Showing papers by "Anne M. Stiggelbout published in 2006"

Reliability and validity of the Beck depression inventory in patients with Parkinson's disease

Abstract: We evaluated the validity, reliability, and potential responsiveness of the Beck Depression Inventory (BDI) in patients with Parkinson's disease (PD). In part 1 of the study, 92 patients with PD underwent a structured clinical interview for DSM major depression and based on this patients were considered depressed (PD-D) or nondepressed (PD-ND). Subsequently, patients filled in the BDI. In part 2, a postal survey consisting the BDI was performed in 185 PD patients and 112 controls. Test-retest reliability was assessed in 60 PD patients. The factor analysis revealed a cognitive-affective and a somatic factor. Cronbachs alpha for the BDI was 0.88. Mean BDI indicated significant differences (P<0.001) between the PD and control group, between the PD-ND and PD-D group, and between PD-ND and control group. In part 1, the receiver operating characteristic curves showed that the area under the curve for the total BDI was 0.88. A cutoff was calculated for the BDI (14/15) that had the highest sum of sensitivity (0.71) and specificity (0.90). In part 2, the test-retest reliability for the BDI total score was 0.89 (intraclass correlation coefficient). The smallest real difference was 3.3 for the total BDI. The BDI is a valid, reliable, and potential responsive instrument to assess the severity of depression in PD. However, an adjusted cutoff is recommended.

Exploring the Reference Point in Prospect Theory: Gambles for Length of Life:

Abstract: Attitude toward risk is an important factor determining patient preferences. Risk behavior has been shown to be strongly dependent on the perception of the outcome as either a gain or a loss. According to prospect theory, the reference point determines how an outcome is perceived. However, no theory on the location of the reference point exists, and for the health domain, there is no direct evidence for the location of the reference point. This article combines qualitative with quantitative data to provide evidence of the reference point in life-year certainty equivalent (CE) gambles and to explore the psychology behind the reference point. The authors argue that goals (aspirations) in life influence the reference point. While thinking aloud, 45 healthy respondents gave certainty equivalents for life-year CE gambles with long and short durations of survival. Contrary to suggestions from the literature, qualitative data argued that the offered certainty equivalent most frequently served as the reference point. Thus, respondents perceived life-year CE gambles as mixed. Framing of the question and goals set in life appeared to be important factors behind the psychology of the reference point. On the basis of the authors' quantitative and qualitative data, they argue that goals alter the perception of outcomes as described by prospect theory by influencing the reference point. This relationship is more apparent for the near future as opposed to the remote future, as goals are mostly set for the near future.

Effects of magnetic stimulation in the treatment of pelvic floor dysfunction

Abstract: OBJECTIVE To correlate, in a pilot study, the clinical results of extracorporeal magnetic innervation therapy (ExMI) of the pelvic floor muscles with functional changes in the pelvic floor musculature, urodynamics and quality of life. PATIENTS AND METHODS In all, 74 patients (65 women and nine men) with urge incontinence, urgency/frequency, stress incontinence, mixed incontinence and defecation problems were included in a prospective study of ExMI using a ‘electromagnetic chair’. All patients were treated twice weekly for 8 weeks. Digital palpation and biofeedback with a vaginal or anal probe were used for registration of the pelvic floor musculature. A urodynamic evaluation, a voiding diary, a pad-test, the King's Health Questionnaire (KHQ) and a visual analogue scale (VAS) were completed by the patient at baseline and at the end of the study. RESULTS In the group as a whole, there were no significant differences in the voiding diary, pad-test, quality of life, VAS score, biofeedback registration and urodynamics before and after treatment. Additional stratification was applied to the total patient group, related to the pretreatment rest tone of the pelvic floor, the basal amplitude registered on electromyography, to age and to previous treatments. However, there were no significant differences in the data before and after treatment within all subgroups (stress incontinence, urge incontinence, urgency/frequency, defecation problems, overactive pelvic floor, age, previous treatments), except for the KHQ domain of ‘role limitations’, where there was a significant improvement in all groups. CONCLUSION ExMI did not change pelvic floor function in the present patients. The varying outcomes of several studies on ExMI stress the need for critical studies on the effect and the mode of action of electrostimulation and magnetic stimulation. In our opinion ‘the chair’ is suitable to train awareness of the location of the pelvic floor. However, active pelvic floor muscle exercises remain essential.

Factors affecting patients' perceptions of choice regarding adjuvant chemotherapy for breast cancer.

