The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P = 0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.

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A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Objective To develop a reliable and valid child and parent self- report instrument to screen children with anxiety disorders. Method An 85-item questionnaire was administered to 341 outpatient children and adolescents and 300 parents. Utilizing item analyses and factor analyses, the original scale was reduced to 38 items. A subsample of children ( n = 88) and parents ( n = 86) was retested an average of 5 weeks (4 days to 15 weeks) after the initial screening. Results The child and parent Screen for Child Anxiety Related Emotional Disorders (SCARED) both yielded five factors: somatic/panic, general anxiety, separation anxiety, social phobia, and school phobia. For the total score and each of the five factors, both the child and parent SCARED demonstrated good internal consistency (α = .74 to .93), test-retest reliability (intraclass correlation coefficients=.70 to .90), discriminative validity (both between anxiety and other disorders and within anxiety disorders), and moderate parent-child agreement ( r = .20 to .47, p Conclusions The SCARED shows promise as a screening instrument for anxiety disorders. Future studies using the SCARED in community samples are indicated.

The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale Construction and Psychometric Characteristics

• In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery , relapse , and recurrence . In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

Conceptualization and Rationale for Consensus Definitions of Terms in Major Depressive Disorder: Remission, Recovery, Relapse, and Recurrence

Objective To replicate and extend work on the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a child and parent self-report instrument used to screen for children with anxiety disorders. Method The 41-item version of the SCARED was administered to a new sample of 190 outpatient children and adolescents and 166 parents. The internal consistency, discriminant, and convergent validity were assessed. In addition, using discriminant function analysis, a briefer version of the SCARED was developed. Results Using item analyses and factor analyses on the 41-item version, 5 factors were obtained: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. In general, the total score and each of the 5 factors for both the child and parent SCARED demonstrated good internal consistency and discriminant validity (both between anxiety and depressive and disruptive disorders and within anxiety disorders). A reduced version of the SCARED yielded 5 items and showed similar psychometrics to the full SCARED. Conclusions In a new sample, the authors replicated their initial psychometric findings that the SCARED is a reliable and valid instrument to screen for childhood anxiety disorders in clinical settings. Furthermore, pending future research, the 5-item SCARED appears to be a promising brief screening inventory for anxiety disorders in epidemiological studies.

Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study.

The Youden Index is a frequently used summary measure of the ROC (Receiver Operating Characteristic) curve. It both, measures the effectiveness of a diagnostic marker and enables the selection of an optimal threshold value (cutoff point) for the marker. In this paper we compare several estimation procedures for the Youden Index and its associated cutoff point. These are based on (1) normal assumptions; (2) transformations to normality; (3) the empirical distribution function; (4) kernel smoothing. These are compared in terms of bias and root mean square error in a large variety of scenarios by means of an extensive simulation study. We find that the empirical method which is the most commonly used has the overall worst performance. In the estimation of the Youden Index the kernel is generally the best unless the data can be well transformed to achieve normality whereas in estimation of the optimal threshold value results are more variable.

/pdf/estimation-of-the-youden-index-and-its-associated-cutoff-2ymhs4o9au.pdf

Estimation of the Youden Index and its associated cutoff point.

The prediction of violence occupies a prominent and controversial place in public mental health practice. Productive debate about the validity of violence predictions has been hampered by the use of methods for quantifying accuracy that do not control for base rates or biases in favor of certain outcomes. This article describes these problems and shows how receiver-operating characteristic analysis can be used to solve them. The article also reanalyzes 58 data sets from 44 published studies of violence prediction. Taken together, these data strongly suggest that mental health professionals' violence predictions are substantially more accurate than chance. Short-term (1-7 day) clinical predictions seem no more accurate than long-term (> 1 year) predictions. Past behavior alone appears to be a better long-term predictor of future behavior than clinical judgments and may also be a better indicator than cross-validated actuarial techniques.

Assessing predictions of violence: Being accurate about accuracy.

Receiver operating characteristic (ROC) analysis traditionally has dealt with dichoto mous diagnostic tasks (e.g., determining whether a disorder is present or absent). Often, however, medical problems involve distinguishing among more than two diag nostic alternatives. This article extends ROC concepts to diagnostic enterprises with three possible outcomes. For a trichotomous decision task, one can plot a ROC surface on three-dimensional coordinates; the volume under the ROC surface (VUS) equals the probability that test values will allow a decision maker to correctly sort a trio of items containing a randomly-selected member from each of three populations. Thus, the VUS summarizes global diagnostic accuracy for trichotomous tests, just as the area under a ROC curve does for a two-alternative diagnostic task. Information gain at points on the surface can be calculated just as is done for two-dimensional ROC curves, and investigators can thus compare three-way ROCs by comparing maximum information gain on...

Three-way ROCs

Clinicians can gain an enhanced understanding of the role of diagnostic tests once they are familiar and comfortable with the descriptions of test performance provided by receiver operating characteristic (ROC) analysis This article explores the ways that ROC methods quantify test accuracy and describes how ROC methods characterize the distributions of test outcomes in study populations

ROC curves, test accuracy, and the description of diagnostic tests.

Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.

https://aapl.org/docs/pdf/Competence%20to%20Stand%20Trial.pdf

AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial

• Receiver operating characteristic analysis yields indices of diagnostic performance that permit innovative mathematical descriptions and comparisons of diagnostic tests whose results are distributed over a range of possible outcomes. We employed data from seven published studies to demonstrate how ROC analysis may be used to characterize the discriminative properties of the dexamethasone suppression test (DST). We also used an intrinsic property of test results—their ability to reduce diagnostic uncertainty—to select cortisol cutoff levels with the highest information content for each of the DST studies. These cutoffs often differ from original authors' definitions of nonsuppression. The information-maximizing cortisol levels vary depending on pretest estimates of the prevalence of depression or melancholia and vary among studies. Receiver operating characteristic analytic techniques provide important tools for a full description of the DST. Future studies should use receiver operating characteristic methods to select cortisol cutoffs and to assess the test's overall performance.

https://jamanetwork.com/journals/psych/articlepdf/494598/archpsyc_46_7_013.pdf

Maximizing Diagnostic Information From the Dexamethasone Suppression Test: An Approach to Criterion Selection Using Receiver Operating Characteristic Analysis

Douglas Mossman

Papers

Assessing predictions of violence: Being accurate about accuracy.

Three-way ROCs

ROC curves, test accuracy, and the description of diagnostic tests.

AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial

Maximizing Diagnostic Information From the Dexamethasone Suppression Test: An Approach to Criterion Selection Using Receiver Operating Characteristic Analysis