Triangulating Clinically Meaningful Change in the Six-minute Walk Test in Individuals with Chronic Heart Failure: A Systematic Review     

Michael J. Shoemaker  Amy B. Curtis  Eric Vangsnes  Michael G. Dickinson 《Cardiopulmonary Physical Therapy Journal》2012,23(3):5-15

Purpose

The purpose of the present review was to use existing, published data to provide an estimate of the amount of change in six-minute walk test distance (Δ6MWT) that represents a clinically meaningful change in individuals with chronic heart failure (CHF).

Methods

The present review included two separate literature searches of the CINAHL and Medline databases for articles that: (1) reported the intraclass correlation coefficient (ICC) of the 6MWT in individuals with CHF, and (2) used the 6MWT along with either aerobic capacity or health-related quality of life (HRQL) as study endpoints in randomized controlled trials (RCTs) of exercise-based intervention for individuals with CHF. The ICCs were used to calculate the minimum detectable difference (MDD) at the 95% confidence interval for each included study. The Δ6MWT associated with aerobic capacity and HRQL within-group effect sizes for the intervention and control groups in each included RCT was analyzed using receiver operating characteristic (ROC) curves.

Results

Thirteen articles reported the ICC for the 6MWT. The mean (standard deviation) MDD calculated based on these data was 43.1(16.8) m. Eighteen RCTs measured the 6MWT and either aerobic capacity and/or HRQL. A Δ6MWT of 40–45 m was associated with at least moderate aerobic capacity and HRQL effect sizes in the intervention groups. The Δ6MWT thresholds that discriminated between intervention and control groups using ROC curves revealed the following sensitivity/specificity for the respective thresholds: 19 m, 94.4/83.3%, 32 m, 83.3/94.4%, and 48 m 44.4/100% (AUC = .935, p = .009, CI_95% .855, 1.015).

Conclusions

A Δ6MWT of approximately 45 m appears to exceed measurement error and be associated with significant changes in either aerobic capacity and/or HRQL.Key Words: heart failure, six-minute walk test, clinically meaningful change, minimum detectable difference  相似文献   

On the Teaching of Science, Technology and International Affairs     

Weiss C 《Minerva》2012,50(1):127-137

Despite the ubiquity and critical importance of science and technology in international affairs, their role receives insufficient attention in traditional international relations curricula. There is little literature on how the relations between science, technology, economics, politics, law and culture should be taught in an international context. Since it is impossible even for scientists to master all the branches of natural science and engineering that affect public policy, the learning goals of students whose primary training is in the social sciences should be to get some grounding in the natural sciences or engineering, to master basic policy skills, to understand the basic concepts that link science and technology to their broader context, and to gain a respect for the scientific and technological dimensions of the broader issues they are addressing. They also need to cultivate a fearless determination to master what they need to know in order to address policy issues, an open-minded but skeptical attitude towards the views of dueling experts, regardless of whether they agree with their politics, and (for American students) a world-view that goes beyond a strictly U.S. perspective on international events. The Georgetown University program in Science, Technology and International Affairs (STIA) is a unique, multi-disciplinary undergraduate liberal arts program that embodies this approach and could be an example that other institutions of higher learning might adapt to their own requirements.  相似文献   

Informed choice and deaf children: underpinning concepts and enduring challenges   总被引：3，自引：0，他引：3  

Young A  Carr G  Hunt R  McCracken W  Skipp A  Tattersall H 《Journal of deaf studies and deaf education》2006,11(3):322-336

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Doulas as community health workers: lessons learned from a volunteer program     

Kane Low L  Moffat A  Brennan P 《The Journal of perinatal education》2006,15(3):25-33

Doulas, women who primarily provide social support during childbirth, have been associated with a number of positive health outcomes. Because the primary model of practice for doulas is a fee-for-service model in which families privately hire a doula, many expectant women who could benefit from doula support are unable to access the service. The Doulas Care program, located in Ann Arbor, Michigan, represents one model in which doulas provide services without charge. As a result of their extended role in the community, doulas who work with the Doulas Care program have unique educational needs. Through the use of focus groups with the program's volunteer doulas, educational needs related to overcoming barriers to being a doula working in the community were identified. Recommendations for education and training are made to improve the support doulas offer as community health outreach workers.  相似文献   

Research summaries for normal birth     

Romano AM 《The Journal of perinatal education》2006,15(3):58-60

In this column, the author presents summaries of four research studies that further support the benefits of normal birth. The topics of the studies address cord clamping of term infants, the association of multiple cesareans and placental abnormalities, induction of labor at 41 weeks, and the World Health Organization's recently released pediatric growth charts.  相似文献   

Understanding practitioners' characteristics and perspectives prior to the dissemination of an evidence-based intervention     

Baumann BL  Kolko DJ  Collins K  Herschell AD 《Child abuse & neglect》2006,30(7):771-787

