Ronald C. Serlin

Effect of Computer Support on Younger Women with Breast Cancer

AbstractOBJECTIVE: Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN: Randomized controlled trial conducted between 1995 and 1998. SETTING: Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago, Ill), and a cancer resource center (Indianapolis, Ind). The latter three sites treat many underserved patients. PARTICIPANTS: Newly diagnosed breast cancer patients (N=246) under age 60. INTERVENTIONS: Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support. MEASUREMENTS AND MAIN RESULTS: Pretest and two posttest surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group. CONCLUSIONS: Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations.

Dimensions of the impact of cancer pain in a four country sample: New information from multidimensional scaling

&NA; We investigated the question of how cultural and linguistic backgrounds affect relationships among ratings (reported by patients with metastatic cancer) of pains reference with such functions as activity, mood, and sleep. Multidimensional scaling (MDS) was used to analyze ratings of pain interference from a sample consisting of four culturally and linguistically different groups from the US (n = 1106), France (n = 324), the Philippines (n = 267), and China (n = 146). Patients all completed the Brief Pain Inventory, a self‐report measure of pain and its interference with function. For each of these samples, MDS solutions consistently revealed two interpretable dimensions. In all samples, one dimension represented affect and the other dimension represented activity. The dimensions were consistently interpretable across all four samples and across three levels of pain severity (‘mild’, ‘moderate’, and ‘severe’). The dimensions were most prominent when pain was moderate, rather than mild (when little interference was produced) or severe (when all domains were highly interfered with). These dimensions may have utility in the study of the epidemiology of pain and of the effectiveness of pain treatment. They may also be useful in clinical assessment to describe different patterns of pain interference.

Misuse of Statistical Tests in Three Decades of Psychotherapy Research.

This article reviews the misuse of statistical tests in psychotherapy research studies published in the Journal of Consulting and Clinical Psychology in the years 1967-1968, 1977-1978, and 1987-1988. It focuses on 3 major problems in statistical practice: inappropriate uses of null hypothesis tests and p values, neglect of effect size, and inflation of Type I error rate. The impressive frequency of these problems is documented, and changes in statistical practices over the past 3 decades are interpreted in light of trends in psychotherapy research. The article concludes with practical suggestions for rational application of statistical tests.

Benchmarking the Effectiveness of Psychotherapy Treatment for Adult Depression in a Managed Care Environment : A Preliminary Study

This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified.

Benchmarks for Psychotherapy Efficacy in Adult Major Depression

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings.

What Good are Statistics that Don’t Generalize?:

Quantitative and qualitative inquiry are sometimes portrayed as distinct and incompatible paradigms for research in education. Approaches to combining qualitative and quantitative research typically “integrate” the two methods by letting them co-exist independently within a single research study. Here we describe intra-sample statistical analysis (ISSA) as a general technique for using quantitative tools to support qualitative inquiry so as to simultaneously provide warrants from qualitative and quantitative traditions. In certain circumstances ISSA makes it possible to relax the requirement that individual participants be treated as the unit of analysis in statistical models, and thus provides justification for coding qualitative observations and drawing statistically based conclusions about observations in a qualitative context. We developed ISSA and describe it here both because it can be used as a tool for qualitative research, and because it illuminates the relationship between method and interpretation in the research traditions that it bridges. In this article, we (a) summarize key features of qualitative and quantitative research relevant to ISSA; (b) describe ISSA as an analytical technique; (c) discuss the quantitative and qualitative justification for ISSA and the nature of the conclusions that can be drawn based on it; and (d) explore the more general implications of ISSA for qualitative and quantitative inquiry.

Shrinking Achievement Differences With Anchored Math Problems Challenges and Possibilities

Multiple measures administered in repeated waves within a nonequivalent dependent variables quasi-experimental design were used to test the effects of a reform-oriented instructional method called Enhanced Anchored Instruction (EAI) on the math achievement of 128 middle school students, including students with learning disabilities (LD). EAI problems are presented in multimedia and hands-on formats, a potential benefit for students with low skills in both reading and math. Overall, students of all ability levels benefited from EAI with effect sizes (η2) ranging from .53 to .59. Results revealed that although students with LD scored lower on pretests, their learning trajectories matched those of students without LD. A maintenance test administered several weeks after instruction showed that students with LD retained what they had learned. Implications for instruction and suggestions for future research are provided.

Knowledge or Certainty? A Reply to Cziko

In an Educational Researcher article, Cziko (April, 1989) questioned contemporary approaches toward the conduct of educational research, especially those involving experimentation. He justified the need for reform by appealing to the inherent unpredictability and indeterminacy of behavior and went on to suggest greater reliance on descriptive research. Cziko drew unwarranted conclusions about the feasibility of experimentation from his premises about indeterminacy, and he misrepresented some of the implications of quantum mechanics, evolution, chaos theory, and individual differences for the study of behavior. Cziko’s framework leads one to have little reason to conduct any kind of research, descriptive or otherwise. Contrary to Cziko’s view, when used appropriately, contemporary research methods provide the intersubjectively available framework necessary for scientific understanding.

More Powerful Tests of Predictor Subsets in Regression Analysis Under Nonnormality.

It is well-known that for normally distributed errors parametric tests are optimal statistically, but perhaps less well-known is that when normality does not hold, nonparametric tests frequently possess greater statistical power than parametric tests, while controlling Type I error rate. However, the use of nonparametric procedures has been limited by the absence of easily performed tests for complex experimental designs and analyses and by limited information about their statistical behavior for realistic conditions. A Monte Carlo study of tests of predictor subsets in multiple regression analysis indicates that various nonparametric tests show greater power than the F test for skewed and heavy-tailed data. These nonparametric tests can be computed with available software.

What Holds Attention to Television? Strategic Inertia of Looks at Content Boundaries

Looks at television that cross content boundaries (both between and within programming) provide an opportunity to examine the causes of attentional inertia—that looks at television become very much more stable after the first few seconds. Previous research left unresolved whether this inertia is due to expectations or biologic processes (strategic vs. nonstrategic processes), and this study allows direct comparisons. The strength of the inertial relationship varied considerably for different kinds of program boundaries, and also for within-program boundaries, with the latter varying as well by the genre in which they were contained. Taken together, the results provided no evidence for nonstrategic, biological processes causing attentional inertia. Instead, several genre-specific explanations based on expectations and cognitive demands are proposed.