratamentos e os animais foram alocados em um único grupo. Desta forma, objetivou-se avaliar o requerimento de resgates analgésicos pós-operatórios por meio da correlação das Escala Analógica Visual (EVA), Escala de dor Composta de Glasgow (GCMPS), Escala de dor Aguda da Universidade do Colorado (EDAUC) e Escala de dor da Universidade de Melbourne (UMPS) em cadelas submetidas à mastectomia total unilateral. A avaliação álgica dos animais foi realizada com o auxílio da EVA, EDAUC, UMPS e GCMPS por meio de dois avaliadores, experiente e não experiente antes da cirurgia (M0), 1 (M1), 2 (M2), 4 (M4), 6 (M6), 8 (M8), 12 (M12) e 24 (M24) horas de pós-operatório. Os resgates analgésicos foram realizados com morfina 0,5 mg/Kg, pela via IM, quando ao menos duas das escalas apresentassem uma pontuação maior ou igual a 50, 2, 9 e 6 pontos respectivamente, e quando esta pontuação fosse observada apenas pelo avaliador experiente. Houve aumento no somatório total de pontos para o escore de dor de M1 a M12 para o avaliador experiente (E) e para o não experiente (NE) para a EVA. Na análise da EDAUC valores maiores em relação a M0 foram observados entre M2 a M8 para o E e de M1 a M12 para o NE. Na GCMPS, maiores escores de dor foram observados entre M1 a M24 para o E e de M1 a M12 para o NE. Já na análise da UMPS o aumento do somatório total de pontos para os escores de dor foram evidenciados entre M1 a M24 para o E e NE. A melhor correlação geral foi de 0,775 entre a GCMPS e a EDAUC e entre os avaliadores foi de 0,925 para a GCMPS. Capítulo I: Conclui-se que a infusão contínua de cetamina promove adequada estabilidade cardiorrespiratória e hemogasométrica, proporciona excelente analgesia adicional no período transoperatório, porém a administração do meloxicam e da morfina no pós-operatório imediato mascarou os efeitos analgésicos pós-operatórios da cetamina, pois não houve diferença no requerimento de resgates analgésicos com morfina, neste período entre os grupos. Capítulo II: Conclui-se que a Escala de dor Composta de Glasgow, foi mais sensível para detectar a necessidade de resgate analgésico pós-operatório em cadelas submetidas à mastectomia total unilateral, não exigindo experiência prévia pelos avaliadores para avaliação dolorosa