Clinically Meaningful Change Estimates for the Six-Minute Walk Test and Daily Activity in Individuals With Chronic Heart Failure

Purpose

The purpose of the present pilot study was to provide a preliminary estimate of the minimum detectable difference (MDD) and minimum clinically important difference (MCID) of the six-minute walk test (6MWT) and daily activity in outpatients with chronic heart failure (CHF).

Methods

A convenience sample of 22 adults with stable New York Heart Association Functional Class II and III CHF performed two baseline 6MWTs separated by 30 minutes of rest. Subjects then wore a triaxial accelerometer for 7 days to monitor daily activity. After 7 weeks of usual care, subjects again wore the accelerometer for 7 days and then returned to the clinic to complete the Global Rating of Change Scale (GRS) with regard to their heart disease and perform another set of 6MWTs. For the 6MWT, the MDD was calculated using the two baseline 6MWT distances. For daily activity, the MDD was calculated using two methods: (1) day-to-day test-retest reliability during baseline monitoring, and (2) baseline to follow-up test-retest reliability in those who reported no change on the GRS. The MCID for the 6MWT and daily activity was calculated using the mean and 95% confidence interval (CI_95%) for those subjects who reported ‘improvement’ on the GRS.

Results

The MDD at the CI_95% for the 6MWT was 32.4 meters. The MCID for the 6MWT was 30.1 (CI_95% 20.8, 39.4) meters. The MDD for daily activity was 5,909 vector magnitude units (VMU·hr.⁻¹) The MCID for daily activity was 1,337 VMU·hr.⁻¹ There was good alignment of the MDD and MCID for the 6MWT, suggesting that clinically meaningful change is approximately 32 meters. However, the calculated MCID was substantially less than measurement error as represented by the MDD, indicating that the MCID was underestimated in this sample or that daily activity may be robust to change in overall disease status.Key Words: six-minute walk test, daily activity, heart failure, clinically meaningful change     

Books on Broadcasting

W.J. Baker's A History of the Marconi Company (Methuen (London), about $12.00)

Tedd Thomey's The Glorious Decade (Ace #29375, 95c paper)

Curtis Mitchell's Cavaleade of Broadcasting (Fpllett, $9.55/4.55)     

Books Dealing with News

Delmor D. Dunn's Public Officials and the Press (Addison-Wesloy paporback, price unknown)

William O. Chittick's State Department, The Press, and Pressure Groups (Wiley-Interscience, $9.95)

Richard W. Lee, Politics and the Press (Acropolis Books (Washington D.C.), $3.95 in paperback, with a hardcover edition available, price unknown)

Curtis D. MacDougal's edited collection, Reporters Report Reporters (Iowa State, $6.50)

Ruth Adler, The Working Press (Bantam, $1.25)     

Motion Pictures

George Rehrauer, THE MACMILLAN BIBLIOGRAPHY: A CRITICAL GUIDE TO THE LITERATURE OF THE MOTION PICTURE (New York: Macmillan, 1982 2 vol. —the first volume is the bibliography itself, $90.00; the second is the index, $50.00).

Paula Rohrlick, EXPLORING THE ARTS: FILM AND VIDEO PROGRAMS FOR YOUNG VIEWERS (New York: R. R. Bowker, 1982—$24.95, paper, plus shipping and handling).

Jason E. Squire, THE MOVIE BUSINESS BOOK (Englewood Cliffs, N.J.: Prentice-Hall, 1983—$13.95, paper).

Gregory Goodell INDEPENDENT FEATURE FILM PRODUCTION: A COMPLETE GUIDE FROM CONCEPT TO DISTRIBUTION (New York: St. Martins's Press, 1982—$17.95).

James Curtis, JAMES WHALE, (Metuchen, N.J.: The Scarecrow Press—$16.50 and $16.00, respectively).

William Schelly, HARRY LANGDON (Metuchen, N.J.: The Scarecrow Press—$16.50 and $16.00, respectively).

Bruce Cook, BRECHT IN EXILE (New York: Holt, Rinehart & Winston, 1983—$16.50).

Marsha McCreadle, WOMEN ON FILM: THE CRITICAL EYE (New York: Praeger, 1983—$21.95).

William Luhr RAYMOND CHANDLER AND FILM (New York: Frederick Ungar, 1982- $14.95/7.95).

Allen L. Woll, THE HOLLYWOOD MUSICAL GOES TO WAR (Chicago: Nelson-Hall, 1983—no price given).

Norma Kagan, AMERICAN SKEPTIC: ROBERT ALTMAN'S GENRE-COMMENTARY FILMS (Ann Arbor: Pierian Press, 1982—$17.95).

David Wilson, SIGHT AND SOUND: A FIFTIETH ANNIVERSARY SFIECTION (London: Faber and Faber, distributed in the United States by Harper dc Row, 1982—$19.95).

Nicholas Pronay and D. W. Spring, PROPAGANDA, POLITICS AND FILM, 1918-45 (London: The Macmillan Press, 1982—$40.00; order in the United States from Humanities Press, Atlantic Highlands, N.J.).

Ina Bertrand and Diane Collins, GOVERNMENT AND FILM (Sydney: Currency Press, 1982- A$14.95).

John Tulloch, LEGENDS OF THE SCREEN: THE NARRATIVE FILM IN AUSTRALIA, 1919-1929 (Sydney: Currency Press, 1981—A$19.95) (order from The Currency Press, 87 Jersey Road, Woollahra NSW 2025).

Roy Armes, THE FILMS OF ALAIN ROBBE-GRILLET (Amsterdam: John Benjamins B. V., 1981) (order in the United States from John Benjamins North America, Inc., One Buttonwood Square, 202, Philadelphia, Pennsylvania 19130—$25.00).

Bruce F. Kawin, FAULKNER'S MGM SCREENPLAYS (Knoxville: University of Tennessee Press, 1982—$32.50/14.95).

Peter Rollins, HOLLYWOOD AS HISTORIAN: AMERICAN FILM IN A CULTURAL CONTEXT (Lexington: University of Kentucky Press, 1983—no price given, paper).

Susan Myrick WHITE COLUMNS IN HOLLYWOOD: REPORTS FROM THE GWTW SETS (Mercer, Ga.: Mercer University Press, 1982—$14.95).

Frank Beaver of the University of Michigan: ON FILM: A HISTORY OF THE MOTION PICTURE and DICTIONARY OF FILM TERMS (both New York: McGraw-Hill, 1983—no price given).     

Learning approaches and lecture attendance of medical students

There are arguably many factors that affect the way a student learns. A recent report by the Higher Education Policy Institute (HEPI) and the Higher Education Academy (HEA) on student academic experience in the UK states that class size is an important factor in the quality of the student experience and that smaller class sizes provide greater educational benefit than the delivery of lectures. This article assesses research related to lectures, lecture attendance of medical students and their learning approaches in higher education outside the clinical setting. A questionnaire and focus groups were employed to gather quantitative and qualitative data. The results show that students value lectures in the curriculum alongside other teaching and learning methods.     

Changing Behaviors and Intrinsic Motivation Through Scenario‐Based Learning: A Case Study

When training occurs on the job over time, the collective wisdom of the organization becomes the norm. This knowledge or way of doing things is not always the best way and may cause problems elsewhere in the system. This article is a case study that looks at the order entry process of a midsized company and describes the motivational aspects of the performance intervention, as well as the systematic design and development of scenario‐based learning.