Medicine in words and numbers: a cross-sectional survey comparing probability assessment scales

Contains fulltext : 56355.pdf ( ) (Open Access)Background / In the complex domain of medical decision making, reasoning under uncertainty can benefit from supporting tools. Automated decision support tools often build upon mathematical models, such as Bayesian networks. These networks require probabilities which often have to be assessed by experts in the domain of application. Probability response scales can be used to support the assessment process. We compare assessments obtained with different types of response scale. Methods / General practitioners (GPs) gave assessments on and preferences for three different probability response scales: a numerical scale, a scale with only verbal labels, and a combined verbal-numerical scale we had designed ourselves. Standard analyses of variance were performed. Results / No differences in assessments over the three response scales were found. Preferences for type of scale differed: the less experienced GPs preferred the verbal scale, the most experienced preferred the numerical scale, with the groups in between having a preference for the combined verbal-numerical scale. Conclusion / We conclude that all three response scales are equally suitable for supporting probability assessment. The combined verbal-numerical scale is a good choice for aiding the process, since it offers numerical labels to those who prefer numbers and verbal labels to those who prefer words, and accommodates both more and less experienced professionals.8 p

Assessing the clinical significance of outcome in agoraphobia research: A comparison of two approaches

We evaluated two methods for characterizing clinically significant change in agoraphobia treatment research: The method proposed by Jacobson and colleagues (1991) and an alternative method, in which the endstate functioning of patients (low, medium, or high) was assessed by several criteria relevant for panic disorder with agoraphobia. Whenever possible, statistically determined cutoff points were applied on these criteria. Comparison of the outcome revealed considerable consonance between both methods, although the Jacobson approach was somewhat more lenient in considering patients recovered. The reliable change index, an additional criterion proposed by Jacobson et al. in order to assess whether patients had experienced true change as a result of treatment, had little informational value: All patients who met the criterion of clinically meaningful change had reliably changed as well. Moreover, the reliable change index did not discriminate between patients with medium and low clinical endstatus

Treatment of panic disorder with agoraphobia: Comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone

Objective: The purpose of this comparative outcome study was to investigate whether the effects of exposure in vivo treatment for panic disorder with agoraphobia could be enhanced by adding interventions specifically for panic attacks before the start of exposure treatment. The additional effect of two types of treatment for panic attacks-pharmacological (fluvoxamine) and psychological (repeated hyperventilation provocations and respiratory training)was examined. Thus, the combined treatment of panic interventions with exposure in vivo could be compared to exposure in vivo alone. Method: Ninety-six patients were randomly assigned to four treatment conditions: double-blind, placebo-controlled fluvoxamine followed by exposure in vivo, psychological panic management followed by exposure, and exposure in vivo alone. Outcome was assessed by self-report measures, a standardized multitask behavioral avoidance test, and continuous monitoring of panic attacks. Seventy-six patients completed the study. Results: All four treatments were effective and resulted in a significant decrease of agoraphobic avoidance. Moreover, the combination of fluvoxamine and exposure in vivo demonstrated efficacy superior to that of the other treatments and had twice as large an effect size (difference between pre- and posttreatment scores) on self-reported agoraphobic avoidance. The other treatments did not differ among each other in effectiveness. Conclusions: Results of the study indicate that the short-term outcome of exposure in vivo treatment can be enhanced by adding fluvoxamine treatment. Psychological panic management combined with exposure was not superior to exposure alone of equal duration