OBJECTIVES: To describe the characteristics and repertoires of community practitioners serving families involved in child physical abuse that may inform training and treatment dissemination efforts. The aims are to: (a) describe the background characteristics of these clinicians; (b) document their most common intervention techniques; (c) examine clinicians' attitudes toward manualized treatment; and (d) understand the organizational climate of community agencies. METHOD: Practitioners from nine different agencies who have worked with cases in which there was child physical abuse (n=77) completed focus group discussions and three self-report questionnaires. Qualitative and quantitative analyses were conducted in tandem. RESULTS: Practitioners reported that they most often focused on family issues and employed family therapy techniques. Although treatment manuals were important, it was difficult to determine how practitioners used or would use these materials with families. An almost equal number of concerns and benefits were raised regarding using manuals in treatment. There was moderate agreement in how practitioners perceived their work environments. Age and attainment of a graduate degree were positively related to greater caring and job satisfaction, respectively, while length of time at a given agency was positively related to greater reports of emotional exhaustion on a measure of organizational climate. CONCLUSIONS: Given the promising benefits of evidence-based treatments for child abuse, it is important that researchers begin to form partnerships with community agencies that will lead to the dissemination and evaluation of effective treatment strategies.  相似文献   

The role of materialism on social,emotional and behavioural difficulties for British adolescents     

Pam Maras  Amy Moon  Taveeshi Gupta  Nicole Gridley 《Emotional and Behavioural Difficulties》2013,18(4):362-380

The relationship between materialism and social-emotional behavioural difficulties (SEBDs) was assessed by comparing a sample of adolescents receiving in-school behavioural support with adolescents not receiving any support. All participants completed the Youth Materialism Scale and the Strengths and Difficulties Questionnaire. Binary logistic regression indicated that adolescents who reported higher levels of materialism were more likely to be classified into a group considered ‘at-risk’ for developing conduct and peer problems. Hierarchical logistic regression assessed the moderation of behavioural support and indicated that adolescents in receipt of behavioural support who reported higher levels of materialism were at a greater risk of hyperactivity in comparison to those who receive support but reported lower levels of materialism. For adolescents not receiving behavioural support, less materialistic attitudes placed them at a greater risk of hyperactivity. These findings highlight the importance of distinguishing between different SEBD typologies and the potential effects of materialism during adolescence.  相似文献   

Curriculum-Based Measurement as a Predictor of Performance on a State Assessment: Diagnostic Efficiency of Local Norms     

Karen L. Sandberg Patton  Amy L. Reschly  James Appleton 《Educational Assessment》2013,18(4):284-301

With the concurrent emphasis on accountability, prevention, and early intervention, curriculum-based measurement of reading (R-CBM) is playing an increasingly important role in the educational process. This study investigated the differences in diagnostic accuracy and utility between commercial norms and local norms when making high-stakes, local decisions. Scores on Dynamic Indicators of Early Literacy Skills Oral Reading Fluency for 1,374 students in Grades 2 to 5 were used to predict outcomes the Georgia reading achievement test, the Criterion Referenced Competency Tests. Local norms were generated using logistic regression and receiver operator characteristic curve analysis. The generated cut scores were compared to the commercial norms for differences in diagnostic efficiency. The generated cut scores were lower than the commercial norms and had improved diagnostic efficiency. Implications related to educational policy and the use of R-CBM are discussed.  相似文献   

UCLA COMMUNITY COLLEGE BIBLIOGRAPHY     

By Amy Liu 《Community College Journal of Research & Practice》2013,37(5):469-473

The research reported in this article explored the extent of self‐censorship in community college theatre programs across the country. What part of the college administration plays in such censorship is also examined. Censorship does exist in community college theatre. Much of the censorship is self‐imposed. Directors avoid plays that are controversial. The audience is protected from harm. Profanity, racial slurs, and negative religious references are cut. When cuts are not made, disclaimers are often published in programs or placed in the lobby or both. Further research opportunities suggested by this study lie in examinations of how theatre departments deal with copyright issues when cutting objectionable material from plays. Defining the responsibility of the community college theatre program to the community is another area of research that needs to be addressed. Little censorship occurs from external sources. Finally, how the responsibilities of the college and the theatre to truth can be resolved with the presence of censorship in academic theatre is an area yet to be adequately explored.  相似文献   

Academic Outcomes Among a Sample of Learning Support Community College Students     

Amy D. Skinner 《Community College Journal of Research & Practice》2013,37(1):50-53

This research examined the relationship between placement in a learning support college program and subsequent academic outcomes. The sample consisted of 275 entering freshmen students who were enrolled in the Learning Support reading courses in the fall of 2005. Data were collected from the Gordon College Office of Institutional Research. The data showed that of the 275 students who enrolled in a Learning Support reading course in the fall 2005 semester, 189 returned for the spring 2006 semester. Data also showed that 58% of the 275 students enrolled in Learning Support reading during fall 2005 successfully completed a basic reading intensive course upon completion of their remedial reading class. One hundred eighty seven students who had previously completed Learning Support reading enrolled (spring 2006 or later) in Introductory English 101 and 121 passed. Fifty-five students who had completed Learning Support reading enrolled (spring 2006 or later) in History 1121, Western Civilization, and 20 students passed. Six of the 205 students who completed Learning Support reading graduated Gordon College within a three-year period. The results of the present study indicate that the Learning Support Reading Program in place at Gordon College has proven to be a beneficial tool for at-risk college students. It is assumed that programs such as the Learning Support Program described here may help students build a foundation that will aid them throughout their college career.  相似文献