An examination of the 'gold standard' diagnosis of major depression in aged-care settings

Objectives: Individual clinical interviews are typically viewed as the “gold standard” when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample.

Design: The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument.

Setting: Low-level aged-care residential facilities in Melbourne (equivalent to “residential homes,” “homes for the elderly,” or “assisted living facilities” in other countries).

Participants: One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning.

Measurements: Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15).

Results: The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure.

Conclusion: Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.

Spurious precision : variability in procedural validity of diagnostic procedures in psychotic disorders and implications for research and treatment

Very few studies have quantified the level of agreement among alternative diagnostic procedures that use a common set of fixed operational criteria. The authors examined the procedural validity of four independent methods of assigning DSM-III-R diagnoses of psychotic disorders. METHOD: The research was conducted as a satellite study to the DSM-IV Field Trial for Schizophrenia and Related Psychotic Disorders. The setting was the National Health and Medical Research Council Schizophrenia Research Unit's Early Psychosis Prevention and Intervention Centre, which focuses on first-episode psychosis. Consecutively admitted patients (N = 50) were assessed by independent raters who used four different procedures to determine a DSM-III-R diagnosis. These procedures were 1) the diagnostic instrument developed for the DSM-IV field trial, 2) the Royal Park Multidiagnostic Instrument for Psychosis, 3) the Munich Diagnostic Checklists, and 4) a consensus DSM-III-R diagnosis assigned by a team of clinician researchers who were expert in the use of diagnostic criteria. RESULTS: Concordance between pairs of diagnostic procedures was only moderate. Corresponding levels of percent agreement, however, ranged from 66% to 76%, with converse misclassification rates of 24%-34% (assuming one procedure to be "correct"). CONCLUSIONS: These findings have significant research and clinical implications. Despite the introduction of operationally defined diagnoses, there remained an appreciable level of differential classification or misclassification arising from variability in the method of assigning the diagnostic criteria rather than the criteria themselves. Such misclassification may impede neurobiological research and have harmful clinical effects on patients with first-episode psychosis.

An observer design procedure for a class of nonlinear time-delay systems

This paper considers a class of uncertain, nonlinear differential state delayed control systems and presents a reduced-order observer design procedure to asymptotically estimate any vector state functionals. The method proposed involves decomposition of the delayed portion of the system into two parts: a matched and mismatched part. Provided that the rank of the mismatched part is less than the number of the outputs, a reduced-order linear functional observer, with any prescribed stability margin, can be constructed by using a simple procedure. A numerical example is given to illustrate the new design procedure and its features.

Algebra skills and traps and diagnostic teaching for the future

Explores on some research about teaching and learning algebra and related classroom issues. Diagnostic instruments that may be used by senior secondary teachers in teaching algebra to senior classes; Strategies for remediating algebraic difficulties and misconceptions; Impact of technology on the algebra curriculum; Usefulness of copying algebraic expressions while using Computer Algebra Systems or mathematics processing software in a calculus class.

Using the results of diagnostic testing to promote mathematical pedagogical knowledge

Teachers require a range of knowledge bases, including both content knowledge and pedagogical knowledge (Shulman, 1986). In recent times there have been calls from a variety of sources for teacher preparation courses to improve the mathematical knowledge of teachers, particularly primary teachers. These calls have been underlined by the recent formation of bodies such as the Institutes of Teachers in Victoria and NSW, as well as the development of teaching standards by professional bodies including the Australian Association of Mathematics Teachers. Rather than simply adopt a "back-to-basics" approach, work is required that uses the results of educational research to design courses that help pre-service students to understand how and why errors are made (by themselves and by children in their own classrooms). Diagnostic testing of preservice students is the first step in the process. However, it is not enough to simply test students and to remediate their misconceptions. Instead, the aim is to use the results of the testing to improve students' pedagogical knowledge as well as their subject content knowledge. This paper outlines one approach to the use of diagnostic testing with pre-service students and how the results can be used to assist in the development of pedagogical knowledge.

A sensitive procedure for the rapid determination of arsenic(III) by flow injection analysis and chemiluminescence detection

A novel chemiluminescence flow injection procedure for the determination of As(III) in aqueous samples is described. The method involves injection of As(III) samples into a 1% (m/v) sodium hexametaphosphate in 0.02 M H₂SO₄ carrier stream, which then merges at a Y-piece with a reagent stream consisting of potassium permanganate (5.0 × 10⁻⁵ M) made up in the acidic sodium hexametaphosphate carrier solution. The chemiluminescence intensity of the resulting reaction mixture was measured at a photomultiplier tube operated at a voltage of 0.93 kV. Under optimized conditions, the method is characterised by a linear range from 0.5 to 5.0 μg l⁻¹, a detection limit of 0.3 μg l⁻¹ and a sampling frequency of 150 h⁻¹. The effects of common anionic and cationic interferences were investigated, and it was found that the only ions to cause serious interference were those which react with potassium permanganate, namely sulphide, iodide and ferrous.