Abstract: Introduction Patients’ perceptions of having had freedom of choice in treatment decision-making are shown to have implications for their quality of life. It is, therefore, important to determine what factors underlie these perceptions. One factor that has been studied is whether or not patients believed that their doctor had offered choice of treatment. However, even when choice is actually offered, patients may still feel that they have no choice. Little attention has been paid to other factors that may contribute to patients’ perceptions of having had no choice. Our purpose was to explore (1) whether early-stage breast cancer patients perceived to have had a choice with regard to adjuvant chemotherapy, and (2) their reasons for having perceived no choice.

Clinical ethical dilemmas: convergent and divergent views of two scholarly communities

Abstract: Objective: To survey members of the American Society for Bioethics and Humanities (ASBH; n = 327) and of the Society for Medical Decision Making (SMDM; n = 77) to elicit the similarities and differences in their reasoning about two clinical cases that involved ethical dilemmas. Cases: Case 1 was that of a patient refusing treatment that a surgeon thought would be beneficial. Case 2 dealt with end-of-life care. The argument was whether intensive treatment should be continued of an unconscious patient with multiorgan failure. Method: Four questions, with structured multiple alternatives, were asked about each case: identified core problems, needed additional information, appropriate next steps and who the decision maker should be. Observations and results: Substantial similarities were noticed between the two groups in identifying the core problems, the information needed and the appropriate next steps. SMDM members gave more weight to outcomes and trade-offs and ASBH members had patient autonomy trump other considerations more strongly. In case 1, more than 60% of ASBH respondents identified the patient alone as the decision maker, whereas members of SMDM were almost evenly divided between having the patient as the solo decision maker or preferring a group of some sort as the decision maker, a significant difference (p Conclusion: Despite distinctively different methods of case analysis and little communication between the two professional communities, many similarities were observed in the actual decisions they reached on the two clinical dilemmas.

Health state classification systems: how comparable are our cost-effectiveness ratios?

Abstract: 223 I an editorial in the March 2005 issue of Medical Care, Fryback1 applauded the publication of the US tariff for the EQ-5D health classification system.2 By comparing the acceptance of the “standard weights” for health states from classification systems with the reluctance of physicists in the 19th century to use the standard kilogram, he nicely illustrated some of the difficulties that are encountered in health economics. His reference to standardization pertained to the hitherto absence of a US tariff, based on a standard valuation protocol. The differences in tariffs is not, however, the only standardization problem. The US Panel on Cost-effectiveness in Health and Medicine3 recommended that for cost-effectiveness analyses (CEAs), generic health state classification systems be used because these use community utilities for health states. The descriptive health status information obtained from patients is converted to community utilities using the algorithms published for these systems in the literature. The major reason for using such systems is that off-the-shelf community utilities are thus available and that the investigator need only collect the descriptive information from the patients. But a spin-off from the use of such systems could be standardization. Were we all to use the same classification system, our utilities would be comparable up to the choice of the tariff. Several classification systems have been developed, however, which hampers a comparison of cost-effectiveness (CE) ratios as much as the availability of different tariffs does. The EQ-5D,4 the Health Utilities Index (HUI),5 and the SF-6D6 (based on the well-known SF-36 health status questionnaire) are the most commonly used. The tools vary in the number of items and domains and in the range of severity of potential health states. Furthermore, they use different methods of measuring community utilities (Standard Gamble v. Time TradeOff)7 and different scoring models (additive or multiplicative).8 In the past few years, a plethora of head-tohead comparisons of 2 or more of these systems have been published.8−11 Often differences in utilities are seen, sometimes of even more than 0.10 on a 0 to 1 scale.9,12 Much has also been said about the differences in the range of health states, and about floor and ceiling effects.7,12 Then how to choose between classification systems? No absolute guidelines are available to this end, and often the choice will be a pragmatic one. Perhaps the investigator already has data collected with the SF-36, so it is convenient to use the SF-6D. Or, an EQ-5D tariff is available for her specific (national) population, so she can choose the EQ-5D to obtain representative community values. For one thing, of course, the system should reflect domains that are important for the particular problem under consideration, but even then the choice may not be obvious. Researchers may argue, for example, that the sensory dimensions that occupy a prominent place in the HUI will not be relevant to their particular disease or intervention, and choose the EQ-5D. But it will not always be possible to predict which aspects of disease will change, hampering the choice of system. In this issue of Medical Decision Making, Winkelmayer and others13 describe the effect of Health State Classification Systems: How Comparable Are Our Cost-Effectiveness Ratios?