Carpal tunnel syndrome: diagnostic usefulness of sonography

PURPOSE: To prospectively evaluate accuracy of sonography for diagnosis of carpal tunnel syndrome (CTS) in patients clinically suspected of having the disease in one or both hands.
MATERIALS AND METHODS: A prospective cohort of 133 patients suspected of having CTS were referred to a teaching hospital between October 2001 and June 2002 for electrodiagnostic study. One hundred twenty patients (98 women, 22 men; mean age, 49 years; range, 19–83 years) underwent sonography within 1 week after electrodiagnostic study. Radiologist was blinded to electrodiagnostic study results. Seventy-five patients had bilateral symptoms; 23 patients, right-hand symptoms; and 22 patients, left-hand symptoms (total, 195 symptomatic hands). Cross-sectional area of median nerve was measured at three levels: immediately proximal to carpal tunnel inlet, at carpal tunnel inlet, and at carpal tunnel outlet. Flexor retinaculum was used as a landmark to margins of carpal tunnel. Optimal threshold levels (determined with classification and regression tree analysis) for areas proximal to and at tunnel inlet and at tunnel outlet were used to discriminate between patients with and patients without disease. Sensitivity, specificity, and false-positive and false-negative rates were derived on the basis of final diagnosis, which was determined with clinical history and electrodiagnostic study results as reference standard.
RESULTS: For right hands, sonography had sensitivity of 94% (66 of 70); specificity, 65% (17 of 26); false-positive rate, 12% (nine of 75); and false-negative rate, 19% (four of 21) (cutoff, 0.09 cm2 proximal to tunnel inlet and 0.12 cm2 at tunnel outlet). For left hands, sensitivity was 83% (53 of 64); specificity, 73% (24 of 33); false-positive rate, 15% (nine of 62); and false-negative rate, 31% (11 of 35) (cutoff, 0.10 cm2 proximal to tunnel inlet).
CONCLUSION: Sonography is comparable to electrodiagnostic study in diagnosis of CTS and should be considered as initial test of choice for patients suspected of having CTS.

Making decisions for intelligent agents in procedure descriptive framework

There are many existing and potential industrial and commercial applications for intelligent agents in the literature. The very challenging issue for these applications is to "do what intelligent agents should do". The BDI (beliefs, desires, intentions) architecture is presented to solve this challenge, and it has attracted much attention. The main difficulty for this architecture is the formalization problem. In this paper, we discuss the "procedure descriptive framework", which is a method for formalizing the BDI architecture. We present decision models for intelligent agents in this framework. This research provides a technique for online agents to form beliefs and make decisions according to the current uncertain environment

A diagnostic 'profile' for chance (probability)

This article presents a profiling tools for identifying students knowledge in chance.

Criminal procedure : Victoria & Commonwealth

This work is a clear and concise study of the principles underlying criminal procedure in Victoria and the Commonwealth jurisdictions. The book provides succinct extracts of leading cases and critiques the law. this content informs readers of the current law and how it can be reformed to deal more appropriately with the complexities and challenges of this area. The text includes a discussion of the recent reforms in Victoria.This book is for all readers with an interest in criminal procedure, including judicial officers,lawyers and students.

Patients' experiences of cardiology procedures using minimal conscous sedation

Aim: The study's purpose was to describe patients' experiences of minimal conscious sedation during diagnostic and interventional cardiology procedures.

Methods: Over a 6-week period, 119 consecutive patients (10% of annual throughput) from a major metropolitan hospital in Melbourne, Australia, were interviewed using a modified version of the American Pain Society Patient Outcome Questionnaire. Patients identified pain severity using a 10-point visual analogue scale and rated their overall comfort on a 6-point Likert scale ranging from very comfortable to very uncomfortable.

Results: Patients were aged 67.6 years (standard deviation 11.1), 70.8% were male, and the mean body mass index was 27.7 (standard deviation 4.8). Patients underwent diagnostic coronary angiography (67.5%), percutaneous coronary interventions (13.3%), or combined procedures (19.2%). Most patients (65%) were comfortable in the context of low-dose conscious sedation. Slight discomfort was reported by 26% of patients; 9% reported feeling uncomfortable primarily as a result of a combination of musculoskeletal pain, angina, and vasovagal symptoms experienced during the procedure. There was significant correlation (rho = .25, P = .01) between procedure length and patients' report of overall comfort, suggesting longer procedures were less comfortable for patients.

Conclusions: The minimal sedation protocol was effective for the majority of patients; however, 9% of patients experienced significant discomfort related to preexisting conditions, highlighting the need for individual patient assessment before, during, and after the procedure.

Stat5 as a diagnostic marker for leukemia

The Jak-Stat-Socs pathway is an important component of cytokine receptor signaling. Not surprisingly, perturbation of this pathway is implicated in diseases of hematopoietic and immune origin, including leukemia, lymphoma and immune deficiencies. This review examines the role of a key component of this pathway, Stat5. This has been shown to be activated in a variety of leukemias and myeloproliferative disorders, including downstream of a range of key oncogenes where it has been shown to play an important role in mediating their effects. Therefore, Stat5 represents a useful pan-leukemia/myeloproliferative disorder diagnostic marker and key therapeutic end point, as well as representing an attractive therapeutic target for these disorders.

Convergent interviewing : a qualitative diagnostic technique for researchers

Purpose – This paper aims to widen knowledge of and explore how convergent interviewing can be used to identify key issues within an organization.
Design/methodology/approach – This paper introduces the convergent interviewing technique and describes the method of selecting the interview subjects. The construction of a round of interviews is explained. The content of the interviews is described and the particular probing nature of the questions demanded by the convergent interview process is explained. The ways to analyze the full set of interviews for groupings or categories is also described. The case study example of a broad research question about influences on work behaviors in a local government council is used to illustrate the convergent interviewing technique.
Findings – The key issues revealed by using the technique can be subsequently used for a variety of research and consulting purposes and settings. Convergent interviewing is an effective research method, which conserves resources.
Originality/value – Convergent interviewing enables researchers to determine the most important and/or key issues within a population rather than a full list of issues in an organization or barriers to change in a particular organizational context.